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PubMed2001

Unicondylar femoral fractures: therapeutic strategy and long-term results. A review of 23 patients.

Unicondylar femoral fractures account for 0.65% of all femoral fractures; they have not been studied extensively in the orthopedic literature. Usually occurring following sports trauma or traffic accidents, these fractures involve the lateral condyle three times more frequently than the medial condyle. Conservative or surgical treatment has been advocated, depending on the fracture type. From 1986 to 1999, 19 patients with unicondylar femoral fractures were surgically treated at our institution: there were 15 males and 4 females, aged 36.2 years on average. According to the AO-ASIF classification, there were 7 B1, 6 B2 and 6 B3 fractures. We used Herbert screws in six cases, Barr screws together with cancellous screws in two, cannulated screws in five, cancellous screws alone in four, a compression screw and plate in one and a T-plate in one. In the same period of time, four patients were treated conservatively with a cast. Sixteen patients treated surgically were evaluated with a mean follow-up of 60 months, using Shatzker and Lambert's criteria: six results were rated as excellent, five good, four fair and one poor, while conservative treatment gave three fair and one poor results. In conclusion, we think that open reduction and internal fixation are essential in the treatment of such fractures.

Adolescent↗
PubMed1993

Bone density and geometry after locked intramedullary nailing. Computed tomography of 8 femoral fractures.

8 patients with femoral shaft fracture treated with locked intramedullary (IM) nailing were examined by computed tomography (CT) a few days after nail removal. Cortical bone density, cortical thickness and geometrical shape of the fracture region were compared to those of the contralateral side. The cortical density was reduced by 23 percent at the mid-fracture level. However, at the same level the cortical thickness had increased by 47 percent, and the antero-posterior and medio-lateral diameters by 30 and 45 percent, respectively. We conclude that the fracture region of the femoral shaft had regained its mechanical properties at the time of nail removal.

Biomechanical Phenomena↗
PubMed2002

[Intramedullary nailing of adult femoral fractures].

OBJECTIVES: We evaluated the results of treatment of adult femoral fractures treated by intramedullary nails. METHODS: Sixty-two patients (15 females, 48 males; mean age 29 years; range 16 to 62 years) with 64 femoral fractures were treated by intramedullary nailing. Eighty-three percent of the fractures was closed and 17% was open. According to the Winquist (W) classification, there were 16 (25%) W0, 22 (34%) W1, nine (14%) W2, nine (14%) W3, and eight (13%) W4 fractures. The mean duration between trauma and surgery was 18 days (range 4 to 130 days), and the mean hospital stay was 25 days (range 11 to 142 days). Open and closed techniques were employed in 62 (97%) and two (3%) fractures, respectively. Nine fractures were unlocked; dynamic and static locking were performed in 39 and 16 fractures, respectively. In the open technique, secondary procedures involved grafting in 14 cases, cerclage in eight cases, grafting and cerclage in 10 cases, and grafting and screw fixation in one case. The results were assessed according to the criteria by Thoresen et al. The mean follow-up was 28 months (range 7 to 62 months). RESULTS: Fifty-one patients (80%) had satisfactory, 13 patients (20%) had poor outcome. All proximal locking screws (n=20) were successfully inserted, whereas 23 (24%) of 95 distal screws missed the nail holes. Complications included superficial infection (n=3), osteomyelitis (n=4), trochanteric bursitis (n=1), irritation of the skin by the distal screws (n=4), heterotopic ossification (n=6), shortening more than 1 cm (n=8), rotational malalignment greater than 10 degrees (n=2), migration of the nail through the knee joint (n=2), drill breakage while preparing the distal holes (n=2), knee range of motion below 100 degrees (n=6), and delayed union (n=2). CONCLUSION: Intramedullary nailing should be the primary indication for stable and unstable femoral fractures.

Adolescent↗
PubMed2001

Reliability of the AO/ASIF classification for pertrochanteric femoral fractures.

