[Treatment of adduction fractures of the femoral fracture with Seppo's fixation device].
Explore the source record for details and available documents.
Aged↗
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.
Proximal femoral fractures in children.
Proximal femoral fractures in children can be divided into three groups: femoral neck fractures, apophyseal trochanteric separations and subtrochanteric fractures. Femoral neck fractures are extremely rare. They are classified according to Delbet and Colonna into four types. The more lateral is the line of the fracture, the better is the prognosis, and the less sequelae occur. The treatment of femoral neck fractures in children is in nearly all cases surgical, only in some pertrochanteric and in the minority of non-complete basicervical fractures conservative treatment can be considered. The surgical treatment is either a closed manipulation with internal fixation, or an open reduction with fixation. The authors prefer closed manipulation, if it is possible to perform. They have themselves treated 5 pathological separations of the femoral head of the coxxa vara adolescentium origin. These injuries are aligned with femoral neck fractures, because they are caused by a traumatic mechanism, and are to be treated like a fracture. Further the authors have treated two cervicotrochanteric fractures by open reduction and 4 patients with pertrochanteric fractures conservatively by skin traction. Apophyseal trochanteric separations are convenient to be treated conservatively, only in case of greater displacement of the greater trochater can an open reduction and internal fixation by traction cerclage be recommended because of the risk of a valgous deformation of the femoral neck. The authors have treated conservatively 3 patients with a separation of the lesser and 2 patients with a separation of the greater tochanter. Subtrochanteric femoral fractures are different from typical diaphyseal fractures.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Neck fracture femoral heads for impaction bone grafting: evolution of stiffness and compactness during impaction of osteoarthrotic and neck-fracture femoral heads.
BACKGROUND: The need for safe bone allografts is increasing and preservation of femoral heads from patients being operated on with hip arthroplasty should be encouraged. However, should we preserve femoral heads from patients operated on for neck fracture as tissue mechanical quality may not be satisfactory? MATERIAL AND METHODS: We compared the evolution of stiffness and compactness of fresh-frozen morselized bone obtained from osteoarthrotic femoral heads and those from neck fractures. Both materials were also compared after freeze-drying and irradiation. We used 6 osteoarthrotic and 6 neck-fracture femoral heads to prepare 4 batches of morselized bone. 18 samples from each batch were impacted in a contained cylinder. Frozen bone grafts were tested after thawing at room temperature for 2 hours and freeze-dried grafts were tested after 30 minutes of rehydration. RESULTS: The stiffness of fresh-frozen neck fracture bone was lower than that of fresh-frozen osteoarthrotic bone at 150 impactions. The stiffness of freeze-dried irradiated bone was higher than that of the fresh-frozen bone and did not differ between osteoarthrotic and neck-fracture bone. INTERPRETATION: Solvent-treated freeze-dried bone from femoral heads procured during arthroplasty for sub-capital hip fractures represents a valuable source of material for allografts, addressing concerns regarding serological testing, medical history and bone quality.
Aged↗
Features of femoral fractures in nonaccidental injury.
Femoral fracture is one of the most common long bone fractures owing to nonaccidental injury, but there is little evidence in the literature about their characteristics. It is important medicolegally to establish a diagnosis of child abuse. Fourteen femoral fractures from definite nonaccidental injury were analysed and compared with 33 femoral fractures caused by definite accident. The age, site, and fracture patterns were carefully studied. Of inflicted femoral fractures, 92.8% (13 of 14) occurred in children younger than 1 year old. On studying the fracture morphology, we conclude that there is no specific roentgenographic site or fracture pattern that allows differentiation between accidental and nonaccidental femoral fractures.
Child↗
Ipsilateral proximal and shaft femoral fractures: spectrum of injury involving the femoral neck.
