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PubMed1981

Distal femoral fractures, results of operative treatment.

In the period from 1974 to 1980 35 patients with distal femoral fractures were treated operatively by internal fixation using AO-methods with functional aftertreatment. There were four local complications. The results in a completely documented group of 24 patients are discussed. Our experiences confirm that condylar plate fixation with functional aftertreatment as developed by the Swiss AO-group has virtually solved the technical problems associated with the simpler mono-, inter- and supracondylar fractures. Even in shattered comminuted fractures with severe damage to soft tissues and articular cartilage the ultimate results were generally good.

Adolescent↗
PubMed1997

The effect of a femoral fracture on concomitant closed head injury in patients with multiple injuries.

OBJECTIVE: We sought to determine the effect of a femoral shaft fracture, and its treatment by early intramedullary nailing, on the neurologic outcome of patients with multiple injuries with a concomitant head injury. DESIGN: Retrospective, case-control design using a prospectively gathered trauma data base. MATERIALS AND METHODS: We identified 46 patients with multiple injuries (mean Injury Severity Score [ISS] = 33.2) with closed head injuries (mean Glasgow Coma Scale [GCS] score = 7.8) and femur fractures, and matched as controls 99 patients with multiple injuries with head injuries but without femur fractures for age, sex, mechanism of injury, ISS (mean ISS = 34.0), and GCS (mean GCS score = 8.0). Follow-up parameters examined included early mortality, length of hospital or intensive-care unit stay, neuropsychological testing, and level of neurologic disability. RESULTS: There were no significant differences in the demographics or injury parameters between the study and control groups. There were no significant differences between the two groups in terms of early mortality (study group, 28%; control group, 27%; p = not significant), length of hospital/intensive-care unit stay (study group, 17.5/6.9 days; control group, 18.0/6.3 days; p = not significant), level of neurologic disability, or results of cognitive testing. CONCLUSION: Our study suggests that a femoral fracture in a patient with a concomitant head injury does not increase mortality or neurologic disability, and supports the continued early intramedullary nailing of femoral fractures for these patients.

Adolescent↗
PubMed2003

Fixation of femoral fractures in multiple-injury patients with combined chest and head injuries.

BACKGROUND: The purpose of the present paper was to study the effects of a femoral shaft fracture and its early stabilization on the morbidity, mortality, and outcome of multiple-injury patients with combined blunt head and chest trauma. The clinical course of patients was analysed using a prospectively gathered data base. METHODS: Out of 352 multitrauma patients, from September 1992 to June 2000, we identified 28 patients with combined blunt chest and head trauma (abbreviated injury scale >/= 2) and a femoral fracture as the study group. A total of 120 patients with combined chest and head trauma but without femoral fracture formed the control group. Parameters examined included injury severity, injury pattern, haemodynamics at admission, mortality, duration of ventilation, length of stay in intensive care unit, and outcome. RESULTS: There were no significant differences regarding the demographics and injury severity (injury severity score) between the two groups. No significant differences were found in terms of mortality, duration of ventilation\intensive care unit stay and outcome. Injury severity (P < 0.0001), age (P = 0.0153), and haemodynamics at admission (P = 0.0036) were shown to have a significant effect on mortality and outcome. Injury severity (P < 0.0001) and age (P = 0.017) had a significant effect on the duration of ventilation\intensive care unit stay. CONCLUSIONS: The present study suggests that a femoral shaft fracture and its early stabilization in a multitrauma patient with combined chest and head injury do not adversely affect mortality and outcome and supports aggressive surgical management for these patients.

Adolescent↗
PubMed2003

[Ipsilateral femoral fracture and anterior hip dislocation in a 15-year-old girl: case report].

Operative management of concomitant ipsilateral femur fracture and anterior hip dislocation has not been previously described in the literature. We report the case of a 15-years-old girl who was injured in a motorcycle accident and presented with a femoral shaft fracture and a concomitant ipsilateral anterior hip dislocation. Operative management consisted of an attempted closed reduction of the femoral fracture, which was unsuccessful; thus, an external fixator was temporarily applied. Subsequently, the hip dislocation was treated by open reduction through an anterolateral approach. Finally, the femoral fracture was securely stabilized using an unreamed femoral intramedullary nail. The postoperative course was uneventful. MRI follow-up after 6 weeks did not reveal any sign of mangled vascularization of the femoral head and radiographs demonstrated normal bony healing of the shaft fracture. Due to the fact that there is no definitive surgical strategy for this rare combination of injuries, concomitant ipsilateral femoral fracture and anterior hip dislocation is an interesting and challenging situation for the trauma surgeon which requires a subtle and exact surgical technique in order to achieve satisfying results.

Aged↗
PubMed1981

Closed femoral fractures: why not simple traction?