20 radiographs of pertrochanteric femoral fractures were classified as to fracture "group" and "sub-group" according to the AO/ASIF Fracture Classification (type 31A) by 15 observers. 3 months later, the same radiographs were reviewed by the same observers. Mean agreement of the observers with the final consensus ranged from 53% (with subgroup classification) to 81% (without subgroup). The mean kappa value for interobserver reliability was 0.33 and 0.34 for classification with subgroup in both observer sessions, respectively. Omission of the subgroup classification resulted in better mean kappa values (0.67 and 0.63, respectively). Mean intraobserver reliability was 0.48 in the fracture "subgroup" and 0.78 in the "group" classification. In conclusion, the results show that the AO/ASIF classification for pertrochanteric fractures is reliable for fracture subgroups 31A1, A2 or A3. The group classification should be used to compare scientific data and determine the best treatment. Further classification of fracture subgroups leads to poor reproducibility of results.

Femoral Fractures↗
PubMed2000

Morphometric and mechanical properties of femora in young adult male turkeys with and without femoral fractures.

Morphologic and torsional mechanical properties of femora were evaluated in three groups of turkeys to determine whether turkeys that incurred femoral fracture have different radiographic, morphologic, and torsional mechanical properties than do turkeys without femoral fracture, and if body weight was a factor differentiating affected and nonaffected turkeys. Nine turkeys with unilateral femoral fractures and nine turkeys without fractures from Farm A were compared with a group of nine age and genetically matched turkeys from Farm B. Turkeys from Farm A were 10 to 25% heavier (26.2+/-0.9 kg) and turkeys from Farm B were 10% lighter (18.2+/-0.9 kg) than expected breed standards. Femoral length, cortical thickness, medullary diameter, and diaphyseal curvature were measured from craniocaudal and lateromedial radiographs. One intact femur from each of five turkeys with a contralateral femoral fracture (Farm A), nine unaffected turkeys from Farm A, and nine turkeys from Farm B were subjected to failure in a torsion test. Geometric and mechanical results were compared. Turkeys from Farm A had a thicker cortex and a smaller medullary diameter than turkeys from Farm B. Turkeys from Farm A had significantly lower torsional stiffness and failure torque values compared with turkeys from Farm B, when differences in body weight were accounted for (analysis of covariance, P < 0.05). Mechanical failure torque calculated from geometric values suggests that organic or inorganic material arrangement and composition may be responsible, in part, for differences between groups. Femoral fractures may be associated with insufficient skeletal adaptation to heavy body weight.

Animals↗
PubMedDate not supplied

Effect of the quality of health care on permanent inability secondary to femoral fractures due to occupational accidents.

OBJECTIVE: To construct and validate an indicator for evaluating the quality of care for femoral fractures, and to assess the contribution of the quality of health care as a determinant of partial permanent inability secondary to femoral fractures due to occupational accidents. MATERIALS AND METHODS: The study was conducted from January to December 1995 at Mexican Institute of Social Security. The instrument was designed with experts' contribution along different stages and validated using implicit criteria and factorial analysis. A case-control study was then conducted to evaluate the contribution of the quality of care to inability secondary to femoral fractures. Cases were 108 active workers with permanent inability secondary to femoral fracture; controls were 94 active workers with fracture of femur but no permanent inability. Logistic regression modeling was used to establish the association between quality of care and partial permanent inability, adjusting by relevant variables. RESULTS: The ultimate indicator of quality of care consisted of the following: Timely care, presurgical management, surgical management, and fracture complications. A final score over 229 points meant that the worker had received good quality of care. Workers getting 229 or less points had received poor quality of care. Forty-eight (44%) cases and 66 (70%) controls received good quality of medical care. The likelihood of partial permanent inability was almost three times higher among workers given poor quality of care (OR 2.95; 95% CI 1.5-5.5). According to the multivariate model, predictors of partial permanent inability were: Having exposed or epiphysiary fractures, being re-submitted to surgery, having less than 90 days of rehabilitation care, and receiving deficient medical care. CONCLUSIONS: The constructed instrument was validated. The level of the quality of care received by workers is a determining factor for the generation of partial permanent inability. In workers having femoral fractures, it is important to consider timely medical care and early rehabilitation, to reduce the high incidence and prevalence of this medical problem in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Accidents, Occupational↗
PubMed1999

The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures.

