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PubMed1986

Management of femoral fractures and pseudofractures in adult hypophosphatasia.

Ten pseudofractures and six complete fractures occurred in five patients with adult hypophosphatasia. The four pseudofractures that were treated non-operatively progressed to complete fracture. The six pseudofractures and six complete fractures that were treated by internal fixation united. New fractures occurred in four patients after the removal of the internal fixation. We recommend that complete fractures, symptomatic pseudofractures, and progressive asymptomatic pseudofractures in patients with adult hypophosphatasia be treated with load-sharing internal-fixation devices, such as rigid intramedullary nails. These should not be removed unless it is absolutely essential. If removal is necessary, however, they should be replaced, preferably during the same anesthetic session. In our opinion, the guidelines developed from this study may be applied reasonably to patients with osteomalacia from causes other than hypophosphatasia, especially if medical therapy has been unsuccessful.

Adult↗
PubMed1983

[Left spontaneous femoral fracture in primary hyperparathyroidism and postgastrectomy bone disease following a Billroth II stomach resection].

In the present case a primary hyperparathyroidism was aggravated by postgastrectomy bone disease and led to a spontaneous fracture of the left femur and to a pseudofracture of the right femur. Renal symptoms like concrements or nephrocalcinosis were based on the intestinal conditioned malabsorption of vitamin-D and calcium not evident. Radiologically there was a mixed pattern of ostitis fibrosa cystica generalisata von Recklinghausen and osteomalacia respectively osteoporosis based on postgastrectomy bone disease. Treatment was fully effective consisting of exstirpation of the adenoma and substitution of calcium and vitamin-D and ingestion of digestive enzymes and many little meals corresponding to the prescriptions of nutrition for partially gastrectomised patients.

Aged↗
PubMed1995

Kasabach-Merritt syndrome complicating treatment of a closed femoral fracture.

The Kasabach-Merritt syndrome of consumptive coagulopathy associated with massive hemangiomas is a potentially life-threatening problem in patients who sustain long bone fractures of the involved extremities. In this syndrome, platelet consumption is caused by their sequestration in the sinusoids and epitheloid chambers of large hemangiomas. Secondary fibrinolysis then occurs with resulting thrombocytopenia, hypofibrinogenemia, and increased fibrin degradation products that can lead to disseminated intravascular coagulation. This can result in massive bleeding even after minor trauma. In such patients, operative management of long bone fractures, including the placement of cutaneous pins for skeletal traction, may be contraindicated; nonoperative management may be necessary. Kasabach-Merritt syndrome must be suspected in patients with large hemangiomas and associated long bone fractures, and appropriate coagulation studies should be obtained before operative management or placement of percutaneous skeletal pins. Decreased hematocrit and fibrinogen levels associated with thrombocytopenia and prolonged prothrombin time and partial thromboplastin time should alert the orthopaedist to the possibility of Kasabach-Merritt syndrome, and prompt hematologic consultation should be obtained. If surgical treatment is deemed too dangerous because of the possibility of uncontrollable disseminated intravascular coagulation, the only prudent option may be a closed reduction and cast application after appropriate medical management of coagulation parameters.

Bone Nails↗
PubMed2004

Alkaptonuric ochronosis with aortic valve and joint replacements and femoral fracture: a case report and literature review.

Alkaptonuria is a rare autosomal recessive disorder of metabolism caused by deficiency of homogentisic acid oxidase and resulting in accumulation of homogentisic acid in collagenous structures. It is characterized by homogentisic aciduria, bluish-black discoloration of connective tissues (ochronosis) and arthropathy of large joints. Less common manifestations include cardiovascular abnormalities, renal, urethral and prostate calculi. Bone fractures are unusual in ochronosis. In this report, we describe a woman, 69 years of age, with a history of dark urine since childhood and progressive pigmentation of the skin, sclera, and auricular cartilages. She had severe arthropathy requiring total joint replacement in both of her knees and right hip. She also had severe aortic stenosis requiring valve replacement, and asymptomatic nephrolithiasis. She presented with a low trauma fracture of the distal femur despite two years of alendroate therapy. We review the etiology, pathogenesis, clinical presentation, diagnosis and treatment of alkaptonuric ochronosis. Early detection is important for prevention and treatment of multiple systems. Nitisinone, a potent inhibitor of 4-hydroxyphenylpyruvate dioxygenase, dramatically reduces production and urinary excretion of homogentisic acid; however, the long-term efficacy and side effects of such therapy are unknown. Identifying the gene for alkaptonuria offers the potential for a new therapeutic approach (replacement therapy with a recombinant enzyme) in the treatment of alkaptonuric ochronosis.

