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PubMed1986

Periprosthetic femoral fractures following total knee arthroplasty.

Supracondylar and distal femoral fractures involving total knee arthroplasties present a relatively new and challenging problem. The alignment of the total knee components prior to and subsequent to the fracture, as well as the patients' range of motion, symptoms, and level of function following their treatment, were investigated in 14 cases. Ten of the patients had nonoperative treatment. Four had had an operative procedure. Osteoporosis, notching of the femur, and revision arthroplasty were identified as predisposing factors with femoral fractures. The results of treatment depended primarily on reduction of varus deformity and/or posterior displacement of the femoral component. Nonoperative treatment was most successful in this regard.

Aged↗

PubMed1997

Total hip arthroplasty for complications of proximal femoral fractures.

OBJECTIVES: To determine problems associated with and to present the results of secondary total hip replacement for complications of proximal femoral fractures. SETTING: An acute care hospital with a prospectively entered database for primary total hip arthroplasty. PATIENTS AND PARTICIPANTS: The prospective database was reviewed to extract all patients undergoing primary total hip replacement for complications of treatment of proximal femoral fractures. These fifty-three patients were then compared with fifty-three patients from the same data bank matched for age, sex, weight, prosthesis type, and length of follow-up but who had not sustained a proximal femoral fracture before total hip replacement. INTERVENTION: Primary total hip arthroplasty for complications of proximal femoral fractures. After the surgical procedure, patients were seen at follow-up intervals of three months and six months and, thereafter, yearly. MAIN OUTCOME MEASUREMENTS: Patients were evaluated using the St. Michael's hip rating scale, which is a scale measuring pain, motion, and function specifically designed for evaluation of total hip arthroplasty. Routine radiographs were obtained at each patient visit. RESULTS: The complications associated with total hip replacement in patients with previous proximal femoral fracture fixation occurred more frequently than in patients who had not had undergone previous fracture fixation; in addition, intraoperative surgical difficulty was significantly greater in those patients who had undergone previous surgery for hip fracture. However, the final hip score at > or = 2 years after total hip arthroplasty was not statistically different between the two patient groups. CONCLUSION: Total hip replacement is a satisfactory salvage procedure for failed fracture treatment despite the increased incidence of operative difficulty and increased incidence of complication.

Aged↗

PubMedDate not supplied

[H3-25-hydroxycholecalciferol metabolism in rats with experimental femoral fractures].

At the 3d day after femoral bone fracture in rats, the concentration of 3H-25-OHD3 injected intraperitoneally 18 h before sacrifice was 25 and 60% higher in the kidneys and small intestinal mucosa, respectively, whereas the incorporation of the label in 1,25(OH)2D3 in the blood serum and small intestinal mucosa was 50 and 70% higher as compared with intact control. The binding of 3H-25-OHD3 in the diaphysis and epiphysis of the fractured bone was 2-3 times as increased at the 3d and 10th days after fracture. A similar but less marked increase in the accumulation of 3H-25-OHD3 was recorded in the paired intact bone of rats with femoral fractures. Incorporation of the label from 3H-25-OHD3 in 1,25(OH)2D3 and 24,25(OH)2D3 in the epiphyses of the fractured bone as well as in the epiphyses and diaphysis of the intact bone of rats with femoral fractures was 1.5-2 times as increased at all the times of the observation period (3, 10, 28 days after fracture).

Animals↗

PubMed1982

[Radiographical and pathohistological study of the femoral neck fractures].