Currently available intramedullary devices for the treatment of unstable pertrochanteric femoral fractures are technically demanding and show a considerable failure rate due to their massiveness and the persistent rotational instability of the head-neck fragment. The Arbeitsgemeinschaft für Osteosynthesefragen (AO/ASIF) therefore designed a new intramedullary device, the proximal femoral nail (PFN), which during a handling study was tested in 4 European clinics. Within one year 191 proximal femoral fractures were treated with the PFN. After a follow up period of at least 4 months technical failures (poor reduction, malrotation or wrong choice of screws) were seen in just 4.6% of the cases. One patient showed a cut-out of the implant but there were no mechanical failures (bending, breaking of the implant) or ipsilateral fractures of the femoral shaft at the tip of the implant. It is therefore concluded that the results of this new implant compare favourably to the currently available implants for the treatment of the unstable pertrochanteric femoral fracture.

Adolescent↗
PubMed1990

Subtrochanteric fractures following Gouffon pinning of subcapital femoral fractures.

Of the first 158 patients in a series of 292 consecutive patients treated for a femoral neck fracture with multiple pinning according to Gouffon's method (Howmedica Inc.), four (2.5 per cent) subsequently suffered a subtrochanteric fracture at the site of the distal pins. The configuration of the fractures was identical. These fractures occurred spontaneously while walking, and one occurred after slight direct trauma. Re-osteosynthesis was required in all four cases using a screw-plate device. If necessary, one or two pins were left in place to secure rotational stability. After a review of these cases and the literature, various modifications to Gouffon's method were introduced, and none of the following 134 patients suffered secondary fractures.

Aged↗
PubMed1975

Influence of vitamin A on wound healing in rats with femoral fracture.

Groups of healthy wounded rats with and without comminuted femoral fractures, and maintained on nutritionally complete commercial rat chow with and without supplemental vitamin A, were studied. The test wounds were standard dorsal skin incisions and s.c. polyvinyl alcohol sponge implants. In some experiments the rats were pair-fed; the rats with femoral fracture not receiving supplemental vitamin A were the lead group for determining food allowanced. In other experiments, the rats were allowed food ad libitum. We found that wound healing of rats with femoral fracture was increased when supplemental vitamin A was given, but the supplemental vitamin A did not completely obviate the adverse effects of fracture. The ratio of the breaking strengths of the skin incisions after formalin fixation to the breaking strengths of the incisions in the fresh state was higher in the unsupplemented rats, supporting the results of our earlier experiments that vitamin A increases the rate of collagen cross-linking.

Administration, Oral↗
PubMed1994

Periprosthetic Femoral Fractures.

Fracture of the femoral shaft around a hip prosthesis presents the simultaneous problems of prosthetic stability and femoral- fracture management. Treatment options include nonoperative stabilization (traction) and operative stabilization by means of intramedullary fixation, extramedullary fixation, or proximal femoral prosthetic replacement.

Journal Article↗
PubMedDate not supplied

[Effect of vitamin D2 and 1 alpha-hydroxycholecalciferol on bone tissue in rats with femoral fractures].

