[Intramedullary nailing in femoral fractures].
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The results of a clinical follow-up study of 107 children treated in the University Hospital Hamburg-Eppendorf because of femoral shaft fractures are shown. Most of the fractures healed with lengthening of the fractured bone and showed a muscles atrophy of the concerned limb as well. This study demonstrates the connections between these alterations.
Results are presented after operative treatment of 195 patients with extracapsular proximal femoral-bone-fractures. After accident early operation time is requested. Operation risk being small, this treatment is regarded as treatment of first choice.
Intraoperative and postoperative fractures of the femur during total hip arthroplasty have become more frequent complications with the advent of pressfit femoral components. Principles of rigid fixation of both the prosthesis and the fracture must be followed to achieve a satisfactory result. Methods of prevention of these complications are highlighted but there still exists a risk of femoral fracture in many clinical settings.
This retrospective study reviews our results with intramedullary nail fixation of 37 fractures of the femur in 35 skeletally immature patients. Five of these fractures were open. Twenty-two patients (average age 12 + 9 years) were treated with reamed intramedullary nails. Fifteen patients (average age 9 + 6 years) were treated with nonreamed nails. All fractures united in 6-12 weeks. There were no infections, delayed or nonunions, nor were there any incidences of avascular necrosis. There were very few significant complications. One patient required excision of heterotopic bone to restore hip motion. When surgical treatment of pediatric femur fractures is indicated, we prefer intramedullary nail fixation (either reamed or nonreamed) depending on age, fracture pattern (level, degree of comminution), and size of femoral canal. Experience and careful surgical judgment are required to appropriately individualize treatment for these patients.
Cerclage wires have been used to stabilize proximal femoral cracks after stem insertion in cementless total hip arthroplasty. The objective of this study was to determine the optimal number and orientation of cerclage wires necessary to prevent stem subsidence and crack propagation. The crack was stabilized by 1, 2, or 3 wires placed either normal to the femoral neck axis or normal to the crack. The femora were compressed to 2,670 N while measuring crack opening and stem subsidence. Wires placed normal to the crack allowed less stem subsidence by 3.17 mm and less crack opening by 1.55 mm compared with wires placed normal to the neck. The addition of multiple wires reduced subsidence by 50% and reduced crack opening to <1 mm. Medial and anterior calcar cracks are best stabilized by at least 2 cerclage wires that are placed normal to the crack.
Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilisation of pertrochanteric fracture, among which is the proximal femoral nail (PFN). We report here the results of a prospective study carried out at our institute on 100 consecutive patients who had suffered a pertrochanteric, intertrochanteric or high subtrochanteric fracture, or a combination of fractures, between December 2002 and December 2005 and were subsequently treated with a PFN. Close to anatomical reduction of the fracture fragments was achieved in 12 patients, while limited open reduction was required in 14 patients. During the follow-up period of 1 year complications occurred in 12 patients. Our results indicate the necessity of a careful surgical technique and modifications that are specific to the individual fracture pattern in order to reduce complications. Osteosynthesis with the PFN offers the advantages of high rotational stability of the head-neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking.
The torsion of both femurs was investigated in 55 patients who had been treated 5-13 years earlier at the age of 1-16 years for femoral shaft fractures. By comparing the anteversion angle of the contralateral hips, determined by the Rippstein method, torsion deformities exceeding 10 degrees were found in the fractured femur of 10 patients. The maximum deformity found was + 27 degrees. None of the patients had complaints due to the torsion deformity. Deformities appeared more frequently in patients treated with adhesive overhead traction of the fractured leg than in patients treated with wire traction with the limb on an oblique frame. However, the difference was not highly significant (0.05 less than P less than 0.10). There was not correlation between age at the time of injury and torsion abnormalities and no correlation between the length of the observation period and the residual deformity, indicating growth correction. Examination of the rotational mobility of the hips was found to be a suitable screening test in the diagnosis of deformities exceeding 10 degrees. Radiological investigation of the anteversion angle of the femoral neck is necessary in the final assessment of a torsion deformity.
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