Symposium. Rigid internal fixation of fractures. Femoral shaft fractures: editorial comment and comparative results.
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Adolescent↗
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[The value of Ender nailing in hip para-articular femoral fractures in gerontologic traumatology. Ender nailing--hip para-articular femoral fractures--gerontologic traumatology].
Nailing according to Ender is one of several competing methods of osteosynthesis for treating per- and subtrochanteric fractures of the femur in geronto-traumatology. Within 5 years we have treated 62 geriatric patients by this procedure. The average-age of our patients was about 76 years. Only 20 of them were able to be examined after a time of ca. 37 months post operationem. Intraoperative complications were backing out of the femur corticalis at the entry hole, followed by perforations of the head or neck of the femur. In one case we saw a supracondylar fracture. In the postoperative period we mostly found dislocations of the nails to cranial or caudal. Moreover there were one wound infect and one pseudarthrosis. The mortality rate came to 6.5% and was never caused by the method. When leaving the hospital the majority of the elderly patients was mobilized and able to walk. In spite of reduction of function of hip and knee and external rotation deformity and shortened legs the patients declared to be content with the result of the operation. Important geronto-traumatological aspects of the Endernailing-method could be seen in the simple procedure, the short operating time, a minimal surgical trauma and a diminishing of the risk of the mostly multi-morbid patients. Regarding the great number of specific complications competing methods are going on to be preferred. Meanwhile the application of Endernails is an exception in geronto-traumatology.
Aged↗
Slipped capital femoral epiphysis following ipsilateral femoral fracture.
Two cases of femoral fracture with a subsequent complication of ipsilateral slipped capital femoral epiphysis point out the possible deleterious effects of angular deformity of the proximal femur during the adolescent growth spurt.
Biomechanical Phenomena↗
Effects of enviromental temperature and femoral fracture on wound healing in rats.
Femoral fracture, unilateral and bilateral, impaired the healing of dorsal skin incisions and formation of reparative granulation tissue in subcutaneously implanted polyvinyl alcohol sponges judged histologically and by breaking strengths and hydroxyproline contents, respectively, 1 week after injury in pair-fed rats kept at 22 degrees C. When rats were transferred to a room at 30 degrees C immediately after skin incision and sponge implants, with or without unilateral fracture, no differences in healing were observed between the two groups. Rats with skin incision, sponge implants, and either femoral fracture or sham-fracture excreted more urinary nitrogen than preoperatively when kept at 22 degrees. Counterpart groups transferred to a 30 degrees room right after operation excreted less urinary nitrogen than preoperatively, but because of lower food intakes postoperatively, the ratio of urinary nitrogen to food intake nitrogen was increased. With equivalent food intakes, pair-fed rats with fracture kept at 22 degrees postoperatively lost more weight and excreted more nitrogen than corresponding rats transfered to a 30 degrees room.
Animals↗
Fracture conference. Cast bracing of femoral fractures.
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Adolescent↗
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↗
External fixation for diaphyseal femoral fractures: a benefit to the young child?
External fixation for the treatment of diaphyseal femoral fractures in children seems an attractive alternative, which explains why its application gets more and more advocates. Between 1984 and 1989 15 children aged from 4 to 10 years were treated for a diaphyseal femoral fracture with an external fixation using a small Hofmann system. Fracture healing was without complications. Four children were able to walk on crutches non-weight-bearing after a short period. Six cases had complications, such as pin tract infection, inexplicable pain, or secondary displacement. One patient sustained a supracondylar fracture through one of the distal pin tracts. Hospital stay was longer than expected. In conclusion external fixation for femoral fractures in children is simple and elegant, but has considerable complications, while presumed advantages are not always obtained. In selected cases it is an attractive alternative, but the indications must be restricted.
Child↗
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↗
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↗
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↗
Intraoperative femoral fractures in cementless total hip arthroplasty.
Ten patients with intraoperative femoral fractures during primary cementless total hip arthroplasty were matched by age, sex, weight, diagnosis, and length of follow-up to 20 patients who had primary cementless total hip arthroplasty without this complication. All fractures were identified in the operating room, and treatment was individualized for each case. Initial stability of the implant was felt to be satisfactory for all cases despite this complication. The mean follow-up was 2.3 years. In this series, no difference was found in clinical or roentgenographic results after cementless total hip arthroplasty between patients who had an intraoperative femoral fracture and patients who did not have this complication. If initial stability of the implant is satisfactory, despite intraoperative fracture, good clinical results can be expected with cementless total hip arthroplasty.
Adult↗
Closed versus open medullary nailing of femoral fractures. Blood flow and healing studied in rats.
