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PubMed1991

[Treatment of diaphyseal femoral fractures in patients with associated and multiple traumas].

There has been analysed an outcome of treatment of diaphysial fractures of femur in 124 victims with associated and multiple damages. The analysed group of victims has been urgently subjected to intramedullary nailing osteosynthesis by means of a rod of our construction. Developed and officially approved method of nailing osteosynthesis not only eliminates application of bulky plaster bandages, skeletal traction systems, but ensures mobility, possibility of carrying out the repeated diagnostic and treatment--and--prophylactic measures and, in the indicated cases, repeated operative intervention. Clinical approval of the method of nailing osteosynthesis by means of the rod of our construction allowed to reduce the term of treatment, number of complications, temporary invalidity and invalidism as compared with the group of patients, subjected to conservative treatment.

Adult↗
PubMed1976

The value of low dosage heparin for the prophylaxis of thromboembolism in patients with transcervical and intertrochanteric femoral fractures.

One hundred and ten female patients, over the age of 60, with intertrochanteric or transcervical fractures were included in a controlled, randomized, clinical trial investigating the value of low dosage heparin in the prophylaxis of deep vein thrombosis. There were 50 completed pairs. Eight (16 per cent) deep vein thromboses occurred in the heparinized group compared with 23 (46 per cent) deep vein thromboses in the control group. The incidence of pulmonary embolism was also reduced. The diagnosis of deep vein thrombosis was made on clinical grounds, supplemented by phlebography and autopsy. There was no difference in the wound hematoma or infection rate. The heparin was commenced on admission to hospital and it is suggested that in this group of patients low dosage heparin prophylaxis should start on admission and not wait until surgery.

Aged↗
PubMed1994

[Risk of fat embolism syndrome after intramedullary nailing in femoral fracture and thoracic injury].

Following the insertion of an intramedullary nail, the fat embolism is a frequent complication in patients with long bone fractures. The respiratory function of patients with fractures of the femur and accompanying severe chest injuries was improved. In general these patients have a high risk to develop a respiratory distress syndrome. The average age of the 22 polytrauma patients studied was 40 years. The injury's severity as assessed using the Hannover Polytrauma-Score (PTS) and the average score was 29 points. Using Suter's scoring system the severity of the respiratory distress syndrome was assessed (Table 3). The insertion of an intramedullary nail was performed on 18 patients. Four of them developed an ARDS (adult respiratory distress syndrome) up to grade IV for a period of 5 days. Two patients suffered an ARDS grade I for a period of 2 days. In the study no typical features of fat embolism syndrome were found in any of these patients.

Adult↗
PubMed2005

Image-guided reconstruction of femoral fractures: is the staff progeny safe?

The potential of adverse effects to progeny caused by preconceptual and fetal exposure to ionizing radiation is an issue of increasing concern to orthopaedic surgeons and assisting staff. Are these fears justified? How effectively is the embryo or fetus protected, and should pregnant staff alter their duties? In this study, an anthropomorphic phantom was exposed fluoroscopically at two geometries common in surgical reconstruction of proximal femur fractures. Scatter radiation was converted to gonadal dose and embryo or fetal dose with and without use of a protective apron. The genetic risk for the orthopaedic surgeon after 10 years of occupational exposure was estimated to be 16,000 times lower than the natural frequency of heritable disease. The excess risk of childhood cancer associated with the dose accumulated during gestation was at least 600 times lower than the corresponding natural frequency. A properly shielded pregnant orthopaedic surgeon is allowed to do 14 hours of hip fluoroscopy during gestation, whereas 2100 hours of fluoroscopy are required for the induction of gross malformation or mental retardation to the growing embryo or fetus. The supplementary dose constraints for pregnant staff provide adequate protection to the unborn child without affecting regular personnel duties.

Dose-Response Relationship, Radiation↗
PubMed2000

The reliability and validity of the Vancouver classification of femoral fractures after hip replacement.

This study assessed the reliability and validity of a new classification system for fractures of the femur after hip arthroplasty. Forty radiographs were evaluated by 6 observers, 3 experts and 3 nonexperts. Each observer read the radiographs on 2 separate occasions and classified each case as to its type (A, B, C) and subtype (B1, B2, B3). Reliability was assessed by looking at the intraobserver and interobserver agreement using the kappa statistic. Validity was assessed within the B group by looking at the agreement between the radiographic classification and the intraoperative findings. Our findings suggest that this classification system is reliable and valid. Intraobserver agreement was consistent across observers, ranging from 0.73 to 0.83. There was a negligible difference between experts and nonexperts. Interobserver agreement was 0.61 for the first reading and 0.64 for the second reading by kappa analysis, indicating substantial agreement between observers. Validity analysis revealed an observed agreement kappa value of 0.78, indicating substantial agreement. This study has shown that this classification is reliable and valid.

