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PubMed1975

Restoration of function in the knee and elbow with a hinge-distractor apparatus.

External hinged distraction devices using transosseous pins and adjustable attachments were applied to mobilize joint contractures; to reduce old dislocations; and to reduce, immobilize, and compress ununited para-articular fractures. Once these procedures were accomplished the devices were then used to maintain the joint surfaces separated at predetermined distances while kinematically normal joint motion was gradually restored, first passively and then actively. The results in thirty-one knees and twenty-eight elbows treated with these devices were encouraging after follow-ups of one to six years.

Adolescent↗
PubMedDate not supplied

Valgus-lateralization osteotomy: notes on surgery.

There are specific forms of nonunion secondary to per-inter-subtrochanteric fractures that make surgical planning a critical phase. In cases such as these, it may be useful to transform the center of the nonunion into an osteotomy plane. Because of the anatomotopographical features, course and progression of the lesion, cases such as these constitute a pathology that is difficult to define in terms of a therapeutic protocol. The authors report the surgical technique used in 4 cases of nonunion of the proximal metaphysis of the femur.

Adult↗
PubMed2003

[Treatment of intertrochanteric fractures of the femur with Ender nails in patients over the age of 65 years].

OBJECTIVES: We evaluated the results of treatment with Ender nails in intertrochanteric fractures of the femur in patients exceeding the age of 65 years. METHODS: Thirty-three patients (18 women, 15 men; mean age 78 years; range 65 to 98 years) were treated with Ender nails for non-pathological fractures of the intertrochanteric part of the femur. The right hips were involved in 17 patients and the left in 15 patients. One patient had bilateral involvement. Serious complicating diseases existed including cardiovascular disease (n=12), pulmonary disease (n=11), and others (n=10) such as diabetes mellitus. According to the Evans-Jensen classification, there were 14 type 1, five type 2, four type 3, four type 4, and seven type 5 fractures. The mean follow-up was 20 months (range 5 to 78 months). RESULTS: The mean length of hospital stay was 15 days (range 9 to 18 days). Mortality was encountered in 10 patients (30.3%) within the first postoperative year, two of whom (6%) died during hospitalization. Twelve patients were alive on final follow-ups, of these eight patients were ambulatory without any significant problem. Postoperatively, one patient developed electrolyte imbalance, and another had urinary infection. Due to migration problems, one of the three nails had to be removed in the early period in one patient, and all nails in five patients after the union was obtained. Union was obtained in all patients within a mean of eight weeks (range 6 to 18 weeks). CONCLUSION: Ender nailing may be appropriate in stable, non-displaced intertrochanteric fractures in the elderly, as it is associated with lower mortality in the early period.

Aged↗
PubMed1992

[Results of repositioning osteotomies in delayed healing or pseudarthrosis of the proximal femur].

The results after valgus osteotomy for delayed or nonunion in 20 patients with femoral neck fractures (9 Pauwels type II and 11 type III) and 10 intertrochanteric fractures are reported. The mean age of the patients at presentation with delayed/nonunion of femoral neck fractures and intertrochanteric fractures was 37.5 and 60 years, respectively. The average interval between injury and valgus osteotomy in the first and second group was 8 and 13 months, respectively. The average size of the preoperatively determined and intraoperatively removed wedge was 30 degrees in both groups. The results of the two fracture groups were analyzed separately. All but one osteotomy in a patient with a nonunion of a femoral neck fracture consolidated without complications. This case developed a nonunion at the osteotomy and required additional surgery consisting of bone graft and refixation to heal. Of the femoral neck delayed/nonunion cases, 15 (75%) healed immediately following valgus osteotomy. In the intertrochanteric delayed/nonunion patients, valgus osteotomy led directly to bone consolidation in 6 (60%). In each fracture group 3 additional cases healed following reoperation for a total consolidation rate of 90%. In the femoral neck group one union was complicated by infection, resulting in ankylosis of the hip and 3.5 years later another patient with a revascularized femoral head required total hip arthroplasty because of a large, loose osteochondral fragment. In two cases union of the former femoral neck fracture could not be achieved. Partial avascular necrosis determined the course and total hip arthroplasty was required for both cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Subtrochanteric nonunion of the femur.

Nonunion of the subtrochanteric region is usually secondary to incorrect surgical treatment. The main cause of failed osteosynthesis is related to interruption of the medial cortex of the femur. Either a closed method, with intramedullary nailing, or an open method, using cortical osteosynthesis and opposing bone graft, may be used to treat the pathology. Surgery differs depending on the instrumentation used for the initial treatment of the fracture. A total of 8 cases of intra- and subtrochanteric nonunion with intramedullary nailing and cortical osteosynthesis are reported.

