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At least 19 recordsLinked to original sources
PubMed2000

Pre-operative traction for fractures of the proximal femur.

BACKGROUND: Pre-operative traction following an acute hip fracture remains standard practice in some hospitals. OBJECTIVES: To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1983 to August 1999), CINAHL (1982 to July 1999), EMBASE (1980 to September 1999), CENTRAL (Issue 4, 1999 of The Cochrane Library) and bibliographies of trial reports. Date of the most recent search: September 1999. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Five randomised trials, mainly of moderate quality, involving a total of 635 predominantly elderly patients, were identified and included in the review. The review has been updated twice to include additional and new data from two of the studies. The availability of this additional data resulted in no important change in the results nor conclusions. The four trials which compared traction with no traction found no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other which compared skeletal traction with skin traction found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and most costly. REVIEWER'S CONCLUSIONS: From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. Where a policy of general or selective application of traction exists, the choice of method must remain a decision based on evaluation of the individual patient. Further, high quality trials would be required to confirm or refute the absence of benefits of traction.

Femoral Fractures↗
PubMed2005

The effect of locked distal screws in retrograde nailing of osteoporotic distal femur fractures: a laboratory study using cadaver femurs.

OBJECTIVES: To examine the effects of locked distal screws in retrograde nails used in unstable osteopenic distal femur fractures. DESIGN: Biomechanical testing of paired human cadaveric femurs. INTERVENTION: Seven matched pairs of embalmed, moderately osteopenic cadaver femurs were instrumented with 12-mm intramedullary nails in a statically locked, retrograde fashion. One femur of each pair had locked distal screws and the other femur had unlocked distal screws. A 2.5-cm gap of bone was cut nine centimeters from the distal condyles to simulate an unstable fracture. The locked distal screw nails were compared to unlocked distal screw nails for collapse of the fracture gap, medial-lateral and anterior-posterior translation of the nail within the fracture site, and fracture angulation. The femurs were axially loaded, cycled, and then loaded to failure. MAIN OUTCOME MEASURES: Motion at the fracture site with axial cyclic loading and site of failure when loaded to failure. RESULTS: After cycling, both locked distal screw and unlocked distal screw nails demonstrated several millimeters medial and anterior translation within the fracture site and approximately 1 mm collapse of the fracture gap. Although no statistically significant differences were found, the locked distal screw nails had less anterior and medial translation, angulation, and collapse of the fracture gap after cycling. Loads to failure were similar for both locked distal screw and unlocked distal screw nails. It was noted that proximal femur failure occurred at the level of the proximal screw hole in the nail at the subtrochanteric level in 7 (4 locked distal screws and 3 unlocked distal screw groups) of the 14 samples. Four other samples failed through the intertrochanteric region (2 locked distal screw and 2 unlocked distal screw groups) and the remainder within the distal fragment by fracture of the femur along the medial cortex. CONCLUSIONS: Although most differences in fixation stability were not significant, the locked distal screw nails exhibited less fracture collapse and anterior and medial translation of the nail at the fracture site than the unlocked distal screw nails. The degree of varus angulation after cyclic loading was also less for the locked distal screw nails. The length of the nail chosen should avoid having proximal locking screws distal to the lesser trochanter, thus averting proximal femur stress risers and fractures.

Bone Screws↗
PubMed2000

Assessment of gestational age based on ultrasonic femur length after the first trimester: a simple mathematical correlation between gestational age (GA) and femur length (FL).

OBJECTIVE: The ultrasonic measurement of the fetal femur length is a sensitive and precise variable for estimation of fetal growth and development. The objective of this study was to predict gestational age in fetuses more than 13 weeks of gestation by ultrasound measurement of the femur length. METHOD: In this study, pregnant mothers were identified by the criteria of normalities such as: well-known LMP, regular menstrual cycles, no use of OCP for the last 3 months, no smoking, no history of diabetes, etc. RESULT: The relation between gestational age and fetal femur length has been determined by cross-sectional analysis of 900 normal fetuses (> or = 14 weeks of gestation) using real time ultrasonography. Mathematical modeling of the data has demonstrated that the femur growth curve is non-linear beyond 13 weeks of gestation. With the aid of a scientific calculator the data were analyzed and a simple second grade equation has been derived: GA (weeks) = 0.262(2) FL (cm) + 2 FL + 11.5, S.D. approximately +/- 5 days(Honarvar's Formula 3). With the use of this data, the error in the estimation of GA given as FL is +/-5 days. CONCLUSION: This simple, new and accurate equation appears to be clinically reliable and easy to use and suggests that previous normal ultrasonic fetal femur length curves for another population may under- or overestimate normal fetal age for the Iranian population. Thus, our formula is an excellent means of estimating true gestational age.

Anthropometry↗
PubMed1975

[Treatment of malignant fractures of the femur with total hip-femur-knee joint alloplastics (author's transl)].

This is to report as an example of 2 such cases, the indications and operative procedures of total hip-femur-knee joint alloplastics for malignant fractures of the femur. This is an alternative to the exarticulation of the femur in the case of impossibility to fix the osteosynthesis material on the remaining femur. The higher radicality of this method in comparison to the common femur-saving way might lead to a wider usage.

