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PubMed1991

Outcome following proximal femoral fracture in the elderly female.

Outcome after proximal femoral fracture was assessed in 89 elderly females. Mortality both in hospital and subsequent to discharge was identified, with a mortality rate of 13.5% at 30 days and 35% after one year. The median length of stay was 28 days, with 40% of subjects transferred for geriatric-orthopaedic care. Delay prior to surgery and its relationship to increased mortality was highlighted. The importance of the fracture population and its selection and influence on outcome is discussed, indicating the need for caution in comparative audit.

Accidental Falls↗
PubMed2000

Mechanical factors responsible for the obstruction of the gliding mechanism of a dynamic hip screw for stabilizing pertrochanteric femoral fractures.

BACKGROUND: In treatment of pertrochanteric femoral fractures with dynamic hip screws (DHSs) (135-degree, Synthes, Bettlach, Switzerland), damage was observed in removed lag screws, leading to the conclusion that the gliding mechanism must have been obstructed as a result of either inappropriate position of the implant or insufficient medial support in the fracture zone. METHODS: The forces and moments transmitted in the screw socket are calculated using a mathematical model to find the optimal position of the implant. RESULTS: The forces and moments depend on the position and orientation of the lag screw as well as on the position of the contact point between the two main fragments. By changing the point of contact, a better decrease of the load to the DHS can be achieved than by changing the position and orientation of the screw. For a low contact point, the model shows the lowest values for the forces in the socket. CONCLUSION: Complete agreement was found between the results of the presented calculations and our own clinical experience in removed DHSs.

Aged↗
PubMed2006

Component exchange in treatment of periprosthetic femoral fractures.

A retrospective analysis of 893 consecutive periprosthetic femoral fractures treated between 1976 and 2001 shows that component exchange with reimplantation of a cemented long-stem implant can be considered a reliable method of treatment with good functional results and low rates of complications (10%) and revision (7.5%). The possibility of increasing the degree of weight bearing postoperatively at an early stage or even immediate full weight bearing (25%) greatly facilitates mobilization of the mostly elderly and fragile patients. Evaluation according to the Harris Hip Score of the operation and rehabilitation results of a representative sample of 120 patients shows an average value of 85 after a mean period of 6.4 years. The patients' own rating is correspondingly high. In the authors' view, stem exchange is currently the method of choice in the majority of cases because of the rather high rate of stem loosening (77%) at the time of operation, the age-related frequently poor quality or loss of bone substance, and the possibility that the implant material may be damaged. The fact that more than one third of the fractures occurred without significant trauma underlines the importance of this injury as a possible sign of previously unrecognized osteolysis and weakening of the bone as a result of loosening of the prosthesis stem.

Adult↗
PubMed2005

Role of long stem revision knee prosthesis in periprosthetic and complex distal femoral fractures: a review of eight patients.

Eight patients, six with periprosthetic and two with complex distal femoral fractures (one pathological, and one with failed internal fixation) were treated with a cemented long stem revision arthroplasty prosthesis to address the issues of articular comminution, stability, alignment and early mobilisation. The average age of the patients was 78 years (range 39-81). There were no intra-operative complications. The mean hospital stay was 12 days (range 8-21). Post-operative complications included one case of posterior dislocation and one superficial infection. All patients had remarkable symptomatic relief at 3 months as indicated by the visual analogue scores. All periprosthetic fractures achieved bony union at a mean time of 3.8 months. The mean follow up was 24 months (range 14-42). The American Knee Society score revealed one 'excellent', five 'good', one 'satisfactory' and one 'poor' result. The mean loss of extension was 7.7 degrees (range 5 degrees -15 degrees ) and the mean flexion achieved was 66 degrees (range: 15 degrees to 85 degrees ). The mean alignment was 6 degrees (range 0 degrees -10 degrees ) valgus. This study highlights the role of long stem prosthesis in periprosthetic and some complex distal femoral fractures in offering stability and early mobilisation.

Adult↗
PubMed2005

Rush pin fixation versus traction and casting for femoral fracture in children older than seven years.

