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Sample records for femoral shaft fracture

  1. Femoral shaft fractures

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C. II

    1985-01-01

    The femur is the longest, largest, and strongest bone in the body. Because of its length, width, and role as primary weight-bearing bone, it must tolerate the extremes of axial loading and angulatory stresses. Massive musculature envelopes the femur. This masculature provides abundant blood supply to the bone, which also allows great potential for healing. Thus, the most significant problem relating to femoral shaft fractures is not healing, but restoration of bone length and alignment so that the femoral shaft will tolerate the functional stresses demanded of it

  2. Ipsilateral femoral neck and shaft fractures: An overlooked association

    International Nuclear Information System (INIS)

    Daffner, R.H.; Riemer, B.L.; Butterfield, S.L.

    1991-01-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG)

  3. Ipsilateral femoral neck and shaft fractures: An overlooked association

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA)); Riemer, B.L.; Butterfield, S.L. (Dept. of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA))

    1991-05-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG).

  4. Subtrochanteric femoral fracture during trochanteric nailing for the treatment of femoral shaft fracture.

    Science.gov (United States)

    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-09-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

  5. Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

    OpenAIRE

    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-01-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nai...

  6. Ipsilateral femoral shaft and vertical patella fracture: a case report

    Science.gov (United States)

    Ozkan, Korhan; Eceviz, Engin; Sahin, Adem; Ugutmen, Ender

    2009-01-01

    Introduction A femoral shaft fracture with an ipsilateral patella fracture has been, to our knowledge, given only cursory attention in English-speaking literature. Case presentation A 15 year old male patient had hitten by a car to his motorcycle came to emergency room and he had been operated for his femoral shaft freacture and vertical patellar fracture which was iniatally missed. Conclusion To us it is vital to obtain CT scan of the patient’s knee if there is an ipsilateral femoral fracture with an ipsilateral knee effusion and a punction which reveals hematoma even in the absence of a fracture line seen in AP and lateral projections. PMID:19829933

  7. Femoral Neck Shaft Angle in Men with Fragility Fractures

    Directory of Open Access Journals (Sweden)

    S. P. Tuck

    2011-01-01

    Full Text Available Introduction. Femoral neck shaft angle (NSA has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric, symptomatic vertebral (91, and distal forearm (67 fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately, nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P=0.001, but larger in those with distal forearm fractures (129.8° versus 128.5°: P=0.01. Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  8. ediatric femoral shaft fractures treated by flexible intramedullary nailing.

    Science.gov (United States)

    Kapil Mani, K C; Dirgha Raj, R C; Parimal, Acharya

    2015-01-01

    Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.

  9. Ender’s Nail fixation in paediatric femoral shaft fractures.

    Directory of Open Access Journals (Sweden)

    Rajeev Dwivedi

    2013-12-01

    Flynn criteria 34 had excellent and 6 had satisfactory results. No poor results were seen. Conclusion: Ender’s nail fixation can be preferred method of treatment for femoral shaft fractures in age group 5 -15 years as the results are excellent and satisfactory. It is technically simple and can be done in a closed manner. It spares the vascularity and growth plate.

  10. Bilateral simultaneous femoral neck and shafts fractures - a case report.

    Science.gov (United States)

    Sadeghifar, Amirreza; Saied, Alireza

    2014-10-01

    Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection.

  11. Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures.

    Science.gov (United States)

    Omar, Mohamed; Suero, Eduardo M; Hawi, Nael; Decker, Sebastian; Krettek, Christian; Citak, Musa

    2015-10-01

    In bilateral femoral shaft fractures, significant malrotation (>15°) occurs in about 40 % of cases after intramedullary nailing. Most of the methods that provide rotational control during surgery are based on a comparison to the intact femur and, thus, not applicable for bilateral fractures. In this study, we evaluated if preoperative virtual reduction can help improving rotational alignment in patients with bilateral femoral shaft fractures. Seven patients with bilateral femoral shaft fractures were initially treated with external fixation of both femurs. After obtaining a CT scan of both legs, the fractures were reduced virtually using the software program VoXim®, and the amount and direction of rotational correction were calculated. Subsequently, the patients were treated by antegrade femoral nailing and rotation was corrected to the preoperatively calculated amount. After external fixation, the mean rotational difference between both legs was 15.0° ± 10.2°. Four out of seven patients had a significant malrotation over 15°. Following virtual reduction, the mean rotational difference between both legs was 2.1° ± 1.2°. After intramedullary nailing, no case of malrotation occurred and the mean rotational difference was 6.1° ± 2.8°. Preoperative virtual reduction allows determining the pretraumatic femoral antetorsion and provided useful information for the definitive treatment of bilateral femoral shaft fractures. We believe that this procedure is worth being implemented in the clinical workflow to avoid malrotation after intramedullary nailing.

  12. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    Science.gov (United States)

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  13. Long-term functional outcome following intramedullary nailing of femoral shaft fractures

    NARCIS (Netherlands)

    el Moumni, Mostafa; Voogd, Emma Heather; ten Duis, Henk Jan; Wendt, Klaus Wilhelm

    Background: The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the long-term functional outcome after antegrade or retrograde intramedullary nailing of traumatic femoral shaft fractures. We further determined

  14. Simultaneous Ipsilateral fracture of the femoral neck and shaft ...

    African Journals Online (AJOL)

    Eight cases with fractures of The shaft and the neck of the same femur are described. Attention is drawn to the high incidence of undiagnosed fractures in cases where these two fractures occur concomitantly. It is emphasized that definitive treatment can only be planned after a full clinical and radiological examination.

  15. simultaneous ipsilateral fracture of the femoral neck and shaft

    African Journals Online (AJOL)

    1971-04-14

    Apr 14, 1971 ... Eight cases with fractures of The shaft and the neck of the ... discovered after a period of 6 months (case 1), 16 days ... The patient made a satisfactory recovery from the ... right hip from 0° to 110° and his knee from 0° to 90°.

  16. Interventions for treating femoral shaft fractures in children and adolescents.

    Science.gov (United States)

    Madhuri, Vrisha; Dutt, Vivek; Gahukamble, Abhay D; Tharyan, Prathap

    2014-12-01

    Fractures of the femoral shaft in children are relatively uncommon but serious injuries that disrupt the lives of children and their carers and can result in significant long-term disability. Treatment involves either surgical fixation, such as intramedullary nailing or external fixation, or conservative treatment involving prolonged immobilisation, often in hospital. To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (accessed 16 August 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013 Issue 7), MEDLINE (1946 to August Week 1 2013), EMBASE (1980 to 2012 week 9), CINAHL (16 August 2013), clinical trials registries, conference proceedings and reference lists; and contacted trial authors and experts in the field. Randomised and quasi-randomised controlled trials comparing conservative and surgical interventions for diaphyseal fractures of the femur in children under 18 years of age. Our primary outcomes were functional outcome measures, unacceptable malunion, and serious adverse events. Two authors independently screened and selected trials, assessed risk of bias and extracted data. We assessed the overall quality of the evidence for each outcome for each comparison using the GRADE approach. We pooled data using a fixed-effect model. We included 10 trials (six randomised and four quasi-randomised) involving a total of 527 children (531 fractures). All trials were at some risk of bias, including performance bias as care provider blinding was not practical, but to a differing extent. Just one trial was at low risk of selection bias. Reflecting both the risk of bias and the imprecision of findings, we judged the quality of evidence to be 'low' for most outcomes, meaning that we are unsure about the estimates of effect. Most trials failed to report on self-assessed function or when

  17. Outcome of non-operative management of femoral shaft fractures in children

    Directory of Open Access Journals (Sweden)

    Akinyoola A

    2011-01-01

    Full Text Available Background: Femoral shaft fractures are common injuries in childhood. There is paucity of information on their presentation and outcome of the available treatment methods in the African population. This study evaluated the outcome of non-operative methods of treatment of femoral shaft fractures in our centre. Patients and Methods: A retrospective review of the database of children aged 14 years and below with femoral shaft fractures treated non-operatively over a 10-year period. Results: A total of 134 patients with 138 fractures met the study criteria. This consisted of 71 boys (mean age = 6.1 years ± SD and 63 girls (mean age = 6.5 years ± SD. Pedestrian vehicular accident was the most common cause of femoral shaft fractures in the study population. The midshaft was the most common site of fractures. There were associated injuries to other parts of the body (especially head injury in 34.3% of the patients. The commonest mode of treatment was skin traction only (87.7%. The mean time to fracture union was 4.9 weeks ± SD (range = 3-15 weeks. The mean length of hospitalisation was 6.7 weeks ± SD (range = 5 days-11 weeks. There was a fairly strong positive correlation between the length of hospitalisation and the presence of associated injuries, especially head injury, upper limb fractures and bilaterality of the fractures. The mean total cost of treatment was #7685 (Naira or $51.2 (range = $14.2-$190. At the last follow up, 97.8% of the fractures united without significant angulation or shortening. Conclusion: The outcome of non-operative treatment of femoral shaft fractures in our setting is comparable to the results of other workers. Methods of treatment that shorten the length of hospitalisation without unduly increasing cost should be encouraged.

  18. Complications and Functional Recovery in Treatment of Femoral Shaft Fractures with Unreamed Intramedullary Nailing

    OpenAIRE

    Sadic, Sahmir; Custovic, Svemir; Smajic, Nedim; Fazlic, Mirsad; Vujadinovic, Aleksandar; Hrustic, Asmir; Jasarevic, Mahir

    2014-01-01

    ABSTRACT Introduction: Fracture of the femoral shaft is a common fracture encountered in orthopedic practice. In the 1939, K?ntscher introduced the concept of intramedullary nailing for stabilization of long bone fractures. Intramedullary nailing has revolutionized the treatment of fractures. Material and methods: The study included 37 male patients and 13 female patients, averaged 39?20,5 years (range, 16 to 76 years). Results and discussion: There were 31 left femurs and 21 right femurs fra...

  19. A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures.

    Science.gov (United States)

    Ellis, Henry Bone; Ho, Christine A; Podeszwa, David A; Wilson, Philip L

    2011-12-01

    Stainless steel flexible Enders rods have been used for intramedullary fixation of pediatric femur fractures with good success. Despite intraoperative anatomic alignment, length unstable femur fractures can present postoperatively with fracture shortening. The purpose of this study was to review all length unstable pediatric femoral shaft fractures in which Enders rods were used and compare those that were locked to those that were not locked. A retrospective clinical and radiographic review of all patients at a single institution undergoing flexible intramedullary fixation for length unstable femoral shaft fractures from 2001 to 2008. A length unstable fracture was defined as either a comminuted fracture or a spiral fracture longer than twice the diameter of the femoral shaft. A total of 107 length unstable femoral shaft fractures fixed with Enders rods were identified, of which 37 cases (35%) had both Enders rods "locked" through the eyelet in the distal femur with a 2.7 mm fully threaded cortical screw. Patient demographics, clinical course, complications, fracture characteristics, and radiographic outcomes were compared for the locked and nonlocked groups. There were no statistical differences between the groups in demographic data, operative variables, fracture pattern, fracture location, time to union, femoral alignment, or major complications. Shortening of the femur and nail migration measured at 1 to 6 weeks postoperatively was significantly greater for the nonlocked cases. The medial and lateral locked Enders rods moved 1.3 and 1.9 mm, respectively, and the unlocked Enders each moved 12.1 mm (P < 0.05). At final follow-up there were significantly more (P < 0.05) clinical complaints in nonlocked group, including limp, clinical shortening, and painful palpable rods. Locking Enders rods for length unstable pediatric fractures is an excellent option to prevent shortening and resulted in no additional complications, added surgical time, or increased blood loss

  20. High revision rate but good healing capacity of atypical femoral fractures. A comparison with common shaft fractures.