Adenocarcinoma↗
PubMed2004

Genetic variation in femur extrinsic strength in 29 different inbred strains of mice is dependent on variations in femur cross-sectional geometry and bone density.

The femurs from groups of mice from 29 different inbred strains were characterized to study the genetic variations in bone parameters. For these analyses, we used peripheral quantitative computed tomography to assess bone size and density in addition to three-point bend testing to assess bone mechanical properties. Highly significant differences between inbred strains were found for all size, density, and mechanical parameters measured (P < 0.0001). Correcting femoral cross-sectional geometry values or bone mechanical properties values for body weight or femur length reduced but did not eliminate the variations in bone geometry or bone mechanical properties. Mice of similar body size had as much as a 40% difference in the midshaft total area of the femur. Regression analysis suggested that 50.9% of the variation in maximum load among strains was related to variations in section modulus, i.e., cross-sectional geometry, 21.5% was related to variations in material bone density, and 27.7% to variations in quality. These components were further analyzed to show that 3.9-27.8% of the variation in maximum load was related to adaptation to mechanical stress. These findings indicate that there is a significant genetic variation in the femur cross-sectional area, density, and mechanical properties between inbred mouse strains. These studies identify inbred mouse strains suitable for future studies identifying genes regulating bone geometry and mechanical properties.

Animals↗
PubMed2003

Strain distribution within the human femur due to physiological and simplified loading: finite element analysis using the muscle standardized femur model.

The aim of the current work was to study the effect of simplified loading on strain distribution within the intact femur using the Muscle Standardized Femur finite element model and to investigate whether the interaction between the intact human femur and the muscles which are attached to the bone surface could accurately be represented by concentrated forces, applied through the centroids of their attachment areas. An instant at 10 per cent of the gait cycle during level walking was selected as the reference physiological load case; nine load cases were analysed. Comparison of the calculated results for the physiological load case with muscle forces uniformly distributed over their attachment areas showed good agreement with in vivo measurements of strain values and femoral head displacement in humans. Simplified load cases generated unrealistic displacement results and high strain magnitudes, exceeding the physiological range. It was found that when muscles with large attachment areas are included in the model and the muscle forces are simplified, stress and strain distributions will be affected not only on the external bone surface in the vicinity of the load application node, but also on the internal surface of the cortical bone. However, applying muscle forces as concentrated loads at the centroids of the attachment areas can serve as first indicators of the physiological stress and strain levels, if results from nodes and elements in the vicinity of the load application nodes are discarded. Omitting muscle forces or fixing the femur in mid-shaft leads to large unphysiological strain values.

Compressive Strength↗
PubMed2001

Strain distribution in the proximal human femur. An in vitro comparison in the intact femur and after insertion of reference and experimental femoral stems.

Six pairs of human cadaver femora were divided equally into two groups one of which received a non-cemented reference implant and the other a very short non-dependent experimental implant. Thirteen strain-gauge rosettes were attached to the external surface of each specimen and, during application of combined axial and torsional loads to the femoral head, the strains in both groups were measured. After the insertion of a non-cemented femoral component, the normal pattern of a progressive proximal-to-distal increase in strains was similar to that in the intact femur and the strain was maximum near the tip of the prosthesis. On the medial and lateral aspects of the proximal femur, the strains were greatly reduced after implantation of both types of implant. The pattern and magnitude of the strains, however, were closer to those in the intact femur after insertion of the experimental stem than in the reference stem. On the anterior and posterior aspects of the femur, implantation of both types of stem led to increased principal strains E1, E2 and E3. This was most pronounced for the experimental stem. Our findings suggest that the experimental stem, which has a more anatomical proximal fit without having a distal stem and cortex contact, can provide immediate postoperative stability. Pure proximal loading by the experimental stem in the metaphysis, reduction of excessive bending stiffness of the stem by tapering and the absence of contact between the stem and the distal cortex may reduce stress shielding, bone resorption and thigh pain.

Adult↗
PubMed1982

[Necrosis of the head of the femur as a complication of the medial fracture of the neck of the femur (author's transl)].

In spite of the progress achieved in accident surgery, medial fractures of the neck of the femur still present a lot of problems. The rate of success achieved in most other cases of bone fracture is not obtained here. The necrosis of the head is the most frequent and most serious complication of the medial fracture of the neck of the femur. Its formation is influenced by different factors, such as fracture line, dislocation of the fragments, time and method of reposition, and method of osteosynthesis. A prognosis whether a necrosis of the head of the femur is to be expected or not can be made when these factors are taken into consideration. So, by means of a primary alloarthroplasty, it will be possible to spare the patient a later reconstruction.

Adolescent↗
PubMed2001

[Proximal femur remodeling after proximal femur varus-derotational osteotomy in treatment of developmental dysplasia of the hip].

The aim of this paper was to assess proximal femur remodelling after proximal femur varus-derotational osteotomy in treatment of developmental dysplasia of the hip up to skeletal maturity. The analysis included 48 osteotomies performed in 33 children between 1st and 10th year of life. The follow-up period was on average 12 years. Supported by statistical evaluation the analysis showed persistent increase of the neck-shaft angle after proximal femur varus-derotational osteotomy, especially in the younger age groups. It also correlated strongly with the amount of varus fixed at the time of operation. On other hand femoral antetorsion corrected during surgery remained unchanged till skeletal maturity.

