[Treatment of femoral fractures with 2 intramedullary nails].
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This paper reports a singular case of pathological fracture through a large osteolytic lesion of the mid-femur consequent on reaction to a hip prosthesis. Not only metal particles but also polyethylene fibres were found at this site, some 15 cm from the prosthesis. The case sheds an interesting light on the reaction to prostheses.
A new radiographic projection of the femur was evaluated for use in the assessment of fracture or osteotomy repair in small animals. The view is obtained by directing the x-ray beam horizontally through the hind limb, from caudad to craniad, with the animal positioned in lateral recumbency, the hip flexed, and the stifle extended. Views obtained, using the new projection, were compared with the standard ventrodorsal views of the pelvis, with hind limbs extended. Osteotomy lines in the femoral shaft were significantly (P less than 0.01) more visible on the horizontal beam view. Significant difference was not evident in visibility of fracture lines between the 2 radiographic projections. The horizontal beam view was easily obtained, and equivalent to the standard ventrodorsal view for radiographic evaluation of femoral fracture and osteotomy repair.
Fractures of the distal femur can be managed successfully with surgery. A good result depends on identification of all fragments, adequate repair of soft tissue, appropriate bone grafting, meticulous intrafragmentary compression, and complete reduction of the joint space. Instrumentation may include condylar blade plates, condylar screws, or locked intramedullary rods. Anatomic reconstruction with stable fixation permits early rehabilitation and recovery of full function after fracture.
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