A study was conducted to evaluate the result of treating closed fractures of the femoral shaft by simple traction in a busy General Hospital with a view to reducing some of te complications experienced in conventional traction splintage devices and to obtaining early discharge from hospital. Functional bracing was used when possible for fractures in the middle of the shaft. Over a two-year-period 45 patients were studied. The preliminary findings indicate that simple skeletal traction applied to fractures of the shaft of the femur gives satisfactory results, reduces the complications of conventional management in a Thomas's splint and shortens the time in hospital. Supplementary functional bracing applied between the fourth and seventh weeks allows this earlier discharge.

Adolescent↗
PubMed1996

[Treatment of femoral fractures on a total hip prosthesis using Charnley's "long stem" prosthesis. Apropos of 18 cases].

PURPOSE OF THE STUDY: This study was performed to analyse the clinical and radiological results obtained after the treatment of femoral fractures after total hip arthroplasties by a Charnley's extra long-stem prosthesis, and to compare these results with those obtained by alternative treatments proposed by various authors. MATERIALS: 18 patients, whose mean age was 68.5 years (extremes: 45 to 86 years). Cooke and Newman fractures classification showed a clear prominence of type III. In 8 cases we found a femoral loosening, prior to the fracture, divided as follows: 4 in grade III and 4 in grade IV, using Vives classification. Type I fractures were always associated to complete femoral loosening. METHOD: Clinical results were analysed by Merle d'Aubigné's scoring system, giving a pre-fracture global score of 13.5. Post-operative radiological analysis was made on the appearance of femoral radiolucent lines and/or modification of the femoral implant. RESULTS: 17 patients were followed, with a mean of 5 years (extremes: 1 to 14 years). Consolidation was always obtained. The global mean functional results were of 15.2, with score improvement, essentially, of soreness and stability. We found 12 good and very good results, 4 poor and 1 bad. Age (< 75 years) and fracture type (II and III) appeared to be important factors influencing the functional result, contrary to the lesional mechanism. 6 non-evolutive bone-cement radiolucent lines appeared, in immediate post-operative phase. One cement-prosthesis radiolucent line appeared later, leading to loosening and rupture of the implant. We deplore 3 stem twistings, of which only one led to implant rupture. Walking with support was possible at the 5th postoperative days. DISCUSSION: Our functional results are encouraging (12 good results, i.e. 71 per cent), compared with other treatments. This technique improved the global functional score. This is due to the simultaneous treatment of the fracture and of the eventual pre-traumatic associated femoral loosening. The technique allows a quick resumption of autonomy, a short hospitalization time for these elderly patients. The main disadvantage of the orthopaedic treatment is the prolonged decubitus and the important risk of secondary loosening. Osteosynthesis by plate has the advantage of keeping a maximum of osseous stock, but delays weight bearing, favours the non union by a large loss of periosteum. It never permits the treatment of the associated loosening during the same operation. It is also at the origin of a cement weakening, while fixing the proximal screws, leading to the difficulty of placing the prosthesis. Major disadvantage of proposed method is the use of a high quantity of cement to ensure stability of the implants; but this has never had negative consequences in our study. CONCLUSION: This surgical technique seems to be a satisfying alternative to the treatment of femoral fractures on total hip arthroplasty, due to the advantages obtained. It is reserved for elderly patients. However, these findings should be taken with caution, due to our small series.

Aged↗
PubMed1995

[Treatment of supracondylar femoral fracture proximal to a knee joint endoprosthesis by retrograde interlocking nailing].

A case of a supracondylar femoral fracture proximal to a total knee prosthesis is reported. This difficult fracture was managed with retrograde intramedullary locked nailing. The time to union was 6 weeks. Cancellous bone grafting was not necessary. At final follow up the patient had a knee score of 90 and a functional score of 80 points. This was equal to the result after joint replacement prior to the injury.

Aged↗
PubMed1994

Parallel Garden screws for intracapsular femoral fractures.

One hundred and eight-five patients with an intracapsular femoral fracture were prospectively studied and followed up until 1 year after injury. All patients were treated by fixation with parallel Garden screws. Fracture union occurred in 82 per cent of patients. Non-union was more frequent in displaced fractures, when the reduction was inadequate and when the screws were placed superiorly or anteriorly in the femoral head. Neither age nor sex were significantly associated with non-union.

Adult↗
PubMed2000

[Risks and results after simultaneous intramedullary nailing in bilateral femoral fractures: a retrospective study of 40 cases].