Aged↗
PubMed2002

[Epidural anesthesia in a child with femoral fracture and congenital pain insensitivity].

An 8-year-old boy with congenital insensitivity to pain underwent open reduction of a fractured femur with osteosynthesis under epidural block, without complications and with intraoperative hemodynamic stability. The postoperative course was favorable with minimal analgesia. Congenital insensitivity to pain is a rare hereditary condition characterized by abnormal response to painful stimuli and associated with orthopedic complications requiring surgery. Anesthesia is essential because, even though pain is absent, autonomic dysfunction and catecholamine metabolism alterations are present. An epidural block can be recommended for patients with congenital insensitivity to pain who must undergo surgery.

Anesthesia, Epidural↗
PubMed2000

Construct stiffness of different fixation methods for supracondylar femoral fractures above total knee prostheses.

Supracondylar fracture of the femur after total knee arthroplasty has an estimated frequency of 0.6%-2.5% among total knee recipients and presents an extremely difficult problem when encountered. The goal of this study is to determine the most stable method of fixation of these supracondylar fractures among currently available devices. Synthetic composite femurs with properties similar to human bone were used, and identical, unstable supracondylar fractures were created in each. Osteotomized specimens were placed into four groups of five. Each group was then tested with one of four devices: the Green-Seligson-Henry (GSH) intramedullary nail, AO 95 degrees blade plate, dynamic condylar screw and sideplate, and condylar buttress plate. After stabilization with the different types of fixation, the constructs were tested individually for bending stiffness in four modes: flexion, extension, varus, and valgus bending. The stiffest fixation was determined in each of the four bending planes. Resistance to all tested directions was greatest for the condylar screw and sideplate construct. Resistance to flexion (stiffness = 30.96 N/mm), extension (stiffness = 36.36 N/mm), varus (stiffness = 35.46 N/mm), and valgus forces (stiffness = 32.26 N/mm) was highest in the group fixed with the dynamic condylar screw. This may be due to the purchase gained by the large lag screw into the distal femur, or it may be the result of the total rigidity of the implant. Although the femoral samples used in this study do not duplicate the typical osteopenic bone encountered at the site of a total knee arthroplasty, they do allow direct comparison of the fixation devices by removing the variability associated with cadaveric bone samples.

Arthroplasty, Replacement, Knee↗
PubMed1990

[The choice of the method of anesthesia as a risk factor in the femoral fracture near the hip joint in elderly patients].

Between January 1983 and December 1988, 317 patients with fractures near the hip joint were operated upon. In a retrospective study we compared 180 patients with general anesthesia (AN) and 137 patients with spinal anesthesia (RA). The average age of patients with RA was 80.5 and with AN 79.8 years. The preoperative management was done by an internist. The operation followed at an average of 2.8 days (Tables 1, 2). All patients were placed into 3 risk groups, based on after preoperative cardiac and pulmonary risk scores, as modified by Goldman (Table 3). Spinal anesthesia was performed with 2 ml 4% hyperbaric mepivacaine (80 mg mepivacaine hydrochloride, 190 mg glucose monohydrate). The AN was induced with thiopental (3-5 mg/kg) and maintained with N2O and enflurane. Fentanyl (0.05-0.15 mg) was given for analgesia. The statistical examination was done using the chi-square test (Fisher-exact or Pearson). The groups were compared for age, time of operation, and risk score (Table 4). The mortality in operations with protection of the femoral head (FP) (Ender pinnings, Böhler pinnings and dynamic hip screws) was significantly higher after RA (13.8%), than with AN (6.5%). In operations with hip prostheses (HP), the mortality for RA (19.0%) was also significantly higher then for AN (4.2%) (Fig. 1). The mortality in group I (4-20 points) was 1.7% in patients with AN (FP 1.4%, HP 2.1%) and 3.7% for RA (FP 4.1%, HP 0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1977

Nocturnal femoral fracture and continuing widespread use of barbiturate hypnotics.

