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PubMed1993

[Intramedullary nailing of old femoral fracture in children].

Intramedullary nailing was performed for 40 old femoral fractures in children. Open intramedullary nailing was used in all fractures. The results showed that intramedullary nailing was suitable for upper and middle third femoral fractures, including transverse or short oblique fractures, multiple segmental fractures, malunited fractures and fractures failed to unite after internal fixation with plate. The authors consider that fresh long oblique or spiral fractures, severe comminuted fractures and lower third femoral fractures are not suitable for intramedullary nailing. In this series, 34 patients have been followed up 2.5 to 8 years (averaged 5.4 years) and all their fractures had been united. The function of the hip and knee was normal in 32 patients. Excellent and good results were obtained in 32 patients (94.1%). The epiphysis of the femoral trochanter and growth of femur have not been damaged by nailing.

Adolescent↗
PubMed1998

The retrograde intramedullary supracondylar nail: an alternative in the treatment of distal femoral fractures in the elderly?

To find out whether retrograde nailing of distal femoral fractures is beneficial for the aged patient, we performed a prospective study of consecutive patients 65 years or older with distal femoral fracture treated with a retrograde femoral nail between 1 March 1993 and 30 April 1996 in our department. In total, 26 patients with unilateral distal femoral fractures had been treated in our department, and 24 patients had been followed up for more than 12 months. All fractures had healed. Six patients did not walk before the injury. According to the Neerscore we counted 10/18 excellent results (> or = 85 points), 6/18 good results (> or = 70 points), 2/18 fair results (> or = 55 points) and no failures (< 55 points). Retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Even in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult proximal locking are the two major technical problems encountered with this implant. Early weight-bearing is not advisable.

Aged↗
PubMed2002

Retrograde flexible intramedullary nailing in children's femoral fractures.

We treated 31 femoral shaft fractures in 28 children with a mean age of 6.7 (5-10) years with retrograde flexible intramedullary nailing. There were 16 isolated fractures, while 12 children had associated injuries. The average time for union was 10.5 weeks and there were no delayed unions. There was one broken nail requiring change of treatment, but no infection or refractures. At follow-up after a mean time lapse of 27 months there was no limb-length inequality exceeding 1 cm and no malunion. We feel that femoral fractures in patients aged 5-10 years can be safely treated with retrograde flexible intramedullary nailing with minimal risk of surgical complications.

Bone Nails↗
PubMed2002

[Treatment of intertrochanteric femoral fractures with the use of a modular axial fixator device].

OBJECTIVES: Intertrochanteric femoral fractures are usually encountered in the elderly, leading to morbidity and even mortality due to age-related systemic complications. In this study, we evaluated the use of a modular axial fixator device in the treatment of intertrochanteric femoral fractures. METHODS: Intertrochanteric femoral fractures of 25 patients (18 females, 7 males; mean age 70 years; range 18 to 91 years) were treated by the use of a modular axial fixator. The fractures were classified according to the Boyd-Griffin classification. Surgery was performed after a mean of 5.76 days following trauma. The patients were allowed to walk using crutches on the second postoperative day and a single crutch after sufficient callus formation was radiologically determined. Final evaluations were made by the Foster's classification. The mean follow-up was 12 months (range 6 to 24 months). RESULTS: The mean operation duration was 34 minutes. Union was achieved in all patients after a mean of 12.3 weeks (range 9 to 18 weeks). Three patients (12%) developed varus deformity of 3, 5, and 9 degrees, respectively. Shortening in a range of 1 cm to 1.5 cm was detected in three patients (12%). Postoperatively, 10 patients developed pin tract infections, none of which required revision or removal of the fixator. Final evaluations yielded excellent and good anatomical results in 72% and 28%, and functional results in 80% and 20%, respectively. CONCLUSION: Reducing both the operation time and the immobilization period is of vital importance particularly in elderly patients with intertrochanteric femoral fractures. Due to its short length, the modular axial fixator offers significant advantages including higher tolerability, rapid weight bearing allowance, and achievement of union without seriously complicating events.

Adolescent↗
PubMed1995

Predicting the prognosis after proximal femoral fracture.

In 338 patients with proximal femoral fractures, age, sex, residence and mobility on admission were found to predict mortality, mobility and housing requirements after 1 year. Application of these data should permit better targeting of rehabilitation and earlier initiation of rehousing arrangements after proximal femoral fracture.