    Science.gov (United States)

    Schilcher, Jörg

    2015-12-01

    Healing of complete, atypical femoral fractures is thought to be impaired, but the evidence is weak and appears to be based on the delayed healing observed in patients with incomplete atypical fractures. Time until fracture healing is difficult to assess, therefore we compared the reoperation rates between women with complete atypical femoral fractures and common femoral shaft fractures. We searched the orthopaedic surgical registry in Östergötland County for patients with subtrochanteric and femoral shaft fractures (ICD-10 diagnosis codes S72.2, S72.3 and M84.3F) between January 1st 2007 and December 31st 2013. Out of 895 patients with surgically treated femoral shaft fractures, 511 were women 50 years of age or older. Among these we identified 24 women with atypical femoral shaft fractures, and 71 with common shaft fractures. Reoperations were performed in 6 and 5 patients, respectively, odds ratio 4.4 (95% CI 1.2 to 16.1). However, 5 reoperations in the atypical fracture group could not be ascribed to poor healing. In 3 patients the reoperation was due to a new fracture proximal to a standard intramedullary nail. In 2 patients the distal locking screws were removed due to callus formation that was deemed incomplete 5 months post-operatively. The one patient with poor healing showed faint callus formation at 5 months when the fracture was dynamised and callus remained sparse at 11 months. Among patients with common shaft fractures, 2 reoperations were performed to remove loose screws, 2 because of peri-implant fractures and 1 reoperation due to infection. Reoperation rates in patients with complete atypical femoral fractures are higher than in patients with common shaft fractures. The main reason for failure was peri-implant fragility fractures which might be prevented with the use of cephalomedullary nails at the index surgery. Fracture healing however, seems generally good. A watchful waiting approach is advocated in patients with fractures that appear to

  1. Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls

    Directory of Open Access Journals (Sweden)

    Bali Kamal

    2013-02-01

    Full Text Available 【Abstract】Objective: Surgical management op-tions for femoral shaft fracture and ipsilateral proximal fe-mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela-tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight bearing with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods: Sixteen cases (10 males and 6 females with a mean age of 41.8 years of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixa-tion at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as tech-nical challenges unique to each fracture pattern was kept for all the patients. Results: The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac-tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion: Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac-ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically de-manding with a definite learning curve. Nevertheless, a ma-jority of these

  2. Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases

    DEFF Research Database (Denmark)

    Houshian, Shirzad; Gøthgen, Charlotte Buch; Pedersen, Niels Wisbech

    2004-01-01

    We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4-11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children...... clinically after median 1.5 (1-3) years. Their median hospital stay was 6 (2-20) days. All fractures were radiographically united at a median of 7 (5-9) weeks. The nails were removed in 29 children after a median of 22 (6-38) weeks postoperatively. At follow-up, we found a leg-length discrepancy up to 1 cm...

  3. Femoral neck-shaft angle in extra-capsular proximal femoral fracture fixation; does it make a TAD of difference?

    Science.gov (United States)

    Walton, N P; Wynn-Jones, H; Ward, M S; Wimhurst, J A

    2005-11-01

    The effect of femoral neck-shaft angle and implant type on the accuracy of lag screw placement in extra-capsular proximal femoral fracture fixation was investigated. Radiographs of all extra-capsular proximal femoral fractures seen in one unit over 18 months were reviewed. Of 399 cases, 307 (237 female, 70 male) were included in the study as they had no contra-lateral proximal femoral metal work. Femoral neck-shaft angle (NSA) of the uninjured hip and magnification adjusted tip-apex distance (TAD) of femoral head lag screw were measured. Type of fixation implant was 135 degrees classic hip screw (CHS) (n=144) or 130 degrees intra-medullary hip screw (IMHS) (n=163). Mean contra-lateral NSA was 130.2 degrees (112.9--148 degrees ) and 64 patients (58 female, 6 male) had a NSA TAD was 18.7 mm (5.8--43.8mm) and 88.9% of cases had a TAD of less than 25 mm. TAD values were significantly greater using an IMHS if NSA was 125 degrees (p=0.028). This was not the case with the CHS. The use of the 130 degrees -IMHS in patients with a NSA 125 degrees and caution is advocated when using this device in such cases.

  4. Development of a fixation device for robot assisted fracture reduction of femoral shaft fractures: a biomechanical study.

    Science.gov (United States)

    Weber-Spickschen, T S; Oszwald, M; Westphal, R; Krettek, C; Wahl, F; Gosling, T

    2010-01-01

    Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40 degrees and a 90 degrees version). We measured relative movements between the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90 degrees showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90 degrees complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.

  5. Femoral shaft fractures in children, treaties with elastic nails of titanium - TENs

    International Nuclear Information System (INIS)

    Solano Urrutia, Antonio Luis; Gallon, Luis Alfonso; Echandia, Carlos

    2003-01-01

    Femoral shaft fractures are a common and temporarily disabling injury in children. Recent advances in orthopedic traumatology have led us at the Hospital Universitario del Valle, in Cali, Colombia, to perform a case series observational study with the use of a more aggressive approach with the new endomedullar titanium nails (TENs) in children suffering femur shaft fractures, in a closed procedure performed under image intensification. The main purpose of this study was to evaluate the outcome of 30 children treated with these nails. Pediatric femoral shaft fractures are more common in males with approximately a 2.75:1 male to female ratio. The age distribution is bimodal, with peaks in the younger than 5 years and mid-teenage groups (10-14 years) because of the increased incidence of high-energy trauma in teenage children (mean age: 9 years). Overall, TENs allowed rapid mobilization with few complications. The results were excellent or satisfactory in our cases. No child lost rotational alignment in the postoperative period. Irritation of the soft tissue near the knee by the nail tip occurred in one patient. As indications, implantation technique, and aftercare are refined, TENs may prove to be the ideal implant to stabilize most pediatric femur shaft fractures, avoiding the prolonged immobilization and complications of traction and spica cast

  6. The effects of intraoperative positioning on patients undergoing early definitive care for femoral shaft fractures.

    Science.gov (United States)

    Apostle, K L; Lefaivre, K A; Guy, P; Broekhuyse, H M; Blachut, P A; O'Brien, P J; Meek, R N

    2009-10-01

    To determine if there is a difference in morbidity and mortality in orthopaedic trauma patients with femoral shaft fractures undergoing early definitive care with intramedullary (IM) nails in the supine versus the lateral position. Retrospective cohort study, single centered. One level 1 trauma center. Nine hundred eighty-eight patients representing 1027 femoral shaft fractures treated with IM nails were identified through a prospectively gathered database between 1987 and 2006. Antegrade IM nail insertion with reaming of the femoral canal in either the supine or lateral position. Mortality was the primary outcome. Admission to intensive care unit (ICU) was the secondary outcome measure and a surrogate measure of morbidity. Literature review was performed to identify factors shown to contribute to morbidity and mortality in orthopaedic trauma patients. Intraoperative position in either the supine or lateral position was added to this list. Logistic regression analysis was performed to determine the magnitude and effect of the independent variables on each of the study end points. To determine if a more significant trend toward less favorable outcomes was observed with increasing severity of injury, particularly injuries of the chest and thorax, subgroup analysis was performed for all those with a femur fracture and an Injury Severity Score > or =18 and all those with a femur fracture and an Abbreviated Injury Score chest > or =3. Intraoperative position in either the supine or lateral position was not a significant predictor of mortality or ICU admission for the original cohort or the subgroup of Injury Severity Score > or =18. However, for the subgroup of Abbreviated Injury Score chest > or =3, intraoperative positioning in the lateral position had a statistically significant protective effect against ICU admission (P = 0.044). For polytrauma patients with femoral shaft fractures, surgical stabilization using IM nails inserted with reaming of the femoral canal in

  7. The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

    OpenAIRE

    Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

    2016-01-01

    Abstract The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery. We collected medical records of elderly patients aged???60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n ...

  8. Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life.

    Science.gov (United States)

    Karaman, Ozgur; Ayhan, Egemen; Kesmezacar, Hayrettin; Seker, Ali; Unlu, Mehmet Can; Aydingoz, Onder

    2014-10-01

    Any intraoperative rotational malalignment during intramedullary nailing (IMN) of femoral shaft fractures will become permanent. We hypothesized that rotational malalignment of the femur and its compensatory biomechanics may induce problems in the hip, knee, patellofemoral and ankle joints. We purposed to clarify the influence of a femoral rotational malalignment of ≥10° on daily activities. Twenty-four femoral shaft fracture patients treated with closed antegrade IMN were included. At last follow-up, to reveal any rotational malalignment, computerized tomography (CT) scans of both femurs (injured and uninjured sides) were examined. The patient groups with or without CT-detected true rotational malalignment ≥10° were compared with respect to the activity scores. Ten of the 24 patients (41.7%) had a CT-detected true rotational malalignment of ≥10° compared with the unaffected side. The AOFAS scores were 100.00 for all of the patients. LKS, WOMAC knee, and WOMAC hip scores were significantly decreased in the patients with rotational malalignment compared to those without. Patients without rotational malalignment tolerated climbing stairs significantly better than those with rotational malalignment. Patients who could not tolerate climbing stairs were consistently complaining of anterior knee pain. A femoral rotational malalignment of ≥10° is symptomatic for the patients, and the hip, knee, and patellofemoral joints were affected. Because of the possibly altered joint loadings and biomechanics, these could render patients prone to degenerative joint disease. In addition, due to the high rates of rotational malalignment after femoral shaft fracture and consequent malpractice claims, it is important for surgeons to be more aware of rotational alignment during surgery.

  9. An evaluation of flexible intramedullary nail fixation in femoral shaft fractures in paediatric age group.

    Science.gov (United States)

    Kumar, Sanjay; Roy, Sandip Kumar; Jha, Amrish Kumar; Chatterjee, Debdutta; Banerjee, Debabrata; Garg, Anant Kumar

    2011-06-01

    Sixty-two femoral shaft fractures in 60 patients treated by elastic intramedullary nailing with mean age of the patients being 9.2 years (range 5 years to 12 years) and average follow-up of 15 months (range 7 months to 60 months) are evaluated. Twenty-eight fractures were fixed with titanium elastic nail while 34 fractures were fixed with Enders nail. There were 40 midshaft fractures, 18 proximal femoral and 4 were fractures of distal third. Fracture patterns were transverse in 35, short oblique in 14 cases and 13 were spiral fractures. Mean age of union in this series was 17 weeks (range 12 weeks to 28 weeks). Ten cases had complications, 5 had nail tip irritation, 3 varus or valgus malalignment and 2 had delayed union. In this series, we did not have any non-union, refracture, limb length discrepancy or any major infection. The result demonstrates 100% union rate irrespective of the age, weight and height of the patient. Regardless of the site of fracture and their pattern, it united every time with elastic nail fixation. We did not find and mismatch in the results of fractures stabilised with titanium elastic nail with that of elastic stainless steel nail.

  10. Open grade III fractures of femoral shaft: Outcome after early reamed intramedullary nailing.

    Science.gov (United States)

    Singh, D; Garg, R; Bassi, J L; Tripathi, S K

    2011-09-01

    Open grade III fractures of femur are a challenging therapeutic problem as most of them are associated with multiple trauma. Method used for skeletal stabilization of these fractures should limit further soft tissue damage, bacterial spread and morbidity in addition to its ease of application, providing mechanical support and restoring normal alignment. Forty-six patients with open grade III fractures of femoral shaft were included in the study. There were 10 grade IIIA, 34 grade IIIB and two grade IIIC fractures that were treated with early reamed intramedullary nailing with adequate management of soft tissue. Patients were reviewed retrospectively. Mean time of union was 27 weeks. Infection rate was 4% and non-union rate was 9%. There were two cases (4%) with limb shortening. No case of angular or rotational deformity was noted. Early reamed intramedullary nailing for open grade III fractures of femoral shaft, after giving due respect to the soft tissue injury, gives satisfactory results with proper alignment, good range of motion, short rehabilitation period and low infection rate. Level IV. Retrospective therapeutic study. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  11. External fixation for closed pediatric femoral shaft fractures: where are we now?

    Science.gov (United States)

    Kong, Heather; Sabharwal, Sanjeev

    2014-12-01

    Recent advances in external fixation technique and pin design have sought to minimize complications such as pin site infection and premature removal of the external fixator. Although newer forms of internal fixation have gained popularity, external fixation may still have a role in managing pediatric femoral shaft fractures. We sought to assess the time to healing, limb alignment, and complications observed in a cohort of pediatric patients with closed femoral shaft fractures who were treated with external fixation. Over a 15-year period, one surgeon treated 289 pediatric patients with femur fractures, 31 (11%) of whom received an external fixator. The general indications for use of an external fixator during the period in question included length-unstable fractures, metadiaphyseal location, refracture, and pathologic fracture. Six patients (19%) had inadequate followup data and four patients (13%) were treated with a combination of flexible intramedullary nails and external fixation, leaving 21 patients for analysis. Mean age at injury was 10 years (range, 6-15 years) and followup averaged 22 months (range, 5-45 months) after removal of the fixator. Radiographs were examined for alignment and limb length discrepancy. Complications were recorded from a chart review. Mean time in the fixator was 17 weeks (range, 9-24 weeks). One patient sustained a refracture and one patient with an isolated femur fracture had a leg length discrepancy > 2 cm. There were no pin site infections requiring intravenous antibiotics or additional surgery. One patient with Blount disease and previous tibial osteotomy developed transient peroneal nerve palsy. Despite improvements in pin design and predictable fracture healing, complications such as refracture and leg length discrepancy after external fixation of pediatric femoral shaft fractures can occur. However, external fixation remains a viable alternative for certain fractures such as length-unstable fractures, metadiaphyseal

  12. Fat embolism syndrome in femoral shaft fractures: does the initial treatment make a difference?

    Directory of Open Access Journals (Sweden)

    Janio Jose Alves Bezerra Silva

    Full Text Available ABSTRACT Objective: To identify the risk factors correlated with the initial treatment performed. Methods: This is a retrospective study involving a total of 272 patients diagnosed with femoral shaft fractures. Of the patients, 14% were kept at rest until the surgical treatment, 52% underwent external fixation, 10% received immediate definitive treatment, and 23% remained in skeletal traction (23% until definitive treatment., Results: There were six cases of fat embolism syndrome (FES, which showed that , polytrauma is the main risk factor for its development and that initial therapy was not important. Conclusion: Polytrauma patients have a greater chance of developing FES and there was no influence from the initial treatment.

