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PubMed2005

[Mini-invasive fixation of proximal femoral fractures: what benefit for elderly patients?].

Fixation is used to treat more than two-thirds of proximal femur fractures. The mortality rate is about 25% at one year in these patients, who have an average age of about 80 years. This is mainly due to aging, but also to a gradual deterioration of general health (especially if the operation has been delayed, or after a long stay in the surgical ward) and to local complications (displacement, infection, hematoma). Two fixation devices (a sliding screw plate and a trochanteric nail) have been designed for mini-invasive treatment with fluoroscopic guidance and an incision smaller than 50 mm. The aim is to respect the soft tissues and thereby to avoid local complications, diminish pain, and facilitate early weight-bearing Hospital discharge is possible after 3 or 4 days. Laboratory experiments have shown the satisfactory resistance of the implant and bone at full weight bearing A preliminary series of 30 patients showed the feasibility of these techniques. Primary fusion was achieved in 27 cases. There were no infections and no bleeding, despite antiplatelet treatment. The techniques have now been optimized and multicenter studies are held to determine their real benefit. Fracture fusion and hip motion should be at least as good as with open surgery (90 to 96% fusions, albeit influenced by the precise position of the implants and by osteoporosis). Mortality may be slightly reduced, thanks to immediate operation, early discharge, and fewer local complications. The cost of treatment could also be significantly reduced by the shorter hospital stay. In a few years' time, mini-invasive treatment may become the standard for elderly patients with proximal femur fractures.

Aged↗
PubMed1998

Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures.

Subtrochanteric fractures frequently occur as high energy trauma usually in younger patients and may lead to severe comminution of the medial cortex. The medial cortex of the proximal femur is exposed to high compressive forces which make fracture stabilization a difficult problem. Bone healing may be seriously compromised due to extensive comminution and fragment devitalization. This requires reduction techniques which do not cause additional damage to the vitality of the bone. With indirect reduction techniques and the use of a condylar blade plate the results have been significantly improved in these fracture types in our department (1). In this report the essential aspects of indirect reduction for subtrochanteric fractures using a condylar blade plate and the treatment results from our department from earlier years (1) and from the last 2 1/2 years will be presented. In the latter period, fifteen patients with a mean age of 49 years (19-87 years) were treated with this method. Fractures resulted from traffic incidents or falls from a great height in 11 cases (73%). Union was achieved in 14 cases (93%) with full weight-bearing after a mean of 3 months (1-4 1/2 months). Malunion was seen in two cases (13%) without the need for further surgery. Non union occurred in one patient (7%) with a III B open injury due to early infection. After repeated debridements, bone grafting and decortication, the fracture was stabilized with a replacement condylar blade plate and healed uneventfully.

Accidental Falls↗
PubMed1996

[Distal femoral fractures. Transarticular reconstruction, percutaneous plate osteosynthesis and retrograde nailing].

Techniques for operative treatment of supra- and intercondylar fractures have changed in recent years. Some of these changes have come about in reduction techniques and implant selection. Operative approach concepts, which had remained unchanged for several decades, have been critically evaluated and modified, leading to a minimally invasive osteosynthesis (MIO) with transarticular joint reconstruction, closed plate positioning techniques or retrograde intramedullary nailing. These techniques result in better operative visualization and management of intraarticular comminution, safer fracture healing and better functional outcome. New strategies and techniques for the avoidance of axial malalignment, rotational deformities and leg length discrepancies are described.

Bone Plates↗
PubMed1996

[Bridging an extensive bone defect with cortico-spongious transplants in femoral fracture caused by gunshot injury].

The treatment of a 12-cm bone defect after shotgun fracture of the femur is described. Semitubular corticospongious bone grafts from both iliac crests, 6 cm long and 0.8 cm wide, were tied into two bundles with an absorbable suture and were laid successively into the diaphyseal defect. With another absorbable suture the bundles were anchored to the condylar 95-deg plate. Two months later the condylar plate was removed and an external fixator placed because of inflammation; the bone implants survived. By 18 months after the injury the bone defect was cured, no inflammation was present, and the patient was able to walk with full weight bearing. Four conditions have to be fulfilled in the treatment of an open comminuted fracture with soft tissue defect: thorough necrectomy, rigid fixation, bone grafting and improvement of the blood supply by means of a microvascular musculocutaneous flap.

Bone Transplantation↗
PubMed1996

Supracondylar femoral fracture above a PFC posterior cruciate-substituting total knee arthroplasty treated with supracondylar nailing. A unique technical problem.

Supracondylar fracture above a total knee arthroplasty with a posterior cruciate-substituting design presents a challenging problem to the orthopaedic surgeon. The standard treatment using a intramedullary rod is made difficult by the design of the PFC cruciate-substituting total knee arthroplasty (Johnson & Johnson Orthopaedics, Raynham, MA), which prevents entry of a standard supracondylar nail to the medullary canal of the femur. A technique for using an interlocking intramedullary rod to treat a supracondylar fracture above a posterior cruciate-substituting total knee arthroplasty is described. A case is presented illustrating this technique.