Medical records and radiographs of 52 patients were studied after inclusion/exclusion criteria were met. The anatomical location of proximal femoral fractures that involved the femoral neck were examined after the primary fracture planes were drawn onto templates of the proximal femur. The AO classification is comprehensive and widely accepted. It has not been used in this injury combination in a large series of patients. Therefore, we classified each fracture by the AO method and then the AO classes were tabulated and analysed. Only three patterns of proximal femoral fractures appeared. The inferior aspect of the fracture line clustered in the inferomedial aspect of the femoral neck above an intact lesser trochanter in each separate pattern: 55 per cent were AO B2.1 (basilar); 35 per cent AO B2.3 (intracapsular); and 10 per cent AO A1.2 (pertrochanteric) fractures). Eleven fractures (21 per cent) were not detected initially. None of these were A1.2, eight were B2.1 and three were B2.3. Despite many proximal femoral fracture types reported in the literature only three fracture patterns were noted in this large study group. A new finding of clustering of these fractures in the inferomedial femoral neck was noted. AO class B2.1 fractures were the most common fractures missed at initial presentation and were the most common type seen.
Femoral Fractures↗
Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail.
We report our initial experience with a new reconstruction nail, the long proximal femoral nail (L.PFN), in the treatment of subtrochanteric femoral fractures and metastases. We performed 52 L.PFN in 49 patients over a period of 18 months with an average follow-up period of 47.7 weeks. Group I consisted of 24 patients, who had L.PFN for traumatic subtrochanteric femoral fractures. Group II consisted of 25 patients, who had L.PFN for femoral metastases and pathological fractures. (Three bilateral.) In nine patients in group I, the fracture was extending to the intertrochnateric region with involvement of the piriformis fossa. Eight patients in group I had open reduction and cerclage cabling of the fracture prior to L.PFN. All the traumatic fractures in group I had united with an average time to union of 19.4 weeks. In eight operations there were technical difficulties with the insertion of proximal locking screws. Five patients in our series had complications but we had no mechanical failures of the implant. L.PFN is a reliable implant for subtrochanteric femoral fractures and metastases. We also showed that open reduction and cerclage cabling of unstable subtrochanteric fractures prior to nailing was not detrimental to fracture healing in our series.
Adult↗
Angulated screw placement in the lateral condylar buttress plate for supracondylar femoral fractures.
Certain supracondylar femoral fractures are not amenable to internal fixation with fixed angle devices. In these instances, the condylar buttress plate is the recommended alternative; however, this is a less rigid device. Because of the decreased rigidity and strength of this device, there is a tendency toward varus angulation and malunion. In six fresh-frozen human knee specimens, segmental osteotomies were created to mimic supracondylar femoral fractures. The medial cortex was completely removed to make the fracture unstable to varus deformity. The fracture was fixed with a lateral condylar buttress plate using 4.5 mm screws. Each specimen was tested once with all the screws installed perpendicular to the plate, and again with the middle screw, just proximal to the fracture, angled 45 degrees diagonally across the fracture into the subchondral bone of the medial femoral condyle. For the construct with all screws placed perpendicular to the buttress plate, the initial stiffness was 410 N/mm, and after 1000 cycles it was 230 N/mm. With a screw placed diagonally across the fracture site, stiffness increased to 833 N/mm on the first cycle, and 796 N/mm after 1000 cycles. In all specimens with the screws placed perpendicular to the plate, the distal fragment had a permanent varus deformity after 1000 cycles, under no load, of 0.91 mm. For the diagonal screw condition, the average magnitude for all six specimens was 0.42 mm. This simple means of screw angulation in the plate strengthened the overall construct to resist the tendency toward varus deformity. The attractive features include the ease of application, and the use of an existing construct.
Aged↗
[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↗
The use of the supracondylar nail in the management of femoral fractures in the presence of other femoral implants in the very elderly.
In a retrospective study we review the use of the supracondylar nail for the treatment of distal femoral fractures above existing knee prostheses or below upper femoral implants in a very elderly population of mean age 85. Over a 2 year period we have used the Smith and Nephew supracondylar nail to stabilise seven distal third femoral fractures either distal to a femoral implant (six cases) or proximal to a total knee replacement. One patient died soon after surgery, one patient had an extension of the fracture proximal to the nail but the others made an excellent functional recovery with early mobilisation of the knee. We recommend the use of the supracondylar nail in the management of these difficult cases. The very elderly patient benefits from the early and stable fixation of these fractures.
