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PubMed1994

Primary femoral shortening osteosynthesis in the management of comminuted supracondylar femoral fractures.

Supracondylar fractures are most often the result of high-energy vehicular trauma in the young population, and the result of low-energy injuries in the elderly. Therefore, these fractures are generally associated with comminution or osteoporosis. Anatomic reconstruction with stable medial buttressing is often not possible. Utilization of AO principles and techniques with anatomic reduction and internal fixation often fails to yield sufficient stability. We have developed a technique for the treatment of these distal femoral fractures which involves shortening by impaction. Rather than achieving anatomic reduction, the femur is shortened by telescoping the fragments to reestablish inherent stability of the bone prior to internal fixation. Over a 20-year period we treated 25 comminuted supracondylar femoral fractures with primary shortening osteosynthesis in 24 patients. Sixteen patients were available for review at an average follow-up of 10 years (range 4-24 years). Ninety-four percent of the patients demonstrated complete radiographic consolidation by 14 weeks after the operative intervention. One patient required secondary bone grafting and reached consolidation at 30 weeks. Primary cancellous grafting was utilized in only 25% of the patients. One-third of the patients in review were given a heel lift; the average shortening in these patients was 2.6 cm (range 2.1-5 cm). Two-thirds of the patients did not require a heel lift, the average shortening in this group of patients being 1.2 cm (range 0.8-2.0 cm). At follow-up the average range of motion of the knee was 114 degrees (range 90 degrees-130 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Rotational remodeling of malrotated femoral fractures: a model in the rabbit.

It is estimated that 20-40% of femoral fractures in children heal in malrotation, yet few patients later complain. To determine if malrotation corrects spontaneously, midshaft osteotomies were made in femurs of 16 rabbits aged 8 weeks and the distal fragments were internally rotated 45 degrees, where they were held with external fixators. The animals were killed between week 0 and week 17. Version of the femoral necks was determined by computed tomography scan (CT). The version altered rapidly toward normal from weeks 0 to 4 and then remained stable, with an average rotational remodeling of 55%.

Animals↗
PubMed1988

Closed unlocked nailing for comminuted femoral fractures.

Fifty consecutive comminuted fractures of the femoral shaft were treated by closed unlocked intramedullary nailing. Twelve unstable fractures also had cast-bracing. There were no cases of infection or non-union, and satisfactory results were achieved in 38 fractures (76%). More severe comminution led to a higher incidence of unsatisfactory results, but malrotation deformity was seen more often in less comminuted fractures and appeared to be due to poor operative reduction. Shortening in severe comminution was the main complication and was not controlled by supplementary cast-bracing. Closed unlocked intramedullary nailing is effective for lesser grades of comminution, but fractures with no cortical continuity at reduction should be treated with a locking nail.

Female↗
PubMed2005

The role and efficacy of retrograding nailing for the treatment of diaphyseal and distal femoral fractures: a systematic review of the literature.

The aim of this analysis has been to evaluate the efficacy of retrograde nailing in the treatment of distal femur and femoral shaft fractures. Articles were extracted from the Pubmed database and the retrieved reports were included in the study only if pre-specified eligibility criteria were fulfilled. Moreover, a constructed questionnaire was administered, aimed at assessing the quality of the outcomes. Twenty-four articles were eligible for the final analysis, reviewing a total of 914 patients (mean age of 48.8 years) who sustained 963 distal and diaphyseal femoral fractures. The overall mortality rate was 5.3%. The incidence of infection was 1.1% and for septic arthritis of the knee was 0.18%. In patients with distal femoral fractures, the mean time to union and rate to union were 3.4 months and 96.9%, respectively. The mean range of knee motion was 104.6 degrees . The rates of knee pain, malunion and re-operations were 16.5, 5.2 and 17%, respectively. Patients with femoral shaft fractures had a mean time to union 3.2 months, whilst the rate of union was 94.2%. The mean range of knee motion was 127.6 degrees . The rates of knee pain, malunion and re-operations were 24.5, 7.4 and 17.7%, respectively. We concluded that retrograde intramedullary nailing appears to be a reliable treatment option, mainly for distal femoral fractures. However, in the management of diaphyseal fractures, retrograde intramedullary nailing is associated with high rates of knee pain and lower rates of fracture union.

