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PubMedDate not supplied

[Effectiveness of multi-factorial intervention for reducing falls with proximal femoral fractures in homes for the aged and nursing homes. Goals and study design of a population-based study].

The article presents the design of an open controlled, non-randomized population based intervention trial in institutionalized elderly that will be performed in Ulm/Germany starting in 1998. The multimodal intervention includes education, counseling, training, and hip protectors as well as information on potential environmental modifications in nursing homes. Two historical and one geographical control group will be formed. All institutionalized elderly will be assessed by means of the Minimum Data Set of the Resident Assessment Instrument. The intervention will last 12 months. The main objective is to test a model for cost-effective reduction of proximal femoral fractures in institutionalized elderly and to demonstrate its effectiveness.

Accidental Falls↗
PubMed1987

[45 years of intramedullary nailing in femoral fractures].

A report is given in this paper based on experiences of 814 cases of intramedullary nailing in femoral shaft fractures performed at the author's hospital between 1941 and 1985 (691 by closed and 123 by open technique). Follow-up checks were made on 470 patients. Results were found to be excellent in 81.5 per cent of these cases, good in 16.1 per cent, and poor in 2.4 per cent. Infections were recorded from 2.3 per cent. The patients were further subdivided by additional relevant parameters, such as indications, concomitant injuries, and postoperative deaths.

Adolescent↗
PubMed1996

A prospective study of urinary retention and risk of death after proximal femoral fracture.

Older age, dementia syndrome and impaired mobility are well recognized risk factors for fatality after fracture of the proximal femur. Urinary retention is recognized as a common complication of elective total hip replacement. In this investigation, we estimated the incidence of urinary retention associated with hip fracture in older women and assessed its relationship to 2-year post-operative fatality. Over a 7-month period, 309 women aged 65 and over were admitted to one trauma unit with hip fracture. Readings of post-voiding residual volume were taken on admission (pre-operative), within 24 hours of operation (post-operative) and 5-7 days post-operatively (recovery). Of the 309 patients, 244 (79%) had readings of post-voiding residual volume taken on admission; 90/244 (37%) had retention pre-operatively, 122/216 (56%) post-operatively and 40/183 (22%) in the recovery phase. One year after operation 305 patients were traced and median follow-up was 2 years. Older age, cognitive impairment, polypharmacy, impaired mobility and urinary retention on admission and during recovery were associated with a higher fatality in the first post-operative year. Pre-operative urinary retention is common among older women with proximal femoral fracture and affects over half post-operatively. Retention is one of several factors associated with higher fatality.

Aged↗
PubMed1993

False aneurysm complicating closed femoral fracture in a child.

False aneurysms are a recognized but rare complication of closed fractures. The authors report the case of a false aneurysm of the superficial femoral artery complicating a closed transverse fracture of the femoral shaft in a child treated with skeletal traction. The literature of this entity is reviewed.

Aneurysm, False↗
PubMed1983

The influence on the spine of leg-length discrepancy after femoral fracture.

We investigated the spines of 15 patients who had significant leg-length inequality as a result of femoral shaft fractures sustained after skeletal maturity but below the age of 21 years. The patients were examined at least 10 years after fracture. The spines were studied clinically and radiographically before and after correction of leg-length inequality with a shoe-raise. Lateral spinal flexion was measured from radiographs. The lumbar scoliosis associated with the leg-length inequality was compensatory: after equalisation of leg-length the overall curve and the axial rotation were corrected completely. There was also an equal range of lateral flexion to either side after correction. Minor malalignments of the whole spine remained despite correction of the compensatory scoliosis, and within the lumbar spine correction of the scoliosis had not occurred equally at all levels. No patients complained of significant discomfort and neither structural abnormalities nor degenerative changes were seen on the radiographs.

Adolescent↗
PubMed2005

[Epithelioid hemangioendothelioma of bone complicated by femoral fracture].

A 54-year-old man was seen with a fracture of the left femur. Plain radiographs revealed a 40-mm lytic centromedullary lesion. Magnetic resonance T1- and T2-weighted sequences showed high and low signals. After stabilization of the fracture, the tumor was removed followed by reconstruction with a vascularized fibula. The pathological examination demonstrated proliferation of non atypical CD34 and CD31 positive epithelioid cells with few lumens, accompanied by abundant fibrous stroma, sometimes masking tumor cells. Satisfactory motion was achieved with no recurrence at 20 months follow-up. Bone hemangioendothelioma can simulate metastasis and must be distinguished by immunohistochemistry. Prognosis is a subject of debate as the tumor is considered to exhibit intermediate malignancy by some authors while other consider it to be a malignant tumor.

Femoral Fractures↗
PubMedDate not supplied

Retrograde intramedullary osteosynthesis of femoral fracture: preliminary results of Maggiore Hospital.

