PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “FEMORAL FRACTURES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed1990

Insertional femoral fracture: a biomechanical study of femoral component stability.

A Taperloc femoral component (Biomet Inc, Warsaw, IN) was implanted in seven fresh-frozen cadaver femora. In loads simulating single-leg stance and stair climbing, axial and rotational stability were tested before fracture, after fracture, and after fracture but with the addition of A-O cerclage wire fixation. All fractures were incomplete, began proximally at the anteromedial neck, and extended distally. More than 90% of the components showed decreased axial and rotational stability after fracture. The addition of cerclage wire fixation after femoral fracture provided acceptable axial stability in only three of seven femora and rotational stability in five of seven femora. In order to provide satisfactory initial implant stability after femoral fracture, improved methods of fixation and longer stemmed implants may be necessary.

Cadaver↗
PubMed2003

Less invasive stabilization system (LISS) in the treatment of distal femoral fractures.

The treatment of distal femoral fractures has been associated with a high rate of complications for a long time. Although implants and surgical techniques have improved, plate osteosynthesis and intramedullary nailing have been accompanied by a high occurrence of infection, non-union and malalignment. The treatment of soft tissue envelopes using "biological" osteosynthesis and minimally invasive approaches has resulted in a decrease in complication rates and ultimately led to the concept of the less invasive stabilization system (LISS). This is an extramedullary-applied, internal fixator shaped according to the implantation site anatomy, with minimal invasiveness. The purpose of this study was to present this new surgical technique and draw attention to its advantages and importance. Although this is not a scientific paper, we hope to provide enough evidence of the LISS usefulness. The main LISS components include multiple-fixed angle screws and an insertion handle for submuscular sliding of a fixator and placement of percutaneous, self-drilling, unicortical screws for fixation of the diaphyseal fracture fragments. The LISS has been designed to preserve periosteal perfusion and to facilitate a minimally invasive application. Since the first implantation of the LISS, only a few studies have been published on its use in treatment of distal femoral fractures. The rate of infection has been low, ranging from 0 to 4%. The rate of delayed union has been between 2.4 and 6.1%, but delayed unions do not necessarily lead to secondary bone grafting or repeat osteosynthesis as the LISS has a high and lasting stability. When the LISS is used, bone grafting is rarely necessary (0 to 1.6% in primary and 0 to 5% in secondary grafting). Also implant failure differs from the failure of plate osteosynthesis because, with the use of LISS, no screw loosening or secondary malalignment occurs. Implant failures (up to 7.4%) were recorded particularly at the time of LISS introduction in surgical practice and were attributed to the technique of implantation rather than to the implant itself. Good treatment outcomes have been reported. The average knee flexion has been 103 degrees and 107 degrees. In 72.5% of the patients, flexion has been more than 90 degrees and an extension lag of > or = 10 degrees has been found in only 7.5% of all cases. The average Neer score has ranged from 73.9 to 77.2 points. In conclusion, the LISS is a useful implant for treatment of distal femoral fractures, especially when bone quality is poor. Infection, delayed union and non-union rates are low, as shown by yet unpublished data from our clinic. Primary bone grafting, which is rarely necessary with this system, is carried out only when there is a great bone loss. Implant failure, such as screw loosening or secondary malalignment, is not seen.

Adult↗
PubMed1994

Staging of healing of femoral fractures in children.

Although the rate of fracture healing has been studied in adults, little such work has been done in children. The authors' objective was to develop staging criteria for assessing callus formation in fractures in children and to determine the relation between the age and sex of the patient and callus formation. They studied callus formation in healing fractures of the femoral diaphysis in 25 patients, 15 boys and 10 girls, ranging in age from birth to 14 years. The patients were selected on a random basis from children presenting with femoral fractures (and no other injuries) to a tertiary-care pediatric hospital in Winnipeg over the period 1988 to 1991. The following staging criteria were developed from other examples of femoral fracture: stage 1, earliest radiographically visible calcification of the callus; stage 2, callus completely bridging the fracture site; and stage 3, mature callus. For the patients in the study, the average times to reach stages 1, 2 and 3 were 11.7, 18.7 and 55.3 days respectively. The sex of the patient had no effect on callus formation. The final stage of healing appeared to take longer with increasing patient age, although this observation was not statistically significant.