Age Factors↗
PubMed2001

Periprosthetic femoral fractures treated with a long-stem cementless component.

Periprosthetic femoral fractures can be a difficult management problem. Proximal femoral fractures with a loose component are managed best with revision arthroplasty. We reviewed the midterm follow-up of 14 proximal femoral fractures managed with a long-stem extensively porous-coated femoral component. The average follow-up in this series was 8.2 years (minimum, 5.3 years). Fractures were treated with open reduction and internal fixation, supplemental cortical strut grafting when required, and a canal-filling implant. All fractures achieved union with an average time to union of 4 months. There have been no component failures requiring revision. Twelve prostheses achieved stable bone ingrowth, 1 component showed stable fibrous ingrowth, and 1 component was not stable but was not symptomatic enough to warrant revision.

Arthroplasty, Replacement, Hip↗
PubMed1999

Nonunion after periprosthetic femoral fracture associated with total hip arthroplasty.

BACKGROUND: Nonunion after a periprosthetic femoral fracture associated with total hip arthroplasty occurs rarely. There is little information, to our knowledge, regarding the prevalence of this complication, its treatment, and the functional outcomes of treatment. The purpose of this study was to identify the patterns and frequency of nonunions of femoral fractures around total hip prostheses and to evaluate the results and problems associated with treatment of this complication in a consecutive series of patients. METHODS: The study included twenty-three nonunions of periprosthetic femoral fractures in twenty-three patients with an average age of fifty-five years (range, twenty-two to eighty-five years) at the time of the initiation of treatment of the nonunion. Thirteen of the fractures occurred during or after a primary total hip arthroplasty, and ten occurred during or after a revision total hip arthroplasty. According to the classification system of Duncan and Masri, there were six B1 fractures (associated with a well fixed prosthesis), seven B2 fractures (associated with a loose stem), and ten B3 fractures (associated with very poor proximal bone). Ten patients were managed with revision to a long-stem prosthesis. Six patients had revision to a proximal femoral replacement prosthesis. A two-stage technique consisting of removal of the prosthesis and open reduction and internal fixation of the nonunion followed by reimplantation of the prosthesis was used in two patients. Two patients were managed initially with bone-grafting alone, and two patients were managed nonoperatively. One patient who had an infection at the site of the nonunion was managed definitively with resection arthroplasty. RESULTS: The duration of clinical follow-up averaged 8.3 years (range, three months to twenty-three years), and that of radiographic surveillance averaged 7.0 years (range, eight months to seventeen years). Of the thirteen patients in whom an attempt to achieve union was made and for whom radiographs were available, nine eventually had bone-healing. Five of the twenty-three femora became infected and were treated with resection arthroplasty. Of the seventeen patients who had not had a resection arthroplasty for infection and for whom radiographs were available at the time of the most recent follow-up, eleven had a stable and well fixed implant and six had a loose implant as seen radiographically or had had a revision because of aseptic loosening. Seventeen patients had no or mild pain at the time of the most recent follow-up, but ten required two-handed support to walk. The overall complication rate was 52 percent (twelve of twenty-three patients). CONCLUSIONS: Nonunion of a femoral fracture associated with a total hip prosthesis is an infrequent problem. Treatment is difficult, with a high rate of complications and relatively poor functional outcomes. The data from this series must be interpreted with caution, as patients were managed over a period of three decades and many did not have the advantage of modern techniques of revision hip arthroplasty. Prevention of nonunion by optimum treatment of the initial fracture is most important. Treatment of a femoral nonunion about a total hip implant should be implemented on the basis of the status of the fixation of the prosthesis and the quality of the surrounding bone.

Adult↗
PubMed2004

Patient effective dose and radiogenic risks from fluoroscopically assisted surgical reconstruction of femoral fractures.

