PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “FEMORAL FRACTURES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2004

[The results of intramedullary fixation with titanium elastic nails in children with femoral fractures].

OBJECTIVES: We evaluated clinical and radiologic results of intramedullary fixation with titanium elastic nails (TEN) in children with femoral fractures. METHODS: The study included 35 femoral fractures of 34 patients (20 boys, 14 girls; mean age 8.3 years; range 5 to 14 years) who were treated by intramedullary fixation with TEN. The results were evaluated according to the scoring system proposed by Flynn et al. Time to union and residual angulations were assessed on anteroposterior and mediolateral radiographs. Femoral anteversion angles and limb lengths were measured in comparison with the normal side by computed tomography (CT) in 14 patients and the results were compared using the Wilcoxon test. The mean follow-up period was 28 months (range 4 to 48 months). RESULTS: According to the criteria by Flynn et al., the results were excellent in 25 fractures (71.4%), successful in nine fractures (25.7%), and poor in one fracture (2.9%). The mean time to union was 7.4 weeks (range 5 to 12 weeks). Mediolateral and anteroposterior radiographs showed an angulation of 10 degrees or less in three fractures and of 8 degrees in one fracture, respectively. Limb length discrepancy of less than 2 cm was detected in seven patients (20.6%). Femoral anteversion angles measured by CT revealed significant retroversions on the fractured sides (p<0.01). CONCLUSION: Intramedullary fixation with TEN may be the preferred method for the treatment of femoral fractures in children aged 5 to 15 years. However, residual rotation detected by CT seems to be a technical challenge to be improved.

Adolescent↗
PubMed2002

[Treatment of intraarticular comminuted supracondylar femoral fractures by indirect plate osteosynthesis].

OBJECTIVES: We evaluated the effectiveness of indirect plating, which is accepted as a biological fixation, in intraarticular comminuted supracondylar femoral fractures. METHODS: Six patients (4 males, 2 females; mean age 35 years; range 14 to 54 years) had distal femoral fractures of Muller type 33.C2 (n=3) and 33.C3 (n=3). There were three closed and three open fractures; of open fractures, two were type II and one was type III according to the Gustilo-Anderson classification. Intraarticular fractures were reconstructed directly through a lateral parapatellar incision, while supracondylar fractures were indirectly reduced without surgical exposure of the fracture site. The distal anatomically reconstructed articular block was fixed to the femoral shaft by a plate inserted retrogradely beneath the vastus lateralis muscle, followed by plate fixation to the femoral shaft by cortical screws sent percutaneously through stab incisions or transmuscularly through limited proximal incisions. The mean follow-up was 25 months (range 12 to 40 months). RESULTS: The average time until union was 15 weeks (range 12 to 20 weeks). No refractures, implant failures, or infections were encountered. Two patients had restricted knee movements (25% to 50%), three had leg length discrepancy (1 to 2.5 cm), and one patient had a valgus deformity of 10 degrees. According to the Johner and Wruhs criteria, the results were as follows: excellent in one patient, good in one patient, satisfactory in two, and poor in two patients. All patients returned to preinjury activity levels. CONCLUSION: Biological plate fixation is effective and may be considered an alternative to other conventional surgical methods in the treatment of distal intraarticular complex supracondylar femoral fractures.

Adolescent↗
PubMedDate not supplied

Intramedullary nailing of femoral fractures in adolescents.

Fifty femoral shaft fractures were treated with reamed, interlocking, intramedullary nails utilizing a greater trochanteric starting point from 1991 through 1998. The 17 girls and 31 boys ranged in age from 10 to 16 years (mean, 13.2 years) at the time of injury. Average follow-up after fracture was 16 months. All fractures united, and the average leg-length discrepancy was 1 mm (range, -10 mm to +11 mm). No patient had angular or rotational deformities. No patients developed osseous necrosis of the femoral head. Despite intramedullary nailing through the greater trochanteric apophysis, articulotrochanteric distance measurements increased only 4.5 mm at the time of last follow-up. No patient developed significant proximal femoral deformity with some follow-up as far as 60 months from the time of surgery. Intramedullary nailing through a trochanteric starting point is a safe, effective method for treating femur fractures in this adolescent age group.

Adolescent↗
PubMed2005

Dynamic compression plates for Vancouver type B periprosthetic femoral fractures: a 3-year follow-up of 18 cases.