A survey of 390 patients aged over 65 with fractured femurs showed that nearly all the fractures that had been caused by nocturnal falls had occurred among the many patients who were still taking barbiturate hypnotics. Barbiturates were also strongly associated with a history of frequent falls. Barbiturates are still prescribed surprisingly often for the elderly. An analysis of 1622 elderly patients referred to a geriatric clinic in Nottingham showed that 41% were taking barbiturates in 1973. By 1976 this fugure had actually increased to 51%, despite the substantial campaign against barbiturate prescribing. This campaign thus appears to have made little or no impact on prescriptions for the elderly in at least one large town. The dangers of barbiturates may well need constant reemphasis.

Accidents, Home↗
PubMed1981

The knee after midshaft femoral fracture treatment: a comparison of three methods.

A retrospective study of knee function has been carried out in 85 patients who had fractures of the midshaft of the femur treated by three currently used methods. Patients who had undergone open medullary fixation, skeletal traction with early knee movements, and skeletal traction with an immobile knee have been compared. All the patients were reviewed personally, with a mean follow-up time of 5 years. We found that 30 per cent of all the patients had minor knee symptoms, and nearly half (45 per cent) had some ligamentous laxity. When bony union resulted, there was no difference in the effect on knee function between the three methods of treatment. Neither skeletal traction nor early knee movement had a harmful effect on the knee in the absence of any major ligamentous injury.

Adolescent↗
PubMed1985

Cephalosporins for prophylaxis in operative repair of femoral fractures. Levels in serum, muscle, and hematoma.

We conducted a prospective controlled study of thirty patients who had an open reduction with internal fixation of a closed fracture of the femur. Each patient received cefamandole, cefazolin, or cefoxitin intravenously (twenty-five milligrams per kilogram of body weight) on entry into the operating room. Intraoperatively, samples of blood, muscle, and organizing hematoma were collected for determination of levels of the antimicrobial agent. Throughout the operation, cefazolin was shown to result in significantly higher levels in serum. The mean concentrations in muscle were similar for all three drugs, but the levels in the hematoma were twice as high with cefazolin as with cefamandole or cefoxitin. No correlation was evident between the concentration of any of these antibiotics in the hematoma and the interval between injury and operation.

Adolescent↗
PubMedDate not supplied

Traction intolerance syndrome: a psychiatric complication of femoral fractures.

Traction Intolerance Syndrome is defined as a behavioral and/or emotional reaction related to skeletal traction severe enough to require psychiatric consultation and/or the use of major psychiatric medication for prolonged periods in the absence of pre-existing major psychiatric illness. Patients often attribute these reactions to the predicament of traction. This syndrome was present in five of nine patients between the ages of sixteen and forty-five who underwent traction for more than three weeks admitted to the UCLA Orthopedic Service during calendar year 1975. Moreover, all the patients were between sixteen and twenty-six years of age, and all the patients in that age range developed the syndrome. The multiple contributions to the pathogenesis of these reactions are described, and the interventions of the liaison psychiatrist in intervention at the biological, psychological, family and hospital staff levels are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

[Evaluation of the recovery of muscular trophicity in aged patients with femoral fractures treated with creatine phosphate and physiokinesitherapy].

Thirty patients over 60 years of age suffering from muscle hypotrophy of the lower limbs due to fracture of the thigh were submitted to rehabilitation training, physiokinesitherapy with and without administration of creatine phosphate (500 mg daily i.m. for 20 days). In order to assess the efficacy of therapy, manual measurement of the circumference of thigh and leg and echotomography were performed in order to measure the thickness of the muscle layer. Manual measurement did not prove to reliable method for evaluation due to the frequent presence of edematous swelling. After 20 days of physiokinesitherapy, echotomography revealed marked recovery of the muscle mass in the 15 patients treated with creatine phosphate who had an increase in muscle mass of 4.4 mm against only 1.5 mm in the group treated with physiokinesitherapy only. This difference is statistically significant (p less than 0.01).

Aged↗
PubMed1951

Problems in intramedullary nailing of femoral fractures.

Intramedullary nailing, an improved method for treatment of fractures of the shaft of the femur, is still in a transitional stage. Experience in 35 cases indicates that supplementary fixation as safeguard against sepparation or overriding often is advisable, particularly in the presence of considerable fragmentation. Wire loops, cross screws and, in some cases, a Collins band modified in such a way as to avoid occlusion of blood supply, have been used for this purpose. For strength and rigidity, the rod used should be as great in diameter as the medullary space can accommodate. A method of preoperative determination of the size of rod to use has been devised. As the intramedullary rod may bend or break, it is advisable that patients be cautioned against full weight bearing on the injured leg too soon after operation.

Dental Occlusion↗