Femoral neck fractures are of great interest for challenging several problems to indicate surgical procedures. Even though ages and general or local conditions of the patient, and types of fracture or some other influencing factors are sufficiently taken into consideration, it is very difficult to foresee the fate of femoral head on the radiogram at the time of injury. This viability of fractured femoral head is the most important factor to choose the method of treatment, but no adequate method of assessing the viability has been established. One hundred and twelve femoral heads removed in the course of endo-prosthetic replacement were examined radiologically and histopathologically to study the factors influencing to the fate of fractured femoral heads. Histological findings of the femoral heads, in particular the extent of necrotic or revascuralized areas on the decalcified section stained with H-E, were compared with radiological findings such as the size or shape of the femoral head, the fracture line, the extent of displacement and osteoporosis or Singh's grade. Several factors which may influence the viability of the fractured femoral head have become clear. The site and direction of fracture line, extent of displacement and destruction of femoral head were thought to be important factors. Medial type of femoral neck fractures could be classified into four groups from a result of this study. They are less displaced, transcervical, crescent shape and severe displaced type. The first two may have a tendency to good revascuralization, and the last two groups to necrosis of the fractured head. This clinical classification is thought to be useful in the treatment of this fracture.

Aged↗

PubMed2002

[Evaluation of functional results following surgical treatment of supracondylar femoral fractures].

OBJECTIVES: We evaluated functional results of patients who underwent surgical treatment for supracondylar femoral fractures. METHODS: Functional results of surgical treatment for supracondylar femoral fractures were evaluated in 23 patients (14 males, 9 females; mean age 34 years; range 14 to 64 years) with the use of the Neer and HSS (The Hospital for Special Surgery) scoring systems. The strength of the quadriceps muscle was measured using Cybex isokinetic testing. The mean follow-up was 52 months (range 13 to 160 months). RESULTS: The average HSS score was 93.8 (range 68 to 100) and the average Neer score was 90.1 (range 55 to 100). The average losses of extension strength at 60 degrees /s and 180 degrees /s were 27.30% and 22.13%, respectively. Statistically significant correlations were found between the losses of extension strength and the Neer and HSS scores (p<0.01). The results showed that the patient's age and sex, the length of time between trauma occurrence and surgery, immobilization period, and the presence of subjective pain complaints had no significant influence on the HSS and Neer scores and on Cybex isokinetic test results (p>0.05). CONCLUSION: Evaluation of the quadriceps muscle strength with the use of objective tests proved helpful in the determination of functional results of surgery following supracondylar femoral fractures.

Adolescent↗

PubMed1996

Femoral fractures: are children at risk for significant blood loss?

OBJECTIVE: To quantify the frequency of blood loss necessitating transfusion and identify the clinical factors predictive of severe hemorrhage in children with femoral fractures. DESIGN: Retrospective review of computerized discharge diagnoses and medical records between January 1, 1987, and July 31, 1992. SETTING: Tertiary care children's hospital. PATIENTS: Children younger than 18 years of age, discharged between January 1, 1987, and July 31, 1992, with a final diagnosis of femur fracture. RESULTS: The 257 patients ranged in age from birth to 18 years with a mean of 6.5 years; 183 (71%) were male. Fractures were closed in 250 (98%) and represented isolated injuries in 225 (87%) patients. The mean systolic blood pressure (SBP) was 119 mmHg, the mean heart rate (HR) was 114 beats/min, and the mean hematocrit (Hct) was 35.2% on arrival. Eight (2.9%) patients had a SBP less than 90 mmHg, all of which were normal values for age. There were 19 patients with a HR > 150, all were < 4 years old with a mean SBP of 110 mmHg and a mean Hct of 35.6%; none required transfusion. There were 18 patients with a Hct < 30%, 4/18 or 22% required transfusion. Seven of the 257 patients (2.7%) received blood transfusions. All were male, with closed fractures, who were older (11.7 +/- 4.9 vs 6.3 +/- 4.7 years) than the 250 nontransfused patients (P = 0.004). There were no significant differences in presenting vital signs, Hct, type of fracture, or time required to get to the emergency department. Five of the seven transfused patients presented with a Hct < 30% as compared to 13 of the 250 nontransfused patients (P < 0.00002). Two of the transfused patients had isolated femoral fractures; one with hemophilia and the other with a prior femoral fracture. The remaining five patients were multiple trauma victims, with significant injuries in addition to femoral fractures. CONCLUSIONS: Otherwise healthy pediatric patients with isolated femoral fractures rarely lose sufficient amounts of blood to necessitate blood transfusion. The majority may be managed by observation alone. Multiple trauma (multiple fractures, pelvic disruptions, retroperitoneal injuries) and underlying disorders are indications for careful monitoring, Hct determination, and cross match for blood. Patients who are older, present with a Hct < 30%, or who have multiple traumatic injuries have a relatively greater risk of needing a transfusion.