BACKGROUND: There is no consensus on the best surgical treatment of periprosthetic femoral fractures. We report our experience with a dynamic compression plate. PATIENTS AND METHODS: We reviewed the results of 18 periprosthetic femoral fractures treated with open reduction and internal fixation using the dynamic compression plate (DCP). There were 7 Vancouver type B1, 2 type B2 and 9 type B3 fractures. 16 cases had previously undergone at least one revision procedure. In addition to a DCP plate, all B2 and B3 fractures were revised to cemented prostheses, and all B3 fractures were revised with impaction grafting. Mean follow-up was 39 months. RESULTS: The mean healing time for those 11 cases that united was 13 months. One B1-type and one B3-type fracture with plate fracture within 8 months of surgery failed to heal. Furthermore, one B1-type fracture and one B2-type fracture failed and developed nonunion. 3 patients died, from causes not related to surgery, within 8 months after surgery without signs of healing. INTERPRETATION: Open reduction and internal fixation using DCPs seems to be a valid method for the treatment of postoperative periprosthetic femoral fractures with stable stem in place. If the stem is unstable, we suggest that DCPs may be used in association with femoral revision using a long stem. In cases with stable stem (B1), we are inclined to agree with other authors that additional fixation using an extramedullary cortical strut graft may be necessary to improve stability and promote final healing.

Adult↗
PubMed1987

Closed management of distal femoral fractures.

Since closed treatment is effective in 80% to 85% of distal femoral fractures, operative intervention is not recommended. Unnecessary surgery produces unwarranted complications. The cast-brace technique should be used in the first week or two after injury to prevent deformities commonly associated with distal femoral fractures. The thigh cast should be carefully molded well over the femoral condyles. Distal femoral traction is preferred to proximal tibial traction to correct fracture deformities. If the closed reduction technique is not satisfactory in the early period after injury, operative intervention can still be readily accomplished. Percutaneous pin fixation of the condyles or intramedullary load-sharing devices are the treatment of choice for the very limited number of fractures that require open reduction and internal fixation.

Bone Plates↗
PubMed2003

Femoral fracture risk in hip arthroplasty: smooth versus toothed instruments.

Compaction of cancellous bone with smooth tamps in total hip arthroplasty has been shown to improve initial implant fixation. It is not known, however, whether this improved fixation occurs at the expense of an increased risk of intraoperative femoral fracture. The current authors explore this issue by comparing the risk of fracture in 10 pairs of femurs prepared with either smooth tamps or conventional toothed broaches. Using one pass for each size, smooth tamps were advanced incrementally into one femur of each pair and toothed broaches were advanced incrementally into the contralateral femur. A controlled impulse, representative of a typical impact during surgery, was applied to the instruments by a drop tower (mean starting force, 3017 N). When the instruments no longer advanced distally, the applied force was increased incrementally. Instrument sizes were increased until a femoral fracture was observed or the impact exceeded 8000 N without causing a femoral fracture. At preoperative templated size, significantly more femurs that had tamps had fractured (eight of 10), compared with femurs that had broaches (two of 10). Smooth tamps therefore increased the risk of intraoperative femoral fracture in vitro in this particular implant design developed for cemented fixation of the femoral component.

Absorptiometry, Photon↗
PubMed2002

The Mennen femoral plate for fixation of periprosthetic femoral fractures following hip arthroplasty.

Periprosthetic fractures can be treated by various methods. The Mennen femoral plate used to be a common implant in our region to stabilise periprosthetic femoral fractures following hip arthroplasty. This device has been used in 16 patients in our region from three different centres. The periprosthetic femoral fractures occurred approximately 7 years after the hip arthroplasty procedure. After stabilisation of the fracture, patients were kept non-weight bearing. Weight bearing was commenced once there was clinical and radiological evidence of fracture union. About 75% of our patients had a complication following fixation of the fracture. In all of these patients the main complication was varus mal-union of the fracture. As per our study the Mennen femoral plate seems to be a weak fixation device. The plate is unable to counter the medial compressive forces on the femur leading to a varus collapse of the fracture.

Accidental Falls↗
PubMed1996

Use of external skeletal fixators in the repair of femoral fractures in cats.

This paper reports the results of fixation of 35 femoral fractures in cats using an external skeletal fixator alone or in combination with supplementary devices. All the fractures healed. The average time to fixator removal was eight weeks and two days. The external skeletal fixator offers a method of repairing many types of femoral fractures in cats allowing sound orthopaedic principles to be maintained and producing a successful outcome.

Animals↗
PubMed1982

The significance of femoral fractures in children.

