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Results for “FEMORAL FRACTURES”

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PubMed1990

Use of flexible intramedullary rods for fixation of femoral fractures in eight dogs.

High-density, polysulfone rods were used to repair 4 comminuted and 4 short-oblique, mid-diaphyseal femoral fractures in 8 dogs. Bony union was achieved in 2 dogs at 10 and 12 weeks after surgery. In one dog, the femoral fracture was healing when amputation of the limb became necessary because of sciatic nerve damage secondary to an ipsilateral pelvic fracture. In a fourth dog, fracture repair resulted in nonunion, despite normal clinical function at 18 months after surgery. In the remaining 4 dogs (50%), the rods failed at 3.5, 4, 6, and 22 weeks after surgery. These fractures were then stabilized by use of other methods. Although several factors may have contributed to failure of the rods, multiple autoclaving of the thermoplastic implants may have caused embrittlement and subsequent breakage.

Animals↗

PubMed1993

[Supracondylar femoral fractures in children before the age of walking].

Supracondylar femoral fractures were found, in this report, to be the most common traumatic lesion in the healthy, pre-walking age infant. Diagnosis of such cases which display no longer a rare occurrence, requires accurate x-ray films on two levels, because incomplete fractures may be easily overlooked. Awareness of the normal development of motor function within the first year of life is of great importance to prevent injuries to the immature musculoskeletal system before the beginning of voluntary walking. The acquisition of motor skills was not interrupted and limb length discrepancy was not noted in any of our patients.

Casts, Surgical↗

PubMed1999

The treatment of difficult proximal femoral fractures with the Russell-Taylor reconstruction nail.

The outcome of 30 proximal femoral fractures and pathological lesions in 29 patients treated with the Russell-Taylor reconstruction nail are reported. Four patients had fractures involving both the femoral neck and shaft (segmental). Fifteen patients had extensive comminuted fractures of the proximal femur and ten patients underwent nailing because of pathological fractures (one bilateral). In nineteen operations there were technical difficulties, nail insertion and proximal interlocking being the commonest. In the elderly there was a high post-operative complication rate. Three nails needed to be revised for failure of fixation. On review, all patients under sixty years of age regained full mobility and returned to their pre-fracture level of activities. Patients with per-trochanteric fractures over the age of sixty had less favourable results. No cancer patient returned to their prefracture mobility level. The Russell-Taylor reconstruction nail proved to be useful in the treatment of segmented and, in a lesser degree, pathological fractures. However, the surgical technique is demanding and there is a high incidence of post-operative complications in the patients over the age of sixty.

Adult↗

PubMed1995

Robotic-assisted internal fixation of femoral fractures.

Closed surgical techniques for the internal fixation of femoral fractures require orthopaedic surgeons to work in close proximity to X-rays. In addition to the occupational health risk this imposes, inexperienced surgeons often encounter great difficulty in achieving optimal positioning of fracture repair fixtures. A vision-guided robotic system has been proposed as a possible solution to these problems and an initial investigation involving two exemplar orthopaedic procedures has been undertaken. Robotic surgery assistance imposes rigorous safety-related design constraints, since the orthopaedic robot must operate in close proximity to the patient and operating staff. The design and implementation of a purpose-built robotic system for orthopaedic surgery assistance is described in this paper.

Femoral Fractures↗

PubMed1998

The mechanism of femoral fracture in an impact accident.

BACKGROUND: Following the crash of a Boeing 737-400 aircraft on the M1 motorway at Kegworth, near Nottingham, England, on January 8, 1989, it became apparent that a large number of pelvic and lower limb injuries had been sustained by the survivors. Had there been a fire, these injuries would have severely hindered the ability of the occupants to escape. The mechanism of pelvic and lower limb injuries in impact accidents previously has been related to flailing of the limbs and axial loading of the femur as in automobile accidents. HYPOTHESIS: A bending load is the primary mechanism of femoral fracture in an impact aircraft accident rather than an axial load. METHODS: Two methods of study have been used to investigate the impact biomechanics of the pelvis and lower limb: a) clinical review of the injuries sustained in the M1 Kegworth accident; and b) impact testing. RESULTS: A clinical review of the M1 aircrash survivors suggested that axial loading was not the primary mechanism causing femoral fractures and suggested that a bending load might be applied to the femur. Impact testing confirmed that axial loading of the femur did not appear to be significant. CONCLUSIONS: Our study suggests that in the presence of intact occupant protection systems, a femoral bending mechanism involving the front seat spar of passenger seats is a primary cause of femoral fracture in an impact aircraft accident.