Bone Nails↗
PubMed1990

[Interlocking nailing of distal femoral fractures. Technique and results].

Treatment with interlocking nails is sufficient for fractures at the distal diaphysis and the distal methaphyseal region of the femur. Fractures associated with intracondylar fissures can be treated with an interlocking nail only in isolated cases. This paper gives a report on 47 cases and compares two series. The complications observed were: infection (4.25%); fracture of nail (4.25%); and deviation of axis (12.08%). We didn't observe pseudarthrosis in any of these patients. Bone healing occurred in all cases.

Adult↗
PubMedDate not supplied

[Effect of vitamin D3 and its metabolites 1,25-dihydroxycholecalciferol and 24,25-dihydroxycholecalciferol on callus mineralization in rats with femoral fracture].

Additional administration of vitamin D3 at a physiological dose of 0.25 microgram daily into rats with femur fracture within 4 weeks did not affect the specific weight and chemical composition (content of Ca2+, P) in diaphyses of intact and impaired femurs as well as the content of Ca2+. Pi and activity of alkaline phosphatase in blood serum of the animals. At a higher dose 2.5 microgram daily vitamin D3 increased concentration of Pi in blood serum but did not alter the other parameters studied. Physiological doses of 1,25-dihydroxycholecalciferol (1.25 (OH)2D3) and 24,25-dihydroxycholecalciferol (24,25 (OH)2D3) (00.3 microgram and 0.25 microgram daily, respectively) did not affect the specific weight and composition of the impaired diaphyses, content of Ca2+ and activity of alkaline phosphatase in blood but increased slightly the Pi concentration. After a 5-fold increase in the dose of 1,25(OH)2D3 (0.15 microgram daily) specific weight and content of Ca2+ were decreased in the impaired bones with simultaneous increase in concentration of Ca2+, Pi and activity of alkaline phosphatase in blood serum. These data suggest that reparation was impaired under the conditions of acceleration of the bone tissue resorption. Increased doses of 24, 25(OH)2D3 (1.25 micrograms daily) stimulated the increase in specific weight and mineralization of the impaired bones and normalized the increased alkaline phosphatase activity in blood serum. Clinical examination of 24,25(OH)2D3 could be recommended as a drug stimulating the reparation under conditions of bone fracture.

24,25-Dihydroxyvitamin D 3↗
PubMed1989

[Quasi-static and dynamic bending stress of the pediatric femur for producing a femoral fracture].

At the Institute of Forensic Medicine of the University of Heidelberg, in the years 1986-1988 thigh loading tests were conducted in order to produce fractures in a total of 28 cadavers of babies and children who had died at ages ranging from 1 day to 6 years. In 18 tests a universal strength testing machine was used and each thigh was loaded quasi-statically from the outside with a blunt edge applied to the middle of the femur, bending it to the point of fracture. The loading velocity amounted 50 mm/min with a defined support distance. The breakage load amounted to 470 N in a 6-day-old baby and increased about evenly up to 2920 N in a 6-year-old child; however, in a newborn 2720 N was needed and in a 15-month-old child, 5700 N. The total deformation way ranged from 16 to 60 mm. The main types of fracture that occurred were: complete and incomplete transverse fractures, oblique fractures, Messerer fractures, and spongiosa fractures. Ten children ranging in age from 2 months up to 27 months were submitted to dynamical thigh loading by means of a failing weight impactor and a horizontal impactor. Only in one case did a transverse fracture occur, when the lateral thigh impacted on an edge at a falling height of 70-93 cm. The forces set up amounted to 320-600 N with the falling weight impactor and to 2370 N with the horizontal impactor. These results suggest that fracture of the femur does not occur if a baby or small child falls from a changing table or from an adult's arm.

Biomechanical Phenomena↗
PubMed2002

Salvage procedures for failed compression hip screw fixation of intertrochanteric femoral fractures: analysis of 50 cases.

We retrospectively studied 50 patients who underwent salvage procedures for failed compression hip screw (CHS) fixation of intertrochanteric fractures from January 1991 to July 2000. Among these patients, seven underwent revision fixed angle plate surgery; 16 patients underwent bipolar hemiarthroplasty; five patients underwent Austin-Moore hemiarthroplasty; another nine patients underwent total hip arthroplasty; and 13 patients underwent removal of the implant. The age, gender, type of falling accident, osteoporosis status and post-operative ambulation status were recorded. The incidence of failed fixation of CHS was estimated at around 9.7%. A fall was recorded in 52% of cases. There was a significant difference in osteoporosis grade between the failed and successful CHS groups (p < 0.005). There was also better postoperative ambulation in the total hip replacement group compared to the other groups (p = 0.03). Surgical management of nonhealed intertrochanteric fractures is a challenge to orthopedic surgeons. The authors suggest multiple factors, such as fracture geometry, bone quality, preservation of acetabulum cartilage and individual patient factors, be considered when performing salvage procedures for failed CHS.