Adolescent↗

PubMed2006

[Internal fixation with the supporting steel of AO femoral condyles for treatment of complicated distal femoral fractures].

OBJECTIVE: To explore the technique and clinical effects of internal fixation of complicated distal femoral fractures using the supporting steel of AO femoral condyles. METHODS: From October 2001 to February 2004, 23 cases of complicated distal femoral fractures were treated with open reduction and internal fixation using the supporting steel of AO femoral condyles. Of 23 cases, there were 19 males and 4 females, aged 27-55 years. The locations were the right side in 10 cases and the left side in 13 cases. Fracture caused by traffic accident in 16 and by fall in 7, including 14 closed fracture and 9 open fracture, 21 fresh fracture and 2 old fracture. According to AO classification, 6 cases were classified as type A extra-articular fracture and 17 cases as type C intra-articular fracture. The X-ray films before operation showed comminuted fracture of femoral intercondylar and femoral supracondylar. All cases received scientific and rational rehabilitative treatment post-operatively. RESULTS: The postoperative follow-up ranged from 6 months to 20 months, 23 cases achieved fracture healing with an average healing period of 10.3 months (from 7 months to 16 months). According to the criteria of Kolmer and Wulff, the results were excellent in 16 cases, good in 4 cases, fair in 2 case and poor in 1 case. The excellent and good rate was 86.9%. CONCLUSION: Internal fixation with the supporting steel of AO femoral condyles for treatment of complicated distal femoral fractures has advantages of reasonable design, convenient operation, firm fixation and reliable clinical outcome.

Adult↗

PubMed1997

Results of an operative policy in the treatment of periprosthetic femoral fracture.

OBJECTIVE: To determine the clinical outcome of patients with periprosthetic femoral fractures treated operatively. DESIGN: Retrospective analysis from 1986 to 1993. SETTING: Edinburgh Orthopaedic Trauma Unit, Edinburgh, Scotland. PATIENTS: Forty-five patients identified from a computer database as being admitted to the Edinburgh Orthopaedic Trauma Unit with periprosthetic femoral fractures. MAIN OUTCOME MEASURES: Clinical outcome grade (good, fair, poor) dependent on integrity of fixation, refracture rate, and ability to perform activities of daily living analyzed against age, type of fracture, prosthetic alignment, loosening, and method of fixation. RESULTS: Type I fractures were more common in uncemented or loosely cemented prostheses, whereas type II fractures occurred predominantly in securely cemented prostheses. Type I fractures treated by revision had the poorest results. Outcome in type II fractures was equally good whether treated by internal fixation or by revision. Age, loosening, and prosthetic alignment did not influence outcome. The mortality rate in this series was 20%. CONCLUSIONS: If a prosthesis is loose, it should be revised, or treatment varies with fracture and prosthetic type. In type I fractures, an uncemented stem may be revised to a cemented one; however, a securely cemented prosthesis probably is better when fixed internally. Type II fractures should be fixed internally because there is less operative insult. Type III fractures probably are not related to the prosthesis and should be fixed internally according to normal practice. The results of an operative policy compare well with the results of conservative management and avoid the problems of long-term immobilization.

Adult↗

PubMed2005

[Bone mineral density in postmenopausal women with proximal femoral fractures--comparative study between quantitative ultrasonometry and gold standard DXA].