Accidents, Aviation↗

PubMed1990

Femoral fractures secondary to low velocity missiles: treatment with delayed intramedullary fixation.

The literature is replete with descriptions of the advantages of intramedullary nailing in the treatment of femoral fractures. However, little has been reported about the use of this method in femoral fractures resulting from gunshot wounds. Often, the amount of bony comminution and retained metal fragments have discouraged attempts at operative intervention. We reviewed our experience with 26 patients who had sustained low velocity gunshot fractures of the femur that were treated operatively with intramedullary fixation. After injury, the patients were stabilized in the emergency room and placed in balanced skeletal traction. They also received local wound care. When the patients recovered from associated injuries and the bullet wounds were healing, a delayed closed intramedullary nailing was performed. Nineteen patients were followed to union. Seventeen had fractures that united at an average of 4.5 months. One patient had a delayed union, and one had a nonunion. There were no deep wound infections and no cases of osteomyelitis. Range of motion was within 10 degree of the unaffected side in all but one patient, and there were neither rotatory nor angular deformities.

Adult↗

PubMed1997

Pneumoretroperitoneum secondary to an open reduction and internal fixation of a femoral fracture: case report.

We present a case of pneumoretroperitoneum detected on computed tomography that resulted from open reduction and internal fixation of a femoral fracture. Retroperitoneal air has many etiologies. These range from the clinically insignificant to the potentially catastrophic, if not recognized promptly. We present a case of retroperitoneal air secondary to open reduction and internal fixation of a femoral fracture. To our knowledge, this association has not previously been described.

Adult↗

PubMed2005

[Use of cortical bone plates allografts for reconstruction of femoral fracture: an experimental study in goats].

OBJECTIVE: To study the outcome of reconstructing goat femoral fracture by use of cortical bone plates allografts that have been kept by deep-freezing at -70 degrees C for 4 weeks after being treated with 48 degrees C ethylene oxide. METHODS: The recipients, sixteen 10-12-month-old goats with fractures of right femur were subjected the operation for transplanting the cortical bone plates allografts in the medial, lateral and back sides of fractured femurs. The goats were sacrificed and the specimens were procured at 3, 6, 12, and 24 weeks after surgery for X-ray photography, Chinese ink perfusion, tetracycline fluorescence labeling and histological observation in order evaluate the healing of fracture and the incorporation of cortical bone plates allografts. RESULTS: The allograft strut was found revascularized at 6 weeks after surgery in the fracture group, whereas at 3 weeks in the control group. The tetracycline fluorescence labeling was poor in the fracture group as compared with that in the control group from 3 weeks to 6 weeks, but it was better in the fracture group than in the control group beyond 6 weeks after surgery. Fracture was healed and bone conjunction between allograft strut and host bone was seen at weeks after operation. The allograft strut was incorporated in host bone, the ability of remodeling of allograft strut and the size of femoral cortex were better in the fracture group than in the control group at 24 weeks after surgery. The fracture was displaced in 19% animals and the allograft bone plates were not fractured. CONCLUSION: The use of allograft strut pre-treated by ethylene oxide sterilization and deep-freezing could underpin fixation and promote healing of femoral fracture, and it can increase bone reservation and augment the strength of femur once the allograft strut is incorporated in the host bone.

Animals↗

PubMed1996

Re-evaluation of two simple prognostic scores of outcome after proximal femoral fractures.

The Belfast and Newcastle simple prognostic scores of outcome after treatment of proximal femoral fractures were recorded shortly after admission on 250 patients. All patients were then followed until discharge, with 87 of those who were the more physically and socially dependent before admission being transferred after surgery for rehabilitation in a geriatric unit. The hospital mortality rate, a hospital stay of over 6 weeks and two measures of rehabilitation outcome, i.e. a delay of over 3 weeks after the operation in regaining independent mobility and any functional decline on discharge compared with the preadmission situation, were recorded for each patient. The prediction of a higher hospital mortality rate and a delay in reaching independent mobility in more dependent patients with both scores reached statistical significance. Longer hospital stays in the more dependent patients did not occur in a situation where care facilities for dependent patients were readily available. The scores, in particular the Belfast score, can be used to compare the casemix of patients with proximal femoral fractures within and between units over time and can predict mortality and delay in achieving independent mobility. They may be helpful in the early selection of patients for transfer to a geriatric unit or orthogeriatric unit for rehabilitation.