This study was undertaken to determine the clinical circumstances of femoral fractures in children. The study was a retrospective investigation of 117 consecutive patients with femoral fractures admitted to The Children's Mercy Hospital, Kansas City, Missouri, from December 1975 to September 1979. Of the 117 patients. 41 had associated injuries. No patient whose only injury consisted of a closed-single femur fracture had evidence of shock. Of 24 children under 2 years of age, 19 sustained injury in an abusive incident. Of 27 children 5 to 6 years of age, 18 sustained injury in an auto-pedestrian accident. Closed-single femur fractures in children do not produce shock. Children who are less than 2 years of age are likely to have sustained injury through abuse.

Accidents, Traffic↗
PubMed1993

[Intramedullary nailing of mid-femoral fractures].

75 consecutive cases of mid-shaft femoral fractures were treated by open intramedullary nailing, using the solid, diamond-shaped Hansen-Street nail. The average age was 32.5 years; road accidents accounted for 43 cases; average operative time was 40 minutes. There were 2 systemic complications but no infections. 56 of the 75 were studied after an average of 5 years and 19 were followed for at least 6 months. At 4 months all fractures were united except 1. Average time to sound bone union was 4 months. There was no residual deformity in varus-valgus or in the sagittal plane. Malrotation was rare and did not exceed 10 degrees. There was shortening of 2 cm in 3 cases of comminuted fractures. All patients followed up returned to regular daily function. The Hansen-Street nail used in an open procedure is an accurate method of anatomic reduction. As opposed to close techniques, we found the procedure to be simple and quick, without undue exposure of the surgical team to radiation and without other complications, such as nerve damage due to traction. This device is indicated for use only in fractures of the middle third of the femoral shaft.

Adult↗
PubMed1980

Treatment of diaphyseal femoral fractures.

The results of 104 patients with fractures of the femoral shaft treated, from 1969 to 1973 at the hôpital du Sacré-Coeur in Montreal, by insertion of a large Küntscher nail alone were compared with those in 70 patients whose femoral shaft fractures were treated, from 1960 to 1975 at the hôpital Notre-Dame in Montreal, with a small Küntscher nail and an autologous iliac graft. Use of a large Küntscher nail without bone grafting gave good results in the majority of patients. Excessive reaming, however, diminished the area of contact between the fragments and prolonged the healing time. Refracture occurred more often. The average length of time for consolidation in nongrafted fractures was found to be equal to the maximum time for grafted fractures (i.e., 16 weeks). A small Küntscher nail with an autologous iliac bone graft could be used safely in fractures of the lower third and in the subtrochanteric region of the femur. Grafting produces earlier healing and weight bearing. The hypertrophic callus protects against refracture.

Bone Nails↗
PubMedDate not supplied

[An in vitro model for producing femoral fractures and for the study of primary stability of cerclage].

PURPOSE: Intraoperative femoral fracture is a well recognized intraoperative complication of cementless total hip arthroplasty (THA). This study was designed to establish an in-vitro model for initiation of fractures of the femur in cementless THA and to assess the effect of fracture fixation by cerclage wiring using steel wire (Protasul). METHODS: Ten human femur specimens were studied. Longitudinal cracks were created by pressing a well fixed conical stem deeper into the femur in a material testing machine. RESULTS: The force necessary to propagate a longitudinal crack in the femur was 1915 N to 9288 N (median 6531 N). This forces are according to 3 to 15 times (median 11 times) body weight. There was no difference of force between left and right femurs from the same individual (U-test). The femoral cortex fractured in 5 cases ventrally, in 6 cases medially and in 1 case laterally. After monofile cerclage wire application the force required to press prosthesis 5 mm deeper into the medullary canal was 0.3 to 2.7 times body weight. After monofile cerclage wire application pressing in the prosthesis 30 mm needed 1.8 to 8.1 times body weight. CONCLUSIONS: During insertion of a conical stem the orthopaedic surgeon should look for fractures of the medial cortex of the femur which is the most frequent location for fractures. This in-vitro model provides a reproductable method for the initiation and propagation of longitudinal femoral fractures in press-fit noncemented THA system and to assess the effect of fracture fixation in the form of cerclage wiring.

Adult↗
PubMed1983

Incidence and sex distribution of proximal femoral fractures in children and adolescents.

During the period 1909-1981, proximal femoral fractures were treated in 2632 adults and 74 children and adolescents in the age group of 0-18 years. The incidence of these fractures in children and adolescents in relation to that in adults is higher than so far indicated in the literature, and in this series amounts to 1:36. Proximal femoral fractures show a male predominance in children and adolescents, and the age of predilection is 11-18 years.