Arthroplasty, Replacement, Hip↗
PubMed1991

[Epidemiology of proximal femoral fractures in La Plata, Argentina].

The epidemiology of proximal femur fractures (FXf) was studied in the city of La Plata, Argentina. At the time of the study the total population was 288,000 inhabitants and 73,900 (30,700 men and 43,200 women) were 50 years of age and over (Table 1). From May 1, 1989 to April 30, 1990 all the patients admitted in local hospitals with FXf were personally interviewed by one of the authors. Patients living outside the city of La Plata or fractures due to metastatic or Paget disease were excluded. During the period of the study 195 patients with FXf (164 women and 31 men) were registered. The median of age was 80 years in females (range 50 to 96) and 77 years of age (range 50 to 93) in males. The incidence of FXf in women 50 years of age and over was 379.4/100,000 inhabitants and in men 101.0/100,000 inhabitants. The female/male ratio was 3.76 (Table 1). The number of FXf was higher in winter than in summer. (Figure 1). Table 3 indicates the incidence of FXf found in several studies performed in different geographical areas. In females the incidence was similar to that observed in other caucasian populations. The female/male ratio found in the present study is the highest recorded in the literature. This is the first epidemiologic study of osteoporosis performed in Argentina. Further studies should ascertain the low incidence found in males as well as the frequency of osteoporosis in other areas of the country that extend from latitude 22 degrees S to 54 degrees S.

Age Factors↗
PubMed2004

Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods.

INTRODUCTION: The objective of this study is to present the results of surgical management of supracondylar fractures of the femur (types A and C according to the AO/ASIF classification) in elderly patients with the use of two different methods of fixation: the mini open dynamic condylar screw fixation (DCS) and the closed retrograde intramedullary nailing (RIN). MATERIALS AND METHODS: Eighty patients with supracondylar fractures of the femur were treated from January 1994 to June 2000 and 72 of them followed up completely. There were 25 (34%) men and 47 (65%) women with a median age of 73.2 years (range 60-88 years). In patients with the same type of fracture, the chosen method was random, one after the other (alternately). RIN was used in 35 patients, and DCS was used in 37. The mean operative time for the DCS fixation group was 145 min (range 115-180 min), whereas for the RIN group it was 92 min (range 76-110 min) (p<0.001) with an average estimated blood loss of 310 cc (range 120-450 cc) and 118 cc (range 90-165 cc), respectively (p<0.001). The mean follow-up was 28 months (range 18-42 months). RESULTS: According to the criteria set by Schatzker and Lambert, excellent results were recorded in 18 (51%), good in 11 (31%), moderate in 3 (9%), poor in 3 (9%) patients with RIN and excellent in 19 (51%), good in 11 (30%), moderate in 4 (11%) and poor in 3 (8%) patients with DCS (p>0.05). The complications that occurred in the RIN group were 2 (6%) stiffness of the knee (mean flexion 80 degrees), 2 (6%) non-unions, 2 (6%) varus deformity and in the DCS group 2 (5%) haematomas, 4 (11%) stiffness of the knee (mean flexion 73 degrees) and 2 (5%) non-unions. CONCLUSION: Although the two methods appear to have the same percentage of excellent results and same time to bony union, RIN is preferable to DCS in terms of less blood loss and shorter operating time.

Age Factors↗
PubMedDate not supplied

An in vitro biomechanical study of bone plate and interlocking nail in a canine diaphyseal femoral fracture model.