INTRODUCTION: Osteoporosis associated proximal femoral fracture is a major public health problem. Diagnostic assessment includes patients history, laboratory testings and bone mineral density measurements. Hereby, dual X-ray absorptiometry (DXA) is regarded as the "Goldstandard". Quantitative ultrasonometry (QUS) of bone is a safe, simple, free of radiation, portable, cost-effective and therefore powerful diagnostic tool. QUS should be taken in account for primary assessment in patients with supposed osteoporosis in clinical practice. AIM OF THE STUDY: We performed this cross sectional pilot study to evaluate the ability of two different QUS-devices (os calcis) in comparison to DXA (lumbar spine and femoral neck) to discriminate postmenopausal women with proximal femoral fractures from healthy, age- and BMI-matched controls. PATIENTS AND METHODS: All together, 44 postmenopausal women were included. Of these, 22 suffered a proximal femoral fracture and were compared with 22 healthy, age- and BMI-matched controls. Bone assessments were performed by DXA (femoral neck and lumbar spine) and QUS of the heel using Achilles and Insight. RESULTS: T- and Z-Score of DXA (femoral neck) were significantly lower in women with hip fracture compared to controls (p < 0.008 and p < 0.01). QUS-Insight also revealed significantly lower values of T- and Z-Score in women with hip fracture compared to controls (p < 0.01 and p < 0.005). QUS-Achilles measurement results also comprised significant differences between the groups (T-Score und Z-Score: p < 0.02). In accordance to the T-Score (femoral neck), all three devices (DXA femoral neck, Achilles and Insight) showed an equal significant correlation (p < 0.001). The correlation in between both QUS-devices was higher (0.956; p < 0.0001) than in between DXA-results (femoral neck vs. lumbar spine, 0.577; p < 0.01). The Z-Score also showed a significant correlation. DXA (lumbar spine) didn't show any significant differences in T- and Z-Score. CONCLUSION: In comparison to the gold standard DXA (femoral neck), both QUS-devices showed an equal ability to significantly discriminate postmenopausal women with proximal femoral fractures from healthy, age- and BMI-matched controls. If our results are confirmed by more cross-sectional and longitudinal studies, QUS could be a helpful and valuable technique in clinical practice. Finally, all patients with osteoporosis-related fractures should be thoroughly investigated during their hospitalisation and effective treatment must be instituted.

Absorptiometry, Photon↗

PubMed2007

Nail-assisted percutaneous plating of pediatric femoral fractures.

Traditional operative treatments for pediatric femoral shaft fractures may result in an unacceptable complication rate, especially in patients with complex fractures. Despite requiring the use of fluoroscopy and presenting some technical difficulty, minimally invasive percutaneous plating is an alternative operative method. We retrospectively reviewed 13 consecutive femoral fractures in children (mean age, 9 years) who were treated by a modified technique of percutaneous plating. Six of the fractures were comminuted. Nine children had associated injuries, including four with head trauma. The primary indication for use of percutaneous plating in this pediatric series was a complex fracture in which flexible nailing would be suboptimal. The results were evaluated by a modification of Flynn's criteria. All fractures united without bone grafts (mean, 11 weeks). No patients had residual radiographic angulations greater than 10 degrees or a leg-length discrepancy greater than 5 mm. All patients had excellent final outcomes. There were no major complications such as deep infection or refracture. The technique provided adequate stability for early functional treatment and predictable healing with maintenance of leg length and alignment. Provisional reduction and stabilization of complex pediatric femoral fractures can facilitate definitive percutaneous plating.

Adolescent↗

PubMed2006

[Intramedullary locked nailing in the treatment of proximal femoral fractures].

