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PubMed2005

Dall-Miles cable and plate fixation system in the treatment of periprosthetic femoral fractures: a review of 20 cases.

PURPOSE: To assess the effectiveness of Dall-Miles cables and plates in the treatment of periprosthetic femoral fractures around hip arthroplasties. METHODS: We retrospectively reviewed 20 cases of periprosthetic femoral fracture treated with the Dall-Miles cable and plate system between November 1999 and December 2002 in James Paget Hospital in the United Kingdom. Demographic data, fracture type, and surgical outcome of the patients were reviewed and assessed. RESULTS: Of the 20 cases of periprosthetic femoral fracture, one was of Vancouver type A, 15 were of type B1, and 4 were of type C. The mean age at operation was 78.5 years (range, 68-90 years) with a male to female ratio of 11:9. The mean time to union was 3.9 months (range, 3-8 months), and the mean follow-up period was 19.4 months (range, 1-4 years). 15 patients achieved satisfactory results, including 2 delayed unions that healed with a residual varus deformity of 15 degrees in the femoral component. Three patients developed deep-seated wound infections. No nonunion of fractures or fixation system failures occurred. CONCLUSION: The Dall-Miles cable and plate fixation system alone is a sufficient treatment for most periprosthetic femoral fractures. In the management of B1 fractures, there was no significant difference in clinical outcome, despite the various combinations of cables and screws used for stabilisation of the plate. However, in cases of comminution at the fracture site, junctional grafting with morsellised autograft may be used in addition to internal fixation to accelerate union.

Aged↗
PubMed1999

Effect of femoral fracture and intramedullary fixation on lung capillary leak.

BACKGROUND: Pulmonary injury is an important complication in the trauma patient with long-bone fractures. The purpose of this study was to determine the effect of femoral fracture or fracture and intramedullary fixation on lung capillary leak. The contribution of leukocytes to lung injury in this model was also determined. METHODS: The pulmonary capillary filtration coefficient was determined in lungs of rats after femur fracture or fracture and reamed or unreamed intramedullary fixation. Pulmonary arterial vascular resistance and lung neutrophil content were also determined. RESULTS: Fracture alone did not cause lung injury, whereas fracture and intramedullary fixation elicited lung capillary leak. Fracture alone and intramedullary fixation increased pulmonary vascular resistance, whereas unreamed intramedullary fixation caused lung leukosequestration. CONCLUSION: Femoral fracture alone does not cause an increase in pulmonary microvascular permeability. Femoral fracture and intramedullary fixation causes lung capillary leak, which is not increased by reaming the femoral canal.

Animals↗
PubMedDate not supplied

Periprosthetic femoral fractures above total knee replacements.

Periprosthetic femoral fractures above total knee replacements can be managed by a variety of methods, including casting, open reduction and internal fixation, external fixation, or revision arthroplasty. Because no single method has emerged as the optimal choice for all such fractures, it is important to understand which options are appropriate for each fracture pattern. Early classification systems focused on displacement as a major indication for either surgical or nonsurgical management. However, recent techniques and current implants have made surgical management preferable for most periprosthetic fractures. Classification based on fracture location can help guide such treatment. Generally, intramedullary nails are best for proximal fractures, fixed-angle devices for fractures originating at the component, and revision arthroplasty for very distal fractures or those with implant loosening.

Arthroplasty, Replacement, Knee↗
PubMed1980

Protein metabolism after unilateral femoral fracture in the rat, and comparison with sham operation.

Urinary excretion of nitrogen, creatinine and N tau-methylhistidine were measured in the rat after unilateral femoral fracture or sham operation. Increased urinary nitrogen excretion occurred in both groups of rats. Cumulative excretion of both nitrogen and N tau-methylhistidine was slightly greater after femoral fracture than after sham operation and this difference agreed quantitatively with loss of muscle protein from the limb with fracture. Sham operation caused no local effect on muscle-protein content and no differences were seen in muscle-protein content between the uninjured hind limb of rats with femoral fracture and either hind limb of sham-operated rats. It was concluded that bone fracture per se does not contribute significantly to the increased urinary nitrogen excretion seen after femoral fracture in the rat; similar changes are produced by equivalent sham operation and any difference between the effects of the two procedures represents local muscle wasting, probably due to disue of the fractured leg.

Animals↗
PubMed1977

Effects of testosterone propionate and environmental temperature on nitrogen balance and wound healing of rats with and without femoral fracture.

