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Results for “FEMORAL FRACTURES”

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PubMed1990

Partridge Cerclene system for femoral fractures in osteoporotic bones with ipsilateral hemi/total arthroplasty.

The Partridge Cerclene system was used for femoral fractures in 15 elderly patients with osteoporotic bones who previously had a hemiarthroplasty (12) or total hip arthroplasty (3) inserted. The operation is less extensive than others have suggested in similar cases. All of the patients could immediately be mobilized out of bed. Weight bearing was not allowed and a splint was required in most cases for the first 3 months. Six fractures around the prosthesis healed uneventfully. One distally located fracture was reoperated due to loosening of the nylon plates. Two patients with distally located fractures showed no signs of osseous healing at follow-up evaluation 12 and 17 months after the operation. They were painless but still dependent on external support. It is concluded that the method is an important alternative treatment in this group of patients, especially in fractures around a hip prosthesis.

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PubMed2000

Prediction of femoral fracture load using finite element models: an examination of stress- and strain-based failure theories.

Finite element (FE) models are often used to model bone failure. However, no failure theory for bone has been validated at this time. In this study, we examined the performance of nine stress- and strain-based failure theories, six of which could account for differences in tensile and compressive material strengths. The distortion energy, Hoffman and a strain-based Hoffman analog, maximum normal stress, maximum normal strain, maximum shear strain, maximum shear stress (tau(max)), Coulomb-Mohr, and modified Mohr failure theories were evaluated using automatically generated, computed tomographic scan-based FE models of the femur. Eighteen matched pairs of proximal femora were examined in two load configurations, one approximating joint loading during single-limb stance and one simulating impact from a fall. Mechanical testing was performed to assess model and failure theory performance in the context of predicting femoral fracture load. Measured and FE-computed fracture load were significantly correlated for both loading conditions and all failure criteria (p < or = 0.001). The distortion energy and tau(max) failure theories were the most robust of those examined, providing the most consistently strong FE model performance for two very different loading conditions. The more complex failure theories and the strain-based theories examined did not improve performance over the simpler distortion energy and tau(max) theories, and often degraded performance, even when differences between tensile and compressive failure properties were represented. The relatively strong performance of the distortion energy and tau(max) theories supports the hypothesis that shear/distortion is an important failure mode during femoral fracture.

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PubMed2004

MRSA in patients presenting with femoral fractures.

AIM: To assess MRSA carrier status in patients from different residences presenting with femoral fractures and to assess the incidence of MRSA deep wound infections post-operatively with regard to MRSA status on presentation. METHOD: One hundred and five patients were screened for MRSA on arrival over a 20-week period. They were then followed up post-operatively to determine the number of patients developing MRSA deep wound infection. RESULTS: One out of three patients came from an institution (nursing, residential home or hospital). Nearly one in four of these patients were MRSA carriers, compared with a carrier rate of less than 1 in 20 in patients admitted from home. Of the 11 cases presenting as MRSA carriers, two developed a MRSA deep wound infection, compared with 2 out of the 94 patients not colonised with MRSA (X2 p < 0.01).

Age Distribution↗
PubMed1998

Intraoperative type 1 proximal femoral fractures: influence on the stability of hydroxyapatite-coated femoral components.

We reviewed a series of 120 uncemented total hip replacements using the Omniflex stem with hydroxyapatite coating. Twenty minor intraoperative proximal fractures occurred. All fractures were treated with cerclage wiring after removal of the stem. Radiographic and clinical results of these 20 patients were compared with the remaining 100 implants in which this complication did not occur. In 20% of the cases of both groups, a migration of less than 2 mm was observed. No differences were detected in Harris Hip Scores, subsidence of the stem, and radiographic behavior. We concluded that a properly stabilized proximal femoral fracture above the lesser trochanter did not influence the clinical and radiographic results at more than 3 years follow-up.

Adult↗
PubMed1984

Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases.

Intramedullary nailing was performed on 520 femoral fractures in 500 patients. The series included eighty-six open fractures and 261 comminuted fractures. Closed intramedullary nailing was used in 497 femora and open intramedullary nailing with cerclage wiring, in twenty-three. The union rate was 99.1 per cent. The range of motion of the knee at follow-up averaged 130 degrees. Complications included four infections (0.9 per cent). Shortening of more than two centimeters occurred in ten patients (2.0 per cent) and malrotation of more than 20 degrees was observed in twelve patients (2.3 per cent). After prompt emergency measures had been taken, routine treatment included strong preoperative traction followed by accurate positioning of the patient on the operating table; selection of the correct insertion point for a properly sized, prebent, flexible, bullet-tipped nail; and accurate reduction of the fracture. Careful rehabilitation of the patient also contributed to the excellence of the results.

Adolescent↗
PubMed1997

[Proximal femoral fractures in patients over 75 years. Vital and functional prognosis of a cohort of 78 patients followed during 2.5 years].