Aged↗
Comments on "Prediction of femoral fracture load using automated finite element modeling" by J.H. Keyak et al. and "Prediction of femoral fracture load using finite element models: an examination of stress- and strain-based failure theories" by J.H. Keyak et al.
Explore the source record for details and available documents.
Automation↗
The results of quadricepsplasty on knee motion following femoral fractures.
Knee motion following femoral fractures is often less than satisfactory. Surgical procedures to increase knee motion are rarely done. This paper presents a series of nine patients who had severe femoral fractures, primarily in the distal third. Once union was obtained, all patients had knee flexion incompatible with normal gait (average 30.2 degrees). All patients underwent a quadricepsplasty at Rancho Los Amigos Medical Center. Eight of the nine achieved knee flexion allowing normal gait (average 78 degrees). This paper presents our indications, methods, results, and complications in performing quadricepsplasty to achieve knee flexion following femoral fractures.
Adult↗
[Bilateral shoulder dislocation fractures, femoral neck and vertebral fractures: a remarkable combination of injuries during an epileptic seizure].
Fracture complications of convulsions are reported occasionally, e.g.: mono- or bilateral posterior shoulder luxations and luxation fractures, central dislocations of the hip as well as fractures of the femoral neck or compression fractures of vertebrae. A case is reported where the patient sustained four such lesions simultaneously. The epileptic seizure occurred following the sudden interruption of a neurotropic therapy with Carbamazepin (Tegretal). A general osteodystrophy was not found. The simultaneous presence of four such lesions following one convulsion has never before been reported and appears to be very uncommon. The frequency and problems of post-epileptic fractures are discussed and the operative treatment of the lesions briefly described.
Adult↗
An experimental study of devices for internal fixation of distal femoral fractures.
Tibial traction for distal femoral fractures, followed after four to eight weeks by plaster, is the common treatment. Because of improved methodology, the proportion of surgically treated fractures had increased. Stable osteosynthesis with different plates is an established therapy for distal femoral fractures. In elderly or other patients with bone fragility, however, these operations often fail. The majority of the distal femoral fractures occur in such patients, and traction in bed is therefore often used. A less rigid device was constructed to meet the special circumstances with bone fragility. This device consists of two Ender's nails: one is inserted from each condyle, and each is connected to two cancellous screws traversing both condyles. The strength of this semielastic osteosynthesis was compared with four existing devices (AO, Rush, Zickel, Ender). Fixation was carried out in 17 pairs of osteotomized postmortem preparations from patients older than 60 years of age. The specimens were submitted to constant bending rate, and the load deformation was registered. The fixation with the condylar plate was strongest and showed the lowest flexibility. The Ender's nails and the Rush pins showed a tendency to lose their Condylar stabilization early. This was less pronounced with the Zickel nail, which, however, tended to displace at the osteotomy site during insertion and fracture the proximal fragment due to the limited bending ability of the blade construction. The new, semielastic device (ECS) was constructed to meet the special circumstances with bone fragility. It consists of two cancellous screws traversing both condyles. It combined easy insertion with moderate flexibility and high residual strength. In extension, it deflected 40 degrees without influencing residual stability. It is an interesting alternative to rigid internal fixation or traction in bed for osteoporotic patients with distal femoral fractures. In combines rigid screw fixation in the condylar part with an elastic adjustment in the femoral shaft above.
Aged↗
The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture.