Adolescent↗
PubMed2006

Pediatric femoral fractures: a systematic review of 2422 cases.

BACKGROUND: The incidence of femoral fractures in children comprise 20 per 100,000 yearly in the United States and Europe. The treatment of femoral shaft fractures in the pediatric population remains controversial. The child's age often directs the management. Nonoperative treatment options include functional treatment for the very young, Pavlic harness, skin or skeletal traction, and spica casting. Operative treatment options include closed reduction and external fixation, open reduction and internal plate fixation, closed reduction and minimally invasive plate osteosynthesis (MIPO), and closed reduction and intramedullary nailing with either flexible or rigid nails. The effect of operative versus nonoperative treatment has been the focus of several comparative studies. OBJECTIVE: To determine the effect of different treatment options on the rate of union, malunion, leg-length discrepancy (LLD), complications, and outcome after femoral shaft fractures in children.

Adolescent↗
PubMed2002

Perioperative fluid volume optimization following proximal femoral fracture.

BACKGROUND: Proximal Femoral Fracture (PFF) or 'hip fracture' is a frequent injury, and adverse outcomes are common. Many patients are elderly, with significant comorbidity. Several factors suggest the importance of developing appropriate techniques to optimize intravascular fluid volume. These may include protocols that enhance the efficacy of clinicians' assessments, invasive techniques such as oesophageal Doppler or central venous pressure monitoring, or advanced non-invasive techniques such as plethysmographic pulse volume determination. OBJECTIVES: To determine the optimal method of fluid volume optimization for adult patients undergoing surgical repair of hip fracture. Comparisons of fluid types (e.g. crystalloid vs. colloid) or of blood transfusion strategies or of other pharmacological interventions (e.g. inotropes) are not considered in this review. SEARCH STRATEGY: Randomized controlled trials (RCTs) since 1985 were identified by searching MEDLINE, EMBASE, the Cochrane Library, the Cochrane Anaesthesia Group's specialized Controlled Trials Register and bibliographies of retrieved articles. Relevant journals and conference proceedings were handsearched. SELECTION CRITERIA: RCTs comparing a fluid optimization intervention with normal practice (control) or with another fluid optimization intervention, in patients following PFF undergoing surgery of any type under anaesthesia of any type. DATA COLLECTION AND ANALYSIS: Searches and exclusion of clearly irrelevant articles were performed by one reviewer. Two reviewers examined independently the remaining studies, extracting study quality and results data. A wide range of short- and long-term outcome data was sought. Study quality was assessed using a ten-point instrument and studies were excluded if they did not meet the study criteria or if results were likely to be biased. Due to a lack of consistency in reporting, combination of data was not generally possible. MAIN RESULTS: Searches identified only four trials, of which two studies, randomizing a total of 130 patients, were of adequate quality and addressed the review question. Both studies were of invasive advanced haemodynamic monitoring during the intraoperative period only. One study randomized patients to 'normal care' or optimization using oesophageal Doppler; the second study randomized patients to 'normal care', oesophageal Doppler or central venous pressure monitoring. In each study, invasive monitoring led to a significant increase in volume of fluid infused and a reduction in length of hospital stay. The pooled Peto odds ratio for in-hospital fatality was 1.44 (95% confidence interval 0.45-4.62). Neither study followed patients beyond hospital discharge or assessed functional outcomes (for example return to previous accommodation). No serious complications were reported to be directly attributable to the monitoring interventions. There were no studies of protocol-guided fluid optimization or of advanced non-invasive techniques. REVIEWER'S CONCLUSIONS: Invasive methods of fluid optimization during surgery may shorten hospital stay, but their effects on other important, patient-centred, longer-term outcomes are uncertain. An adverse effect on fatality cannot be excluded. Other fluid optimization techniques have not been evaluated. The lack of randomized studies of adequate quality addressing this important question is disappointing given the high incidence and frequently adverse outcome of PFF. More research is needed.