In rats, bilateral closed femoral fractures were produced. On the left side, closed intramedullary nailing was done, and on the right side, the nail was inserted by an open procedure. The healing process of the fractures was evaluated at 4, 8, and 12 weeks, bone and muscle blood flows were also determined. Reaming had no acute impact on bone blood flow, while reaming and fracture halved total bone flow (P < 0.04), and reduced cortical diaphyseal flow to approximately one quarter (P < 0.01). No differences were found between the open and closed methods. At 4 weeks, the bending moment, rigidity, and fracture energy of the fractures treated by closed medullary nailing were greater than those treated by open nailing. The fracture energy was still greater at 8 weeks, while no differences were seen in bending moment and rigidity. At 12 weeks, however, there were no differences in the mechanical parameters. Bone blood flows in both the cortical diaphysis and callus area were increased at 4 and in the callus area at 8 weeks in bones treated by the open method. No differences were found at the end of the experiment. Muscle blood flow was not different in the two limbs, and was constant during the experimental period. We conclude that femoral fractures treated by closed nailing heal better in the initial phase compared with those that have been openly nailed. This difference cannot be explained by an impaired muscle or bone blood flow due to open surgery.
Animals↗
Specific metabolic effects imposed by Streptococcus pneumoniae upon the response to femoral fracture in the rat.
The possible potentiation of an infection upon the metabolic consequences of trauma was tested in rats using a 2 X 2 block design which included control, femoral fracture, pneumococcal infection, and fracture plus infection groups. Infection introduced unique metabolic effects different from those of starvation, femoral fracture, or both together. Infection-induced effects included an accelerated conversion of 14C-alanine to glucose, higher serum haptoglobin, alpha2-macrofetoprotein, copper, and ceruloplasmin values, and lower serum iron, zinc, and transferrin concentrations. The first three of these infection-induced effects were diminished in rats with a femoral fracture. No measured effect of infection was increased in traumatized rats.
Animals↗
[The treatment of pertrochanteric femoral fractures by trochanteric nailing (author's transl)].
The treatment of pertrochanteric femoral fractures in elderly patients should be undertaken immediately for vital reasons. The operating time is considerably reduced by the simplicity of trochanteric nailing. Consequently, the postoperative complications are considerably fewer in comparison to other methods. This type of treatment guarantees considerably greater chances of survival through the outstandingly successful healing.
Adult↗
[Bilateral femoral fracture at the site of bilateral hip prostheses. A case report].
Fracture of the femoral shaft after hip arthroplasty is a serious problem. In most cases, minimal trauma is responsible for the fracture. Predisposing factors include severe osteoporosis, loosening of the prosthetic stem and perforations of the cortex. The incidence in our patient material in 2.3% after total hip arthroplasty and 2.9% after revision. Operative treatment may consist in osteosynthesis with compression plates, screws, or cerclage wires with or without revision of the arthroplasty. We give a case report covering treatment and 2-year follow-up for a bilateral proximal femoral fracture in a 72-year-old farmer with bilateral total hip replacements. Both fractures were treated similarly, with replacement of the femoral components by a cementless Wagner revision stem prosthesis and cerclage wiring of the fragments. No classic osteosynthesis was required to manage the fractures.
Aged↗
Negative experiences with pins-in-plaster for femoral fractures.
Six healthy young men sustaining femoral shaft fractures in traffic accidents were treated in pins-in-plaster. Complications included pintract infection (3/6), shortening, angulation (1), malrotation (2). Recasting and rehospitalization was frequent. These adverse experiences with this method of treatment of femoral shaft fractures should discourage its further use.
Accidents, Traffic↗
[Treatment of femoral fracture with the Ilisarov fixator].
From July 1990 to December 1991, femoral fractures in seven patients were stabilized using the Ilisarov apparatus. Second-degree open communited fractures in four patients were stabilized primarily by this technique. Three other patients suffered from redislocations following internal fixation (n = 2) or a refracture (n = 1). The average duration of fixation in shaft fractures (n = 3) was 21 weeks, in supracondylar fractures (n = 4), 13.5 weeks. The fixation period we observed was thus shorter than that reported for other external fixation devices. Because of the complications that were noticed, however, the Ilisarov technique should only be used in particular cases.
Adult↗
The treatment of femoral fractures by cast-brace and early walking: a review of seventy-nine patients.
Seventy-nine cases of fracture of the femoral shaft treated by cast-brace and early walking have been reviewed. Discrepancy in femoral length was assessed by scanogram. The cases were analysed to relate the incidence of shortening greater than 2 centimetres to the type and site of the fracture, and the time which elapsed from injury until the cast-brace was applied. Such shortening was encountered most frequently when the cast-brace was applied within the first two weeks from injury or after six weeks and in those patients with comminuted fractures of the middle third of the femoral shaft.
Adult↗