OBJECTIVE: To compare the structural properties and the interfragmentary motion in ostectomized canine femurs stabilized with either an 8-mm interlocking nail system (IN) or a 10-hole dynamic compression broad plate (DCP). ANIMAL OR SAMPLE POPULATION: Ten pairs of adult canine femurs with a 25-mm mid-diaphyseal gap. METHODS: Bone specimens were divided into 2 groups (10 femurs each). Left femurs were stabilized with a DCP and 8 bicortical screws; right femurs were stabilized with an IN and 3 screws. Mechanical tests were performed in eccentric axial loading and in craniocaudal bending. The testing was first conducted nondestructively and then until breakage. Structural properties, ie, stiffness, yield limits, and failure limits, were determined. Interfragmentary motion was measured during nondestructive tests with the use of an optoelectronic device. Axial, transverse, and rotational motions were calculated. Mean values of stiffness, yield and failure limits, and axial and shear motions for each fixation method were compared using a paired t test within each group (P <.05). RESULTS: Mean (+/-SD) values of stiffness and failure limit were significantly higher for IN constructs than for DCP constructs in compression, while there was little difference in the results between each tested group in bending. Mean yield load values were significantly higher for IN than for DCP specimens in compression as well as in bending. The axial-motion analysis revealed significant differences between IN and DCP groups during bending tests only. The highest score of transverse motion at the gap was recorded during bending tests, and was higher for DCP than for IN specimens. There were insignificant differences between the two groups with regard to rotation around the diaphyseal axis. CONCLUSIONS AND CLINICAL RELEVANCE: Structural properties and interfragmentary shear motion analysis demonstrated a much higher rigidity in the IN-bone than in the DCP-bone constructs.

Animals↗
PubMed2004

The value of a prognostic scoring system in the rehabilitation of elderly patients with proximal femoral fractures.

AIM: To evaluate a prognostic scoring system for elderly patients with hip fractures, which can, on admission, predict on the basis of pre-injury prognostic factors the possible length of stay in hospital, progress of rehabilitation, level of self-caring and rehousing needs at discharge. METHODS: A prognostic scoring system, developed on the basis of pre-injury level of independence in activities of daily living (ADL) (Katz), medical comorbidities and Pfeiffer's mental scoring system was used (Svensson O et al. J Bone Joint Surg 1996; B78: 115-8). The study was conducted on a cohort of 63 patients prospectively recruited from consecutive admissions. RESULTS: Ninety percent of the patients (without comorbidities and mental score > 7; group 3/3) who were independently mobile pre-injury remained independently mobile at discharge (CI 95% 0.79-0.97). Pre-injury score was found to be significantly related to the level of ADL at 2 weeks after operation and at discharge from hospital (CI 95% 0.69-0.9). There was a pattern in duration of hospital stay in different groups (score 3/3 = 22 days, 2/3 = 31 days and 1/3 = 33 days). A pattern of community placement and housing after discharge was noticed in relation to the pre-injury score. CONCLUSION: 3/3 score groups are most likely to achieve independence with mobility and ADL on the acute orthopaedic ward and to be discharged directly to their pre-injury homes. They also were the least likely group to need rehabilitation in a dedicated orthogeriatric rehabilitation unit. 2/3 score groups are most likely to benefit from rehabilitation in a dedicated orthogeriatric rehabilitation unit. 1/3 and 0/3 score groups are least likely to benefit from rehabilitation in a dedicated orthogeriatric unit, in terms of achieving independence with mobility and ADL. They were also the most likely group to need long-term high dependency residential care. Early liaison with social and community services is essential for effective and timely planning of discharge.

Activities of Daily Living↗
PubMed1993

[DHS (Dynamic Hip Screw)-osteosynthesis in the management of femoral fractures in the hip region and the place of this method in the treatment of such injuries].

In the last four years we performed 182 osteosynthesizes with Dynamic Hip Screw, besides other methods on the fractures of the hip region. Here we are presenting the evaluation of our results, which, regarding the international scene, fall into the medium category. The operations were performed within three days after the injuries in 61 per cent of our patients. Our results are good in 80 per cent of our patients. The incidence of method-specific complications is 15 per cent in our statistics/such as wound haematomas, local infections, cut out of the device of the femoral head, metal failures, the fracture of the femur at the site of the introduction of the device). The rate of complications is 30 per cent in case of Ender nailing. More than a 1 cm shortening in the fracture after weight bearing was observed in the 47 per cent of our DHS cases. Patients who are complaining of pain during weight bearing belong to this group. In accordance with other authors, we consider the DHS osteosynthesis, due to its high stability, the best technique in case of unstable pertochanteric fractures of elderly patients. We recommend the angular plate fixation to the pertrochanteric fractures in young patients, in whose case it requires a more accurate reposition and who are able to walk without weight bearing. We can achieve good results with Ender nails in case of stable pertrochanteric fractures of elderly patients.

Adult↗
PubMed1993

Operative treatment of distal femoral fractures proximal to total knee replacements.