Testosterone exerted a sparing effect on nitrogen urinary excretion and balance in pair-fed rats with femoral fracture, dorsal skin incision, and subcutaneously implanted polyvinyl alcohol sponges, whether kept at 22 or 30 degrees C for 1 week postoperatively. No difference in 14-or 21-day wounds was observed among rats with dorsal skin incision and sponge implants, kept at 22 degrees, and starting immediately after operation, given daily IM injections of either 3 mg or 1 mg testosterone propionate in peanut oil, compared with similarly wounded rats given saline or peanut oil injections. Wound healing was impaired in rats kept at 22 degrees for 7 days following a skin incision, sponge implants, and femoral fracture. Testosterone administration begun immediately after operation, 2 mg/day subcutaneously, did not improve the impaired healing of pair-fed rats with fracture compared with rats without fracture. There was somewhat less collagen and a higher ratio of ground substance to collagen in the skin incisions and sponge granulomas of the testosterone group. No differences in wound healing were observed in pair-fed rats moved to a 30 degrees room postoperatively, among rats with or without fracture, nor among rats with femoral fracture given testosterone or saline subcutaneously.

Animals↗
PubMed2002

[Open reduction and intramedullary fixation through minimal incision with Ender nails in femoral fractures of children aged from 6 to 16 years].

OBJECTIVES: We evaluated functional and radiologic results of the treatment in patients aged 6 to 16 years, who underwent indirect reduction with Ender nails through minimal incisions for troublesome femoral fractures. METHODS: We treated femoral fractures of 20 children (3 girls, 17 boys; mean age 10 years; range 7 to 15 years) by indirect reduction and relative stabilization with Ender nails through mini-incisions. Indications for intramedullary nailing were the presence of multiple fractures, accompanying head injuries, neurological or pathologic disorders. According to the Müller classification, there were two 32A1, three 32A2, nine 32A3, three 32B1, and three 32B2 fractures. Secondary callus formation was monitored with follow-up serial x-ray examinations. Range of motion of the hips and knees, leg length discrepancy, and the femoral anteversion were examined clinically. The mean follow-up was 30.5 months (range 24 to 46 months). RESULTS: Surgery was performed after a mean of 4.5 days of admission. The mean hospital stay was 12 days. Full weight-bearing was achieved after a mean of 69 days (range 45 to 98 days). Union was obtained in all patients without any complications. Ender nails were removed surgically after a mean of 10.3 months (range 6 to 16 months). The femoral anteverison was more than 10 degrees in three patients. The mean leg length shortening was 0.35 cm (range 0 to 1 cm). CONCLUSION: Intramedullary nailing of femoral fractures with Ender nails through minimal incisions provides a safe and adequate stabilization in cases in which conservative treatment is likely to fail, and in multiple fractures, open fractures, coexistent head injuries, in mentally-retarded children, and in children aged from 6 to 16 years.

Adolescent↗
PubMed2005

Distal femoral fractures: a review of fixation methods.

The treatment of distal femoral fractures has evolved; nevertheless, these fractures remain difficult to treat and carry an unpredictable prognosis. Over the years, many different strategies have been used with varying success. This review outlines the problems presented by distal femoral fractures and the results of current surgical techniques.

Femoral Fractures↗
PubMed2003

Intramedullary fixation of diaphyseal femoral fractures in elderly patients: analysis of outcomes and complications.

The efficacy of intramedullary fixation for diaphyseal femoral fractures in young patients has been well documented. There is a paucity of data, however, on the efficacy of intramedullary techniques used in the ever growing elderly population. The purpose of this study was to analyze the outcomes and rate of perioperative complications associated with using intramedullary fixation to treat diaphyseal femur fractures in patients older than 65 years. We retrospectively reviewed the medical records and radiographs of 21 patients (17 men, 4 women) with isolated diaphyseal femoral fractures treated with anterograde intramedullary nailing at our institution. All fractures united. Ten surgical complications occurred in 9 (43%) of the 21 patients, and 7 medical complications occurred in 4 patients (19%); overall, 17 medical or surgical complications occurred in 11 patients (52%). Although more than half of the patients had an intraoperative or postoperative complication, intramedullary fixation is an effective method for achieving union in elderly patients with diaphyseal femoral fractures.

Aged↗
PubMed1975

Haemostatic plug formation and stability in the rabbit mesentery after femoral fracture.