Bone Nails↗
PubMed2004

Management of periprosthetic femoral fractures after total knee arthroplasty using a distal femoral allograft.

This study is a review and discussion of 12 consecutive patients who were revised with a distal femoral allograft for periprosthetic supracondylar fractures of the femur associated with poor bone quality by the same surgeon between 1990 and 2001. Two were lost to follow-up. The average age was 65 years, and the mean follow up was 6 years. Charts were reviewed to identify complications and graft survivorship. Functional assessment consisted of the modified Hospital for Special Surgery (HSS) knee score and the MOS 36-ITEM Short Form Health Survey. Radiographs were evaluated by 3 independent observers to determine graft union, resorption, and component loosening. The average postoperative HSS score and SF-36 were 75 and 88, respectively. Mean flexion was 100 degrees. Nine patients achieved union and were able to fully bear weight. Three patients required more surgery as a result of postoperative complications. Radiographs showed no migration, no loosening, and good interface union in 9 of the 10 patients available for follow-up. We concluded that this is a viable salvage procedure for this type of injury.

Aged↗
PubMed1983

Causative factors responsible for femoral fractures in infants and young children.

The causative factor responsible for producing a femoral fracture was determined in 74 children 5 years of age or younger admitted to Oklahoma Children's Memorial Hospital over a 5-year period. Almost one-half of the fractures (34/74) were sustained as a result of suspected or confirmed abuse; most (17/26) of the fractures in infants less than 1 year of age were a result of abuse. Seven automobile-pedestrian accidents were causative in children 2 years or older. An accurate history, good record keeping, common sense, and awareness of the incidence of abuse will assist the orthopedist in recognizing abuse when it is likely, and sparing the family when it is not.

Accidents, Traffic↗
PubMed1994

Femoral fractures in the newborn calf: biomechanics and etiological considerations for practitioners.

The etiology of femoral fractures in calves during assisted parturition was examined from the perspective of biomechanical force analysis. Femurs were collected from newborn calf cadavers. Their physical dimensions of length, cortical thickness, and diameter were measured from radiographs, and the data were recorded. The bones were then frozen until tested. The thawed bones were compressed axially in a materials testing machine until they broke, whereupon the breaking strength of the bones at the failure site was recorded. Fracture locations were documented radiographically, and the cortical thickness and bone diameter at the fracture site were determined. Fracture configurations and locations were similar to those found in clinical cases associated with forced extraction. The breaking strength of all femurs fell within the magnitude of forces calculated to be created when mechanical devices are used to assist delivery during dystocia. An etiology based on wedging of the femur in the maternal pelvis and resulting compression during forced extraction is suggested to account for the occurrence of supracondylar fractures of the femur of calves delivered in anterior presentation using mechanical devices in a manner commonly performed by veterinarians and owners. It is recommended that care should be exercised to correct or rule out the possibility of premature engagement of the calf's stifle into the birth canal, and thereby reduce the frequency of this type of fracture occurrence in the field.

Animals↗
PubMed2006

The retrograde nail for distal femoral fractures in the elderly: high failure rate of the condyle screw and nut.

Displaced distal femoral fractures in elderly patients benefit from surgical fixation. We describe the use of a retrograde femoral nail to treat these fractures. The implant has a special condyle screw and nut that allows for manual compression of the fracture when there is an additional inter-condylar split. We present our results when using this implant to treat 16 patients over a 13-month period. The mean patient age was 78 years (range, 65-96 years). All 16 patients were available at the time of final follow up and proceeded to union at an average time of 11 weeks (range, 10-14 weeks). Twenty-six condyle screw and nuts were used. Ten out of 26 condyle screws in 10 out of 16 patients failed by disengaging at a mean time of 10 weeks (range, 8-12 weeks). Our union rate was unaffected by the nut and bolt disengaging. This would suggest that the condylar compression generated by the nut and bolt may not be critical for union.