PURPOSE OF THE STUDY: A retrospective series of 40 patients who underwent simultaneous intramedullary nailings for bilateral femoral shaft fractures was analyzed. The aim of our study was to verify that simultaneous nailing without reaming does not increased risk of fat embolism and to assess clinical and radiological outcome. MATERIAL AND METHOD: This series included 27 men and 13 women, mean age 27.8 years, who underwent first intention intramedullary nailing between 1986 and February 1999. Thirty-two patients had multiple fractures. Mean ISS was 23 (range 9 to 59). Among the 80 femoral shaft fractures, 15 were open fractures, 3 were associated with sciatic paralysis, and 4 were complicated by an interruption of the femoral vessels. The AO classification was: type A=44; type B=25; type C=11. Mean delay to simultaneous centromedullary nailing was 3. 8 days: surgery was performed on the day of arrival for 25 patients. General anesthesia was used in all cases with respiratory assistance (FIO(2) =50 to 100 p. 100). Mean nail diameter was 11.6 (range 10-14). Gurd criteria and PaO(2) were followed to assess pulmonary function. Clinical and radiological outcome was assessed using the modified Thorensen criteria. RESULTS: Preoperatively, PaO(2) was< 87 mmHg in 8 patients. Four of these patients showed a discrete drop off and three improved well above the normal level. Only one patient experienced an important decrease but did not develop respiratory distress. Among the 32 patients with a normal level preoperatively, PaO(2) remained in the normal range in 18, fell to a limit level but below 87 mmHg in 4, and showed a substantial drop off of 46 to 172 mmHg in 10. Two of these 10 patients developed respiratory distress due to fat embolism which was fatal in one case. One other patient died in the immediate postoperative period of an undetermined cause. All of the other patients recovered normal gas levels within a few hours or days. There were four cases of phlebitis, including one with pulmonary embolism, one case of respiratory distress by pulmonary superinfection, and one case of septicemia. Both femoral fracture sites became infected in one patient. Malunion occurred in two cases. Two vascular repairs of the femoropopliteal axis were unsuccessful, leading to above knee amputations. Thirty-four patients have been examined after a minimal 12 months follow-up (mean 30 months). Outcome was excellent for 48 femurs, good for 10 and fair for 10. DISCUSSION: This continuous series of simultaneous bilateral femoral shaft intramedullary nailings appears to be the only such report to date. The clinical and radiological outcomes were comparable with those achieved in one-side femoral fractures. The risk of fat embolism is inevitable after long bone fractures. Many factors favoring the risk are recognized, the most important being delay to fixation. Reaming creates excessive pressure in the medullary canal and could thus contribute to the risk. The presence of an associated chest trauma is not a formal contraindication if effective hematosis is preserved as evidenced by the blood gases. CONCLUSION: Simultaneous nailing of bilateral femoral shaft fractures can be performed if blood gases remain acceptable and minimal reaming is used.

Adolescent↗
PubMed1993

[Distal femoral fractures treated by external fixation with Orthofix].

In the period from November 1987 to March 1990 17 supracondylar femoral fractures were treated a.m. Orthofix at the orthopaedic departments in Roskilde and Køge, Denmark. The fractures were classified according to Müller et al. There were 13 in group 2A and four in group 3A. In 16 cases the fractures occurred after minimal trauma. Time of operation was 55 minutes (30-150). The patients were fully mobilized after 16 days. The dynamizising procedure took place after six weeks, and the fixator was removed when the fracture was healed after 11 weeks. According to Neer's scoring system the results were good or excellent in 12 cases, and fair on one case. In all patients we found solid bony union. In seven cases we found pin infection. It was not necessary to operate because of the infection in any of these cases. Four cases were complicated with dislocation of the fracture because of bad locking at the ball joint of the fixator. We find this method easy to use in contrast to traditional osteosynthesis. The patients are quickly mobilized. It is easy to correct the fracture and the method gives solid bony healing.

External Fixators↗
PubMed2000

[Perioperative treatment of a patient with hereditary angioedema (HAE) in a case of a young patient with osteosynthesis from a femoral fracture].

The following case report describes hereditary angioedema (HAE) in a juvenile male patient presenting with femoral fracture. The clinical characteristics, pathophysiological changes, diagnostics and management of anaesthesia for patients with hereditary angioedema will be discussed. Hereditary angioedema (HAE) is a rare autosomal dominant disorder, which is caused by congenital deficiency of functional C1-inhibitor (C1-INH). Patients are suffering from episodic and painless edema of the skin (face and limbs) and mucous membranes of the respiratory and gastrointestinal tracts (the latter causing abdominal cramps due to edema of the intestine). Life-threatening airway obstruction may occur when patients develop laryngeal edema. It is important to differentiate HAE from the more frequent allergic angioedema because of differences in the pharmacological treatment of acute attacks of HAE. C1-INH-concentrate is effective in both treatment of acute attacks and prevention of edema, especially in children, juveniles and young women.

Adolescent↗
PubMed1988

Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins.

One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.

Adult↗
PubMed1985

[Proximal femoral fractures in cats and dogs].

Fractures of the femoral head, neck and greater trochanter including physeal separations are common in the growing dog and cat. These lesions are discussed and illustrated from the standpoints of the anatomy and pathophysiology, etiology, diagnosis and surgical therapy. The prognosis is favorable under the conditions of early anatomical reduction, gentle tissue handling to preserve the blood supply and stable internal fixation. Persistent avascular necrosis of the femoral head as seen in human patients does not appear as a complication in small animals. This review is based on 235 internal fixations out of which 145 are reevaluated clinically as well as radiographically.

Animals↗