BACKGROUND: The optimal treatment for femoral fractures in children is controversial. The purpose of this study was to compare the results of Rush pin fixation with those of conservative treatment, and to evaluate the sequels of growth plate injury by internal fixation. METHODS: Eighteen femoral shaft fractures in 17 children who had concomitant head injury or multiple traumas were treated surgically. The mean age at operation was 9 years 3 months (range, 7 years 5 months to 11 years 1 month). One Rush pin was inserted from the tip of the greater trochanter, without reaming, to fix the fracture. Another 20 age-matched children treated by traction and casting were the control subjects. RESULTS: All the fractures united without consequences. In addition to a decrease in hospital stay with the use of the Rush pin (10 days vs. 27 days, p<0.05), fewer leg length discrepancies (4.2 mm vs. 7.1 mm, p<0.05) were also noted, compared with conservative treatment. The growth of the proximal femur after Rush pin fixation was evaluated after an average of 59 months. No femur shortening, coxa valgus, or hip dysplasia was noted. CONCLUSIONS: Intramedullary Rush pin fixation for femoral shaft fracture in children older than 7 years is a simple and reliable alternative. One narrow and non-reaming pin inserted from greater trochanter did not demonstrate femoral growth inhibition.

Casts, Surgical↗
PubMed2004

Distal femoral fractures: long-term outcome following stabilisation with the LISS.

We studied 29 patients with distal femoral fractures stabilised using the less invasive stabilisation system (LISS). Four patients were excluded from the final follow-up (three deaths and one case of quadriplegia). The mean age of the remaining 25 patients (9 males and 16 females) was 60.9 years and the mean follow-up 18 months (range 12-24 months). Eleven patients were tertiary referrals from other hospitals (seven cases were referred due to failure of primary fixation). Overall, there were 12 cases of high-energy trauma (7 open fractures). According to the AO classification, there were 5 Type 33A, 2 Type 33B and 12 Type 33C fractures and 4 Type 32A, 1 Type 32B, 1 Type 32C fractures. Functional assessment was performed using the modified Hospital for Special Surgery (HSS) and the Schatzker and Lambert scores. The average time to union in 22 cases was 3.5 months (range 2-5 months). All of the acute cases united without the need for bone grafting. There were three out of seven cases of non-union in the salvage group still undergoing treatment. The overall result in the acute cases was good and in the salvage cases fair. While this is a small series of patients, our preliminary data indicate favourable results using the LISS in stabilising acute distal femoral fractures. However, when the LISS is used as a revision tool the results seem to be less satisfactory. The system appears to be user-friendly and no technical difficulties were encountered.

Adolescent↗
PubMed1993

[Closed locked nailing of complex femoral fractures in adults. Apropos of 68 cases].

Complex fractures of the femoral shaft rise problems due to high energy trauma with major soft-tissues injuries and bone comminution so increasing operative difficulties, risk of infection and delayed union. Our aim was to appraise the outcome of these problems when using a closed intramedullary locked nailing. There were 52 men and 16 women. Aged 16 to 83 years. 52 patients had multiple-injuries. There were 17 open fractures. The 68 cases were subdivided according to a classification in 3 types. Stable fractures type A and B1 were excluded. The shaft was divided into 5 zones. Patients were initially treated by skeletal traction closed nailing was performed 1-36 days later (average 9.5). All patients were reviewed until complete healing. Final follow-up was 6 to 35 months postoperatively (average 15). A dynamisation was performed in 19 cases at a average delay of 12 weeks. Sixty six of the 68 fractures united. Open fractures united after 26.4 weeks, in average and closed fractures after 23.25 weeks (p < .05). There was no correlation between time of surgery following the injury and the delay of healing. Shortening was noted in 4 cases. 8 patients had an angulation 5-15 degrees of in the varus or the valgus plane. 3 patients (4.4 per cent) had more than 5 degrees of angulation in the AP plane. An external rotation deformity of 10-35 degrees was noted in 4 patients. The incidence of deformities was the main problem. It could be minimize by a precise technique. Mobility of the knee was the other problem, but it appeared generally to depend much more on knee injury than on femoral fracture.

Adolescent↗
PubMedDate not supplied

Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them.

Flexible intramedullary nailing has become a popular method of fixation of pediatric femoral fractures. The authors analyzed their first 5-year experience with titanium elastic stable intra-medullary nailing, specifically to report the complications associated with this technique and to provide recommendations to avoid these complications. Seventy-eight children with 79 femoral fractures were treated by this method. Complications included pain/irritation at the insertion site (41), radiographic malunion (8), refracture (2), transient neurologic deficit (2), and superficial wound infection (2). Ten patients required reoperation prior to union. Malunion and/or loss of reduction requiring reoperation was strongly associated with the use of nails of mismatched diameters (odds ratio = 19.4) and comminution of more than 25% (odd ratio = 5.5). Pain at the insertion site was significantly associated with bent or prominent nail ends. Most complications are minor, and many are preventable. Surgeons should advance nail ends to lie against the supracondylar flare of the femur to avoid symptoms at the insertion site and should avoid implanting nails of two different diameters. Comminuted fractures should be monitored carefully and might benefit from additional immobilization.