The objectives were to assess patient effective radiation dose from fluoroscopically guided surgical reconstruction of femoral fractures and provide normalized data for the estimation of patient effective dose and risks associated with such procedures performed in any laboratory. The fluoroscopic control required during surgical reconstruction of femoral fractures was classified into two types identified by beam orientation, i.e., posterior-anterior (PA) and lateral crosstable (LC) exposures. The duration and the dose area product (DAP) of each exposure were monitored in 24 patients with femoral fractures. Patient dose per DAP unit and per minute of fluoroscopy were measured at 14 radiosensitive organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. The typical effective dose to patients with femoral fracture treated surgically in our institution was 11.6-21.7 microSv. This effective dose is estimated to cause an excess of 1.4 fatal cancers per million patients treated, and an excess of 0.4 hereditary disorders per million of births. Induction of deterministic skin injuries to treated patients is highly improbable at the dose levels found in this study. Patient effective dose and associated risks from a typical fluoroscopically guided surgical fixation of femoral fracture are low. However, they may be significantly elevated if treated patients are young individuals and/or the fluoroscopic exposure is prolonged. The present data may be used to determine effective dose to patients undergoing surgical reconstruction of femoral fracture in any institution.

Adult↗
PubMed1998

Intramedullary nailing of femoral fractures in adolescents.

A prospective study of adolescents with femoral fractures treated with intramedullary nailing was done to identify complications and evaluate the outcome of this method of treatment. Sixty patients with femoral fractures have been treated with antegrade intramedullary nailing. Magnetic resonance imaging scans were obtained to evaluate for subclinical avascular necrosis of the femoral head. The average patient age was 12 years. All patients had open physes at the time of surgery. Implants were removed in 33 patients to date at an average of 10 months after initial nailing. All but two patients continue to have no signs of avascular necrosis, no rotational or angular deformity, and no nerve palsy. Two patients have had subclinical avascular necrosis as seen on magnetic resonance imaging. One patient had avascular necrosis develop in both femoral heads 1 year after nail removal from the right femur. The second patient has asymptomatic marrow changes on magnetic resonance imaging consistent with avascular necrosis with no femoral head collapse. It is thought that intramedullary nailing of pediatric femoral fractures is a safe treatment option. Few complications and a small risk of subclinical presentation of avascular necrosis of the femoral head that can become evident after removal of the implant have been found.

Adolescent↗
PubMed2001

Repair of diaphyseal femoral fractures in cats using interlocking intramedullary nails: 12 cases (1996-2000).

OBJECTIVE: To determine the outcome of femoral fractures repaired with 4.0- and 4.7-mm interlocking intramedullary nails in cats. DESIGN: Retrospective study. ANIMALS: 12 cats with diaphyseal femoral fractures. PROCEDURE: Records of all cats in which the 4.0- and 4.7-mm interlocking nail system was used for repair of diaphyseal femoral fractures at the Animal Medical Center and Florida Veterinary Specialists between 1996 and 2000 were reviewed. Information included signalment, type of fracture, size of the implant, details of the surgery, intra- and postoperative complications, fracture healing, and clinical outcome. RESULTS: Femoral fractures in 12 cats were repaired. Eleven of the fractures were comminuted, with 2 of these being open. Clinical outcome was excellent in 7 cats, good in 3, and fair in 1. One resulted in a nonunion. Complications included screw breakage (1 cat) and fracture distal to the nail (1). Fracture distal to the nail occurred from a second trauma. CONCLUSION AND CLINICAL RELEVANCE: Use of the interlocking nail has been limited in cats because of the small diameter of the medullary canal. Use of the 4.0-mm nail will allow for greater application of this implant in small patients. Results of this study indicate that the 4.0- and 4.7-mm interlocking nails can be used to repair simple or comminuted diaphyseal femoral fractures in cats.

Animals↗
PubMed2000

Periprosthetic femoral fractures in Northern Ireland.

Twenty-five patients with periprosthetic femoral fractures were admitted to the Ulster Hospital between August 1998 and May 2000. Average age was 77 years (range, 42-96 years) with a female to male ratio of 2:1. Twenty-four of the fractures occurred following primary joint arthroplasty on average 7.6 years from insertion of the primary prosthesis. One patient sustained an intraoperative fracture during revision surgery. In the majority (80%), the periprosthetic femoral fracture was associated with a traumatic event. On average, two days elapsed from the time of injury until admission to our unit. Time from admission to surgery was on average 4 days. All patients were treated by open fracture fixation. Duration of stay in the fracture unit was on average 20 days. Prior to their fracture 92% of patients were living at home and 84% were mobile either unaided or with the use of a stick. At most recent review, 72% are back living at home and 60% are mobile either unaided or with the use of a stick. We emphasise that there is the likelihood of an increase in periprosthetic femoral fractures due to the increasing number of primary arthroplasties being performed on a more active, ageing population. Preventative measures and cost implications are also discussed.