Blood Volume↗
PubMed2002

Surgical management of pediatric femoral fractures.

In contrast to adult femoral fractures, there are many ways to treat a child's femoral fracture. The differences mainly involve ease of postoperative care and small rates of various complications. The surgeon should be familiar with at least one of the options for each age range and be adept at performing them to provide the best care for children of all ages.

Adolescent↗
PubMedDate not supplied

Femoral fracture in children (a prospective study of two hundred and four fractures).

A PROSPECTIVE study of 204 femoral fractures in 200 children admitted continuously to a single surgical unit during a period of two years (1979-81), was carried out to determine the adverse effects on the overall outcome of treatment, due to lack of standard orthopaedic equipment to apply low friction traction. There was no case of fracture of the femoral neck, confirming its rarity in children. Left femur was fractured more than the right and middle third shaft was the commonest site. Spiral type of fracture was more common than the transverse or oblique type. Thirty percent of fractures were due to the Road Traffic Accidents while sport injuries were almost the same in number. 32 percent of total cases had other associated injuries, where skull fractures headed the list. To our satisfaction there was no death in this series. The stay in hospital for various different groups ranged from 21 days to 36 days. The average follow-up was 10 months (range 6 months to 2 years). All femoral fractures united and the only noteworthy complications was in two patients at the end of two years, who had residual shortening of upto 1.2 centimetres. The absence of longitudinal overgrowth in our series (a well known complication) may be due to our failure to maintain adequate reduction of the over-riding fragments probably due to the non-availability of the low friction traction appliances. A malposition of femoral fracture in children, to certain limits, should be left to the Nature's kindly help of remodelling the younger bones and surgical intervention should be avoided.

Accidents, Traffic↗
PubMed2002

[Mortality in patients with proximal femoral fractures during the first year after the injury].

PURPOSE OF THE STUDY: The authors present an overview of mortality of patients with proximal femur fractures treated at the authors' Department in 1997 in dependence on different factors relating to the preinjury condition and the treatment itself. The aim of the work was to determine the impact of these factors on the risk of mortality and compare the findings with the data published by other authors dealing with the same issue. MATERIAL: In the given year 244 patients with 248 proximal femur fractures, 58 men (24%), 186 women (76%), average age 77 years were treated. There were 115 (47%) fractures of femoral neck, 117 (47%) pertrochanteric fractures and 16 (6%) intertrochanteric (high subtrochanteric) fractures. Thirty-nine fractures (16%) were treated conservatively, internal fixation was performed in 116 fractures (47%), i.e. 6 times by a plate, 94 times by a DHS, 16 times by the Gamma nail, and 93 fractures (37%) were treated by arthroplasty (62 times by hemiarthroplasty and 31 times by total hip arthroplasty). METHODS: The following data was recorded in all patients of the monitored group: age, sex, social environment and physical activities of the patient prior to the injury, mechanism of the injury, type of fracture, surgical risk expressed by the respective class of the ASA score, therapeutic procedure, type of anesthesia and interval between the injury and operation. Recorded was also the number of mortality in the course of primary hospitalisation and one year after the injury or operation. At the end of the one-year monitoring statistical evaluation was made of the relation between mortality and the above mentioned monitored factors and the results were compared with those published in similar types of study. RESULTS: In the period of one year after the injury or operation 85 patients died of the total number of 244 (56 women and 29 men). The number of decreased patients was increasing in individual age decades and the highest number was recorded in case of men in 9th decade (80%) and 10th decade (100%). The lowest number of mortality related to patients who lived with their families prior to the injury (26.5%) and the highest number was in patients from social care institutes (43.8%). Patients with impaired mobility already prior to the injury and not leaving their homes accounted for 46.7% of mortality. In the course of one year after the injury 33.0% died of fracture of femoral neck, 30.7% of pertrochanteric and 35.7% of intertrochanteric (high subtrochanteric) fracture. Dependence of mortality on ASA score was as follows: ASA I-0%, ASA II-4.3%, ASA III-21.3%, ASA IV-42.1%, ASA V-68.9%. The highest number of mortality of operated on patients was in the group treated by hemiarthroplasty (41.1%). After spinal anesthesia 26.6% of patients died within one year and after general anesthesia 26.7% of them. There was an evident increase in the number of mortality in patients operated on in the interval longer than 3 days after the injury. DISCUSSION: The mortality in the followed up group was statistically significantly influenced by the age (p = 0.003), sex (p < 0.01) and ASA score (p < 0.001). This corresponds to the results of other studies. The dependence of mortality on environment and mobility prior to the injury, type of the fracture, type of surgical treatment and type of anesthesia has not been proved. CONCLUSION: Based on the evaluation of the data monitored in the group a conclusion was made that absolute mortality risk in the first year after the injury related to patients with pathological fractures due to metastasis. A higher risk related to male patients older than 80 years with the surgical risk of ASA IV and higher and this risk rate was the highest in the time interval within 3 months after the injury or operation.