Formation of the callus at the site of a femoral fracture in rats without vitamin D deficiency is accompanied by an increase in the specific mass and mineralization of the unaffected pair bone, which indicates general intensification of the processes of mineralization occurring in the skeleton during fractures. Vitamin D deficiency leads to hypocalcemia, retardation of callus mineralization, and drastic demineralization of the intact thighbone thus pointing to pathological enhancement of skeleton resorption as the main source of calcium required for covering bodily requirements. Like vitamin D2 in a dose of 0.300 microgram, administration of 1 alpha-hydroxyvitamin D3 (1 alpha-HCD3) in a dose of 0.025 microgram daily to rats with femoral fractures kept on the vitamin D-deficient diet provides for effective calcium homeostasis maintenance and mineralization of the callus and unaffected bones. This demonstrates high biological activity of 1 alpha-HCD3 and its efficacy in promoting the processes of mineralization during fractures. The increase in the phosphorus content in the diet until the calcium/phosphorus ratio reaches 1:2 (instead of the optimal 1:1), aggravates hypocalcemia and sharply enhances demineralization of the intact bone in vitamin d-deficient rats with femoral fractures and reduces mineralization of the callus in rats given 1 alpha-HCD3. The data obtained indicate the necessity of reliable correction of potential vitamin D deficiency and optimization of the calcium-phosphorus ratio in the diet and preparations, as well as a possibility of applying 1 alpha-HCD3 in the combined treatment of fractures.

Animals↗
PubMed1999

Risk factors for postoperative femoral fracture in cementless hip arthroplasty.

The objective of this study was to evaluate the incidence of and risk factors for femoral fracture in patients who underwent cementless hip arthroplasty during a 3-year period. Several predisposing factors have been reported; we tried to find another predictive indicator that could be recognized preoperatively. The records of all patients who underwent cementless hip arthroplasty from December 1993 to December 1996 were reviewed. The characteristics and clinical features (including age, gender, diagnosis, geometry of the proximal femur, and quality of bone) of the patients who had fractures were compared with those of patients who did not have fractures. During the 3-year study, 425 patients underwent a total of 454 cementless hip arthroplasties. There were 16 postoperative fractures (3.5%, 16 patients). Patients who suffered femoral fracture were significantly older than patients without fracture (65.6 +/- 10.9 yr vs 52.6 +/- 16.2 yr, p < 0.001). The fracture group had poorer preoperative bone quality compared with the nonfracture group (3.3 +/- 0.6 vs 3.8 +/- 0.7, Singh's Index of Osteoporosis, p < 0.01). The canal flare index of the proximal femur was significantly lower in the fracture group than in the nonfracture group (3.3 +/- 0.40 vs 3.8 +/- 0.7, p < 0.01). Our results indicate that old age and osteoporosis affect the likelihood of periprosthetic femoral fractures, and that a low flare index is a predictive indicator of femoral fracture. These factors should be taken into account during preoperative planning, and cemented arthroplasty should be considered for patients with these risk factors.

Aged↗
PubMed1983

[Dislocated supracondylar femoral fractures, slipped epiphyses and epiphyseal fractures in children].

Dislocated supracondylar femoral fractures are usually transverse fractures and are unstable. In our opinion the primary treatment of these fractures should be surgical in order to save the patient a protracted healing period. Osteosynthesis using a straight plate is impossible, as the distal fragment is too short. Condylar plates are contraindicated and angular plates have too little stability. We feel that intramedullary pins are unsuitable in children. They provide too little stability when the distal fragment is short. Up to now we have achieved the best results with external fixation. Slipped epiphyses and epiphyseal fractures do not present problems as far as the surgical procedure is concerned (removal of the displaced periosteum, repositioning and compression). Healing is not delayed. The long-term results are poor, however, due to premature closure of the damaged epiphyseal plate.

Adolescent↗
PubMed2004

[Operative treatment of complicated distal femoral fractures].

OBJECTIVE: To explore an effective way for treating severe complicated distal femoral fractures. METHODS: Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3 type according to AO/ASIF classification, were treated with a lateral condylar buttress plate or self-designed aliform anatomical plate, and operated on with allogeneic bone grafting. RESULTS: All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 4-11 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. CONCLUSION: The internal fixation for complicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive, the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.

Adult↗
PubMed1994

[Primary treatment of unstable pertrochanteric femoral fractures using a head-neck prosthesis in elderly patients].

