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At least 451 records · Page 25Linked to original sources
PubMed1987

Nonunion of intertrochanteric fractures of the femur following open reduction and internal fixation. Results of second attempts to gain union.

A retrospective review was performed on 20 patients treated at the authors' hospital between 1961 and 1981 with noninfected nonunions following primary open reduction and internal fixation (ORIF) of intertrochanteric femoral fractures. All patients were available for follow-up examination. Each patient was interviewed at an average follow-up period of 6.6 (0.8-11.9) years. The group consisted of 15 women and five men with an average age at the time of fracture of 63 (36-86) years. Only one fracture was "stable" while 19 were "unstable" with loss of medial support. The initial fixation device was a sliding nail or screw in four patients, fixed nail plate in 11, Smith-Petersen in two, Deyerle pins in one, and was unrecorded in two. Of the 20 cases, it was possible to obtain the original postoperative roentgenograms in 12. Anatomic reduction had been achieved in four, medial displacement osteotomy had been used in two, varus positioning in one, and valgus positioning in five. Subsequent operative treatment for the nonunions consisted of three endoprostheses, six total hip arthroplasties, and 11 repeated attempts at ORIF. Of those treated with repeat ORIF, nine (82%) achieved radiographic union at an average time of six months. Of the remaining two who did not achieve union with the second ORIF, one achieved union following removal of internal fixation and bone grafting (five months) and one required a total hip arthroplasty. The postoperative functional results, as determined by a modified Harris hip score, were improved over the preoperative functional results for each treatment mode. Functional results were best in those patients who achieved union with a second surgical attempt.

Adult↗
PubMed1987

Subtrochanteric fracture of the femur. Fixation using the Zickel nail.

We divided 131 patients who had a subtrochanteric fracture into four clinical groups: elderly patients who had a fracture secondary to minor trauma, patients who had a fracture due to high-energy trauma, those who had a pathological fracture, and patients who had a fracture that previously had been treated unsuccessfully with internal fixation. In each patient operative fixation was performed using the Zickel device, and overall satisfactory results were obtained in 90 per cent. Considering the challenging nature of subtrochanteric fractures, complications, which included a rate of non-union of approximately 5 per cent, were minimum. Technical details for each of the four groups are emphasized.

Adolescent↗
PubMed1977

8. Self-compressing implants in the management of fractures.

Internal fixation of fractures has become increasingly important since the introduction of self-compressing implants. Rigidity of fixation thus ensured permits primary bone healing. Two types of self-compressing implants are available--screws and plates. The former produces compression between fracture fragments, the latter, along the long axis of the bone. Two common types of plates are the dynamic compression plate and the Osteo self-compressing plate. Use of self-compressing implants requires familiarity with the technique, a definite plan of operation, and strict asepsis and lack of infection in the patient. Indications for the technique include failure or unsuitability of closed reduction of fractures, care of associated serious soft-tissue injuries, and displaced intra-articular fractures. Use of self-compressing plates hastens rehabilitation, lessens joint stiffness and reduces the duration of hospitalization. The incidence of nonunion with self-compression techniques is lower than with traditional methods of fracture management.

Bone Plates↗
PubMed1984

Survey of orthopaedic surgical research in a university center (Linköping).

Since 1969, seven orthopedic dissertations on the following subjects were submitted from the author's hospital. Postoperative use of special elastic bandages and oxyphenbutazone significantly decreased the frequency of thrombosis. Use of a randomized single-blind technique significantly improved chronic cases of lumbago by a new traction treatment called auto-traction. Two control groups were treated by bed rest and analgesics or routine physiotherapy measures. With a new mechanical device for tibial osteotomy, the precision of the angular change was significantly increased. In intracapsular hip fractures treated by Deyerle's technique, only 18% had necrosis of the femoral head after two years. By use of a new radiologic method for determining the stability of tibial fractures it was possible to determine a stability quotient; the quotient established the point at which the fracture could be mobilized without risk of delayed union or pseudarthrosis. In shoulder joint dislocations, three to four weeks of immobilization resulted in a recurrence rate equal to that of ordinary treatment in a sling. In a randomly selected group of people in Sweden, the incidence of shoulder dislocations was 2%. Forty percent of these patients had never seen a doctor. In Colles' fracture, the uptake of radioactive Tc-MDP was significantly increased by treating the fracture with electromagnetic fields. Arthroscopic percutaneous meniscectomies reduced the operation time normally required for an arthrotomy by an average of 30 minutes.