Twenty fractures of the distal part of the femur proximal to a total knee replacement were treated operatively by members of the New England Trauma Study Group. Notching of the anterior aspect of the femoral cortex was associated with only two of these fractures, and none of the knee prostheses was loose at the time of the fracture. All twenty fractures were treated with open reduction and stable internal fixation, and the operation on fifteen fractures was supplemented with bone grafts. Every fracture healed, and eighteen healed after a mean of sixteen weeks (range, six to forty weeks). Union of the other two fractures was delayed, but repeat open reduction and internal fixation combined with autogenous bone-grafting resulted in union. After operative treatment, the patients returned to the level of activity that they had had before the fracture. The pre-existing tibiofemoral alignment and range of motion of the knee were also restored. At the time of follow-up, the average clinical rating of the Knee Society for all twenty knees had not decreased compared with the score before the fracture.

Aged↗
PubMed1996

Measuring stability of wire cerclage in femoral fractures when performing total hip replacement. In vitro study on a standardized bone model.

The stability of wire cerclage was investigated on a wooden model. Two semitubular shells made of hard oak were firmly joined together using cerclage wires of different diameters and with different techniques. A conical test piece was then implanted. The test set-up was subjected once to an axial force of 4 kN and a torque of 20 Nm using a testing machine. Implant excursion at the interface was measured. One hundred forty measurements carried out on test pieces with fissures demonstrated that cerclage wires with the largest diameter possible should be used with a double-loop technique. Wire diameters under 1.2 mm are unsuitable for cerclage of the femur because they rupture easily. The most stable cerclage is obtained with two double cerclages using 1.5-mm stainless steel wires. Although micromotion is greater than for the reference group without fissures, no cases of excursions exceeding 100 microns could be measured. In comparison with a femoral shaft that is not fractured, marked instability remains. It is recommended that a tightening tool be used to tighten the wires, as this achieves considerably more stable cerclage than that achieved with two forceps.

Bone Wires↗
PubMed2002

Musculoskeletal effects of the recombinant human IGF-I/IGF binding protein-3 complex in osteoporotic patients with proximal femoral fracture: a double-blind, placebo-controlled pilot study.

The administration of recombinant human IGF-I complexed with its predominant binding protein IGF binding protein-3 (rhIGF-I/IGFBP-3) may allow the safe administration of higher doses of IGF-I than can be accomplished with rhIGF-I alone. The aim of this randomized, double-blind, placebo- controlled pilot study was to evaluate the short-term safety and musculoskeletal effects of rhIGF-I/IGFBP-3 in older women (aged 65-90 yr) with recent hip fracture. Within 72 h after the event, 30 patients received continuous administration of either placebo (n = 10), 0.5 mg/kg.d rhIGF-I/IGFBP-3 (n = 9), or 1 mg/kg.d rhIGF-I/IGFBP-3 (n = 11). Treatment was administered by sc infusion through a portable mini-pump for a total of 8 wk after hip fracture surgery, with patient follow-up to 6 months after surgery. Efficacy evaluations included a contralateral hip bone density determination, markers of bone turnover (including serum osteocalcin and urinary excretion of N-telopeptide), grip strength, and tests of functional ability. During the administration of rhIGF-I/IGFBP-3, mean serum levels of IGF-I significantly (P < 0.001) increased from 83 ng/ml to 289 ng/ml (0.5 mg/kg.d) and 393 ng/ml (1 mg/kg.d), respectively. Both doses were well tolerated, and no hypoglycemia or other therapy-induced side effects were observed. After an initial loss of hip bone density after hip fracture surgery, patients treated with 1 mg/kg.d rhIGF-I/IGFBP-3 regained a substantial portion of their femoral bone mass. At 6 months postfracture (4 months after the 2-month infusion), they showed a statistically not significant decrease from baseline in hip bone density (-2.6%, P = 0.53). Placebo-treated patients, on the other hand, failed to regain lost bone: at 6 months postfracture, bone density in the placebo group had declined by 6.1% (P = 0.04). Additionally, in patients treated with 1.0 mg/kg.d rhIGF-I/IGFBP-3, grip strength had increased from baseline by 11.4% by the end of the study (P = 0.04) whereas patients on placebo lost 11.6% from baseline (P = 0.16). This increase in muscle strength in the high-dose group was associated with a positive effect on functional recovery. We conclude that a 2-month infusion of rhIGF-I/IGFBP-3 in patients with recent hip fracture is feasible, safe, and well tolerated. Analyzing the effects on bone mass, muscle strength, and functional ability, we observed beneficial trends. In the context of a small exploratory study, these findings should be interpreted with caution, but they support the need for future trials to further assess the therapeutic potential of rhIGF-I/IGFBP-3 in elderly subjects with osteoporosis.

Aged↗