Adolescent↗
PubMedDate not supplied

Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating.

Twenty-seven patients underwent submuscular bridge plating for unstable pediatric femoral fractures with contraindications to fixation with flexible intramedullary nails. This report discusses the technique and results. A precontoured plate was tunneled proximally through a small distal incision in the subvastus plane to bridge the fracture. The plate was secured to the femur, with screws placed percutaneously proximal and distal to the fracture to reduce and stabilize the fracture. A retrospective review of radiographs and clinical follow-up was analyzed for postoperative alignment, any change in alignment or instrumentation failure, bony union, clinical exam, and complications. There were no intraoperative or postoperative complications. There has been no instrumentation failure or loss of reduction. Early callus was seen by 6 to 8 weeks and stable bony union by 12 weeks in all patients. Submuscular plating is a reasonable option for operative stabilization of comminuted and unstable pediatric femoral fractures.

Adolescent↗
PubMedDate not supplied

Treatment of unstable peritrochanteric femoral fractures using a 95 degrees angled blade plate.

OBJECTIVE: To clarify the efficacy of a 95-degree angled blade plate fixation in the treatment of unstable peritrochanteric fractures of the femur. DESIGN: Retrospective, clinical study. SETTING: University hospital. PATIENTS: Thirty-nine consecutive patients with peritrochanteric femoral fractures were followed for a minimum of 12 months. There were 29 subtrochanteric fractures and 10 intertrochanteric fractures (reverse obliquity pattern) for which the compression hip screw could not be used because of comminution of the trochanteric area and fracture extension to the lateral cortex. The mean age of the patient population at the time of operation was 54 (range, 17-71) years. INTERVENTION: Open reduction and internal fixation of the pertrochanteric fractures using a 95 degrees angled blade plate. MAIN OUTCOME MEASUREMENTS: Time to fracture union, operation time, and complications. RESULTS: Duration of clinical follow-up averaged 26 (range, 12-36) months. The average time to osseous union for those fractures that healed primarily was 19 (range, 13-28) weeks. Two of 39 fractures united with 10 degrees varus deformity, but no corrective surgery was warranted. Limb length discrepancy more than 1.5 cm did not occur. Implant failure before solid bony union occurred in 1 case with a severely comminuted subtrochanteric fracture. Postoperative infection or osteonecrosis of the femoral head did not occur any time throughout the follow-up period. CONCLUSION: A 95 angled blade plate can be a useful alternative fixation device for the treatment of unstable peritrochanteric femoral fractures.

Adolescent↗
PubMedDate not supplied

Is external fixation in pediatric femoral fractures a risk factor for refracture?

The aim of this study was to investigate whether external fixation is a risk factor for refracture by comparing the outcomes of children who received three different forms of treatment of femoral fractures. One hundred ninety-two patients treated for femoral fracture between 1990 and 1999 who underwent final examination were assessed. One hundred were treated with hip spica casting after traction, 57 with closed reduction and external fixation, and 35 with open reduction and external fixation. Morbidity results such as time to union, length of hospital stay, refracture, and wire site infection were statistically evaluated. Patients undergoing open reduction had a greater time to union and length of hospital stay and a higher refracture rate. The difference was statistically significant. Wire site infection occurred in all three groups; there was no statistically significant difference between groups. The authors concluded that external fixation is not a risk factor for refracture in the treatment of pediatric closed femoral diaphyseal fractures, and that it may be used with ease in clinics with shortages of personnel and space.

External Fixators↗
PubMed2005

Assessing leg length discrepancy after femoral fracture: clinical examination or computed tomography?