Arthroscopy↗
PubMed1984

Reconstruction of the acetabular wall with bone graft in arthroplasty of the hip.

The fate of autologous bone grafts under a layer of methylmethacrylate cement, previously investigated in dogs, was observed in eight patients. The grafts were incorporated into the acetabular bone within six to ten months. Reinforcement of the inadequate acetabulum with autologous bone graft is necessary in order to withstand the long-term repetitive loading in patients with total hip arthroplasties. Reconstruction of the medial acetabular wall (using autologous bone chips), combined with fixation of the socket with methylmethacrylate, was successful in all eight patients with a follow-up period of two to six years.

Acetabulum↗
PubMed1978

Subtrochanteric fractures of the femur.

The results of treatment of fifty-six patients with subtrochanteric fractures of the femur are presented and a new classification of these fractures is described. In forty-seven fractures treated with internal fixation there were nine failures of fixation. One type of lesion, the three-part spiral subtrochanteric fracture, occurred eighteen times and accounted for eight of the failures of fixation.

Adolescent↗
PubMed1995

Fractures of the proximal part of the femur.

The orthopaedic surgeon has a multitude of internal fixation devices and techniques available for use in the treatment of subtrochanteric fractures of the proximal femur. The successful use of second-generation locking nails is technically demanding. Close attention to positioning of the patient, reduction of the fracture, placement of the guide-wire, and insertion of the nail and of the proximal and distal locking screws is mandatory. The newer, high-strength hip-screws allow good fixation of a fracture that extends into the piriformis fossa. If medial comminution is present, this technique is best performed in conjunction with indirect reduction and bone-grafting. With proper technique, these devices allow the surgeon to manage predictably a complex subtrochanteric fracture that previously had to be treated with traction or extensive dissection and with (frequently inadequate) internal fixation.

Adult↗
PubMedDate not supplied

The results of a multicenter Italian study on the use of the Gamma nail for the treatment of pertrochanteric and subtrochanteric fractures: a review of 1181 cases.

A total of 1147 pertrochanteric and subtrochanteric fractures, 10 delays in consolidation and non-union, 24 pathologic fractures and osteolysis with the risk of fracture, treated with a gamma nail in 17 Italian departments of traumatology, were collected. In 70% of the patients weight-bearing was allowed during the first week postsurgery; 77% of the patients followed-up recovered the same ability to walk that had preceded trauma. Complications included intraoperative (1.8%) and postoperative (1.1%) diaphyseal fractures, cephalic screw cut out (2.2%), and breakage of the nail (0.4%). There were two cases of infection (0.3%). Most of the complications were related to errors in technique. The safest procedure is constituted by the choice of a nail with a thinner caliber, 2 mm diaphyseal over-reaming, insertion of the nail without the use of a hammer, and distal locking; the cephalic screw must always be inserted in the lower portion of the femoral head.

Adult↗
PubMed1994

Fracture through the bone of traumatic myositis ossificans. A report of three cases.

We describe three cases of traumatic myositis ossificans in which fractures occurred through a mature, quiescent ossification mass. None of the fractures reactivated the original pathological process, no callus was formed and union did not occur. The nonunion became painless over a period of months. This unusual late complication of myositis ossificans seems to require only symptomatic treatment by temporary splintage and subsequent mobilisation. We could find no previous report of a similar case.

Adolescent↗
PubMed1993

Intertrochanteric fractures of the femur in rheumatoid arthritis patients.

In a series of 33 intertrochanteric femoral fractures in patients suffering from classic rheumatoid arthritis (RA), the typical patient was about 70 years of age, osteopenic, and severely affected by longstanding polyarticular RA of joints other than the hip. Prefracture involvement of the hip joint (other than osteopenia) was apparent radiographically in only 9.1% of patients. There was a higher rate of avascular necrosis (9.7%) and nonunion (6.5%) than expected in the nonrheumatoid general population. There was also a high rate of secondary displacement. Of three patients with avascular necrosis, two had had corticosteroid treatment.

Aged↗