The AO/ASIF proximal femoral nail (PFN) is a new device designed for the treatment of the unstable trochanteric femoral fracture. This study reports the outcome in such fractures treated using the PFN at a District General Hospital. All patients presenting to our department with unstable trochanteric femoral fractures were treated operatively using the PFN. A total of 76 patients were included in the study and were followed up to fracture union or fixation failure. A case documentation form and follow-up form were used to collect the data which included the Salvati and Wilson assessment of hip function. The majority of the procedures were reported by the operating surgeon as "easy" or "usual". Distal locking was difficult in three patients. In one patient, the fixation failed because the screws were wrongly positioned and was revised to a THR. Mortality rate, during the first 3 months, was 27%. Of the surviving patients, screws cut through the femoral head in four patients (8%), however, fractures united in all the patients. There was one incidence of fracture around the tip of the nail. Seventy-eight percent of the patients at the final follow-up scored >20 points (out of 40 points), using the Salvati and Wilson hip function scoring system. According to the patients and/or their carers, outcome was described as good or very good in 94% of the patients and the level of function was similar to pre-injury level in 50% of the patients. We conclude that the PFN is a useful device in the treatment of the unstable trochanteric femoral fracture. It is a relatively easy procedure and a biomechanically stable construct allowing early weight bearing. Femoral neck screws positioning is critical.
Aged↗
Perioperative fluid volume optimization following proximal femoral fracture.
BACKGROUND: Proximal Femoral Fracture (PFF) or 'hip fracture' is a frequent injury, and adverse outcomes are common. Several factors suggest the importance of developing techniques to optimize intravascular fluid volume. These may include protocols that enhance the efficacy of clinicians' assessments, invasive techniques such as oesophageal Doppler or central venous pressure monitoring, or advanced non-invasive techniques such as plethysmographic pulse volume determination. OBJECTIVES: To determine the optimal method of fluid volume optimization for adult patients undergoing surgical repair of PFF. Comparisons of fluid types, of blood transfusion strategies or of pharmacological interventions are not considered in this review. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library, issue 4, 2003), MEDLINE (1985 to 2003), EMBASE (1985 to 2003), and bibliographies of retrieved articles. Relevant journals and conference proceedings were handsearched. SELECTION CRITERIA: Randomized controlled studies comparing a fluid optimization intervention with normal practice or with another fluid optimization intervention, in patients following PFF undergoing surgery of any type under anaesthesia of any type. DATA COLLECTION AND ANALYSIS: Searches and exclusion of clearly irrelevant articles were performed by one reviewer. Two reviewers examined independently the remaining studies, extracting study quality and results data. A wide range of short- and long-term outcome data were sought. Studies were excluded if they did not meet selection criteria or if results were likely to be biased. Due to inconsistent data reporting, combination of data was not generally possible. MAIN RESULTS: Searches identified four trials, of which two studies, randomizing a total of 130 patients, were of adequate quality and addressed the review question. Both studies were of invasive advanced haemodynamic monitoring, either oesophageal Doppler ultrasonography or central venous pressure monitoring, during the intraoperative period only. In both, invasive monitoring led to significant increases in fluid volumes infused and reductions in length of hospital stay. The pooled Peto odds ratio for in-hospital fatality was 1.44 (95% confidence interval 0.45-4.62). Neither study followed patients beyond hospital discharge or assessed functional outcomes. No serious complications were directly attributable to the interventions. There were no studies of protocol-guided fluid optimization or of advanced non-invasive techniques. REVIEWER'S CONCLUSIONS: Invasive methods of fluid optimization during surgery may shorten hospital stay, but their effects on other important, patient-centred, longer-term outcomes are uncertain. Adverse effects on fatality cannot be excluded. Other fluid optimization techniques have not been evaluated. The lack of randomized studies of adequate quality addressing this important question is disappointing. More research is needed.
Femoral Fractures↗
Arthroplasties (with and without bone cement) for proximal femoral fractures in adults.