Aged↗

PubMed1989

External fixation of femoral fractures. Indications and limitations.

The role of external fixation in the management of femoral shaft fractures is reviewed based on a study of 24 femoral fractures managed by either an AO or a Wagner external fixator during 1983-1986. Indications included open fractures with soft-tissue injury (13 patients), comminuted shaft fractures (six patients), and unstable operative candidates (five patients). In 14 patients, external fixation was a temporary method (Group I), while in ten patients it was the definitive method of stabilization (Group II). Twenty-one patients achieved solid union, two developed a delayed union, and one had a nonunion. Three patients developed pin-tract infections, and one developed osteomyelitis after intramedullary fixation in Group I. Two patients in Group II developed shortening (2.1 cm and 3.2 cm). Loss of motion occurred in 11 patients, averaging 56 degrees. It is suggested that external fixation be considered in the following types of femoral fractures: open fractures for aggressive management of soft-tissue injuries; closed fractures in severely traumatized, burn, or head injury patients; fractures about the knee resulting in floating knees; and infected femoral nonunions and pseudarthroses.

Adolescent↗

PubMed1998

Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw.

OBJECTIVE: To compare the results after operative treatment of unstable per- and subtrochanteric fractures with the Gamma nail, compression hip screw (CHS), or dynamic hip screw with a laterally mounted trochanteric stabilizing plate (DHS/TSP). DESIGN: Prospective. PATIENTS: One hundred seventy patients with unstable trochanteric femoral fractures surviving six months after operation. Eighty-five patients were randomized to treatment with the Gamma nail (n = 50, Gamma group) or the compression hip screw (n = 35, CHS group) and compared with a consecutive series of eighty-five patients operated with the dynamic hip screw with a laterally mounted trochanteric stabilizing plate (DHS/TSP group) MAIN OUTCOME MEASUREMENTS: Radiographs were analyzed for fracture classification, evaluation of fracture reduction, implant positioning, later fracture dislocation, and other complications. Pre- and postoperative functional status of the patients were recorded, with a minimum of six months follow-up. RESULTS: Eighteen percent of the patients in the Gamma group, 34 percent in the CHS group, and 9 percent in the DHS/TSP group suffered significant secondary fracture dislocation during the six months follow-up, leading to a varus malunion, lag screw cutout, or excessive lag screw sliding with medialization of the distal fracture fragment. Two patients (4.0 percent) in the Gamma group suffered an implant-related femoral fracture below the nail, and one had a deep infection. The reoperation rates were 8.0 percent in the Gamma group, 2.9 percent in the CHS group, and 5.9 percent in the DHS/TSP group. All but one fracture in the Gamma and CHS groups and two fractures in the DHS/TSP group healed within six months. Approximately three-fourths of the patients had returned to their preoperative walking ability after six months, with a trend toward better functional outcome in the DHS/TSP group. Use of a TSP reduced the secondary lag screw sliding as compared with the conventional CHS, without affecting fracture healing. CONCLUSION: The TSP may be an aid in the treatment of these difficult fractures because the problem with femoral shaft fractures using the Gamma nail is avoided and the medialization of the distal fracture fragment frequently associated with the CHS is prevented.

Activities of Daily Living↗

PubMed2004

Aspirin therapy and bleeding during proximal femoral fracture surgery.

To assess the effect of daily low-dose aspirin therapy on perioperative bleeding of patients operated on for proximal femoral fracture, we did a prospective case-control study. During 14 months, we followed up 104 patients, 39 of whom were taking aspirin before the injury. The bleeding was estimated by the number of blood units needed perioperatively, the change in hemoglobin values, and followup on complications and drain volume. The aspirin-treated group received an average of 0.5 units of blood more than the control group, postoperatively. This finding was statistically significant. The groups did not differ significantly in any other bleeding parameter. No major bleeding occurred in the patients. It is safe to do surgery for a proximal femoral fracture in patients who are taking aspirin.

Aged↗

PubMedDate not supplied

Treatment of femoral fractures in children by pediatric orthopedists: results of a 1998 survey.