  13. Treatment of a femoral shaft fracture in a patient with congenital hip disease: a case report

    Directory of Open Access Journals (Sweden)

    Koutsostathis Stefanos D

    2010-07-01

    Full Text Available Abstract Introduction We present a rare case of two concomitant morbidities treated in one operation. To our knowledge, this is the first report of its kind in the literature. Case presentation A 57-year-old Greek woman was admitted to the emergency department having sustained a spiral mid-shaft femoral fracture. She also suffered from an ipsilateral hip congenital dysplasia with ankylosed hip joint due to severe arthritis. She was treated with a total hip arthroplasty using a long stem performing as an intramedullary nail. Conclusion We undertook a complex operative treatment of both co-morbidities in a one stage procedure with a satisfactory clinical result.

  14. Repeat LISS treatment for femoral shaft fractures due to hardware failure: a retrospective analysis of eleven cases.

    Science.gov (United States)

    Li, Xu; Xu, Xian; Liu, Lin; Shao, Qin; Wu, Wei

    2013-10-01

    To evaluate the effectiveness of a replating technique having a less-invasive stabilization system (LISS) for femoral shaft fractures due to LISS failure in adults. There were 11 patients with hardware failure of LISS for femoral shaft fractures, on an average of 50 days after the primary operation. The failed implants were removed, and the fractures were replated with a LISS following the rationale of biological osteosynthesis. Radiological fracture union and incidence of postoperative complications were employed to evaluate the effectiveness of this replating technique for femoral shaft fractures. Operative duration including removing failed hardware and replating fractures averaged 81.5 min, with an average blood loss of 330 ml. Patients had an average follow-up of 25.7 months. Radiological evaluation indicated that fracture union occurred in an average of 4.4 months in all patients. The length and alignment of the affected limb were satisfactory, and hardware failure did not recur. The replating technique with LISS for femoral shaft fractures due to hardware failure of LISS can obtain satisfactory results when the appropriate rationale of biological osteosynthesis and functional exercise is followed.

  15. Complications and functional recovery in treatment of femoral shaft fractures with unreamed intramedullary nailing.

    Science.gov (United States)

    Sadic, Sahmir; Custovic, Svemir; Smajic, Nedim; Fazlic, Mirsad; Vujadinovic, Aleksandar; Hrustic, Asmir; Jasarevic, Mahir

    2014-01-01

    Fracture of the femoral shaft is a common fracture encountered in orthopedic practice. In the 1939, Küntscher introduced the concept of intramedullary nailing for stabilization of long bone fractures. Intramedullary nailing has revolutionized the treatment of fractures. The study included 37 male patients and 13 female patients, averaged 39 +/- 20.5 years (range, 16 to 76 years). There were 31 left femurs and 21 right femurs fractured. 46 fractures were the result of blunt trauma. Low energy trauma was the cause of fractures in six patients, of which five in elderly females. 49 fractures were closed. Healing time given in weeks was 19.36 +/- 6.1. The overall healing rate was 93.6%. There were three (6.25%) major complications nonunion. There were one (2%) delayed union, one (2%) rotational malunion and no infection. The shortening of 1 cm were in two patients. Antercurvatum of 10 degrees was found in one patient. There was no statistically significant reduction of a motion in the hip and knee (p knee extensors) muscle weakness (p fractures.

  16. Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study.

    Science.gov (United States)

    Saengsin, Jirawat; Vaseenon, Tanawat; Pattamapaspong, Nuttaya; Kritsaneephaiboon, Apipop

    2017-08-01

    A minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted. Twenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests. All of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.-0.7). When we compared two methods of measurement using Bland

  17. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial

    Directory of Open Access Journals (Sweden)

    Tank Gyaneshwar

    2016-08-01

    Conclusion: Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

  18. ”DAMAGE CONTROL“ STRATEGY IN THE TREATMENT OF POLYTRAUMA PATIENTS WITH OPEN FEMORAL SHAFT FRACTURE COMBINED WITH SPLENIC RUPTURE - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ivan Golubović

    2011-09-01

    Full Text Available Polytrauma represents the most difficult form of trauma epidemic. Appropriate treatment of the femoral shaft fracture in polytrauma patients can significantly reduce mortality and morbidity. External skeletal fixation in patients with femoral shaft fracture presents a minor surgical trauma with minimal blood loss. In modern trauma centres, external skeletal fixation in polytrauma patients is a temporary method (as a part of „damage control“strategy where immediate extensive internal fixation could be risky. It is usually postponed until the patient status is stable with normal vital parameters.This paper presents a polytrauma patient with dominant abdominal injury and femoral shaft fracture. During the same operation, external skeletal fixation was applied after abdominal surgery was done. Conversion of external into internal fixation was carried out because of postoperative febrile state that lasted for 14 days. External skeletal fixation was a definitive method of treatment. Fracture of the femoral shaft healed after 7 months with good functional outcome.External skeletal fixation is a successful method of treatment for femoral shaft fracture in polytrauma patients. It is a temporary method as a part of „damage control“ strategy and is usually followed by internal fixation. Sometimes, it is a definitive treatment method in patients with open and comminuted fractures of the femoral shaft and in polytrauma patients when the above mentioned conversion is not safe.

  19. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial.

    Science.gov (United States)

    Gyaneshwar, Tank; Nitesh, Rustagi; Sagar, Tomar; Pranav, Kothiyal; Rustagi, Nitesh

    2016-08-01

    Literature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures. The study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5-12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n=17) or stainless steel (n=17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria. Based on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed

  20. Surgical strategies in polytraumatized patients with femoral shaft fractures - comparing a German and an Australian level I trauma centre.

    Science.gov (United States)

    Andruszkow, Hagen; Dowrick, Adam S; Frink, Michael; Zeckey, Christian; Krettek, Christian; Hildebrand, Frank; Edwards, Elton R; Mommsen, Philipp

    2013-08-01

    Femoral shaft fractures are one of the most common injuries in multiple trauma patients. Due to their prognostic relevance, there is an ongoing controversial discussion as to the optimal treatment strategy in terms of Damage Control Orthopaedics (DCO) and Early Total Care (ETC). We aimed to describe the differences in fracture management and clinical outcome of multiple trauma patients with concomitant femoral shaft fractures treated at a German and an Australian level I trauma centre using the same inclusion criteria. Polytraumatized patients (ISS ≥ 16) with a femoral shaft fracture aged ≥ 16 years treated at a German and an Australian trauma centre between 2003 and 2007 were included. According to ETC and DCO management principles, we evaluated demographic parameters as well as posttraumatic complications and clinical outcome. Seventy-three patients were treated at the German and 134 patients at the Australian trauma centre. DCO was performed in case of increased injury severity in both hospitals. Prolonged mechanical ventilation time, and length of ICU and hospital stay were demonstrated in DCO treatment regardless of the trauma centre. No differences concerning posttraumatic complications and survival were found between both centres. Survival of patients after DCO was similar to those managed using ETC despite a greater severity of injury and lower probability of survival. There was no difference in the incidence of ARDS. DCO was, however, associated with a greatly increased length of time on mechanical ventilation and length of stay in the ICU. We found no differences concerning patient demographics or clinical outcomes in terms of incidence of ARDS, MODS, or mortality. As such, we propose that comparability between German and Australian trauma populations is justified. Despite a higher ISS in the DCO group, there were no differences in posttraumatic complications and survival depending on ETC or DCO treatment. Further research is required to confirm

  1. frequency of ipsilateral femoral neck fractures in patients

    African Journals Online (AJOL)

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft ... nailing of the shaft fracture, which makes treatment of the neck ... chest, spine), while the other had maxillofacial injuries.

  2. Frequency of ipsilateral femoral neck fractures in patients with ...

    African Journals Online (AJOL)

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft fractures. Objective: To establish the frequency of ipsilateral femoral neck fractures amongst all patients presenting with femoral shaft fractures in Mulago Hospital. Methodology: This was a descriptive ...

  3. Adductor insertion avulsion syndrome with stress fracture of femoral shaft: MRI findings

    International Nuclear Information System (INIS)

    Lawande, M.A.; Sankhe, S.; Pungavkar, S.A.; Patkar, D.P.

    2007-01-01

    Full text: Chronic vague hip pain may be caused by stress-related injury in the proximal or mid-femoral diaphysis. This has been described as an entity called adductor insertion avulsion syndrome, or thigh splints. In the appropriate clinical setting, the radiologist interpreting the magnetic resonance imaging must be aware of this condition as its imaging findings are subtle. The diagnosis will help the clinician plan the appropriate management. Magnetic resonance imaging can also depict the complications such as stress fracture

  4. Low-Energy Traumatic Obturator Hip Dislocation with Ipsilateral Femoral Shaft Fracture in a Patient with Omolateral Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    G. Gazzotti

    2016-01-01

    Full Text Available Ipsilateral obturator hip dislocation and femoral shaft fracture are rare. We report such a case in an older woman after a low-energy injury. She had a knee prostheses in the same limb. The patient was treated by open manipulative reduction of the luxation without opening joint and open reduction and internal fixation of the femur with angular stability plate and screws. We could not find a similar case in the literature. An early diagnosis of the dislocation is crucial in order to obtain good results. Great awareness and radiologic examination are fundamental to achieve precocious diagnosis of both these rare combined injuries, as treatment in these cases is considered an emergency. The first step was an attempt to reduce the dislocation by closed means but it failed. Then we performed a short approach at the trochanteric region and used Lambotte forceps to manoeuvre the proximal femur without opening the joint achieving reduction. Thereafter the femoral shaft fracture underwent open reduction and internal fixation with an angular stable plate. After a 2-year follow-up the outcome was very good.

  5. Management of Femoral Shaft Fractures with Elastic Titanium Nails in Pediatric Patients

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    Yunus Güzel

    2016-06-01

    Full Text Available Objective: The aim of this study was to evaluate the func­tional and radiological results of the application of intra­medullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The frac­ture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spi­ral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months. Positive union criteria were accepted as pain-free weight-bearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks. Limb shortness was determined in 5 (14% patients. No significant association was detected be­tween shortness and fracture pattern. No varus or valgus angulation of >10˚ was determined in any patient. Conclusion: Application of titanium elastic nails in pe­diatric femoral diaphysis fractures is a comfortable, eco­nomic, and reliable method which is allows early weight-bearing.

  6. A case report of a completely displaced stress fracture of the femoral shaft in a middle-aged male athlete - A precursor of things to come?

    Science.gov (United States)

    Larsen, Peter; Elsoe, Rasmus; Rathleff, Michael S

    2016-05-01

    Displaced stress fractures of the femoral shaft are very uncommon. The proportion of middle-aged and older age groups participating in long-distance running, triathlon and other high intensity sports is increasing. As a consequence stress fracture of the femoral shaft may be on the rise in the future. The patient was 43 years old male caucasian triathlete. The authors met the patient after he was admitted with a displaced femoral shaft fracture. The fracture occurred during running at the national championship in ½ Ironman. The patient reported that his symptoms had gradually developed over the last month before the fracture with pain localized anterior to the thigh. The patient interpreted the symptoms as local muscle damage. A clinical examination was conducted by a physiotherapist and the symptoms were interpreted as a simple muscle injury in the quadriceps. When presented with a patient with non-traumatic, diffuse anterior thigh pain in an individual of this age, who is participating in high-level endurance running; clinicians should consider the possibility that the cause of the symptoms may be a femoral shaft stress fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing.

    Science.gov (United States)

    Lee, J R; Kim, H-J; Lee, K-B

    2016-04-01

    The femoral shaft fractures with large fragments makes anatomical reduction challenging and often results in non-union. In some studies, the degree of fragment displacement was reported to have affected non-union, but the association between the one fragment size and degree of displacement has not been fully clarified. Therefore we performed a retrospective study to assess: (1) the more influential factor of non-union: the degree of fragment displacement, or the fragment size? (2) the non-union rates according to different sizes and degrees of displacement. The degree of displacement is the more potent factor of non-union than the third fragment size in femoral shaft fractures. We assessed retrospectively 64 cases, which could be followed up for longer than one year. Fragments were divided according to the length of their long axis into three groups: group A (0-3.9cm), (n=21); group B (4-7.9cm), (n=22); group C (8cm or more), (n=21). Fragment displacement was also assessed in the proximal (P) or distal (D) end to the nearest cortex of the femoral shaft, and divided into the following groups: group P1 (n=44) or D1 (n=47), (0-9mm); group P2 (n=10) or D2 (n=11), (10-19mm); group P3 (n=7) or D3 (n=3), (20-29mm); and group P4 (n=3) or D4 (n=3), (30mm or more). The bone union rate was 86% in the small (less than 8cm) fragment groups and 71% in the large (8cm or more) fragment group (P=0.046). With respect to the degree of displacement, the union rate was lower (P=0.001) and the average union time was longer (P=0.012) in the 20mm or more group for both the proximal fragment part and the distal fragment part (P=0.002, P=0.014). A logistic regression analysis underlined the displacement in the proximal site (OR: 0.298, 95% CI: 0.118-0.750) as in the distal site (OR: 0.359, 95% CI: 0.162-0.793) as a larger effect on union rate than the fragment size that as no effect in logistic regression (OR 3.8, 95% CI: 0.669-21.6). Non-union develops significantly more frequently in

  8. 3D atlas-based registration can calculate malalignment of femoral shaft fractures in six degrees of freedom.