INTRODUCTION: The aim of the study is evaluation of results of operative treatment the proximal femoral fractures with intramedullary locked nailing. MATERIAL AND METHOD: In years 1996-2004 44 patients were treated because of proximal femoral fractures with closed reduction and stabilization with intramedullary locked nailing. There were 15 women and 29 men in average age 60 years (18-95 years). There were 2 femoral neck fractures and 42 peritrochanteric fractures. The fracture of femoral shaft in 2 patients accompanied the fracture of proximal part of femur. The morphology of fractures was estimated according to AO classification. Clinical results were evaluated with Harris hip score (HHS). RESULTS: The average follow up is 8 months (from 6 to 24 months). There was good reduction of 27 fractures on postoperative radiograms. The average 15 degrees of varus lack of reduction was noted in 17 peritrochanteric fractures (from l0 to 35 degrees). There were mainly 31.A.3 unstable fractures according to AO classification. 3 patients died during three postoperative months from causes not connected with operative treatment. 39 fractures united in the period from 10 to 16 weeks. Delayed union--after 6 months occurred in 2 persons. Fatigue fracture of intramedullary rods occurred to both of this patients. The average Harris Hip Score was 86 points (from 70 to 100 points) after union of fractures. CONCLUSIONS: (1) The use of intramedullary locked nailing in the treatment of fractures of proximal part of femur leads to union without additional immobilization. (2) Closed intramedullary locked nailing in the treatment of unstable intertrochanteric fractures is connected with the risk of varus malalignment of fragments, which does not delay union, but decreases functional outcome. (3) Proper operative technique decreases the number of intra- and postoperative complications.

Adolescent↗

PubMedDate not supplied

Mechanical properties of different combinations of flexible nails in a model of a pediatric femoral fracture.

Flexible nailing of pediatric femoral shaft fractures is based on the principle of using two C-shaped nails to create six points of fixation. However, clinical studies using various nail combinations demonstrate similar outcomes. This study aimed to compare the mechanical properties of different nail combinations by testing them in a model of a child's midshaft femoral fracture. The two C-shaped nails were compared with two straight nails and with paired S- and C-shaped nails. The constructs were tested in four-point bending and torsion. Graphs of the data were produced, from which the bending and torsional stiffness of the constructs was calculated. The results showed that there was no significant difference between the mechanical properties of the three different constructs. The conclusion is that any of the tested nail combinations can be used to treat a midshaft fracture of the femur in a child.

Biomechanical Phenomena↗

PubMed1996

Audit of surgical delay in relationship to outcome after proximal femoral fracture.

To ascertain the influence of surgical delay on outcome after proximal femoral fracture in elderly females, a cohort study of patients presenting in 1987 was compared to 1989/90. Organisational changes in the intervening period were introduced to reduce delay to surgical intervention. Two hundred and eighty females aged 65 years and over presenting from the local catchment area of an acute inner-city teaching hospital were enrolled in the study. Seventy-nine patients received surgery in 1987 and 186 in 1989/90. The one year mortality was 34% and 26% respectively. The proportion receiving surgery within 24 hours rose from 34% in 1987 to 57% in 1989/90. The relative hazard of the group receiving surgery on day 2 in comparison to day 1 was 1.7 (95% CI 1.0 to 2.9) when adjusted for co-variance of age and mental score. Medically fit elderly patients presenting with proximal femoral fracture have improved survival with early surgery within 24 hours of admission. Improvements in the organisation of hospital care will result in important benefits for the increasing number of elderly females presenting with proximal femoral fracture.

Aged↗

PubMed1987

Osteoporosis and proximal femoral fractures in the female elderly of Jerusalem.

The incidence of proximal femoral fractures in women between the ages of 45 and 75 years was investigated in 735 women of whom 378 were of Western origin and 230 of Eastern origin; 127 women were excluded from this study either because they were Israeli or because their country of origin was unknown. In a general population study, the incidence of osteoporosis was 7.3% in the Western group and 16.7% in the Eastern group, whereas the incidence of proximal femoral fracture was 0.16% in the general population of the Western group and 0.13% in the population of the Eastern group. This finding does not confirm that the degree of osteoporosis is closely related to the incidence of proximal femoral fracture. Other factors may be closely related to the incidence of fractures.

Age Factors↗

PubMed1992

External fixation for diaphyseal femoral fractures: a benefit to the young child?