Adult↗
PubMed2005

The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome.

BACKGROUND: The treatment of a supracondylar femoral fracture following total knee arthroplasty is complicated by the presence of the prosthetic components. Anterior femoral notching during arthroplasty has been implicated as a contributing risk factor for femoral fracture. We retrospectively reviewed the effect of anterior femoral notching on the subsequent occurrence of a periprosthetic supracondylar fracture of the distal aspect of the femur and the outcomes of primary total knee arthroplasty in such patients. METHODS: The prevalence and depth of femoral notching were determined on a review of the lateral radiographs by observers blinded to the clinical results of 1089 consecutive total knee replacements performed in 1997 and 1998. Linear and logistic regression modeling was used to analyze the relationship between femoral notching and the prevalence of supracondylar femoral fracture, postoperative range of motion, the Knee Society score, and the Knee Society functional and pain scores. RESULTS: Femoral notching was performed in 325 (29.8%) of the 1089 knees in our series. During an average follow-up period of 5.1 years, only two supracondylar femoral fractures occurred, both in femora treated without notching. Femoral notching was not associated with an increased rate of fracture (p = 1.000) or with significant differences in the measures of outcome (range of motion [p = 0.117], knee score [p = 0.967], functional score [p = 0.861], need for a lateral release [p = 0.234], or postoperative pain [p = 0.948]). CONCLUSIONS: This study demonstrated no difference in knees managed with or without notching of the anterior distal aspect of the femur with respect to the occurrence of a supracondylar fracture, range of motion, Knee Society score, Knee Society function, or pain.

Adult↗
PubMed2005

Periprosthetic femoral fractures associated with contralateral hip disease.

Femoral osteolysis associated with contralateral hip degenerative changes is a risk factor for ipsilateral periprosthetic femoral fracture. We report 5 comminuted proximal shaft fractures around loose femoral implants occurring in patients with both symptomatic femoral lysis and a painful hip on the other side. Our evolving strategy involves timely revision surgery once this pattern is recognized. Once fracture has occurred, emergent revision requires extensive medical evaluation, availability of long-stem revision implants, and appropriate instrumentation and allografts for fracture fixation.

Adult↗
PubMed2004

Surgical treatment of femoral fractures in children. Comparison between external fixation and elastic intramedullary nails: a review.

Femoral fractures represent about 2% of all fractures in childhood. Children with femoral fractures always need to be admitted to hospital and the use of resources is much higher than for other childhood fractures. During the past decade, there has been a trend towards surgical treatment of these fractures, one advantage being the shorter time required in hospital. Two common surgical treatment options are external fixation (EF) and elastic stable intramedullary nails (ESIN). Both methods have their advantages and disadvantages, and neither of them solves all of the problems. Used in a complementary manner, they are safe and reliable for the treatment of femoral fractures in children, and they give good long-term results and few serious complications.

Bone Nails↗
PubMedDate not supplied

Radiation exposure during skeletal traction treatment of pediatric femoral fractures.

Radiation-exposure data during femoral fracture management has not been previously reported. We report a retrospective analysis of radiation exposure in 45 patients aged 5-12 years (average, 8.3) with isolated femoral shaft fractures treated by 90/90 degrees femoral skeletal traction. Group I had 32 patients aged 5-9 years (average, 7.3), and group II had 13 patients of an average age of 10.7 years. Total average radiation dose before casting was 0.699 rads and was independent of age and gender. In addition to potential complications of tractions and increased hospital stay with attendant fiscal and psychosocial burdens, radiation exposure with this type of management, in this series, was significant.

Age Distribution↗
PubMed1980

Supracondylar femoral fractures as a complication to Ender nailing of trochanteric fractures. A new device for osteosynthesis.

Supracondylar femoral fractures is an uncommon complication to Ender nailing of a trochanteric fracture. Seven cases were traced to study the fracture pattern and the results of the therapy. The most common fracture type extends obliquely from the hole of the insertion medially in a proximo-lateral direction. Prolonged traction in bed in these cases should be avoided. Rigid internal fixation using angle blade plates if frequently insufficient in highly osteoporotic bone. As an alternative to both traction in bed and rigid fixation a new osteosynthetic device for semielastic fixation was used as demonstrated in two of these cases. It has a connection piece between one elastic intramedullary nail of the Ender type and two cancellous bone screws. The device, applied from the medial as well as the lateral condyle, ensures a fixation less prone to mechanical failure in osteoporotic skeleton. It does not interfere with the loading forces of the bone and is stable enough to allow patients to be mobilized from bed. We now use it for all types of distal femoral fractures.

