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Interlocking nails for treatment of femoral fractures.

A series of 23 fractures of the femur were treated using femoral interlocking nails. The average follow-up period was 14.8 months. There were 14 closed fractures and 9 compound fractures. Closed nailing was done for 8 patients and open nailing for 15 patients. All the fractures united. There were no superficial or deep infections. The most common complication was leg length discrepancy; shortening occurred in 5 patients whereas lengthening occurred in 2 patients. It is a technically demanding procedure but it is the method of choice in our Institution for stabilising complex fractures of the femoral shaft.

Adolescent↗

Compartment syndrome as complication of skin traction, in children with femoral fractures.

We report the history of two 3-year-old children with femoral shaft fractures, who developed severe compartment syndromes following skin traction. Both children were admitted in our department for treatment of their compartment syndromes. In both, important and permanent disability persisted. The causative role of the skin traction is proven by the fact that in one infant, the compartment syndrome developed in the non-fractured limb. Cautious application of skin traction, conscientious observation, immediate diagnosis, and aggressive treatment of threatening compartment syndromes will prevent these tragic complications.

Anterior Compartment Syndrome↗

Mortality following surgery for proximal femoral fractures in centenarians.

Although the number of centenarians in our population is increasing, mortality rates following hip fracture in this group of patients has not yet been reported. The medical records of a consecutive series of 13 centenarians with proximal femoral fractures who presented to the Derbyshire Royal Infirmary over a 20 year period were retrospectively reviewed. The majority of patients were female (M:F 2:11) and had suffered intertrochanteric fractures. The recorded incidence of surgical complications was low. The mortality at 30 days, 6 months and 1 year were 31%, 50% and 56%, respectively representing a 20% increase in mortality at 1 year when compared to the expected mortality rates among their non-injured peers. When compared with over 1000 hip fracture patients of all ages in previous prospective studies, the centenarians in this series were found to have a significantly higher mortality during hospital admission (p<0.001) and at 1 year (p=0.002). The treatment of hip fractures in centenarians poses a challenge. Optimal anaesthesia, expeditious surgery and a co-ordinated multidisciplinary approach to care is essential in these patients.

Aged↗

An algorithm for the treatment of Vancouver type B2 periprosthetic proximal femoral fractures.

The number of individuals with periprosthetic fractures of the proximal part of the femur is increasing. Multiple treatment methods have been described but none that correlate to fracture type and few with mostly good-to-excellent results. This article describes an algorithmic reconstruction tactic for treating patients with periprosthetic fractures associated with a loose femoral component. The stem is approached through the fracture fragments. Reconstructing the tube of the proximal part of the femur with 18G cerclage wires allows for canal preparation and implantation of the new stem. Application of the allograft struts and cables maximizes the biomechanical integrity of the proximal part of the femur to promote fracture repair and implant fixation. No treatment failures have occurred as of this date.

Aged↗

Compartment syndrome as a complication of skin traction in children with femoral fractures.

We report the history of two 3-year-old children with femoral shaft fractures, who developed severe compartment syndromes after skin traction. Both children were admitted in our department for treatment of their compartment syndromes. In both, important and permanent disability persisted. The causative role of the skin traction is proved since, in one infant, the compartment syndrome developed in the nonfractured limb. Cautious application of skin traction, conscientious observation, immediate diagnosis, and aggressive treatment of threatening compartment syndromes will prevent these tragic complications.

Child, Preschool↗

Chronic sepsis following intramedullary nailing of femoral fractures.

We reviewed 12 patients with chronic drainage after intramedullary nailing of a femoral shaft fracture. The fractures tended to be the result of high-speed trauma and were frequently comminuted. Six were open fractures and six were closed injuries. All but one had been managed initially with the open nailing technique, exposing the fracture site. In six cases we left the nail in place until bone union occurred, an average of 33 months after injury, removing the hardware thereafter. The remaining six patients, each with bone sequestra at the fracture site, underwent nail removal, debridement of nonviable bone, and external fixation followed by bone grafting; this group took 37 months to heal. There was one persistent nonunion in each group. Drainage did not cease in either group until the nail and all sequestra had been removed. There was an average of 4.3 cm of shortening, but no angulation greater than 10 degrees. Six patients were left with less than 45 degrees of knee flexion and only five had 100 degrees or more of knee flexion.

Adult↗

Pressure recordings in patients with femoral fractures in cast-braces and suggestions for treatment.

Five patients with femoral-shaft fractures were treated by cast-brace application and early ambulation. As fracture healing progressed, pressures between the thigh and the cast were recorded with the patients lying still, contracting the quadriceps while lying down, and in four weight-bearing postures. Control results were gained by application of a second cast-brace to three of the patients when they had recovered completely. Resting pressures averaging sixteen millimeters of mercury were recorded under the whole cast. Much higher values were recorded under the proximal two-thirds of the cast, and these increased as healing proceeded. Removal of the hip hinge, thereby eliminating fixed abduction, reduced pressure recordings significantly.

Adolescent↗