Intravascular volume optimisation during repair of proximal femoral fracture. Regional anaesthesia is usually technique of choice.
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Following an experimentally applied fracture of the upper limb fat embolism can be demonstrated in the lungs. By quantitative histological evaluation and biochemical lipid analysis a definite correlation can be observed between the amount of fat in the lungs and the time interval that had elapsed between fracture and death of the animals. More fat is to found in lungs histologically as well as biochemically in those animals, in which the time interval was shorter (165 minutes) than in those which survived for a longer period of time (168 hours). The electronmicroscopic morphometric examination turned out an increased volume of the interstitium 72 hours after the fracture.
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Fractures of the distal part of the femur in children are difficult to classify as suggested by Aitken, Harris and Salter if the epiphyseal cartilage is injured. Such injuries are rare if seen in relation to the grand total of paediatric lesions. There are late complications, however. In unilateral closure of the epiphyseal cartilage growth will be irregular and there will be differences in leg length. The sequels to knee joint distortions with ruptures of the ligaments are significant. These ruptures will also result in leg malpositioning due to epiphyseal closure. Corrective measures are often necessary to straighten out the axial deviation and to compensate the differences in leg length. The authors' own patient material comprises besides epiphyseal fractures eight such ligamentous lesions with late complications.
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