Aged↗
PubMed1980

Femoral fractures in patients with lower extremity amputations.

Femoral fracture in patients with lower extremity amputations is relatively rare (reported incidence in 341 amputee patients, 2.35%). Lack of adequate support and balance, and osteoporosis on the amputation side, may explain the predisposition to fracture of the ipsilateral extremity. The prosthesis was in use at the time of the accident in only 3 of 9 cases studied, most falls occurring during transfer activity without a prosthesis. Proximal femoral fractures in below-knee amputee patients responded to open reduction with internal fixation and early ambulation. Others were treated with closed reduction and cast immobilization. Overall union was 100%, with all patients regaining their previous ambulatory levels and prosthesis skills.

Adult↗
PubMed1997

Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. A comparative study.

Multiply injured patients (an Injury Severity Score of 17 points or more) who were admitted to one of two level-I regional trauma centers between 1983 and 1994 because of a fracture of the femoral shaft with a thoracic injury (an Abbreviated Injury Scale score of 2 points or more) or without a thoracic injury were studied retrospectively. The patient populations and the protocols for the treatment of trauma were similar at the two centers; however, the centers differed with regard to the technique that was used for acute stabilization of the fracture of the femoral shaft. At Center I intramedullary nailing with reaming was used in 217 (95 per cent) of the 229 patients, whereas at Center II a plate was used in 206 (92 per cent) of the 224 patients. This difference was used to investigate the effect of acute femoral reaming on the occurrence of adult respiratory distress syndrome in multiply injured patients who had a chest injury. Three groups of patients were evaluated: those who had both a fracture of the femur and a thoracic injury, those who had a fracture of the femur but no thoracic injury, and those who had a thoracic injury without a fracture of the femur or the tibia. The third group was studied at each center to determine if there was a difference between the institutions with regard to the rate of adult respiratory distress syndrome. Patients who had diabetes, chronic obstructive pulmonary disease, asthma, hepatic or renal failure, or an immunosuppressive condition were excluded from the study. The records were abstracted to determine the Injury Severity Score, Abbreviated Injury Scale score, and Glasgow Coma Score for each patient. Requirements for fluid resuscitation were calculated for the first twenty-four hours; these included the number of units of packed red blood cells, fresh-frozen plasma, and platelets that were transfused and the volume of crystalloid that was used. The duration of intubation, the duration of hospitalization, and the occurence of adverse outcomes (death, multiple organ failure, adult respiratory distress syndrome, pneumonia, and pulmonary embolism) were determined for each patient. The groups of patients were analyzed as a whole and then were stratified into subgroups (according to whether or not they had a thoracic injury and whether the Injury Severity Score was less than 30 points or 30 points or more) to determine if the type of fixation of the femoral fracture affected the rate of adult respiratory distress syndrome or mortality. Logistic regression models were used to analyze the data. The over-all occurrence of adult respiratory distress syndrome in the 453 patients who had a femoral fracture was only 2 per cent (ten patients). The rates of adult respiratory distress syndrome for the patients who had a thoracic injury but no femoral fracture (eight [6 per cent] of 129 patients at Center I, compared with ten [8 per cent] of 125 patients at Center II) did not differ between centers, suggesting that the institutions were comparable in their treatment of multiply injured patients. The occurrence of adult respiratory distress syndrome in the patients who had a femoral fracture without a thoracic injury did not differ substantially according to whether the fracture had been treated with a nail (118 patients) or a plate (114 patients). Likewise, the frequency of adult respiratory distress syndrome, pneumonia, pulmonary embolism, failure of multiple organs, or death for the patients who had a femoral fracture and a thoracic injury was similar regardless of whether nailing with reaming (117 patients) or a plate (104 patients) had been used. The use of intramedullary nailing with reaming for acute stabilization of fractures of the femur in multiply injured patients who have a thoracic injury without a major comorbid disease does not appear to increase the occurrence of adult respiratory distress syndrome, pulmonary embolism, failure of multiple organs, pneumonia, or death.

Abbreviated Injury Scale↗