INTRODUCTION: Femoral shaft fractures treated with intramedullary nailing often heal with a leg length discrepancy (LLD). LLD is commonly evaluated by clinical examination and computed tomography (CT) scanogram. We assessed the correlation between these two techniques of calculating LLD. METHODS: We reviewed 35 skeletally mature patients who sustained a femoral shaft fracture between January 1997 and December 1999. Leg length was measured clinically with direct measurement and a block test. Each patient was asked whether they felt they walked with a limp and whether they felt they had a leg length discrepancy. Each patient underwent a CT scanogram to measure femoral and total leg length. The correlation between clinical examination and scanogram was analysed using the Pearson Product Moment Correlation. RESULTS: Of the 35 patients, 15 patients (43%) had a measurable LLD. There was a positive correlation between direct leg length measurement and the block test (P = 0.003), and between the block test and patient perception of limp and LLD. CT scanogram was performed on 29/35 patients. There was no correlation between CT scanogram and clinical measurement of leg length or between CT scanogram and patient perception of LLD or limp. DISCUSSION: Leg length discrepancy commonly occurs following treatment of femoral shaft fractures. We found that there was a strong correlation between direct leg length measurement and the block test, and between both methods of clinical leg length measurement and patient perception of a limp or LLD. Our study found no correlation between CT scanogram and clinical leg length measurement or patient perception of limp or LLD. CONCLUSION: Our study shows that physical examination (direct measurement and the block test) is more reliable and clinically relevant than CT scanogram measurement in the assessment of LLD after femoral fracture.

Adolescent↗
PubMed1995

Supracondylar femoral fractures in the frail elderly. Fractures in need of treatment.

The investigators of this study reviewed 112 consecutive frail elderly patients with supracondylar femoral fractures to evaluate primarily functional outcomes to optimize initial treatment of these challenging patients. A high 1-year mortality rate (22%) and significant decrease in function and quality of life occurred in frail elderly patients who sustained supracondylar femoral fractures. No statistical relationship could be found among preinjury function, age, cognitive function, type of fracture, treatment, and overall results. Nine percent of patients required late above-knee amputation in the involved extremity because of displacement of the fracture or infection or both. Optimal treatment for this type of patient remains elusive. Primary above-knee amputation may be the preferred treatment in patients who are this severely affected.

Aged↗
PubMed2001

[Techniques of extramedullary osteosynthesis in proximal femoral fractures].

Plate osteosynthesis at the proximal femur is possible for intertrochanteric and subtrochanteric femoral fractures. Common implants are the dynamic hip screw (DHS), the dynamic condylar screw (DCS) and the condylar blade plate. The dynamic hip screw is mainly used in introchanteric femoral fractures, whereas the other two devices are suitable for stabilizing subtrochanteric fractures. Those extramedullary implants compete with several intramedullary nailing systems. Because of less soft tissue compromise the nailing systems have been favored by many surgeons during the last decade. This is particularly true for the subtrochanteric area where intramedullary devices offer higher primary stability, allowing initial full weight bearing. A good indication for the extramedullary technique with a two-hole dynamic hip screw is the stable intertrochanteric fracture with an intact lesser trochanter. The other fracture types of the proximal femur in the intertrochanteric and subtrochanteric area are better treated with intramedullary devices. The remaining indications for the dynamic condylar screw and the condylar blade plate are correction osteotomies and some salvage procedures.

Bone Plates↗
PubMed2003

Dall-Miles plates for periprosthetic femoral fractures. A critical review of 16 cases.

Fourteen patients with 16 periprosthetic femoral fractures around hip replacement were treated with Dall-Miles plates between June 1996 and February 2000. There were 10 Vancouver B3, three B1 and three type C fractures. In addition to a Dall-Miles plate, two of the fractures (one B3 and one C type) were also stabilised with one strut graft and nine B3 fractures were revised with impaction grafting. Of the three B1 fractures treated with plates, two failed through fracture of the plate. A further two patients with B3 fractures treated with plates also failed with fracture of the plate. Failure of these plates occurred within 6 months of surgery. All non-unions and fixation failures in this series were in cases where the femoral component did not bypass the most distal fracture line by at least two cortical diameters. The Dall-Miles plates and cable system alone is insufficient for the treatment for periprosthetic femoral fractures. It must be supplemented with additional intramedullary or extramedullary fixation.

Aged↗
PubMedDate not supplied

Treatment of femoral fractures in patients with craniocerebral injury.

9.4% of the patients sustaining cranio-cerebral injury also suffer from femoral fractures. Only those patients who undergo operation and internal fixation during the first week either by nailing or plating recover completely without any orthopedic disability. Conservative treatment or late orthopedic surgical intervention almost always resulted in permanent locomotor disability. It is concluded that early surgical intervention by either nailing or plating of femoral fractures helps in nursing, prevents deformity and leads to the complete recovery of these fractures in patients suffering from concomitant cranio-cerebral injuries.

Adolescent↗