Aged↗
PubMed1991

Subtrochanteric femur fractures: a comparison of the Zickel nail, 95 degrees blade plate, and interlocking nail.

Seventy-nine nonconsecutive patients with subtrochanteric femur fractures were divided into three groups based on the method of fracture fixation. Group I consisted of 21 patients treated with a Zickel nail, Group II comprised 25 patients treated with a 95 degrees blade plate, and Group III included 33 patients treated with an interlocking nail. All patients in Group I and Group II had open reduction and internal fixation of their fractures. Ninety-four percent of the patients in Group III were treated by closed intramedullary nailing. The average operating times for Groups I, II, and III were 212, 272, and 181 min, respectively, while blood loss averaged 900, 1,500, and 600 ml for each group, respectively. Group I had one infection, ten malunions, and one nonunion. Group II had one infection, six malunions, and two nonunions. Group III had no infections, two malunions, and one nonunion. We conclude that closed interlocking nailing is the treatment of choice for acute nonpathologic subtrochanteric femur fractures in adults. There is decreased blood loss, reduced operating time, and fewer complications than with either the Zickel nail or the 95 degrees blade plate regardless of the fracture pattern or the degree of fracture comminution.

Adult↗
PubMed1991

Total hip arthroplasty following failed internal fixation of hip fractures.

A retrospective review was performed on 27 consecutive patients with total hip arthroplasty (THA) following failure of internal fixation of fractures of the proximal femur. The results were comparable to primary THA in femoral neck fractures. Considerably less satisfactory results were obtained in THA in intertrochanteric fractures. Bone loss and medial displacement of the femoral shaft led to high incidence of intraoperative complications and postoperative dislocations. Extreme care must be taken to avoid fracture and penetration of the femoral shaft. Autograft, allograft, or head and neck replacement components should be available for reconstruction of the difficult cases.

Adult↗
PubMed1990

[Stable fixation after extra-articular surgical operations on the proximal segment of the femur].

The authors consider the principal extraarticular palliative surgical interventions on the proximal part of the femur: operations after McMurray and Schantz. Their aims, the main indications and the clinical results are determined taking into consideration the use of various methods of immobilization. The paper is based on the findings of investigations into the long-term results of the treatment in 90 patients after the Schantz operation and in 113 patients after the McMurray operation. A direct connection between the clinical results and the methods of postoperative stabilization of the bone fragments has been established.

Casts, Surgical↗
PubMed1990

[Experience with using polymer-metal endoprosthesis in the treatment of medial fractures of the femur neck in elderly patients].

The author analyses his experience in using polymer metalic endoprostheses in 36 patients with medial fractures and false joints of the femoral neck in the elderly persons. The average age of the patients operated was 74 years. The head and the neck of the endoprosthesis were made of polymer: polyamide-12 and its limb was made of metal: titan BT-5. The immediate and the long-term results (6 months to 10 years) have been studied. The functional results of endoprosthetics were good in 27 cases (81.8%), satisfactory in 4 cases (12.2%) and bad in 2 cases (6%). Using polymer (polyamide-12) as a construction material for endoprostheses contributes to a softer transmission of the efforts and stresses from the articular cartilage to the subchondral and remote parts of the skeleton and improves the restoration of the biomechanical equilibrium between the endoprosthesis and the bone structure.

Age Factors↗
PubMed1989

Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate.

The results were retrospectively analyzed of 47 subtrochanteric fractures of the femur treated with a 95 degrees condylar blade-plate to establish whether two different surgical techniques yielded different results. Before 1981, treatment consisted of extensive visualization of the fracture lines, permitting anatomic reduction of all fragments, stable internal fixation with the blade-plate, and optional autologous bone grafting as recommended by the AO group. Twenty-four fractures were treated accordingly and constituted Group I of this study. In 1981, visualization of the fracture lines was abandoned, especially at the medial cortex; an indirect reduction technique was used to gain optimal alignment and stability without aiming at anatomic reduction, and bone grafting was discontinued. Twenty-three patients were treated accordingly and constituted Group II. The use of prophylactic antibiotics as a routine for all major trauma was instituted at the time the surgical technique was changed. Thus, only two of the 24 patients in Group I received antibiotics as opposed to 20 of the 23 patients in Group II. Average time to bony union for those fractures that healed primarily was 5.4 months in Group I and 4.2 months in Group II. Delayed or nonunion was 16.6% in Group I and 0% in Group II, and the infection rate was 20.8% versus 0% in the two groups. The four cases with a delayed union were aseptic, but three of the four nonunions were infected. The functional end result was comparable for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