Age Factors↗
PubMed2003

Cortical onlay allograft struts in the treatment of periprosthetic femoral fractures.

Cortical onlay strut allografting is emerging as a very attractive option for periprosthetic femoral fractures around stable implants. The cortical struts essentially represent biologic bone plates. In addition to conferring mechanical stability they may enhance fracture healing and can potentially increase bone stock. If appropriately selected and prepared, cortical struts can be customized to fit any femur. Because the modulus of elasticity of allograft struts is similar to that of the host bone there is less stress shielding of the host bone than with other more rigid forms of internal fixation. Cortical struts can also be used in combination with other modalities of periprosthetic fracture treatment. They can be useful when combined with plate fixation or with revision to a long-stem prosthesis, and as adjunctive stabilizers at the junction between the host and a proximal femoral structural allograft.

Arthroplasty, Replacement, Hip↗
PubMed1991

Grosse-Kempf intramedullary nailing of femoral fractures.

The Grosse-Kempf nail is a versatile interlocking intramedullary nail with proximal and distal locking. The locking transfixion screws afford additional axial and rotational stability and have expanded the use of intramedullary fixation to include all types of femoral fractures distal to the lesser trochanter and to within 7 cm of the knee joint. Forty consecutive femoral shaft fractures treated by this method have been reviewed. Solid union occurred in 39 cases at six months from surgery. Complications were directly related to technical difficulties and fracture personality. The surgical technique is demanding and requires special expertise training and equipment, but the benefits to the patient are so great that this is now regarded as the method of choice for treating femoral shaft fractures in adults.

Adolescent↗
PubMed2002

Lateral and anterior plating of intra-articular distal femoral fractures treated via an anterior approach.

Thirty-five patients with 36 displaced distal femoral fractures (16 AO-type C2 and 19 AO-type C3) were treated with an anterior approach and double plating and followed for an average of 7 (3-44) months. Bone grafting with allograft and demineralized bone matrix was used. Postoperative therapy included immediate ROM and non-weight bearing for 12 weeks. Two patients died during hospitalization and one was lost to follow-up. Reductions were near anatomic in all but three patients. Uneventful healing by 16 weeks occurred in 24/36 fractures. Double plating via the anterolateral approach minimized stripping of the medial side and improved controlled access to the distal femur.

Bone Plates↗
PubMed1985

[Comparative implant analysis in the operative treatment of unstable per- and subtrochanteric femoral fractures and results of 300 osteosyntheses with the 130 degree double T plate].

We have found that the 130 degrees-Double-T-Plate, when used to repair unstable intertrochanteric femoral fractures in patients in the eighth decade, where high morbidity (92%), osteoporosis and immobility is common, lowers the postoperative complication rate (8,5%), mortality rate (12%) hospital course (means = 24 days) and, last but not least, the total cost of medical care. The biomechanical superiority of these implants over others was shown by comparing moments of inertia, elasticity, bending strength, load capacity and spring constant. In 300 cases of unstable intertrochanteric femoral fractures treated with the 130 degrees-Double-T-Plate, 79% yielded very good to good results, 11% satisfactory results and 10% poor results.

Adult↗
PubMed1980

Degree and frequency of rotational deformities after infant femoral fractures and their spontaneous correction.

Based on 124 radiographic follow up results of infant femoral fractures the degree and frequency of a rotational deformity in relation to the fracture site and the therapeutical method are demonstrated and the reasons for the differences are discussed. The varying results of the follow up study and a repeated examination 4-6 years later confirm the assumption that the infant skeleton is able to correct even posttraumatic rotational deformities of the femur. The shape of the proximal femoral portion reveals that the correction takes place within the femoral stem rather than by torsion in the area of the femoral neck.

Child↗
PubMed1987

Proximal femoral fractures.