Adult↗
PubMed1986

Epidemiology of diaphyseal femoral fracture.

The incidence of diaphyseal femoral fracture in adults, aged 20 years and older, was determined in Stockholm County using hospital admission rates. The validity of the data was investigated by a study of the medical records of a sample of 277 cases and also by determining the incidence in a subpopulation of 139 cases using an alternative method. The incidence decreased from age 20 to middle age after which it increased into old age. The age-related increase was more pronounced in women and in fractures caused by moderate trauma. From 1972 to 1981, the incidence of diaphyseal femoral fracture caused by moderate trauma increased annually by 10 per cent in women aged 75 years and older.

Adult↗
PubMedDate not supplied

Mortality in patients with bilateral femoral fractures.

OBJECTIVES: To determine and compare the mortality rates of patients with bilateral versus unilateral femoral fractures and to determine the contribution of the femoral fracture to, and identify risk factors for, such mortality. STUDY DESIGN: Retrospective analysis using trauma registry data on consecutive blunt trauma patients with unilateral (800 patients, group I) or bilateral (eighty-five patients, group II) femoral fractures. METHODS: Univariate data analysis was performed to compare the groups' ages, Injury Severity Scores, Glasgow Coma Scale values, mortality, and the presence of adult respiratory distress syndrome (ARDS). Logistic regression analysis was performed to determine variables statistically associated with mortality. RESULTS: Group II patients had a significantly higher Injury Severity Score (30.2 versus 24.5, p < 0.001), lower Glasgow Coma Scale value (12.3 versus 13.1, p = 0.05), higher mortality rate (25.9 vs 11.7%, p < 0.001), and higher incidence of ARDS (15.7 versus 7.27%, p = 0.014) than group I patients. Group II patients also had significantly more closed head injuries, open skull fractures, intraabdominal injuries requiring surgical intervention, and pelvic fractures; the rates of thoracic injury were similar. Regression analysis of variables evident on admission revealed a significant correlation between bilateral femoral fractures and death; however, other factors (shock, closed head injury, and thoracic injury) had much stronger correlations with mortality. CONCLUSIONS: Patients with bilateral femoral fractures have a significantly higher risk of death, ARDS, and associated injuries than patients with unilateral femoral fractures. This increase in mortality is more closely related to associated injuries and physiologic parameters than to the presence of bilateral femoral fractures. The presence of bilateral femoral fractures should alert the clinician to the likelihood of associated injuries, a higher Injury Severity Score, and the potential for a more serious prognosis.

Adult↗
PubMed1992

A preliminary experience with the Russell-Taylor reconstruction nail for complex femoral fractures.