Aged↗
PubMed1983

[Treatment of per- and subtrochanteric femoral fractures in conjunction with coxarthrosis].

When both a coxarthrosis and a sub- or pertrochanteric fracture of the femur are simultaneously present, it is, as a rule, most difficult to carry out a closed reduction of the fracture on the extension table. In almost all cases, an open reduction has to be performed. When such an open reduction is necessary, this should not give reason to dispense with the advantages offered by the Ender nailing method and select another technique of osteosynthesis. An early mobilisation, which is of particular importance to old patients, can be achieved best by the aforementioned osteosynthesis. On the other hand, the implantation of a resection prosthesis as the logical treatment of a coxarthrosis coinciding with a per- or subtrochanteric fracture of the femur is in most cases out of question when the patient has not been sufficiently prepared, and should therefore be reserved for surgical intervention at a later date.

Aged↗
PubMed1977

Domiciliary management of simple femoral fractures in children.

Twenty-six children with a simple fracture of one femur were nursed at home while on gallows traction, under the supervision of health visitors. The average stay in hospital before they were allowed home on traction was 8,5 days. A control group of 28 children with similar fractures, who were nursed only in hospital, spent an average of 34 days in hospital. No complications of treatment were encountered in either group. It is suggested that when there is an efficient health visiting service, children with uncomplicated fractures of the femur can be nursed at home, with benefit to the hospital, the child, and his family.

Child↗
PubMedDate not supplied

Experimental femoral fracture immobilized by rigid and flexible rods (a rabbit model).

Experimental fractures in rabbits demonstrated that flexible intramedullary rod fixation of the midshaft long bone fracture enhances the fracture healing and may promote early mobility. When compared to rigid fixation, both excess flexibility and excess rigidity inhibited optimal fracture healing. The occurrence of angulation deformities with plastic rods also demonstrate the disadvantage of a very flexible rod.

Animals↗
PubMed2006

Extended osteotomy for periprosthetic femoral fractures in total hip arthroplasty.

Total hip arthroplasty periprosthetic fractures that involve a loose prosthesis and are located at or beyond the tip of the prosthesis are difficult to manage and have higher complication and nonunion rates. In this case report, I describe a fracture-site exposure that allows simple insertion of a long, distally fixed revision prosthesis. In an extended femoral osteotomy, the entire proximal fragment opens the upper segment in "clamshell" fashion. The proximal segment is repaired with or without femoral strut allografts and multiple cerclage wires. With this method, 7 periprosthetic fractures united successfully, and none has required further reconstruction.

Aged↗
PubMed1989

[Surgical stabilization of femoral fracture following implantation of straight shaft prostheses].

Fractures of the shaft of the femur at the level of a hip endoprosthesis may cause serious problems in regard to operative stabilization as well as to bony union. The therapeutic procedure and the clinical course are described in two patients. The technical procedure is demonstrated on a plastic femur model. The advantages of cementless implantation of the femoral shaft are discussed in view of this complication.

Aged↗
PubMed1985

[Considerations on the time of surgery of femoral fractures].

As shown by a study elaborated in 1980 by the A.O. (Working Association for Osteosynthesis) which was based on the data of 1127 patients, the number of general complications occuring during the primary treatment of fractures of the femur had increased by 13%. However, this study also comprised a great number of polytraumatically injured persons possessing other indications for surgery than patients with monosseous fractures of the femur shaft. So all monosseous fractures of the shaft were compiled with the aid of the A.O. computer in Bern, and 1257 cases were received. It is clearly demonstrated by evaluating these cases that a primary treatment of fractures of the femur has a significantly better effect than a delayed treatment. The number of cardiac complications increases with the time interval passing between injury and treatment. The same effect was not statistically proved for pulmonary complications; on the contrary some pulmonary complications occured during primary treatment in young patients, i.e. in a group of patients where this is expected least of all. For the future, the circulatory parameters of these patients must be estimated with special accuracy. Fatalities only occurred in the group of the oldest patients; the number of deaths increased significantly with the time interval after the injury. The differences between the present study and the preceding. A.O. study of 1980 are explained by the relatively great number of polytraumatically injured persons with fractures of the femur included in the first study. However, no satisfactory explanation does exist for the deaths occurred in 1972 at our own hospital, mentioned at the beginning of this report.

Adult↗
PubMed2001

[External femorotibial transfixation in femoral fracture with joint involvement in a child].

Long bone fractures combined with joint injuries run a high risk of destabilising the articulations. Remaining joints incongruence can lead to early arthosis especially in cases of severe injuries or not achieved anatomical reduction. A number of osteosynthesis methods are available for anatomical repair of the articular facet. This report presents a seven years old boy with an open comminuted fracture of the distal femur and consecutive joint instability, treated with a Transfixation (Orthofix) of the knee joint. The functional results suggest this method as an alternative treatment.

Child↗