Child↗
PubMedDate not supplied

[Early diagnosis by scintigraphy of femur head necrosis after femur neck fracture].

Necrosis of the head of the femur with segmentary collapse after transcervical fractures occurs in 30 to 50% of the cases. Diagnosis of avascular necrosis should be made early before the head collapses. In a clinical and experimental study, we attempted to perform early screening for this complication. We studied 41 fractures of the neck of the femur with technitium scintigraphy with intravenous injections and compared uptake in pathological and normal heads. In the first group of 20 cases of fresh fractures, scintigraphy was performed before operation then repeated every three months to the 36th months later. High uptake we seen in 12 of the 20 cases then returned to normal 12 to 18 months later. Consolidation occurred in all 12 without necrosis. In 8 cases uptake was low initially then rose greatly and remained higher than normal. Necrosis occurred in 6 of these 8 cases. In a second group of 21 patients with a history of necrosis of the head of the femur, uptake was high. Pathologic examination of the surgical specimen after resection for prosthesis showed cell growth around the zone of necrosis. In conclusion, this technique, when possible, would appear to be highly useful to screen for necrosis early.

Female↗
PubMed1987

[Total femur replacement in osteogenic sarcoma of the femur].

A 14-year-old girl was admitted with a diagnosis of osteogenic sarcoma of the distal femur. Pre-operative chemotherapy was effective, and sclerosis of the lesion made clear the presence of a proximal femoral and pulmonary metastasis. Total femur and knee joint replacement with titanium alloy was made after a total resection of the femur. Her post-operative clinical course was excellent without local recurrence. Now, 14 months after the operation, she can walk without crutches. We wish to emphasize that the presence of a pulmonary metastasis is not absolutely a contraindication as long as the tumor appears surgically resectable and responsive to per-operative chemotherapy.

Adolescent↗
PubMed1978

Proximal strain distribution in the loaded femur. An in vitro comparison of the distributions in the intact femur and after insertion of different hip-replacement femoral components.

The distribution of strain in the proximal part of loaded cadaver femora was measured in vitro using strain gauges applied to the cortex. The loading conditions simulated single-limb stance and the strains were recorded first with the femora intact and then with the femoral components of six different designs inserted. Each femur served as its own control. After insertion of a femoral component, the pattern of strain in the proximal part of the femur was reversed compared with that in the intact femur, in that the maximum strain occurred around the tip of the prosthesis rather than at the calcar femorale. A massive decrease in stress in the region of the calcar femorale was found when the implants were in place, and it was concluded that this decrease could contribute substantially to the calcar femorale resorption sometimes observed in patients after total hip replacement. Transfer of load directly to the calcar femorale through a larger collar in direct contact with the cortical bone restored 30 to 40 per cent of the normal strain to the calcar femorale and shifted the strain pattern toward normal. Compared with the less stiff stems tested, the larger, stiffer stems, which provide more protection against fatigue failure, did not affect the strain pattern adversely.

Aged↗
PubMed1982

[Femur remodelling procedures following osteotomies at the coxal end of the femur in the treatment of congenital dislocation of the hip (author's transl)].

This paper was prepared on the basis of 801 case histories (1019 hips) of children treated for congenital dislocation of the hip in our clinic during the last 25 years. Over the years a variety of surgical methods have been employed in the clinic in the treatment of congenital dislocation of the hip, such as open repositioning (with detorsion osteotomy), reconstructive repositioning after Colonna-Zahradnicek, and in recent years open repositioning with pelvic osteotomy. All these interventions were always accompanied by osteotomy of the coxal end of the femur. The type of osteotomy performed depended on requirements: detorsion osteotomy without altering the diaphysis-collum angle (CCD), detorsion varisation adduction osteotomy with or without shortening of the femur. If the need for detorsion osteotomy is completely beyond doubt, we believe that adduction is usually unnecessary and sometimes even detrimental, especially in cases with preoperative growth disturbances of the proximal epiphysis and metaphysis. In none of the cases with permanent inhibition of growth of the acetabular margin did the adduction operation (varisation) have a favorable effect on hip development. Detorsion osteotomy without adduction (and if necessary with abduction) and with simultaneous pelvic osteotomy is the best point of departure for subsequent physiological development of the hip in children.

Acetabulum↗
PubMed1980

[The stresses in femur. I. Intact femur without consideration of the iliotibial tract (author's transl)].

Stresses in femur under different load conditions were computed with the finite element method. The computer model was composed of 1950 spatial elements. The calculated results were confirmed using 34 strain gauge rosettes, attached on the femur surface. The load conditions were chosen as at the stance phase of walking and as standing on two legs. Additionally, the effect of joint forces under different directions were investigated. It is the main conclusion of this work that the computed quantitative results are only relevant when the geometry and the material properties of the metaphysical bone are copied exactly for the computer model.

Biomechanical Phenomena↗