    Science.gov (United States)

    Crookshank, Meghan C; Beek, Maarten; Hardisty, Michael R; Schemitsch, Emil H; Whyne, Cari M

    2014-01-01

    This study presents and evaluates a semi-automated algorithm for quantifying malalignment in complex femoral shaft fractures from a single intraoperative cone-beam CT (CBCT) image of the fractured limb. CBCT images were acquired of complex comminuted diaphyseal fractures created in 9 cadaveric femora (27 cases). Scans were segmented using intensity-based thresholding, yielding image stacks of the proximal, distal and comminuted bone. Semi-deformable and rigid affine registrations to an intact femur atlas (synthetic or cadaveric-based) were performed to transform the distal fragment to its neutral alignment. Leg length was calculated from the volume of bone within the comminution fragment. The transformations were compared to the physical input malalignments. Using the synthetic atlas, translations were within 1.71 ± 1.08 mm (medial/lateral) and 2.24 ± 2.11 mm (anterior/posterior). The varus/valgus, flexion/extension and periaxial rotation errors were 3.45 ± 2.6°, 1.86 ± 1.5° and 3.4 ± 2.0°, respectively. The cadaveric-based atlas yielded similar results in medial/lateral and anterior/posterior translation (1.73 ± 1.28 mm and 2.15 ± 2.13 mm, respectively). Varus/valgus, flexion/extension and periaxial rotation errors were 2.3 ± 1.3°, 2.0 ± 1.6° and 3.4 ± 2.0°, respectively. Leg length errors were 1.41 ± 1.01 mm (synthetic) and 1.26 ± 0.94 mm (cadaveric). The cadaveric model demonstrated a small improvement in flexion/extension and the synthetic atlas performed slightly faster (6 min 24 s ± 50 s versus 8 min 42 s ± 2 min 25 s). This atlas-based algorithm quantified malalignment in complex femoral shaft fractures within clinical tolerances from a single CBCT image of the fractured limb.

  9. Effectiveness of plate augmentation for femoral shaft nonunion after nailing

    Directory of Open Access Journals (Sweden)

    Chin-Jung Lin

    2012-08-01

    Conclusion: Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.

  10. Current indications for open Kuntscher nailing of femoral shaft ...

    African Journals Online (AJOL)

    Current indications for open Kuntscher nailing of femoral shaft fractures. A S Bajwa FCS(SA)ORTH. E Schnaid FCS(SA)ORTH. M E B Sweet MD PhD(rned). University of Witwatersrand, Johannesburg, South Africa. Key Words: Kuntscher nail, intramedullary nail, femoral fracture. We retrospectively reviewed 32 patients with.

  11. Clinical and Radiographic Outcomes After Submuscular Plating (SMP) of Pediatric Femoral Shaft Fractures.

    Science.gov (United States)

    Stoneback, Jason W; Carry, Patrick M; Flynn, Katherine; Pan, Zhaoxing; Sink, Ernest L; Miller, Nancy H

    2018-03-01

    To evaluate lower extremity strength and alignment among children who underwent submuscular plating (SMP). Subjects who underwent SMP for a length unstable femoral fracture returned for isokinetic strength testing ≥2 years after surgery. Extensor and flexor strength deficits (percent difference) between the operative and nonoperative limbs were evaluated. Radiographic measurements of mechanical alignment [anatomic lateral distal femoral angle (aLDFA)] and qualitative measurements (The Pediatric Outcomes Data Collection Instrument, PODCI) were obtained from all subjects. The upper 97.5% confidence interval approach to establishing clinical equivalency was utilized to compare differences in strength and alignment between the operative and nonoperative limbs. An extensor strength deficit of >19% and an aLDFA discrepancy of >5 degrees were considered to be clinically significant. The average age at surgery of the 10 subjects included in the study was 8.7 years. The hardware was placed an average of 27.9 mm from the distal femoral physis and was removed 6.4 months postsurgery. Among all subjects, the median PODCI scores were ≥97 according to all subscales. There was no significant difference in extension torque between the operative versus nonoperative limbs at 60 degrees/s (P=0.5400), 120 degrees/s (P=0.4214), or 180 degrees/s (P=0.8166). More importantly, extension strength deficits between the operative and nonoperative limbs were not clinically significant at 60 degrees/s [upper 97.5% confidence interval (CI), 10.9%], 120 degrees/s (upper 97.5% CI, 11.0%), or 180 degrees/s (upper 97.5% CI, 10.7%). The difference in aLDFA between the operative and nonoperative limb was less than the predefined clinically significant threshold of 5 degrees for all subjects. SMP achieves satisfactory clinical and functional results. In this series, extensor strength deficits and/or lower extremity malalignment were not clinically meaningful. High patient satisfaction can be

  12. [Long-Term Outcomes of the Treatment of Pediatric Femoral Shaft Fractures Treated with Bryant's Vertical Traction].

    Science.gov (United States)

    Urban, J; Toufar, P; Kloub, M

    2017-01-01

    PURPOSE OF THE STUDY The paper aimed to evaluate the long-term outcomes of the treatment of diaphyseal femur fractures in children treated with Bryant's vertical traction. Moreover, we also assessed the size of overgrowth in the injured femur. MATERIAL AND METHODS The study included 23 patients with 23 femoral shaft fractures treated with Bryant's vertical traction at our department in 2009-2014. The following parameters were assessed: sex, ïnjured side, weight, age, mechanism of injury, potential abuse, type of fracture, duration of traction, and total length of hospital stay. The healing time of the fracture was the same as the duration of traction. Also assessed was the size of femoral shortening after the removal of traction, the presence of skin complications in the course of treatment and potential development of compartment syndrome. At the mean follow-up of 47.8 months (range 22-85 months) from the date of injury the patients were evaluated clinically and radiologically for: length of limbs, presence of rotational deformity, range of motion of knee and hip joints, potential pain or limping, potential scoliosis of the spine and presence of scars after traction. Finally, through a questionnaire we learned about the opinions of parents as to the treatment method and about the possibility of home traction. RESULTS All the fractures healed. There was a total of 17 injured boys and 6 injured girls. Whereas 12 patients sustained a fracture of the left femur, 11 patients sustained a fracture of the right femur. The mean weight of patients at the time of injury was 13.9 kg (range 5-20 kg). The mean age at the time of traction was 30.8 months (range 1-70 months). The injury most frequently occurred from various falls, altogether in 15 cases (65.2%). Traffic accidents were registered as the cause of injury in 3 cases (13%). No abuse was confirmed. The average duration of traction was 19.8 days (range 8-26 days). The total length of hospital stay took on average 23

  13. Minimizing Leg Length Discrepancy After Intramedullary Nailing of Comminuted Femoral Shaft Fractures: A Quality Improvement Initiative Using the Scout Computed Tomography Scanogram.

    Science.gov (United States)

    Gheraibeh, Petra; Vaidya, Rahul; Hudson, Ian; Meehan, Robert; Tonnos, Frederick; Sethi, Anil

    2018-05-01

    To prevent leg length discrepancy (LLD) after locked femoral nailing in patients with comminuted femoral shaft fractures. Prospective consecutive case series aimed at quality improvement. Level 1 Trauma Center PATIENTS:: Ninety-eight consecutive patients with a comminuted femoral shaft fracture underwent statically locked intramedullary nailing, with a focused attempt at minimizing LLD during surgery. A computed tomography scanogram of both legs was performed on postoperative day 1 to assess for residual LLD. Patients were offered the option to have LLD >1.5 cm corrected before discharge. LLD >1.5 cm. Twenty-one patients (21.4%) were found to have an LLD >1.5 cm. An LLD >1.5 cm occurred in 10/55 (18%) antegrade nail patients and 11/43 (26%) retrograde nail patients (P = 0.27). No difference was noted based on the mechanism of injury, surgeon training and OTA/AO type B versus C injury. Ninety of 98 patients left with 1.5 cm after locked intramedullary nailing for a comminuted femoral shaft fracture without being informed and the option of early correction. We recommend using a full-length computed tomography scanogram after IM nailing of comminuted femur fractures to prevent iatrogenic LLD. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  14. [Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

    Science.gov (United States)

    Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

    2018-05-25

    To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has

  15. "Push-past" reaming as a reduction aid with intramedullary nailing of metadiaphyseal and diaphyseal femoral shaft fractures.

    Science.gov (United States)

    Gary, Joshua L; Munz, John W; Burgess, Andrew R

    2014-06-01

    Eccentric reaming of cortical bone near a fracture site can introduce malalignment when an intramedullary nail is placed. The authors describe a technique of reaming metadiaphyseal and diaphyseal femur fractures in which maintaining reduction at the fracture site is not necessary to obtain an excellent alignment of long bone fractures after intramedullary nailing. They have found that central reaming proximal and distal to, but not at, the fracture site allows for excellent reduction of long bone fractures when the intramedullary nail is passed. The reamer is stopped just before the fracture site and then "pushed" across the fracture prior to resumption of reaming. The authors present "push-past" reaming as a technical trick to facilitate reduction of femoral fractures treated with intramedullary nails and a consecutive series of 18 cases in which excellent postoperative alignment was achieved. Copyright 2014, SLACK Incorporated.

  16. Is Contralateral Templating Reliable for Establishing Rotational Alignment During Intramedullary Stabilization of Femoral Shaft Fractures? A Study of Individual Bilateral Differences in Femoral Version.

    Science.gov (United States)

    Croom, William P; Lorenzana, Daniel J; Auran, Richard L; Cavallero, Matthew J; Heckmann, Nathanael; Lee, Jackson; White, Eric A

    2018-02-01

    To determine native individual bilateral differences (IBDs) in femoral version in a diverse population. Computed tomography scans with complete imaging of uninjured bilateral femora were used to determine femoral version and IBDs in version. Age, sex, and ethnicity of each subject were also collected. Femoral version and IBDs in version were correlated with demographic variables using univariate and multivariate regression models. One hundred sixty-four subjects were included in the study. The average femoral version was 9.4 degrees (±9.4 degrees). The mean IBD in femoral version was 5.4 degrees (±4.4 degrees, P alignment during intramedullary stabilization of diaphyseal femur fractures. This is also an important consideration when considering malrotation of femur fractures because most studies define malrotation as a greater than 10-15-degree difference compared with the contralateral side. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  17. Can a semi-automated surface matching and principal axis-based algorithm accurately quantify femoral shaft fracture alignment in six degrees of freedom?

    Science.gov (United States)

    Crookshank, Meghan C; Beek, Maarten; Singh, Devin; Schemitsch, Emil H; Whyne, Cari M

    2013-07-01

    Accurate alignment of femoral shaft fractures treated with intramedullary nailing remains a challenge for orthopaedic surgeons. The aim of this study is to develop and validate a cone-beam CT-based, semi-automated algorithm to quantify the malalignment in six degrees of freedom (6DOF) using a surface matching and principal axes-based approach. Complex comminuted diaphyseal fractures were created in nine cadaveric femora and cone-beam CT images were acquired (27 cases total). Scans were cropped and segmented using intensity-based thresholding, producing superior, inferior and comminution volumes. Cylinders were fit to estimate the long axes of the superior and inferior fragments. The angle and distance between the two cylindrical axes were calculated to determine flexion/extension and varus/valgus angulation and medial/lateral and anterior/posterior translations, respectively. Both surfaces were unwrapped about the cylindrical axes. Three methods of matching the unwrapped surface for determination of periaxial rotation were compared based on minimizing the distance between features. The calculated corrections were compared to the input malalignment conditions. All 6DOF were calculated to within current clinical tolerances for all but two cases. This algorithm yielded accurate quantification of malalignment of femoral shaft fractures for fracture gaps up to 60 mm, based on a single CBCT image of the fractured limb. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  18. The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture.

    Science.gov (United States)

    Yildirim, Ahmet Ozgur; Aksahin, Ertuğrul; Sakman, Bulent; Kati, Yusuf Alper; Akti, Sefa; Dogan, Ozgur; Ucaner, Ahmet; Bicimoglu, Ali

    2013-05-01

    The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2 months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. There were 14 (42.4 %) patients in Group A, 12 (36.4 %) patients in Group B and 7 (21.2 %) patients in Group C. The mean patella score in Group C (74 ± 7.02) was significantly lower when compared with Group B (87.6 ± 9.9) and group A (90.6 ± 6.1) (p < 0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.

  19. Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures

    International Nuclear Information System (INIS)

    Coetzee, J.C.; Van der Merwe, E.J.