Eleven cases of complex femoral fractures were seen from November 1987 to November 1989; five ipsilateral femoral neck and shaft fractures and six comminuted subtrochanteric fractures. High-energy accidents accounted for most of these injuries. There were numerous associated injuries, many requiring operative procedures. All of the fractures were treated with Russell-Taylor reconstruction nails. All fractures united, but there were two delayed unions. There was no delay in diagnosis of the femoral neck fractures, and all healed without avascular necrosis. Malalignment occurred in one case, shortening of the femur occurred in two cases, and in two cases only one screw could be placed in the femoral head. In three patients technical errors related to nail insertion led to fracture complications. The use of the Russell-Taylor reconstruction nail is technically demanding. However, we conclude that in complex femoral fractures, this device offers superior stabilization over other currently used methods of internal fixation.

Adult↗
PubMed1987

Locked flexible intramedullary nails in treatment of unstable femoral fractures.

Twenty patients with unstable femoral fractures were treated with distally locked flexible intramedullary nails. We present our surgical technique and our results. The method has the following advantages: it prevents rotational malalignment and shortening, it is a closed procedure, no reaming is necessary, there is no increase in c-arm time, and there is minimal increase in operative time. Locked flexible intramedullary nails should be used in patients with unstable femoral fractures who have dense metaphyseal bone. Osteopoenia is a contraindication to this method as it increases the risk of nail penetration into the hip.

Adolescent↗
PubMed2005

[New osteosynthesis techniques for the treatment of distal femoral fractures].

The treatment of distal femoral fractures was for a long-time associated with high complication rates. Although implants and surgical techniques were improved, plate osteosynthesis and intramedullary nailing suffered from considerable rates of infection, non-union und malalignment. Attention to the soft tissue envelope by "biological" osteosynthesis and minimally invasive approaches resulted in decreased complication rates. Out of this movement grew the concept of minimal invasive plating with an internal fixator -- the LISS-DF (Less Invasive Stabilization System -- Distal Femur) -- and the retrograde nailing concept. This article should give a review about these two new techniques for the treatment of distal femoral fractures. Indications, the clinical use and the aftercare will be discussed.

Bone Plates↗
PubMed2000

Risk factors for intraoperative femoral fractures during total hip replacement.

BACKGROUND AND AIMS: Intraoperative femoral fractures are a serious complication of total hip replacement. The purpose of this study was to evaluate the risk factors of intraoperative femoral fractures in a retrospective analysis of a series of 3,566 total hip replacements. MATERIALS AND METHODS: The patients were divided into two groups, A and B. Group A patients had no intraoperative femoral fractures and Group B patients had intraoperative femoral fractures. In Group A there were 3,483 patients (97.7%) and in Group B, 83 (2.3%). The following potential risk factors were evaluated: sex, age, diagnosis, previous surgery at the homolateral hip, surgical approach, fixation type of the femoral component, prosthesis type, surgical stage during which the fracture occurred, and the lead operating surgeon. RESULTS: The fracture incidence was higher in females (p < 0.005) in uncemented femoral components (p = 0.005), in patients who had previous surgery at the homolateral hip (p < 0.005), and in revision surgery (p < 0.005). CONCLUSION: The analysis of intraoperative femoral fracture risk factors should allow the surgeon to improve the surgical performance and therefore reduce the incidence of this severe intraoperative complication.

Adult↗
PubMed2006

Severity of injuries associated with femoral fractures as a result of motor vehicle collisions.

INTRODUCTION: Femoral fractures are often the result of high-velocity injuries, and the early identification of associated injuries is important. The purpose of this study was to review the associated injuries present in a current UK series of patients who sustain femoral fractures as a result of motor vehicle accidents. MATERIALS AND METHODS: All cases of femoral fractures were extracted from the UK co-operative crash injury study (CCIS) database, from 1998 to 2002. Associated injuries, skeletal and non-skeletal, were identified by body region and severity (according to the abbreviated injury scale and injury severity scale). RESULTS: A total of 5,841 crashes were investigated in that time period, and there were 365 car occupants who sustained a femoral fracture. The 16-35 age group accounted for nearly half of all cases. A total of 313 patients (85.2%) had at least one other concomitant significant injury, of which 84 (23.0%) had skeletal injury only, 45 (12.3%) had non-skeletal injury only, and 184 (50.4%) had both. The opposite lower limb was the most common skeletal injury, and thoracic injuries were the most common visceral injuries. Thoracic injuries also accounted for the most serious injuries (AIS 4-6). The overall mortality was 40.5% in our series. CONCLUSION: Concomitant injuries are to be expected in the majority of cases of femoral fractures sustained as a result of MVCs. There should be a low threshold for involving a general surgical team in the management of these cases.