PURPOSE OF THE STUDY: The purpose of this study was to highlight factors influencing vital and functional prognosis at 2.5 years of elderly people being treated for a proximal femoral fracture. MATERIAL: The study was based on 78 patients more than 75 years old admitted to the orthopedic department for emergency treatment. After post-operative care, patients were transferred to a geriatric readaptation unit. The average patient age at the time of surgery was 85 years. METHODS: This was a retrospective study. Survival graphs were established for the entire population as well as for the sub-populations characterized by a studied parameter. Mortality factors were compared via a univariable analysis. A multivariable logistical regression analysis isolated the factors explaining mortality at 12, 18, and 30 months and survival at 30 months, as well as factors explaining functional prognosis at 1 year. RESULTS: The overall mortality rate was 41 per cent, 48.5 per cent of deaths occur within the first year. Factors which are harmful for vital prognosis are the following: high degree of dependence before the fracture, the existence of a neuropsychiatric pathology, and age factor (more than 85 years). 61.5 per cent of surviving patients were independent for daily activities. 77 per cent of surviving patients lived in their usual place of residence. Factors which were harmful for functional prognosis were the following: type of the fall, symptomatic of an underlying pathological state, and existence of a neuropsychiatric pathology. Nutrition was also a predictive factor concerning the patient's out come. DISCUSSION: The average age of the studied population was higher than in most studies in literature. The treatment is mainly based on hip arthroplasty. The group of patients of over 85 have the highest mortality rate. However, a better survival rate at 18 months has been observed for patients older than 90 years. The delay before surgical care was significantly negative if longer than 6 days. However, a delay of 3 to 6 days was not significantly harmful for survival. Within the studied population, the maximum autonomy gain was observed during the first 6 months. The type of non-accidental fall, symptomatic of an associated pathology, was a factor for functional prognosis which has not been often mentioned. So was the biological deficit of nutrition. Social status acted as an indicator of functional status evolution. CONCLUSION: Therapeutic choices can only be guided by assessments of patients' vital and functional prognosis. A sophisticated or even expensive device should be demanded for patients with favorable prognosis. For patients with precarious functional and vital prognosis, priority should be given to less invasive techniques with immediate walking. The cost of the device should be correlated with patient's functional investment.

Age Factors↗
PubMed1997

Management of a femoral fracture complicated by clostridial myositis.

A clinical case of clostridial myositis secondary to a comminuted femoral fracture is described. This case is unusual because, despite the severe degree of obvious muscle necrosis and gas production, the dog had minimal signs of systemic toxicity. Union of the fracture was achieved but six months postoperatively muscular contracture had resulted in permanent stifle extension.

Animals↗
PubMed1996

Repair of a mid-diaphyseal femoral fracture in a boar.

A simple, oblique fracture of the middle portion of the diaphysis of the right femur was successfully repaired in a 10-month-old 150-kg Berkshire boar, using a 4.5-mm 9-hole broad dynamic compression plate applied to the lateral surface of the bone. A lateral surgical approach provided excellent access to the fragment ends. Intravenous administration of atracurium besylate facilitated traction along the long axis of the bone and fracture reduction. The plate was luted with 5% gentamicin sulfate-impregnated polymethyl methacrylate. Lack of a third trochanter in the porcine species facilitated retraction of the superficial gluteal muscle and provided a smooth plating surface. Full breeding activity by the boar resumed 190 days after surgery without complications. Massive soft tissue in the area over the femur, extensive production of callus, and cautious behavior by the boar contributed to successful fracture repair, indicating that domestic swine may be good surgical candidates for femoral fracture repair.

Animals↗
PubMed1983

Incidence and stability of trochanteric femoral fractures.

Sex, age and stability were recorded in 376 cases of trochanteric femoral fractures. In 168 cases the age and sex specific incidence was determined. When comparing our results with those in previous studies from the same region there was no increase that could not be related to age. This is in contrast to other reports from Scandinavia where investigators have found an increase in fracture incidence that could not be explained by the increasing number of old people. We, as others, have found a high proportion of unstable fractures. The unstable fractures did not occur more frequently in the oldest age groups.

Adult↗
PubMed1989

Epidural methadone for analgesic management of patients with conservatively treated proximal femoral fractures.

Epidural methadone analgesia was initiated soon after admission to emergency room in elderly patients who sustained osteoporotic proximal femoral fracture and who were considered to be high surgical risks. The severe pain was significantly reduced, enabling early mobilization of the patients. The analgesia was discontinued only when nonnarcotic analgesia sufficed. The treatment lasted for about 3.5 weeks. One minor complication was observed during the treatment period. We concluded that patients who have femoral neck fracture who are at high risk for operation and have to be observed and stabilized before operation can be managed by continuous epidural methadone analgesia.

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