    1992-01-01

    Owing to the continuous turnover of registrars and radiographers, most of the trauma-related orthopedic surgery in this academic hospital is done by inexperienced surgeons-in-training and the fluoroscopy by junior radiographers. This could result in excessive radiation doses. Calibrated lithium fluoride thermoluminescent chips were secured to various parts of the primary surgeon's body to quantify the radiation dose received during the insertion of an intramedullary nail. Closed intramedullary fixation of 15 fractures of the femur was done with interlocking as necessary. The total average exposure time was 14 minutes 45 seconds per procedure. Distal locking took up 31% of this time. The mean radiation dose to the surgeon's eyes and thyroid was 0,13 mGy and to the dominant hand 2,10 mGy. This would allow the performance of about 350 such procedures per year before the maximum permissible dose level was reached. Recommendations to decrease irradiation dosage are made. 6 refs., 6 tabs

  20. Four Weeks in a Single-Leg Weight-Bearing Hip Spica Cast is Sufficient Treatment for Isolated Femoral Shaft Fractures in Children Aged 1 to 3 Years.

    Science.gov (United States)

    Jaafar, Sami; Sobh, Ali; Legakis, Julie E; Thomas, Ronald; Buhler, Kelsey; Jones, Eric T

    2016-01-01

    Hip spica casting regimens for the treatment of femoral shaft fractures in a pediatric population aged 1 to 3 years vary. Patient charts were reviewed to determine if there are any clinical differences between 3 and 4 weeks in an ambulatory single-leg hip spica (SLHS) cast versus 6 to 8 weeks in a standard double-leg, non-weight-bearing hip spica cast. The medical records of 109 patients with femoral shaft fractures treated with a hip spica casting from January 1, 2008 to December 31, 2011 were examined. After exclusions, 94 patients were eligible for inclusion in the study. Patient records were assessed, noting age, weight, type of cast, time in cast, and complications. All casts were applied by senior pediatric orthopaedic surgeons at a single institution. Two groups were evaluated: 59 patients in the SLHS group and 35 in the double-leg hip spica group. The 2 groups were demographically similar with an average age of 2 years, 70.2% of patients were male, 45.7% were black, and 35.1% were white. The average time to cast removal was 4.1 weeks for the single-leg group and 5.3 weeks for the double-leg group (Pshaft fractures in patients less than 4 years old can be treated in a weight-bearing SLHS casts for approximately 4 weeks with fewer alignment and skin complications. Level III-clinical retrospective comparative study.

  1. Intramedullary nailing of femoral shaft fractures in polytraumatized patients. a longitudinal, prospective and observational study of the procedure-related impact on cardiopulmonary- and inflammatory responses

    Directory of Open Access Journals (Sweden)

    Husebye Elisabeth E

    2012-01-01

    Full Text Available Abstract Background Early intramedullary nailing (IMN of long bone fractures in severely injured patients has been evaluated as beneficial, but has also been associated with increased inflammation, multi organ failure (MOF and morbidity. This study was initiated to evaluate the impact of primary femoral IMN on coagulation-, fibrinolysis-, inflammatory- and cardiopulmonary responses in polytraumatized patients. Methods Twelve adult polytraumatized patients with femoral shaft fractures were included. Serial blood samples were collected to evaluate coagulation-, fibrinolytic-, and cytokine activation in arterial blood. A flow-directed pulmonary artery (PA catheter was inserted prior to IMN. Cardiopulmonary function parameters were recorded peri- and postoperatively. The clinical course of the patients and complications were monitored and recorded daily. Results Mean Injury Severity Score (ISS was 31 ± 2.6. No procedure-related effect of the primary IMN on coagulation- and fibrinolysis activation was evident. Tumor necrosis factor alpha (TNF-α increased significantly from 6 hours post procedure to peak levels on the third postoperative day. Interleukin-6 (IL-6 increased from the first to the third postoperative day. Interleukin-10 (IL-10 peaked on the first postoperative day. A procedure-related transient hemodynamic response was observed on indexed pulmonary vascular resistance (PVRI two hours post procedure. 11/12 patients developed systemic inflammatory response syndrome (SIRS, 7/12 pneumonia, 3/12 acute lung injury (ALI, 3/12 adult respiratory distress syndrome (ARDS, 3/12 sepsis, 0/12 wound infection. Conclusion In the polytraumatized patients with femoral shaft fractures operated with primary IMN we observed a substantial response related to the initial trauma. We could not demonstrate any major additional IMN-related impact on the inflammatory responses or on the cardiopulmonary function parameters. These results have to be interpreted

  2. Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study.

    Science.gov (United States)

    Samiezadeh, Saeid; Tavakkoli Avval, Pouria; Fawaz, Zouheir; Bougherara, Habiba

    2014-08-01

    Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the abovementioned complications. In this study, a new hybrid concept for nails made of carbon fibers/flax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages. Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23N (P<0.05), and the mean stress in the vicinity of fracture by 2.11MPa (P<0.05) at 45% gait cycle, while only 0.33mm and 0.39mm (P<0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur. Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants. Copyright © 2014. Published by Elsevier Ltd.

  3. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating.

    Science.gov (United States)

    Park, Jin; Kim, Sul Gee; Yoon, Han Kook; Yang, Kyu Hyun

    2010-02-01

    The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. : Retrospective data analysis, November 1996-March 2006. A level I trauma center. Eighteen patients with 18 nonisthmal femoral nonunions. Seven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and 11 patients with 11 fractures treated for nonisthmal femoral shaft nonunions after nailing with AP combined with bone grafting. Union and complications. Five nonunions in the EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shaft nonunion (odds ratio, 6.5; P = 0.002). AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.

  4. FRACTURE SHAFT HUMERUS: INTERLOCKING

    Directory of Open Access Journals (Sweden)

    Deepak Kaladagi

    2014-12-01

    Full Text Available BACKGROUND: The incidence of humeral fracture has significantly increased during the present years due to the population growth and road traffic, domestic, industrial, automobile accidents & disasters like tsunami, earthquakes, head-on collisions, polytrauma etc. In order to achieve a stable fixation followed by early mobilization, numerous surgical implants have been devised. PURPOSE: The purpose of this study is to analyze the results of intramedullary fixation of proximal 2/3rd humeral shaft fractures using an unreamed interlocking intramedullary nail. INTRODUCTION: In 40 skeletally matured patients with fracture shaft of humerus admitted in our hospital, we used unreamed antegrade interlocking nails. MATERIAL: We carried out a prospective analysis of 40 patients randomly selected between 2001 to 2014 who were operated at JNMC Belgaum, MMC Mysore & Navodaya Medical College, Raichur. All cases were either RTAs, Domestic, Industrial, automobile accidents & also other modes of injury. METHOD: Routine investigations with pre-anaesthetic check-up & good quality X-rays of both sides of humerus was taken. Time of surgery ranged from 5-10 days from the time of admission. Only upper 1/3rd & middle 1/3rd humeral shaft fractures were included in the study. In all the cases antegrade locked unreamed humeral nails were inserted under C-arm. Patient was placed in supine position & the shoulder was kept elevated by placing a sandbag under the scapula. In all patients incision taken from tip of acromion to 3cm over deltoid longitudinally. Postoperatively sling applied with wrist & shoulder movements started after 24 hours. All the patients ranged between the age of 21-50 years. RESULTS: Total 40 patients were operated. Maximum fracture site were in the middle third- 76%, 14% upper 1/3rd. All 40 patients achieved union. The average time of union was 8-10 weeks. All patients regained full range of movements except in few cases, where there was shoulder

  5. TIBIAL SHAFT FRACTURES.

    Science.gov (United States)

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2011-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

  6. The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture: A retrospective case-control study.

    Science.gov (United States)

    Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

    2016-08-01

    The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate.

  7. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  8. Elastic stable intramedullary nailing of femoral shaft fractures in children: Particularities and results at Sylvanus Olympio teaching hospital of Lomé, Togo

    Directory of Open Access Journals (Sweden)

    Akakpo-Numado Gamedzi Komlatsè

    2014-01-01

    Full Text Available Introduction: The elastic stable intramedullary nailing (ESIN presently seems the best technique in the surgical treatment of femoral shaft fractures (FSF in >6-year-old children. We hereby report technical difficulties and therapeutic results after our first 8 years of experience. Patients and Methods: It′s a retrospective study over a period of 8 years from January 2005 to December 2012 in the Paediatric Surgery Department of Sylvanus Olympio Teaching Hospital of Lomé. Indications, technical particularities and results were studied. Results: There were 32 patients, 17 were boys and 15 were girls, with a mean age of 11 years old. The mean time to surgery was 21 days (range: 14 and 51 days. A callus was always removed before reduction. The osteosynthesis was stable in 22 cases, but in 10 others, it had been completed with a cast immobilisation. The operation needed a blood transfusion in 18 cases. With a mean follow-up of 3.5 years, the results were excellent in 29 patients (90.63% and good in 3 patients (9.37%. Conclusion: Although undertaking an ESIN can be difficult, due to the lack of adequate equipment the procedure produces satisfactory outcome.

  9. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  10. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  11. Humeral Shaft Fracture: Intramedullary Nailing.

    Science.gov (United States)

    Konda, Sanjit R; Saleh, Hesham; Fisher, Nina; Egol, Kenneth A

    2017-08-01

    This video demonstrates the technique of intramedullary nailing for a humeral shaft fracture. The patient is a 30-year-old man who sustained a gunshot wound to his right arm. The patient was indicated for humeral nailing given the comminuted nature of the diaphysis and to allow for minimal skin incisions. Other relative indications include soft-tissue compromise about the arm precluding a large surgical exposure. This video presents a case of a comminuted humeral shaft fracture treated with an intramedullary nail. Anatomic reduction and stable fixation was obtained with this technique. This case demonstrates a soft-tissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time, and decreasing blood loss. In the correct clinical setting, humeral nailing provides an expeditious form of fixation that restores length, alignment, and rotation of the fracture humeral diaphysis.

  12. Femoral fractures : indications an[d] biomechanics of external fixation

    NARCIS (Netherlands)

    A.H. Broekhuizen (Tom); B. van Linge

    1988-01-01

    textabstractInternal fixation can be carried out in various ways. For femoral shaft fractures, an (interlocking) nail is becoming increasingly popular, instead of open realignment of the fracture. External fixation, which has become a generally accepted method of treating fractures of the lower

  13. Ipsilateral proximal femur and shaft fractures treated with hip screws and a reamed retrograde intramedullary nail.

    Science.gov (United States)

    Ostrum, Robert F; Tornetta, Paul; Watson, J Tracy; Christiano, Anthony; Vafek, Emily

    2014-09-01

    Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results. We investigated the use of hip screws and a reamed retrograde intramedullary (IM) nail for the treatment of this combined fracture pattern in terms of postoperative alignment (malunion), nonunion, and complications. Between May 2002 and October 2011, a total of 95 proximal femoral fractures with associated shaft fractures were treated at three participating Level 1 trauma centers; all were treated with hip screw fixation (cannulated screws or sliding hip screws) and retrograde reamed IM nails. The medical records of these patients were reviewed retrospectively for alignment, malunion, nonunion, and complications. Followup was available on 92 of 95 (97%) of the patients treated with hip screws and a retrograde nail. Forty were treated with a sliding hip screw, and 52 were treated with cannulated screws. There were five proximal malunions in this series (5%). The union rate was 98% (90 of 92) for the femoral neck fractures and 91.3% (84 of 92) for the femoral shaft fractures after the initial surgery. There were two nonunions of comminuted femoral neck fractures after cannulated screw fixation. There was no difference in femoral neck union or alignment when comparing cannulated screws to a sliding hip screw. Four open comminuted femoral shaft fractures went on to nonunion and required secondary surgery to obtain union, and one patient developed symptomatic avascular necrosis. The treatment of ipsilateral proximal femoral neck and shaft fractures with hip screw fixation and a reamed retrograde nail demonstrated a high likelihood of union for the femoral neck fractures and a low risk of malunion. Comminution and initial displacement of the proximal femoral fracture may still lead to a small incidence of malunion or nonunion, and open comminuted femoral shaft fractures

  14. Evaluation of malrotation following intramedullary nailing in a femoral shaft fracture model: Can a 3D c-arm improve accuracy?