External fixation for the treatment of diaphyseal femoral fractures in children seems an attractive alternative, which explains why its application gets more and more advocates. Between 1984 and 1989 15 children aged from 4 to 10 years were treated for a diaphyseal femoral fracture with an external fixation using a small Hofmann system. Fracture healing was without complications. Four children were able to walk on crutches non-weight-bearing after a short period. Six cases had complications, such as pin tract infection, inexplicable pain, or secondary displacement. One patient sustained a supracondylar fracture through one of the distal pin tracts. Hospital stay was longer than expected. In conclusion external fixation for femoral fractures in children is simple and elegant, but has considerable complications, while presumed advantages are not always obtained. In selected cases it is an attractive alternative, but the indications must be restricted.

Child↗

PubMed1998

Treatment of distal femoral fractures in the elderly. Results with the retrograde intramedullary supracondylar nail.

The drawbacks of plating techniques for the treatment of distal femoral fractures are the need for a large exposure with the possible risk of soft tissue damage, devascularisation of bone fragments and loss of the possible positive effect of the fracture hematoma. Moreover, early weight bearing is not advisable with these implants. To find out whether the retrograde nailing of distal femoral fractures is beneficial we performed this study. Between March 1, 1993 and September 1, 1995, 25 patients with 26 distal femoral fractures were treated in our department with retrograde femoral nailing. According to the ASIF-classification we classified 20 fractures as supracondylar A fractures and 6 fractures as intercondylar C fractures. All fractures were closed and without important soft tissue damage. One patient dies of a not fracture-related cause before fracture healing was achieved. Twenty-five fractures healed. According to our relative Neer-score we counted 18/25 (72%) excellent results (> or = 85 points), 5/25 (20%) good results (> or = 70 points), 1 (4%) fair result (> or = 55 points and 1 (4%) bad result (< 55 points). The retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Also in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult interlocking are the 2 major technical problems encountered with this implant. Early weight bearing is not advisable.

Adolescent↗

PubMed2006

Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty.

BACKGROUND: Periprosthetic femoral fractures following total hip arthroplasty are becoming more prevalent. When a fracture occurs in a femur with substantial proximal bone deficiency, the surgical options for revision are limited. One option includes the use of a proximal femoral allograft. METHODS: We retrospectively assessed the results and complications of the use of a proximal femoral allograft to treat twenty-five Vancouver type-B3 periprosthetic fractures in twenty-four patients. The mean duration of follow-up was 5.1 years. Clinical results were graded with use of the Harris hip score. Radiographs were assessed for evidence of trochanteric union, host-allograft union, allograft resorption, and component loosening or fracture. Failure of the procedure was defined as the need for revision surgery requiring graft removal. RESULTS: The mean postoperative Harris hip score was 70.8. At the time of the final follow-up, twenty-one of the twenty-four patients reported no or mild pain and twenty-three patients were able to walk; fifteen required a walking aid. The greater trochanter united in seventeen of the twenty-five hips, and osseous union of the allograft to the host femur occurred in twenty hips. There was mild graft resorption in four hips and moderate graft resorption in two. Four (16%) of the twenty-five hips required repeat revision. CONCLUSIONS: The use of a proximal femoral allograft for the treatment of a Vancouver type-B3 periprosthetic femoral fracture can provide a satisfactory result in terms of pain relief and function at five years.

Aged↗

PubMed1990

Knee function after complex femoral fractures treated with interlocking nails.

Twenty-three complex femoral fractures were treated with interlocking nails. After fracture healing, knee function was analyzed, including alignment, quadriceps and hamstring strength, thigh atrophy, and range of motion (ROM). Similar to previous studies in the preinterlocking nail era, knee function was impaired in comparison with the contralateral limb. Seventy-three percent of patients had decreased quadriceps strength, and 60% had decreased hamstring strength. Sixty-five percent had thigh atrophy. The ROM and alignment were satisfactory. Despite the advantages of early ROM with femoral fractures treated with interlocking nails, knee function is often unsatisfactory once fracture union has occurred. Therefore, a formal knee rehabilitation program is recommended to achieve an optimal result.

Adolescent↗