The effect of standardised trauma (femoral fracture) on the formation time and stability of haemostatic plugs in transected microvessels of the rabbit mesentery was studied in relation to alterations in fibrinogen concentration, platelet count, platelet adhesiveness, and haematocrit. In contrast to most other studies, platelet adhesiveness as a percentage was found to decrease post-traumatically. One week after trauma, the haemostatic plugs were maximally stable and at the same time venular haemostatic plug formation time was significantly reduced. These findings coincide with high levels of fibrinogen and increased numbers of circulating adhesive platelets.

Animals↗
PubMed2004

Epidemiology of femoral fractures in children in the West Midlands region of England 1991 to 2001.

We have attempted to describe the epidemiology of femoral fractures in children in the West Midlands region of the National Health Service in England. Our source of data was the Regional Hospital Episode Statistics database for the years 1991-2 to 2001-2. Cases were defined as emergency hospital admissions in patients aged under 16 years, with a diagnostic code of femoral fractures in any field, and resident in the West Midlands. Between 1991-2 and 2001-2, 3272 children aged under 16 years with femoral fractures were admitted to hospital. The crude incidence during this period decreased from 0.33 to 0.22 femoral fractures/1000/year. Those caused by traffic accidents decreased by 43%, and by falls by 29%. The peak age-gender-specific incidence (0.91/1000/year) was in two-year-old boys, and this was 50% higher than in the next highest age-gender group. In the first year of life, the incidence in boys and girls was the same. Thereafter the rate in boys exceeded that in girls, varying from 1.6 times at 11 years to 4.7 times at 14 years. Falls accounted for 49% of the fractures, varying from 77% in one-year-olds to 26% in eight-year-old children. Traffic accidents were responsible for 26% of fractures varying from 55% in ten-year-old to 2% in one-year-old children. Maltreatment was recorded in 1.3% of all cases, and in 8.5% of children under one year. Twice as many fractures were seen in May to August than in January (winter). The rates of fractures were associated with deprivation for all age-gender groups. Fractures of the shaft accounted for 58% of all fractures, varying from 70% in three-year-old to 34% in 13-year-old children. Our findings show that there has been a decrease in the incidence of femoral fractures during the 1990s and early 2000s. Two-year-old boys had twice the rate than any other single-year age-gender group. More deprived areas had much higher rates which suggests the potential for greater prevention. A relatively low rate of maltreatment was recorded compared with that in some other studies.

Adolescent↗
PubMed2005

Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation.

We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations. Our results suggest that the use of the proximal femoral nail may allow a faster post-operative restoration of walking ability, when compared with the dynamic hip screw.

Aged↗
PubMed1994

Intramedullary nailing of femoral fractures in morbidly obese patients.

Charts of all patients undergoing reamed femoral nailing for traumatic femoral fractures at two level I trauma centers over 5 years were reviewed. Seven patients who met the criteria for morbid obesity (> or = 200% of ideal body weight or > or = 100 lb over ideal body weight or body-mass index > or = 37 kg/m2) were identified. There were four women and three men, average age 41.8 years, average weight 300.7 lb. The Body-Mass Index, considered the best measure of relative obesity in adults, averaged 49.2 kg/m2 (normal, 20-25 kg/m2; morbidly obese > or = 37 kg/m2). There were four femoral shaft fractures, two subtrochanteric, and one combined femoral neck-femoral shaft fracture. Surgical procedures averaged 3.8 hours in duration with an average blood loss of 1100 mL. Intraoperative and postoperative complications were numerous; difficulty in establishing a start point resulted in two fractures of the greater trochanter, and one partial trochanteric osteotomy was necessary for access in a third patient. Postoperatively two patients developed wound infections that required antibiotic treatment plus wound debridement, and four patients developed complications related to deep vein thrombosis with one fatal pulmonary embolus documented. All femoral fractures in the six surviving patients united.

Adult↗
PubMed2000

Proximal femoral fracture in Northern Ireland between 1985-1997--trends and future projections.