    Science.gov (United States)

    Ramme, Austin J; Egol, Jonathan; Chang, Gregory; Davidovitch, Roy I; Konda, Sanjit

    2017-07-01

    Difficulty determining anatomic rotation following intramedullary (IM) nailing of the femur continues to be problematic for surgeons. Clinical exam and fluoroscopic imaging of the hip and knee have been used to estimate femoral version, but are inaccurate. We hypothesize that 3D c-arm imaging can be used to accurately measure femoral version following IM nailing of femur fractures to prevent rotational malreduction. A midshaft osteotomy was created in a femur Sawbone to simulate a transverse diaphyseal fracture. An intramedullary (IM) nail was inserted into the Sawbone femur without locking screws or cephalomedullary fixation. A goniometer was used to simulate four femoral version situations after IM nailing: 20° retroversion, 0° version, 15° anteversion, and 30° anteversion. In each simulated position, 3D c-arm imaging and, for comparison purposes, perfect lateral radiographs of the knee and hip were performed. The femoral version of each simulated 3D and fluoroscopic case was measured and the results were tabulated. The measured version from the 3D c-arm images was 22.25° retroversion, 0.66° anteversion, 19.53° anteversion, and 25.15° anteversion for the simulated cases of 20° retroversion, 0° version, 15° anteversion, and 30° anteversion, respectively. The lateral fluoroscopic views were measured to be 9.66° retroversion, 12.12° anteversion, 20.91° anteversion, and 18.77° anteversion for the simulated cases, respectively. This study demonstrates the utility of a novel intraoperative method to evaluate femur rotational malreduction following IM nailing. The use of 3D c-arm imaging to measure femoral version offers accuracy and reproducibility. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Avaliação epidemiológica e radiológica das fraturas diafisárias do fêmur: estudo de 200 casos Epidemiological and radiological evaluation of femoral shaft fractures: study of 200 cases

    Directory of Open Access Journals (Sweden)

    Frederico Barra de Moraes

    2009-06-01

    Full Text Available OBJETIVO: avaliar as características epidemiológicas e radiológicas dos casos de fratura diafisárias de fêmur, ocorridos de 1990 a 2005, tratados cirurgicamente no Hospital de Acidentados - Clínica Santa Isabel - de Goiânia, Goiás, com o propósito de contribuir para o melhor planejamento de medidas preventivas e terapêuticas a adotar em relação a essas fraturas. MÉTODOS: Foram avaliados retrospectivamente 200 prontuários e radiografias seriadas de pacientes com fraturas diafisárias do fêmur. Não foram incluídos os pacientes com menos de 10 anos de idade, pois o tratamento para esse grupo foi conservador. Foram descartados 25 prontuários por não fornecer todos os dados necessários ao estudo. Os pacientes foram analisados quanto ao sexo, idade, lado da fratura, exposição óssea, mecanismos de trauma, classificação das fraturas, traumas associados, tempo de consolidação e tipos de fixação cirúrgica. A análise estatística foi feita pelos testes do qui-quadrado, exato de Fisher" e t de Student, considerando significância quando p OBJECTIVE: to evaluate epidemiological and radiological characteristics of the femoral shaft fractures, surgically treated from 1990 to 2005 at Hospital de Acidentados - Clínica Santa Isabel - in Goiânia, Goiás, aiming to contribute to better preventive and therapeutic measures planning to adopt on those fractures. METHODS: 200 patients' files and x-rays with femoral shaft fractures have been retrospectively evaluated. Patients below the age of 10 years were not included because the treatment for this group was conservative. 25 files have been discarded for not supplying all the necessary data to the study. The patients were assessed for sex, age, side of the fracture, bone exposure, mechanisms of trauma, classification of the fractures, associated trauma, time for bone healing and types of surgical devices. Statistic analyses were made by chi-squared, Fisher and Student's-t tests

  16. Fracture Union in Closed Interlocking Nail in Femoral Fracture

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    R L Sahu

    2010-09-01

    Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

  17. Incidence and epidemiology of tibial shaft fractures.

    Science.gov (United States)

    Larsen, Peter; Elsoe, Rasmus; Hansen, Sandra Hope; Graven-Nielsen, Thomas; Laessoe, Uffe; Rasmussen, Sten

    2015-04-01

    The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and complete population and report the distribution of fracture classification, trauma mechanism and patient baseline demographics. Retrospective reviews of clinical and radiological records. A total of 196 patients were treated for 198 tibial shaft fractures in the years 2009 and 2010. The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Proximal femoral fractures.

    Science.gov (United States)

    Webb, Lawrence X

    2002-01-01

    Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

  19. Ipsilateral humeral neck and shaft fractures

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    Zhu Bin

    2017-01-01

    Full Text Available Background/Aim. Fractures of the proximal humerus or shaft are common, however, ipsilateral neck and shaft humerus fracture is a rare phenomenon. This combination injury is challenging for orthopaedic surgeons because of its complex treatment options at present. The purpose of this study was to review a series of ipsilateral humeral neck and shaft fractures to study the fracture pattern, complications and treatment outcomes of each treatment options used. Methods. A total of six patients (four female and two male with the average age of 42.8 years (range: 36–49 years was collected and reviewed retrospectively. Two of them were treated with double plates and four with antegrade intramedullary nail. According to the Neer’s classification, all proximal fractures were two-part surgical neck fractures. All humeral shaft fractures were located at the middle of one third. Five fractures were simple transverse (A3, one fragmented wedge fracture (B3. One patient had associated radial nerve palsy. Results. All surgical neck fractures except one united uneventfully in the average time span of 8.7 weeks. Four humeral shaft fractures healed in near anatomic alignment. The remaining two patients had the nonunion with no radiological signs of fracture healing. The average University of California, Los Angeles End-Results (UCLA score was 23.1. On the contrary, the average American Shoulder and Elbow Surgeon's (ASES score was 73.3. The patients treated with antegrade intramedullary nails presented 70.5 points. The ASES scores were 79 in the double plates group. Conclusions. Ipsilateral humeral shaft and neck fracture is extremely rare. Both antegrade intramedullar nailing and double plates result in healing of fractures. However the risk of complication is lower in the double plating group.

  20. OUTCOME OF INTERTROCHANTERIC FRACTURES TREATED WITH SHORT FEMORAL NAIL

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    Yadkikar Shriniwas V, Yadkikar Vishnu S, Patel Mayank, Dhruvilkumar Gandhi, Kunkulol Rahul

    2015-07-01

    Full Text Available Aim: To study the functional and anatomical outcome of Inter trochanteric fractures of femur treated with Short femoral nail. Method: This was retrospective study carried out in which 60 patients (50 Male & 10 Female of 5th to 8th decade of life who underwent Short femoral nail fixation for both Stable & unstable Inter Trochanteric fractures. From the records each patient data was assessed for time required for mobilization, average fracture healing time, degree and grade of hip range of movements, complications, anatomical reduction achieved using Short femoral nail fixation. Results: 55 cases achieved Anatomical reduction. Good to Excellent Hip range of Motion was in 55 (90 % cases. Fracture union was seen in all cases. No evidence of Z Effect, AVN of femoral head, Implant failure, Fracture of femoral shaft below the Nail tip was seen in any case, However Reverse Z Effect was seen in 4 & shortening of less than 2 cm was seen in 2 cases, External rotation of 10 degree was seen in1 case. Average fracture Union time was 14 weeks. Conclusion: Short femoral nail appears to be better implant for fixation of both Stable & unstable Inter Trochanteric fractures as it fulfills the biomechanical demands being minimally invasive, less blood loss , it prevents excessive varus collapse at fracture site, produces less stress riser effect below the nail tip, Short operative time, Facilitates early mobilization & functional recovery of patients. But Anatomical fracture reduction & optimal implant placement are absolutely must for better results.

  1. Outcomes in closed reamed interlocking nail in fractures of shaft of femur

    International Nuclear Information System (INIS)

    Mohammad, T.; Sawati, A.; Ahmed, A.

    2015-01-01

    Femoral shaft fracture is one of the common fractures seen in accident and emergency department of our hospital. Violent forces are required to break this and strongest of human bones. There are various treatment modalities for femoral shaft fractures in adults like traction, brace, platting, intramedullary nail (IMN), external fixators and inter locking nails. The study was done with an objective to evaluate the results of closed reamed interlocking nail in fractures of shaft of femur. Methods: A prospective study of 114 cases of femoral shaft fractures was carried out at orthopaedic unit of Ayub Teaching Hospital Abbottabad during 1 year. All these cases were treated with statically locked nails under spinal or general anaesthesia. These cases were followed up for up to one year and Results of the interlocking nail were observed in terms of union and complications. Results: Out of 114 patients, 95 underwent union in 90-150 days with a mean of 110.68 days. Ten patients had dynamization within six weeks because of obvious fracture gap in radiograph. There were 3 patients who had non-union, and 6 patients had delayed union which was treated with dynamization. Conclusion: Close reamed interlocking intramedullary nail in femoral shaft fractures is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and fracture healing response is good. (author)

  2. Mating of a PROSTALAC spacer with an intramedullary nail for reconstruction of an infected interprosthetic femoral shaft fracture: a case report.

    Science.gov (United States)

    Kamath, Atul F; Austin, Daniel; Lee, Gwo-Chin

    2012-08-01

    Reconstruction for concurrent infection of an ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is a challenge. We report a 2-stage reconstruction of a THA for chronic infection of both the THA and TKA with severe femoral bone loss secondary to interprosthetic fractures. The reconstruction involved using a custom-made, temporary, antibiotic-impregnated PROSTALAC spacer mated with an intramedullary nail. The acetabulum was then exposed and the necrotic cartilage was removed and curetted. The acetabulum was reamed to accept a PROSTALAC acetabular shell. The shell was cemented into the acetabulum with antibiotic cement. The custom-made spacer was then inserted distally first into the tibia. The distal end of the intramedullary nail was interlocked with a bicortical bolt to minimise nail rotation. Antibiotic-impregnated cement was moulded around the nail and spacer. The proximal end of the spacer was then reduced into the acetabular socket, and the joint was irrigated and the wound closed. A customised abduction brace was fitted, and partial weight bearing was allowed. Sufficient leg length, soft-tissue tension, and range of hip motion were restored, and a total femur and constrained liner was re-implanted 4 months later. Mating of an intramedullary nail with a PROSTALAC spacer is a viable reconstructive option.

  3. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope

    2015-01-01

    Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large....... The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have...... frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. Conclusion: This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type...

  4. Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases

    International Nuclear Information System (INIS)

    Williams, M.; Timsit, M.A.; Karneff, A.; Pertuiset, E.

    1999-01-01

    We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively. (orig.)

  5. A risk-adapted approach is beneficial in the management of bilateral femoral shaft fractures in multiple trauma patients: an analysis based on the trauma registry of the German Trauma Society.

    Science.gov (United States)

    Steinhausen, Eva; Lefering, Rolf; Tjardes, Thorsten; Neugebauer, Edmund A M; Bouillon, Bertil; Rixen, Dieter

    2014-05-01

    Today, there is a trend toward damage-control orthopedics (DCO) in the management of multiple trauma patients with long bone fractures. However, there is no widely accepted concept. A risk-adapted approach seems to result in low acute morbidity and mortality. Multiple trauma patients with bilateral femoral shaft fractures (FSFs) are considered to be more severely injured. The objective of this study was to validate the risk-adapted approach in the management of multiple trauma patients with bilateral FSF. Data analysis is based on the trauma registry of the German Trauma Society (1993-2008, n = 42,248). Multiple trauma patients with bilateral FSF were analyzed in subgroups according to the type of primary operative strategy. Outcome parameters were mortality and major complications as (multiple) organ failure and sepsis. A total of 379 patients with bilateral FSF were divided into four groups as follows: (1) no operation (8.4%), (2) bilateral temporary external fixation (DCO) (50.9%), bilateral primary definitive osteosynthesis (early total care [ETC]) (25.1%), and primary definitive osteosynthesis of one FSF and DCO contralaterally (mixed) (15.6%). Compared with the ETC group, the DCO group was more severely injured. The incidence of (multiple) organ failure and mortality rates were higher in the DCO group but without significance. Adjusted for injury severity, there was no significant difference of mortality rates between DCO and ETC. Injury severity and mortality rates were significantly increased in the no-operation group. The mixed group was similar to the ETC group regarding injury severity and outcome. In Germany, both DCO and ETC are practiced in multiple trauma patients with bilateral FSF so far. The unstable or potentially unstable patient is reasonably treated with DCO. The clearly stable patient is reasonably treated with nailing. When in doubt, the patient is probably not totally stable, and the safest precaution may be to use DCO as a risk

  6. One-stage lengthening using a locked nailing technique for distal femoral shaft nonunions associated with shortening.

    Science.gov (United States)

    Wu, Chi-Chuan; Lee, Zhon-Liau

    2004-02-01

    To assess the effectiveness of a one-stage lengthening using a locked nail technique for the treatment of distal femoral shaft nonunions associated with shortening. Retrospective. University hospital. During a 6-year period, 36 distal femoral shaft nonunions associated with shortening (>1.5 cm) were treated by the one-stage lengthening technique. Indications for this technique were distal femoral shaft aseptic or quiescent infected nonunions, 1.5-5 cm shortening, and a fracture level suitable for the insertion of two distal locked screws. The surgical technique involved skeletal traction using the femoral condyle, local débridement, lengthening by lengthening was 2.5 cm (range 1.5-3.5 cm). One-stage lengthening using the locked nailing technique to treat distal femoral shaft nonunions associated with shortening can achieve a high success rate and low complication rate. The key to successful treatment is the patient's complete cooperation with strictly protected weight bearing until the fracture has healed.

  7. Treatment of neglected femoral neck fracture

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    Anil K Jain

    2015-01-01

    Full Text Available Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the "Pubmed" search with the keywords "NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture." A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a treated by muscle-pedicle bone grafting (MPBG, (b closed/open reduction internal fixation and fibular grafting (c open reduction and internal fixation with valgus osteotomy, (d miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective, classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu′s staging neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90

  8. Fractures of the shafts of the tibia and fibula

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C.