Accidents, Traffic↗
PubMed2005

The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures.

BACKGROUND: Isolated coronal plane fractures of the distal femoral condyles (Hoffa fractures) occur uncommonly, are difficult to diagnose, and may be challenging to treat. The combination of supracondylar distal femoral fractures and these coronal plane fractures is thought to occur rarely. The purposes of the present study were to identify the frequency of the association between supracondylar-intercondylar distal femoral fractures and coronal fractures of the femoral condyle and to describe the radiographic evaluation of these injuries. METHODS: One hundred and eighty-nine patients with 202 supracondylar-intercondylar distal femoral fractures were retrospectively evaluated clinically and radiographically. RESULTS: Coronal plane fractures were diagnosed in association with seventy-seven (38.1%) of the 202 supracondylar-intercondylar distal femoral fractures. Fifty-nine (76.6%) of these coronal fractures involved a single condyle, and eighteen involved both the medial and lateral femoral condyles. Eighty-five percent of the coronal fractures involving a single condyle were located laterally. Patients with an open distal femoral fracture were 2.8 times more likely to have a coronal plane fracture than patients with a closed fracture were (95% confidence interval, 1.54 to 5.25). Coronal plane fractures were diagnosed in 47% of the 102 knees that were evaluated with computerized tomography, compared with 29% of the 100 knees that were not (p = 0.008). Ten coronal plane fractures that had been unrecognized preoperatively were identified only at the time of operative fixation of the distal femoral fracture; none of these fractures occurred in patients who had been evaluated with computerized tomographic scanning preoperatively. CONCLUSIONS: Coronal plane fractures frequently occurred in association with high-energy supracondylar-intercondylar distal femoral fractures; in the present study, the prevalence of associated coronal plane fractures was 38%. The lateral condyle was involved more frequently than the medial condyle was. Coronal plane fractures of both condyles were observed commonly, and the majority of coronal plane fractures were associated with open wounds. Since the surgical tactic for the treatment of a supracondylar-intercondylar distal femoral fracture may be altered by the additional diagnosis of a coronal plane fracture component, preoperative computerized tomographic scanning of the injured distal part of the femur, particularly when there is an associated open wound, is strongly recommended.

Femoral Fractures↗
PubMed1999

Deep infection and fracture healing in immediate and delayed locked intramedullary nailing for open femoral fractures.

Fifty-nine patients with 61 open femoral fractures were treated with immediate locked intramedullary (IM) nailing (group 1; n=15), delayed IM nailing following nonoperative treatment (group 2; n=42), and delayed IM nailing following external fixation (group 3; n=7). Sixteen fractures were Gustilo type I, 28 were type II, 7 were type IIIA, 6 were type IIIB, and 4 were type IIIC open fractures. Four (6.6%) deep infections occurred. Significant differences existed in the deep infection rate (DIR) between types I and II and all type III fractures (2.3% for types I and II versus 17.6% for type III). The deep infection rate did not differ significantly among the nailing groups (13.3%, 2.6%, and 15.3% for groups 1, 2, and 3, respectively), nor did the deep infection rate correlate with the degree of fracture comminution, the existence of polytrauma or polyskeletal trauma, or preexistence of superficial or pin-site infections. Seven (11.7%) of these fractures resulted in nonunion, excluding one secondary amputation; the nonunion rate correlated with fracture location. There were no significant differences in the mean fracture healing times between any of the nailing groups. These results suggest that IM nailing for the treatment of type III open femoral fractures should be considered carefully, regardless of whether it is performed immediately or delayed.

Adolescent↗