BACKGROUND: Numerous types of arthroplasties may be used in the surgical treatment of a hip fracture (proximal femoral fracture). The main differences between the implants are the design of the stems, whether the stem is fixed in place with or without cement, whether a second articulating joint is included within the prosthesis (bipolar prosthesis) or whether the whole hip joint is replaced. OBJECTIVES: To review all randomised trials that have compared different arthroplasties for the treatment of hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register. Additional trials were identified by searching reference lists of relevant articles, conference proceedings, and contact with trialists. Date of most recent search: January 2001. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing different arthroplasties (and or cement), for the treatment of hip fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten-item checklist and extracted data. MAIN RESULTS: Thirteen trials involving 1464 patients were included. One trial investigated two comparisons. Cemented prostheses, when compared with uncemented (four trials, 391 participants) were associated with a lower risk of failure to regain mobility (relative risk (RR) 0.60, 95% confidence interval (CI) 0.44, 0.82) and of post-operation pain at a year or later (RR 0.51, 95% CI 0.31, 0.81). For this comparison, there were no significant differences in any other outcome. Comparison of unipolar hemiarthroplasty with bipolar hemiarthroplasty (six trials, 742 participants) showed no significant differences between the two types of implant. Two trials of 269 patients compared different types of hemiarthroplasty with a total hip replacement and two trials of 151 patients compared either different types of prosthesis head or different bipolar prostheses. Because of the limited number of cases and the use of different prostheses, no definite conclusions could be made from these four studies. REVIEWER'S CONCLUSIONS: Cementing prostheses in place seems to reduce pain post-operatively and results in better mobility, but because of the under-reporting of outcomes and the small number of patients involved, no definite conclusions can be made. The role of bipolar prostheses and total hip replacement is uncertain. Further well-conducted randomised trials are required.
Adult↗
Arthroplasties (with and without bone cement) for proximal femoral fractures in adults.
BACKGROUND: Numerous types of arthroplasties may be used in the surgical treatment of a hip fracture (proximal femoral fracture). The main differences between the implants are the design of the stems, whether the stem is fixed in place with or without cement, whether a second articulating joint is included within the prosthesis (bipolar prosthesis) or whether the whole hip joint is replaced. OBJECTIVES: To review all randomised trials that have compared different arthroplasties for the treatment of hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register which is compiled by regular searches of the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and CINAHL. Additional trials were identified by searching reference lists of relevant articles, conference proceedings, and contact with trialists. Date of most recent search: October 2003. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing different arthroplasties (and/or cement), for the treatment of hip fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten-item checklist and extracted data. MAIN RESULTS: Fifteen trials involving 1670 patients were included. One trial involved two comparisons. Cemented prostheses, when compared with uncemented (five trials, 482 participants) were associated with a lower risk of failure to regain mobility (relative risk (RR) 0.60; 95% confidence interval (CI) 0.44 to 0.82) and of post-operation pain at a year or later (RR 0.51, 95% CI 0.31 to 0.81). For this comparison, there were no significant differences in any other outcome. Comparison of unipolar hemiarthroplasty with bipolar hemiarthroplasty (seven trials, 857 participants) showed no significant differences between the two types of implant. Two trials of 269 patients compared different types of hemiarthroplasty with a total hip replacement and two trials of 151 patients compared either different types of prosthesis head or different bipolar prostheses. Because of the limited number of cases and the use of different prostheses, no definite conclusions could be made from these four studies. REVIEWERS' CONCLUSIONS: Cementing prostheses in place seems to reduce pain post-operatively and results in better mobility, but because of the under-reporting of outcomes and the small number of patients involved, no definite conclusions can be made. The role of bipolar prostheses and total hip replacement is uncertain. Further well-conducted randomised trials are required.
Adult↗
Controlled femoral fracture: easy in.
Revision femoral surgery is a demanding procedure with the potential for severe intraoperative complications, including bone loss and femoral fracture. The extended trochanteric osteotomy is a reproducible and safe technique to remove the femoral components for infection, loosening, component failure, malposition, and dislocation. From 1992 to 1996, 142 consecutive hip revisions were performed with the use of an extended proximal femoral osteotomy. This technique allowed component extraction without fracture in all patients and subsequently allowed for neutral reaming of the femoral canal with placement of the revision stems in proper alignment. There were 2 nonunions of the osteotomized fragments at an average postoperative follow-up period of 2.6 years. Additional complications included 4 fractures of the osteotomized fragment and one malunion. We have found that use of the osteotomy is an efficient, safe and reliable technique in revision hip arthroplasty.
Adult↗