The Distal Femoral Nail (DFN), Mathys Medical Ltd. Switzerland) was used in our division for the treatment of fractures of the distal metaepiphysis, and in some cases of the diaphysis, of the femur. A total of 16 cases treated over 30 months, between October 2000 and March 2003 (minimum 6, maximum 61 months), were analyzed retrospectively. A total of 11 metaepiphyseal fractures (65%) and 6 diaphyseal fractures (35%) were treated. Consolidation of the fracture was observed in 15 cases out of 16 (equal to 93.8%) with a mean time of 140 days (minimum 120 days, maximum 240 days) after surgery. Mean flexion of the knee equal to 90 degrees and 3 cases of stiffness with lower mobility at 45 degrees were observed: in 2 cases stiffness was of extra-articular origin caused by exuberant bone callus. There were no iatrogenic complications of the vascular type, nor were there infections, or cases of implant loosening. Shortening (1 cm) in a type B2 fracture (based on the AO classification) was observed. The results we obtained suggest that DFN represents a valid alternative to the open treatment of fractures of the distal metaphysis of the femur; in cases of patients with multiple trauma or in elderly patients where invasiveness is reduced, importance is awarded to less blood loss, a shorter amount of time required for surgery, and early mobilization and weight-bearing.

Adolescent↗
PubMed1987

[Femoral fractures in subjects with total prostheses of the hip or knee].

Thirty three fractures of the shaft of the femur, which occurred after 28 total hip replacements and 8 total knee replacements, are reviewed. Fracture occurred adjacent to the femoral component of the hip prosthesis in 5 cases, distal to the femoral component in 8, at the tip of the femoral component in 12 hips and 5 knees and between the femoral components of hip and knee replacements in 3 cases. Treatment was by fixation with a plate in 29 cases, revision of a total hip replacement in 2 and traction in the other 2. The mean follow up was 2.5 years. Fractures healed in 3-4 months and function was usually restored. Aseptic loosening of a total arthroplasty after plating of a fracture did not occur. Two prostheses became infected, requiring removal of a hip and revision of a knee. Aetiological factors are stress-raisers in the femoral shaft after revision arthroplasty, defects in the cortex, and modification of shaft elasticity between the stems of hip and knee prostheses. Detection of a cortical defect during revision arthroplasty and bone grafting may help to prevent fracture. Fixation with a plate seems to be the best treatment, but if there is evidence of loosening revision with a long-stemmed component is indicated.

Adult↗
PubMed1999

Unreamed intramedullary nailing for pathological femoral fractures. Good results in 30 cases.

We have used the AO unreamed femoral nail for stabilization of impending and complete pathological fractures since March 1994. 27 patients with 30 pathological fractures (23) or impending fractures (7) of the femur were retrospectively analyzed. These included 18 subtrochanteric fractures, 11 shaft fractures and 1 distal fracture. The mean age of the patients was 68 (51-84) years. All patients were treated with a solid femoral nail inserted by an unreamed technique. The nail was inserted through a minimally invasive approach and with a median surgical time of 55 (35-70) minutes. A reconstructive proximal locking option (spiral blade) was used in 25 cases. There were no intraoperative complications, no operative mortality. Reliable skeletal stability was obtained in all cases and most were able to mobilize early with minimum discomfort. 1 case was revised for a secondary fracture through a distal metastasis at 6 months. The median survival was 5 (2-9) months. Unreamed nailing with the AO solid femoral nail appears to be a good option for the stabilization of pathological femoral fractures.

Aged↗
PubMed1983

The treatment of femoral fractures by cast-brace application and early ambulation. A prospective review of one hundred and six patients.

One hundred and six patients with 108 femoral shaft fractures were treated with a cast-brace. Ninety-eight cast-braces included an abdominal band and hip hinge. At follow-up three femora showed coronal malalignment that exceeded 9 degrees and sixty-nine showed varying degrees of sagittal malalignment (thirty-eight having anterior bowing and thirty-one, posterior bowing). Four patients regained only 100 degrees of knee flexion or less and four others had hyperextension of the knee of more than 10 degrees. Thirty-eight patients showed signs of knee instability but only four of them had symptoms of instability. Four fractures were treated operatively to correct excessive shortening or angulation and another fracture was bone-grafted to promote union. The mean shortening was 10.9 millimeters (standard deviation, 8.8 millimeters). Although the more comminuted of the eighty-five middle-third fractures shortened more than the others, the results of this method of treatment for these comminuted fractures were acceptable.

Adult↗
PubMed2001

Intracranial pressure-alterations during controlled intramedullary reaming of femoral fractures: an animal study.

Reaming during intramedullary nailing increases the intramedullary pressure (IMP) and can cause fat intravasation and subsequently lead to pulmonary dysfunction, especially in polytraumatized patients with lung contusion as well as increases in intracranial pressure (ICP).ICP changes were measured in two groups consisting of 12 sheep each with either a fractured or intact femur. The animals were exposed to haemorrhagic shock and were resuscitated by autoinfusion. Transverse midshaft fractures were created bilaterally in one group before reaming of both femoral shafts. Controlled reaming was performed at 15 and 50 mm/s driving speed (DS) and at 150 and 450 revolutions per minute (RPM) with a reaming control system using AO-Reamers. Fat intravasation was measured by transoesophageal sonography (TES) and Gurd test. ICP monitoring was performed with a piezo-electric epidural catheter. Haemodynamic and respiratory parameters, ICP, and cerebral perfusion pressure were measured continuously. High DS and low RPM caused higher IMP and ICP increases in both groups. Significantly higher microemboli were observed in TES in the fractured group as compared to the unfractured group with the same reaming parameters (P=0.021). However, the existence of a femoral fracture did not show a significant influence on changes in ICP (P-value=0.057). Reaming should be performed at a low DS and high RPM to minimize the risk of fat intravasation and the subsequent ICP increase.

Animals↗