    1985-01-01

    Fractures of the shafts of the tibia and fibula are the most common long bone fractures. This chapter discusses tibial and fibular shaft fractures. Treatment of tibial and fibular fractures is similar and, therefore, reference is primarily made to the tibia. Diagnostic techniques are also evaluated

  9. Análise de fraturas diafisárias do fêmur em crianças menores de 3 anos de idade Femoral shaft fractures: an assessment in children younger than 3 years old

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    João Paulo Machado Bergamaschi

    2007-01-01

    Full Text Available Este estudo consiste na reavaliação ortopédica e psicossocial de crianças que sofreram fratura do fêmur até a idade dos três anos e objetiva a análise de suas causas prováveis e detecção de indícios de ocorrência de Síndrome de Maus Tratos. Trinta e cinco crianças menores de três anos de idade sofreram fratura diafisária de fêmur e foram atendidas no Pronto Socorro do Serviço de Ortopedia e Traumatologia da Santa Casa de São Paulo, no período de janeiro de 1996 a agosto de 2002, sendo que 18 compareceram para reavaliação. Como causa relatada das fraturas observamos: queda em 13 (72,2% casos, queda de objetos sobre o membro em três (16,7% e fratura no parto em dois (11,1%. Constatamos suspeita de Síndrome dos Maus Tratos em nove (maus tratos físicos em seis [33,3%] e negligência em três [16,7%] casos, fratura patológica em quatro (22,2%, causa acidental em três (16,7%, e outras causas em dois (11,1% casos. Maus tratos constituem uma importante causa a ser investigada nos casos de fratura do fêmur em crianças com menos de três anos de idade, sendo o provável mecanismo responsável por metade das fraturas aqui estudadas.This study consists of an orthopaedic and psychosocial re-evaluation of children who experienced femur fractures as young as 3 years old and aims to analyze potential causes and detect Child Abuse rates. Thirty-five children under the age of three years who experienced femoral shaft fractures received care at the Emergency Department of the Orthopaedics and Traumatology Service of Santa Casa de São Paulo within the period ranging from January, 1996 to August, 2002. Eighteen patients returned to the hospital for re-evaluation. The reported causes for fractures were: fall in 13 cases (72.2%, object fall on the limb in 2 cases (11.1%. Child abuse was suspected in 9 cases (physical abuse in 6 cases (33.3%, negligence in 3 cases (16.7%, pathological fracture in 4 cases (22.2%, accidental causes in 3

  10. Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

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    Mohammad Haghighi

    2017-03-01

    Full Text Available Background:Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead topostoperative acute anemia and some other complications.Tranexamic acid (TA is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusionrequirements during some elective surgeries (1-3.The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA on intraoperative blood loss and asubsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.Methods:Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullarynailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. GroupI, the intervention group with eighteen patients received 15 mg/kg (TA via intravenous infusion before surgical incision.Patients in the placebo group received an identical volume of normal saline.Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobinchange as well as transfusion rates and volumes were compared between the two groups.Results:Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups,respectively (P=0.570. Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group(5.6% compared to the placebo group (30% (P=0.06. No significant difference in The Allowable Blood Loss during thesurgery was found between the two groups (P=0.894.Conclusion:Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion duringtraumatic femoral fracture operation.

  11. Bilateral femoral neck fractures following pelvic irradiation

    International Nuclear Information System (INIS)

    Mitsuda, Kenji; Nishi, Hosei; Oba, Hiroshi

    1977-01-01

    Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was found out, but thickness of the internal membrane and thrombogenesis were not recognized. Treatment should be performed according to degree of displacement of fractures. In this case, artificial joint replacement surgery was performed to the side of fracture of this time, because this case was bilateral femoral neck fractures and the patient had received artificial head replacement surgery in the other side of fracture formerly. (Tsunoda, M.)

  12. The effect of hip positioning on the projected femoral neck-shaft angle: a modeling study.

    Science.gov (United States)

    Bhashyam, Abhiram R; Rodriguez, Edward K; Appleton, Paul; Wixted, John J

    2018-04-03

    The femoral neck-shaft angle (NSA) is used to restore normal hip geometry during hip fracture repair. Femoral rotation is known to affect NSA measurement, but the effect of hip flexion-extension is unknown. The goals of this study were to determine and test mathematical models of the relationship between hip flexion-extension, femoral rotation and NSA. We hypothesized that hip flexion-extension and femoral rotation would result in NSA measurement error. Two mathematical models were developed to predict NSA in varying degrees of hip flexion-extension and femoral rotation. The predictions of the equations were tested in vitro using a model that varied hip flexion-extension while keeping rotation constant, and vice versa. The NSA was measured from an AP radiograph obtained with a C-arm. Attributable measurement error based on hip positioning was calculated from the models. The predictions of the model correlated well with the experimental data (correlation coefficient = 0.82 - 0.90). A wide range of patient positioning was found to result in less than 5-10 degree error in the measurement of NSA. Hip flexion-extension and femoral rotation had a synergistic effect in measurement error of the NSA. Measurement error was minimized when hip flexion-extension was within 10 degrees of neutral. This study demonstrates that hip flexion-extension and femoral rotation significantly affect the measurement of the NSA. To avoid inadvertently fixing the proximal femur in varus or valgus, the hip should be positioned within 10 degrees of neutral flexion-extension with respect to the C-arm to minimize positional measurement error. N/A, basic science study.

  13. Closed External Fixation for Failing or Failed Femoral Shaft Plating in a Developing Country.

    Science.gov (United States)

    Aliakbar, Adil; Witwit, Ibrahim; Al-Algawy, Alaa A Hussein

    2017-08-01

    Femoral shaft fractures are one of the common injuries that is treated by open reduction, with internal fixation by plate and screws or intramedullary nailing, which can achieve a high union rate. To evaluate the outcome of using closed external fixation to augment a failing plate; with signs of screw loosening and increasing bone/plate gap; a failed plate; broken plate; screws completely out of bone with redisplacement of fracture. A retrospective study on 18 patients, aged between 17-42 years, who presented between 6-18 weeks after initial surgical fixation, with pain, difficulty in limb function, deformity and abnormal movement at fracture site, was done. X-Rays showed plating failure with acceptable amount of callus, which unfortunately had refractured. Cases associated with infection and no radiological evidence of callus formation were excluded from this study. Closed reduction was done by manipulation, then fracture fixation by AO external fixator. The patients were encouraged for full weight bearing as early as possible with dynamization later on. Of the 18 patients who underwent external fixation after close reduction, 15 cases showed bone healing in a period between 11-18 weeks (mean of 14.27 weeks) with good alignment (Radiologically). Removal of external fixator was done followed by physical therapy thereafter. Closed external fixation for treatment of failing or failed femoral plating, achieves good success rate and has less complications, is a short time procedure, especially in a hospital with limited resources.

  14. Tibial shaft fractures in football players

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    Daisley Susan

    2007-06-01

    Full Text Available Abstract Background Football is officially the most popular sport in the world. In the UK, 10% of the adult population play football at least once a year. Despite this, there are few papers in the literature on tibial diaphyseal fractures in this sporting group. In addition, conflicting views on the nature of this injury exist. The purpose of this paper is to compare our experience of tibial shaft football fractures with the little available literature and identify any similarities and differences. Methods and Results A retrospective study of all tibial football fractures that presented to a teaching hospital was undertaken over a 5 year period from 1997 to 2001. There were 244 tibial fractures treated. 24 (9.8% of these were football related. All patients were male with a mean age of 23 years (range 15 to 29 and shin guards were worn in 95.8% of cases. 11/24 (45.8% were treated conservatively, 11/24 (45.8% by Grosse Kemp intramedullary nail and 2/24 (8.3% with plating. A difference in union times was noted, conservative 19 weeks compared to operative group 23.9 weeks (p Conclusion Our series compared similarly with the few reports available in the literature. However, a striking finding noted by the authors was a drop in the incidence of tibial shaft football fractures. It is likely that this is a reflection of recent compulsory FIFA regulations on shinguards as well as improvements in the design over the past decade since its introduction.

  15. Flexible intramedullary nailing for femoral diaphyseal fractures in children

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    Rojan Tamrakar

    2017-12-01

    Full Text Available Background & Objectives: Although various treatment options are available for the treatment of femoral diaphyesal fractures in children, the titanium flexible nailing has gained popularity because it is safe, easy procedure with rapid recovery and high success rate. The aim of this study was to evaluate the outcome of titanium elastic nails in treating paediatric femoral diaphyesal fractures at Patan Hospital.Materials & Methods: There were 35 cases which were all fixed with titanium flexible intramedullary nail under image intensifier at the Patan hospital from January 2013 and December 2015. Patients were evaluated in follow-ups to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, implant failure, range of movement of hip and knee joints, and time to unite the fracture. The final results were evaluated using criteria of titanium elastic nail (TEN outcome score described by Flynn et al.Results: The mean age of the patients was 8.51 years. Among 35 patients (22 boys and 13 girls, there were 19 mid-shaft fractures, nine proximal third fractures and seven distal third fractures. Fracture patterns were transverse (22, oblique (10, spiral (2, and comminuted (2. The mean time for fracture union was 8.17 weeks radiologically whereas 9.83 weeks clinically. According to TEN outcome score, excellent and good results were in 28 cases (80% and seven cases (20% respectively.Conclusion: Flexible titanium nailing is a safe and satisfactory treatment for diaphyseal femoral fractures in children, because it provides rapid recovery, short rehabilitation and immobilization as well as very high union rate with few complications.

  16. Subchondral insufficiency fractures of the femoral head

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    Davies, M.; Cassar-Pullicino, V.N. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom); Darby, A.J. [Department of Pathology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom)

    2004-02-01

    The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. (orig.)

  17. Atypical femoral fractures related to bisphosphonate therapy

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    Tarun Pankaj Jain

    2012-01-01

    Full Text Available Bisphosphonates (BP are a commonly prescribed class of drugs for the prevention of osteoporosis-related fractures. Paradoxically, however, they have recently been linked to atypical fractures in the shaft of the femur. Since many physicians including radiologists, are not aware of this entity, the incidence is likely underreported. These fractures usually occur in the sub-trochanteric region of the femur in the setting of low-energy trauma. It starts as a fracture line involving the lateral cortex and then progresses medially to give rise to a complete fracture. The fracture line is usually transverse, and there is a medial spike associated with a complete fracture. These fractures can be bilateral. Awareness of these atypical fractures and their radiological appearance should enable their early and accurate detection and thus lead to specific treatment.

  18. Tibia shaft fractures: costly burden of nonunions

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    Antonova Evgeniya

    2013-01-01

    Full Text Available Abstract Background Tibia shaft fractures (TSF are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion. Methods We retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives. We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32 in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date. Results Among the 853 patients with TSF, 99 (12% had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture and were more likely to have their TSF open (87% vs. 70% than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P  Conclusions Nonunions in TSF’s are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs.

  19. Ipsilateral femoral neck and trochanter fracture

    Directory of Open Access Journals (Sweden)

    Devdatta S Neogi

    2011-01-01

    Full Text Available Ipsilateral fractures in the neck and trochanteric region of the femur are very rare and seen in elderly osteoporotic patients. We present a case of a young man who presented with ipsilateral fracture of the femoral neck and a reverse oblique fracture in the trochanteric region following a motor vehicle accident. A possible mechanism, diagnostic challenge, and awareness required for identifying this injury are discussed.

  20. Spontaneous stress fractures of the femoral neck

    International Nuclear Information System (INIS)

    Dorne, H.L.; Lander, P.H.

    1985-01-01

    The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head

  1. Femoral neck fracture following groin irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Grigsby, Perry W; Roberts, Heidi L; Perez, Carlos A

    1995-04-30

    Purpose: The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies. Methods and Materials: The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis. Results: The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture. Conclusion: Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication.

  2. Femoral neck fracture following groin irradiation

    International Nuclear Information System (INIS)

    Grigsby, Perry W.; Roberts, Heidi L.; Perez, Carlos A.