SUMMARY: This study aimed to determine treatment preference of various femoral fracture patterns in children by pediatric orthopedists and whether it is practice dependent. In September 1998, members of the Pediatric Orthopedic Society of North America were surveyed to determine their current preferences in treating each of four middle one-third femoral fracture patterns in four age groups. Forty-four percent (286/656) of those surveyed responded. For each fracture pattern, operative treatment was increasingly preferred over nonoperative as patient age increased, and the preferred treatments within the operative and nonoperative categories changed significantly as patient age increased. Fourteen specific cases of femoral head avascular necrosis were noted after rigid reamed and unreamed rodding. There is a statistically significant trend by pediatric orthopedists to treat older children's femur fractures operatively and younger children's nonoperatively. The consensus treatment is age dependent. The numerous cases of avascular necrosis after rigid rodding are a concern.

Adolescent↗

PubMedDate not supplied

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↗

PubMed2006

External fixation of femoral fractures in multiply injured intensive care unit patients.

We report the results of a prospective study of 42 patients with multiple injuries, including femoral fractures, who required intensive care unit (ICU) admission and whose fractures were treated by means of external fixation. The Injury Severity Score (ISS) ranged from 18 to 41 and the average Glasgow Coma Scale (GCS) on admission was 12. Seventeen fractures were open. All patients had their fractures stabilised within 6 hours from admission by means of external fixation. After a follow-up of 11 months (range 4-20), 28 fractures had healed within 6 months (range 4.5-8) and 13 developed non-union which was treated successfully with secondary intramedullary nailing. One patient developed deep infection following secondary nailing and another patient died from adult respiratory distress syndrome (ARDS). We conclude that external fixation of severe femoral fractures in critically ill patients is an easy and quick method of stabilisation which does not compromise their condition. If however it is intended to be used as a final method, these patients require a close follow-up since the rate of delayed and non-union is high.

Adult↗

PubMed1994

Thoracic and lumbar fractures associated with femoral shaft fractures in the multiple trauma patient. Occult presentations and implications for femoral fracture stabilization.

Two-hundred-and-one patients with femoral shaft fractures were identified in a 5 year period at three institutions. Seven patients (3.5%) were found to have associated thoracic or lumbar fractures of various types. All resulted from high-velocity trauma. Four (57%) of these patients had thoracic or lumbar fractures that were undiagnosed on admission and before femoral fracture stabilization. A neurologic deficit persisted in four patients, and the possible contribution of femoral intramedullary rodding with positioning and traction must be considered. A high index of suspicion for thoracic and lumbar fractures is required when evaluating the high velocity trauma patient with a femoral shaft fracture. Presence of the thoracic or lumbar fracture may require initial spine stabilization or alter the method of femoral fracture treatment.

Adult↗

PubMed1999

Stabilisation of acute femoral fractures in Paget's disease.

Eleven cases of acute femoral fractures in patients with Paget's disease are presented following stabilisation with the solid AO femoral nail. In three cases with severe deformity of the femur, reaming was required to enable implant insertion. No corticotomies were required. The median operation time was 55 (35-65) min. There was no operative mortality and no patient developed signs of acute respiratory distress syndrome/fat embolism. Skeletal stability was achieved in all cases. The reconstruction proximal locking option (spiral blade) was utilised in ten of the eleven cases. In all cases a 9 mm nail was inserted. One patient (pagetic sarcoma) died 23 months after surgery. Ten of the eleven fractures healed uneventfully. The mean time to union was 32 (26-42) weeks.

Acute Disease↗

PubMed1999

A new ultrasound-based method for the assessment of torsional differences following closed intramedullary nailing of femoral fractures.

OBJECTIVE: A torsional difference of more than 15 degrees is found in up to 30% of patients following closed intramedullary nailing of femoral fractures. The diagnosis is usually established postoperatively by computed tomography. A torsional deformity of more than 15 degrees should be corrected by early derotation. In order to enable an intraoperative control and possible correction to avoid a second operation for the patient, a new ultrasound-based method suitable for the intraoperative setting has been developed, using the anterior condylar line as a distal reference line. DESIGN AND PATIENTS: In a prospective study the torsional difference after closed intramedullary nailing of femoral fractures was measured postoperatively by ultrasound in 32 patients and compared with standard CT readings. RESULTS: Torsional differences measured by ultrasound and CT showed a high correlation (r = 0.8) and a median difference of less than +/-3 degrees. CONCLUSIONS: By the introduction of the anterior condylar line as a distal reference line femoral torsion can accurately be assessed by ultrasound in a position required for intraoperative control and possible correction.

Adolescent↗