The aims of this study were to identify changing trends with time of the incidence of proximal femoral fracture and to enable future number of hip fractures to be projected. Hospital theatre records in Northern Ireland were surveyed in 1985, 1991, 1994 and 1997 to establish the number of surgical procedures for proximal femoral fracture. The age and sex specific rates for males and females aged 50+ years were calculated. Analysis of age and sex specific incidence rates was undertaken using linear regression and Poisson regression. A 1.6% increase per annum (95% CI 1.0-2.2) was noted in males and females from 1985 to 1997. Projected increases in rates of proximal femoral fracture were calculated using population projection for 2001, 2006, 2011 and 2016. Modelling (a) assuming the age standardised rates in 1997 remain static and continue predicted a 55% fracture increase in males and a 29% increase in females by 2016, (b) assuming the secular increases continued predicted a 93% fracture increase in males and a 67% increase in females and (c) assuming further linear growth on a log-scale predicted a fracture increase in males of 135% and 99% in females. The number of proximal femoral fractures in Northern Ireland is increasing faster than that anticipated due to demographic changes alone, supporting a secular increase which was evident throughout the period of time studied, in contrast to that reported from other regions in the United Kingdom.

Age of Onset↗
PubMed2001

How common is abuse in Greece? Studying cases with femoral fractures.

AIMS: To examine the extent of undiagnosed child abuse in Greece by studying young children with femoral fractures, which may be associated with abuse. METHODS: Fifty seven consecutive cases of children under 6 years of age with femoral fracture were identified from the Emergency Department Injury Surveillance System database. Controls were 4162 children with other orthopaedic injuries from the same database. RESULTS: Whereas in the literature about one third of femoral injuries among young children are attributed to child abuse, no child in the studied series had been diagnosed or even investigated in this context. Nevertheless, the pattern of occurrence of femoral injuries was compatible with that of child abuse, in that patients were frequently very young boys of low socioeconomic status, and the accident had frequently occurred under poorly identified or implausible conditions at time periods when most family members were crowded at home. CONCLUSIONS: Epidemiological risk factors for child abuse characterise femoral fractures in young children in Greece. It appears that child abuse is present in this country as in most other cultures. There is a clear need for refocusing medical personnel and hospital social services so that the problem is revealed, quantified, and appropriately dealt with.

Accidental Falls↗
PubMed1975

Trochanteric femoral fractures treated with McLaughlin osteosynthesis.

Of 317 patients with trochanteric femoral fractures, 305 were treated with McLaughlin osteosynthesis. The mortality rate was 14.5 per cent. The postoperative complication rate (35.6 per cent) was dominated by cardiopulmonary (10.6 per cent) and thromboembolic (10.6 per cent) events. Wound infection was found in 3.8 per cent and osteitis in 0.9 per cent. In all, 106 patients had stable fractures according to the Evans classification. Of these, four had to be re-operated due to penetration or a loose bolt. Two hundred and eleven patients (66.6 per cent) had unstable fractures. Follow-up of 169 patients showed two-thirds to have healed in unchanged position. Only 14.8 per cent of the 169 patients had significant fracture complications, particularly varus dislocation of more than 20 degrees (nine patients) and penetration of the nail (eight patients). A total of 10 patients (5.9 per cent) had to be re-operated because of varus dislocation, broken plate or development of pseudarthrosis after removal of the osteosynthesis material. McLaughlin osteosynthesis is concluded to be a suitable method for the treatment of trochanteric femoral fractures--also of the unstable type.

Aged↗
PubMed1994

Low intensity ultrasound treatment increases strength in a rat femoral fracture model.

Bilateral closed femoral shaft fractures were made in 22 male Long-Evans rats. In 16 animals, ultrasound was applied to one limb for 15 minutes daily 10 times within the first 14 postoperative days. The treated limbs received a 200 microseconds burst of 1.5 or 0.5 MHz sine waves repeated at 1.0 kHz at a spatial average and temporal average intensity of 30 mW/cm2. The contralateral limb of each animal served as a nontreated control. Six remaining animals with fractures and six additional animals without fractures received sham ultrasound treatment to control for the effects of anesthesia and handling. Fracture repair was evaluated on postoperative day 21 by radiography, mechanical testing in torsion, and histology. Five of 16 ultrasound-treated fractures showed obliteration of the fracture gap on radiographs, whereas none of the 28 controls did. The average maximum torque of fractures treated with either signal was 22% greater than that of the contralateral controls (p < 0.05). The stiffness of treated fractures was greater than that of control fractures, but the difference was significant only in animals treated with the 1.5 MHz signal (p < 0.02). Sham treatment did not affect repair in the control group. These results indicate that low-intensity pulsed ultrasound at either 0.5 or 1.5 MHz can accelerate fracture repair at 21 days in this highly controlled model.

Animals↗