Adolescent↗
PubMed2005

Cephalomedullary nailing for proximal femoral fractures.

From May 1999 to April 2002, we treated 14 patients with subtrochanteric femoral fractures and seven patients with ipsilateral fractures of the femoral neck and shaft using a second-generation cephalomedullary interlocked nail. Patients mean age was 36 (20-60) years, and 19 fractures were caused by high-energy trauma. Four patients had associated injuries. The average follow-up was 23 (16-30) months. Per-operatively, we had problems in locating the entry portal in four patients, and one nail was driven through the inter-condylar notch. All fractures except two united. One patient had non-union of the femoral neck and one of both neck and shaft. One patient united with shortening of more than 1.5 cm and varus angulation at the fracture site. Two patients had loosening and backing out of the proximal screw. The second-generation cephalomedullary nail is a suitable treatment option for proximal femoral fractures, but it requires a high degree of accuracy and technical expertise.

Adult↗
PubMed1987

Prevention of fat embolism syndrome in patients with femoral fractures--immediate or delayed operative fixation?

From January 1976 until August 1980, femoral fractures in our department were initially stabilized with tibial traction and fixed operatively after 4-7 days. From August 1980 the fractures were treated with immediate operative fixation. In this retrospective study, we compared the incidence of fat embolism syndrome in 106 patients treated with delayed operative fixation to the incidence in 114 patients treated with immediate operative fixation. Eleven patients (10.4%) developed fat embolism syndrome in the group treated with delayed fixation, compared with two patients (1.8%) in the immediate osteosynthesis group (p less than 0.02). We concluded that early operative fixation of femoral fractures seems beneficial for the prevention of fat embolism syndrome.

Adolescent↗
PubMed2001

[A condylar plate in distal femoral fractures].

Up to the seventies, the surgical treatment of supra- and bicondylar femoral fractures was difficult and was accompanied by a lot of complications. In most studies conservative treatment was recommended. In the last 30 years the clinical outcome after surgical treatment has improved. This was a result of the development of new implants and improved surgical techniques. Today, the primary surgical treatment is the therapy of choice. We reviewed from 1986 to 2000 105 distal femoral fractures which in 32 cases were treated with a condylar blade plate. The final results were rated using the system that was described by Neer. The averaged follow up time was 9 years. Low postoperative infection rates and in 75% excellent and satisfactory results combined with low cost are the state of art which has to be the reference for new methods and new implants in the future.

Adult↗
PubMed1997

Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial.

OBJECTIVES: To assess whether intraoperative intravascular volume optimisation improves outcome and shortens hospital stay after repair of proximal femoral fracture. DESIGN: Prospective, randomised controlled trial comparing conventional intraoperative fluid management with repeated colloid fluid challenges monitored by oesophageal Doppler ultrasonography to maintain maximal stroke volume throughout the operative period. SETTING: Teaching hospital, London. SUBJECTS: 40 patients undergoing repair of proximal femoral fracture under general anaesthesia. INTERVENTIONS: Patients were randomly assigned to receive either conventional intraoperative fluid management (control patients) or additional repeated colloid fluid challenges with oesophageal Doppler ultrasonography used to maintain maximal stroke volume throughout the operative period (protocol patients). MAIN OUTCOME MEASURES: Time declared medically fit for hospital discharge, duration of hospital stay (in acute bed; in acute plus long stay bed), mortality, perioperative haemodynamic changes. RESULTS: Intraoperative intravascular fluid loading produced significantly greater changes in stroke volume (median 15 ml (95% confidence interval 10 to 21 ml)) and cardiac output (1.2 l/min (0.1 to 2.3 l/min)) than in the conventionally managed group (-5 ml (-10 to 1 ml) and -0.4 l/min (-1.0 to 0.2 l/min)) (P < 0.001 and P < 0.05, respectively). One protocol patient and two control patients died in hospital. In the survivors, postoperative recovery was significantly faster in the protocol patients, with shorter times to being declared medically fit for discharge (median 10 (9 to 15) days v 15 (11 to 40) days, P < 0.05) and a 39% reduction in hospital stay (12 (8 to 13) days v 20 (10 to 61) days, P < 0.05). CONCLUSIONS: Proximal femoral fracture repair constitutes surgery in a high risk population. Intraoperative intravascular volume loading to optimal stroke volume resulted in a more rapid postoperative recovery and a significantly reduced hospital stay.

Aged↗