The absolute number of hip fractures is large, increasing, and related to osteoporosis as well as other factors. By 65 years of age, 50% of women will exhibit bone mineral below the fracture threshold; by age 85, 100%. Trabecular bone loss, which occurs before cortical bone loss, is characteristic of postmenopausal osteoporosis, while cortical bone loss, which increases with age (especially after the age of 70), is characteristic of senile osteoporosis. Estrogen treatment is reasonable for early postmenopausal osteoporosis, less so for the senile variety. The elderly often lose the renal ability to 1-alpha hydroxylate 25-OH vitamin D and thus lose the ability to absorb calcium; they are refractory to D3 therapy, and may require more expensive therapy with 1,25-(OH)2-vitamin D. "Trivial" trauma with falls caused by loose rugs, electric cords, and the like may often be the primary cause of proximal femoral fractures. Sedative drugs are also hazardous. The polyfactorial problem of proximal femoral fractures requires treatment by a multidisciplinary medical team.

Aged↗
PubMed1989

Femoral fractures in Paget's disease.

Since the original description of osteitis deformans, the treatment of femoral fractures occurring in this disease process has been difficult. A retrospective study of 35 fractures treated over an 8-year period was undertaken to identify the factors that influenced the results. The fractures were classified according to four fracture patterns: subcapital, intertrochanteric, subtrochanteric, and shaft. Chart and radiographic analyses were then performed. The results identified subtrochanteric fractures, occurring in a somewhat younger population, to be the problem fracture. The other three fracture groups did well with standard methods of treatment. Uncemented arthroplasties were not successful; this correlates with the known bone physiology of this age group and this disease process. Blood loss was not statistically significant in any group, although it was greater in the subtrochanteric population. Preoperative assessment by bone scanning and preoperative medical treatment is recommended in the subtrochanteric fracture group.

Adult↗
PubMed1986

Femoral fracture treatment in head-injured children: use of external fixation.

Seven cases of femoral fractures in head-injured children with spasticity and/or decerebrate posturing and seizures were treated with external fixation. The fractures healed with good alignment, maintenance of length, and without infection. The technique is recommended both for its simplicity and lack of complications relative to other management approaches.

Child↗
PubMed2005

[Further development of the diagnosis-related groups system--fact or fiction? Differentiation of case severities in patients with proximal femoral fractures 2003-2005].

BACKGROUND: The previous system of hospital financing based on the returns (consisting of payments received minus cost of patient treatment) is undergoing considerable changes on the basis of learning to apply the new Diagnosis-Related Groups (G-DRG) system which differentiates the financial returns according to the individual severity of each case. AIM OF THE STUDY: 1. What are the differences in cost and returns when applying the G-DRG systems 2003, 2004 and 2005 to well-defined groups of patients (for example, surgery of proximal femoral fractures)? 2. The influence exercised by secondary (supplementary) diagnosis on the grouping of the patients. 3. Has the G-DRG system been appropriately developed further in respect of improved differentiation according to severity of the cases and homogenisation of the patient groups? PATIENTS AND METHODS: The study was based on comprehensive clinical data of 169 proximal femur fracture patients. We assessed the Case-Mix index, relative weights and returns, basic DRG, DRG, the number and weight of secondary diagnoses relevant for complexity and comorbidity levels (CCL), the summands of the CCL's and the resulting PCCL values (Patient Clinical Complexity Levels). The data were subjected to analysis of variance and graphically descriptive analysis. RESULTS: The effective Case Mix index decreases in the 2004 and 2005 systems compared to 2003. This is due to a significant drop in returns based on an unchanged rate of receipts of 3000 . The progressive development of the systems was partly associated with major changes in grouping without significant intra-group homogenisation or improved inter-group discrimination of indications. The differentiation process does not fully utilise the differentiation potential of the basic data. CONCLUSIONS: No definite improvement of the differentiation potential of the G-DRG systems seems to have been achieved by the 2004 and 2005 systems compared to 2003 using the data of the relevant group of patients with proximal femoral fractures. From 2005 onward the financial lumpsum receipts and returns will definitely affect hospital budgets. Hence, a substantial improvement of the the basis of calculation is imperative for 2005 as well as complete publication of the relevant data. It is indeed doubtful whether the extension of the convergence phase to 5 years presently under discussion would provide sufficient time for an adequate solution of the financial and system problems.

Aged↗