OBJECTIVE: Evaluation of the treatment of unstable pertrochanteric femoral fractures with a femoral head prosthesis in older patients. DESIGN: Descriptive. SETTING: University Hospital Nijmegen, the Netherlands. METHOD: From January 1988 through December 1992, 15 patients with 15 unstable pertrochanteric femoral fractures were treated with a femoral head prosthesis and additional wiring of the trochanter. The group consisted of 11 women and 4 men with a mean age of 86 years. Two operations were secondary treatments after broken angled-plate fixation. The other 13 were primary treatments. RESULTS: A stable fixation allowing weight-bearing was achieved in all cases. The operations were accompanied by high morbidity and mortality rates: 4 patients died within 3 months after surgery. One dislocation of the prosthesis occurred. Twelve fractures consolidated, pseudarthrosis of the greater trochanter occurred twice. Five patients regained their preoperative walking ability. CONCLUSION: Femoral head prosthesis with additional wiring is an alternative with few mechanical complications in the treatment of unstable pertrochanteric femoral fractures.

Aged↗
PubMed1990

Undiagnosed abuse in children younger than 3 years with femoral fracture.

We retrospectively evaluated 138 children younger than 3 years with femoral fractures who presented to the emergency departments of three major Michigan hospitals between 1979 and 1983. Patients were classified into one of the following four subgroups based on presenting history: accident (22%), bone pathology (8%), abuse (10%), and uncertain origin (60%). Distribution of common fracture types among the four subgroups was similar. Of the uncertain group, 22 cases of abuse were identified during admission and 7 additional cases were found at a later date. The total number of femoral fractures secondary to abuse was 43 (31%) of 138. Children younger than 3 years presenting with a femoral fracture should evoke a high suspicion for abuse.

Age Factors↗
PubMedDate not supplied

Are children with femoral fracture haemodynamically unstable?

OBJECTIVE: To assess the occurrence of hypovolaemic shock in children who have sustained traumatic femoral fracture. METHODS: A retrospective descriptive study was performed on a cohort of children with traumatic femoral fracture presenting over a five and a half year period from 1 January 1996 to 1 July 2001. Selected parameters for analysis included administration of a fluid bolus, as well as all available vital signs within 4 h following injury relating to pulse, systolic blood pressure, respiratory rate, skin capillary refill time and mental status. Fluid and blood transfusion records were examined, as was the need for intraosseous access. Initial haemoglobin and haematocrit results were also obtained. RESULTS: There was no evidence for haemodynamic instability in the 100 patients who met the selection criteria when compared with internationally accepted normal vital sign parameters. No significant difference was found in the initial vital signs between patients who received fluid bolus and those that didn't. No patient needed intraosseous access or fluid resuscitation. One patient received blood transfusion without evidence of haemodynamic instability. Haemoglobin and haematocrit values were not significantly decreased. Ninety-two percent of patients in this study had isolated femoral fracture. CONCLUSIONS: No evidence for haemodynamic instability was found in a cohort of children with traumatic femoral fracture.

Child↗
PubMed2001

Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): the technique and early results.

The treatment of supracondylar femoral fractures in the past three decades has evolved from non-operative to operative treatment. While operative fixation utilizing either plate fixation or rigid intramedullary nail fixation has improved patient outcomes, the problems of malunion, nonunion, need for bone grafting, joint stiffness, and infection persist. An emphasis on maintenance of the soft tissue envelope around fractures has improved efficacy in increasing osseous healing and decreasing infection. Out of this movement grew the concept of submuscular plating for distal femoral fractures, and subsequently L.I.S.S. fixation (Less Invasive Stabilization System) for distal femoral fractures. The technique and early results utilizing the L.I.S.S. for distal femoral fractures is described. The technique of L.I.S.S. fixation first begins with traditional direct visualization and internal fixation of the articular surface. Closed reduction is then performed on the metaphyseal / diaphyseal component of the fracture, followed by submuscular fixation utilizing the L.I.S.S. fixation. The L.I.S.S. can best be thought as an "internal" external fixator.

Bone Screws↗