    1995-01-01

    Purpose: The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies. Methods and Materials: The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis. Results: The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture. Conclusion: Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication

  3. Femoral head vitality after intracapsular hip fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.

    1983-01-01

    Femoral head vitality before, during and at various intervals from the operation was determined by tetracycline labeling and/or 99 sp (m)Tc-MDP scintimetry. In a three-year follow-up, healing prognosis could be determined by scintimetry 3 weeks from operation; deficient femoral head vitality predicting healing complications and retained vitality predicting uncomplicated healing. A comparison between pre- and postoperative scintimetry indicated that further impairment of the femoral head vitality could be caused by the operative procedure, and as tetracycline labeling prior to and after fracture reduction in 370 fractures proved equivalent, it was concluded that the procedure of osteosynthesis probably was responsible for capsular vessel injury, using a four-flanged nail. The four-flanged nail was compared with a low-traumatic method of osteosynthesis, two hook-pins, in a prospective randomized 14 month study, and the postoperative femoral head vitality was significantly better in the hook-pin group. This was also clearly demonstrated in a one-year follow-up for the fractures included in the study. Parallel to these investigations, the reliability of the methods of vitality determination was found satisfactory in methodologic studies. For clinical purpose, primary atraumatic osteosynthesis, postoperative prognostic scintimetry and early secondary arthroplasty when indicated, was concluded to be the appropriate approach to femoral neck fracture treatment. (Author)

  4. Three-dimensional measurement of femoral neck anteversion and neck shaft angle.

    Science.gov (United States)

    Sangeux, Morgan; Pascoe, Jessica; Graham, H Kerr; Ramanauskas, Fiona; Cain, Tim

    2015-01-01

    We present a three-dimensional measurement technique for femoral neck anteversion and neck shaft angles which do not require alignment of the femoral and scanner axes. Two assessors performed the measurements on 11 patients (22 femurs). Repeatability between assessors was 2.7 degrees for femoral neck anteversion and 4.8 degrees for neck shaft angle. Measurements compared with an alternative single slice method were different by 2 degrees (3 degrees) in average. The method was repeatable and appropriate for clinical practice.

  5. Femoral fracture repair using a locking plate technique in an adult captive polar bear (Ursus maritimus).

    Science.gov (United States)

    Zimmerman, Dawn M; Dew, Terry; Douglass, Michael; Perez, Edward

    2010-02-01

    To report successful femoral fracture repair in a polar bear. Case report. Female polar bear (Ursus maritimus) 5 years and approximately 250 kg. A closed, complete, comminuted fracture of the distal midshaft femur was successfully reduced and stabilized using a compression plating technique with 2 specialized human femur plates offering axial, rotational, and bending support, and allowing the bone to share loads with the implant. Postoperative radiographs were obtained at 11.5 weeks, 11 months, and 24 months. Bone healing characterized by marked periosteal reaction was evident at 11 months with extensive remodeling evident at 24 months. No complications were noted. Distal mid shaft femoral fracture was reduced, stabilized, and healed in an adult polar bear with a locking plate technique using 2 plates. Previously, femoral fractures in polar bears were considered irreparable. Use of 2 plates applied with a locking plate technique can result in successful fracture repair despite large body weight and inability to restrict postoperative activity.

  6. Selective arteriography in femoral head fractures

    Energy Technology Data Exchange (ETDEWEB)

    Mannella, P; Galeotti, R; Borrelli, M; Benea, G; Massari, L; Chiarelli, G M

    1986-01-01

    The choice between conservative and radical operation in case of femoral neck fractures is very important because it is the determining factor for a successfull therapy. In case of epiphysial necrosis, an endoprosthesis as well as an osteosynthesis will be carried out. Selective arteriography of the medical circumflex artery represents the most reliable study to establish, immediately after the fractures, the possible presence of a post-traumatic ischemic necrosis. Angiography, as a reliable diagnostic tool, has to be carried out in the most selective way and needs the image subtraction technique. The authors report their preliminary results on the reliability of angiography in the femoral epiphyseal ischemic necrosis diagnosed by comparing the results of angiography with the wood light test carried out on the surgically removed femoral head. 18 refs.

  7. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days f...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  8. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days f...

  9. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Satoshi; Ishido, Yasuhiro [Saiseikai Sendai Hospital, Kagoshima (Japan); Okano, Toshihiro [Ibusuki National Hospital, Kagoshima (Japan); Komiya, Setsuro [Kagoshima Univ. (Japan). Faculty of Medicine

    2002-09-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  10. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    International Nuclear Information System (INIS)

    Yamaguchi, Satoshi; Ishido, Yasuhiro; Okano, Toshihiro; Komiya, Setsuro

    2002-01-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  11. Mortality Following Periprosthetic Proximal Femoral Fractures Versus Native Hip Fractures.

    Science.gov (United States)

    Boylan, Matthew R; Riesgo, Aldo M; Paulino, Carl B; Slover, James D; Zuckerman, Joseph D; Egol, Kenneth A

    2018-04-04

    The number of periprosthetic proximal femoral fractures is expected to increase with the increasing prevalence of hip arthroplasties. While native hip fractures have a well-known association with mortality, there are currently limited data on this outcome among the subset of patients with periprosthetic proximal femoral fractures. Using the New York Statewide Planning and Research Cooperative System, we identified patients from 60 to 99 years old who were admitted to a hospital in the state with a periprosthetic proximal femoral fracture (n = 1,655) or a native hip (femoral neck or intertrochanteric) fracture (n = 97,231) between 2006 and 2014. Within the periprosthetic fracture cohort, the indication for the existing implant was not available in the data set. We used mixed-effects regression models to compare mortality at 1 and 6 months and 1 year for periprosthetic compared with native hip fractures. The risk of mortality for patients who sustained a periprosthetic proximal femoral fracture was no different from that for patients who sustained a native hip fracture at 1 month after injury (3.2% versus 4.6%; odds ratio [OR], 0.90; 95% confidence interval [CI], 0.68 to 1.19; p = 0.446), but was lower at 6 months (3.8% versus 6.5%; OR, 0.74; 95% CI, 0.57 to 0.95; p = 0.020) and 1 year (9.7% versus 15.9%; OR, 0.71; 95% CI, 0.60 to 0.85; p accounting for age and comorbidities. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  12. Comparison of tibial shaft ski fractures in children and adults.

    Science.gov (United States)

    Hamada, Tomo; Matsumoto, Kazu; Ishimaru, Daichi; Sumi, Hiroshi; Shimizu, Katsuji

    2014-09-01

    To examine whether child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures. Descriptive epidemiological study. Prospectively analyzed the epidemiologic factors, injury types, and injury mechanisms at Sumi Memorial Hospital. This study analyzed information obtained from 276 patients with tibial fractures sustained during skiing between 2004 and 2012. We focused on 174 ski-related tibial shaft fractures with respect to the following factors: age, gender, laterality of fracture, skill level, mechanism of fracture (fall vs collision), scene of injury (steepness of slope), snow condition, and weather. Fracture pattern was graded according to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and mechanical direction [external (ER) or internal rotation (IR)]. Tibial shaft fractures were the most common in both children (89.3%) and adults (47.4%). There were no significant differences in gender, side of fracture, mechanism of fracture, snow condition, or weather between children and adults. Skill levels were significantly lower in children than in adults (P differences in some of these parameters, suggesting that child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures.

  13. Femoral head fracture without hip dislocation

    Directory of Open Access Journals (Sweden)

    Aggarwal Aditya K

    2013-10-01

    Full Text Available 【Abstract】Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries. Key words: Femur head; Hip dislocation; Classification; Arthroplasty, replacement, hip

  14. Radiographic anatomy of the proximal femur: femoral neck fracture vs. transtrochanteric fracture

    Directory of Open Access Journals (Sweden)

    Ana Lecia Carneiro Leão de Araújo Lima

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the correlation between radiographic parameters of the proximal femur with femoral neck fractures or transtrochanteric fractures. METHODS: Cervicodiaphyseal angle (CDA, femoral neck width (FNW, hip axis length (HAL, and acetabular tear drop distance (ATD were analyzed in 30 pelvis anteroposterior view X-rays of patients with femoral neck fractures (n = 15 and transtrochanteric fractures (n = 15. The analysis was performed by comparing the results of the X-rays with femoral neck fractures and with transtrochanteric fractures. RESULTS: No statistically significant differences between samples were observed. CONCLUSION: There was no correlation between radiographic parameters evaluated and specific occurrence of femoral neck fractures or transtrochanteric fractures.

  15. The Incidence of Atypical Femoral Fractures in Patients with Rheumatic Disease: Yamagata Prefectural Committee of Atypical Femoral Fractures (YamaCAFe) Study.

    Science.gov (United States)

    Takakubo, Yuya; Ohta, Daichi; Ishi, Masaji; Ito, Juji; Oki, Hiroharu; Naganuma, Yasushi; Uno, Tomohiro; Sasaki, Akiko; Akabane, Takeru; Dairaku, Katsuyuki; Goto, Shinichi; Goto, Yasuo; Kanauchi, Yumiko; Kobayashi, Shinji; Nakajima, Taku; Masuda, Keiji; Matsuda, Michiharu; Mura, Nariyuki; Takenouchi, Kenji; Tsuchida, Hiroyuki; Onuma, Yasushi; Shibuya, Junichirou; Seino, Mitsuyoshi; Yamaguchi, Osamu; Hiragami, Ken; Urayama, Yasuhiro; Furukawa, Takashi; Okuda, Shouta; Ogura, Ken; Nakamura, Takeshi; Sasaki, Kan; Konta, Tsuneo; Takagi, Michiaki

    2017-08-01

    Atypical femoral fractures (AFFs) have been reported to occur with minimal or spontaneous subtrochanteric and femoral shaft fractures with a characteristic transverse pattern, compared with typical femoral fractures in young patients with high-energy trauma. AFFs are related to long-term use of bisphosphonates (BPs), glucocorticoids and rheumatic diseases. We have estimated a blind analysis of AFFs in rheumatic patients receiving BPs and glucocorticoids ordinary over a long time in all Yamagata prefectural area through radiographic examination. The 123 AFFs including suspected cases over six years were collected and reviewed by two independent orthopedic surgeons. We found 86 patients with a total of 99 AFFs between 2009 and 2014 (1.43 cases/100,000 person/year). Of these 99 AFFs, 11 were in 8 rheumatic patients including three patients with bilateral AFFs. The incidence of AFFs in rheumatic patients had trend to increase from 2012. The mean age of all 8 patients was 54.9 years. All 8 patients received BPs and 7/8 received prednisolone (PSL). The mean dose of PSL was 14 mg/day. Compared to patients with unilateral AFFs, those with bilateral AFFs in rheumatic patients were on a higher dose of PSL (20 mg/day vs. 7 mg/day) and had less femoral neck-shaft angle (129° vs. 136°, p rheumatic patients showed a trend to increase from 2012 to 2014 in Yamagata prefecture. Careful management of AFFs is of particular importance in rheumatic patients who have taken high doses of PSL and have small femoral neck-shaft angle.

  16. Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape.

    Science.gov (United States)

    Kim, Jong-Min; Hong, Soo-Heon; Kim, Jong-Min; Lee, Bum-Sik; Kim, Dong-Eun; Kim, Kyung-Ah; Bin, Seong-Il

    2015-07-01

    The aim of this study was to determine (1) variations in the shape of the proximal, middle, and distal femur in a series of Korean patients who had undergone total knee arthroplasty (TKA), (2) the preoperative relationship between these three parameters and the distal valgus cutting angle referenced off the femoral intramedullary guide, and (3) whether there was any relationship between femoral bowing and variations in the shape of the proximal or distal femur in the coronal plane. The preoperative long-standing anteroposterior radiographs of 316 consecutive osteoarthritis patients who underwent primary TKA from 2009 to 2011 were examined. The femoral neck shaft angle, the femoral shaft bowing angle, and the mechanical lateral distal femoral angle were measured to assess the shape of the proximal, middle, and distal femur, respectively. The valgus cutting angle of the femur was defined as the angle between the distal anatomical and mechanical axes of the femur. The study population showed large variations in femoral shape. The mean femoral intramedullary guide angle was 6.5° ± 1.3° (range: 4°-13°). The femoral shaft bowing angle was the factor that showed the strongest correlation with this angle (P shaft angle showed no correlation (n.s.). The femoral shaft bowing angle showed a weak correlation with the mechanical lateral distal femoral angle (P = 0.001), but was not significantly correlated with the femoral neck shaft angle (n.s.). Apparent femoral bowing (>3° of lateral or medial bowing) was found in 42 (13.3 %) of cases (37 cases of lateral bowing and five of medial bowing). Cases with lateral apparent femoral bowing >3° had a distal cutting angle of 8.6° ± 2.2° relative to the femoral intramedullary guide. The femoral intramedullary guide angle was mainly influenced by femoral shaft bowing among femoral deformities in the coronal plane. Therefore, to increase the accuracy of distal femoral cut during TKA, it is necessary to confirm femoral

  17. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation.

    Science.gov (United States)

    Zacherl, Max; Gruber, Gerald; Glehr, Mathias; Ofner-Kopeinig, Petra; Radl, Roman; Greitbauer, Manfred; Vecsei, Vilmos; Windhager, Reinhard

    2011-10-01

    Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

  18. Stress fracture of the femoral neck in a child (stress fracture)

    International Nuclear Information System (INIS)

    Coldwell, D.; Gross, G.W.; Boal, D.K.

    1984-01-01

    Femoral neck stress fracture is extremely rare in childhood. We report a case of femoral neck stress fracture in an 11-year-old girl. Differentials diagnosis and a brief review of the literature follow. (orig.)

  19. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1999-01-01

    OBJECTIVE: A prospective study of 207 laymen and professionals answered a questionnaire regarding the expectations of the long-term outcome 6 months after a unilateral tibial shaft fracture. The aim was (1) to disclose the expected outcome after unilateral tibial shaft fracture, and (2) to compare...... these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...

  20. Intramedullary nailing for the treatment of aseptic femoral shaft non-unions after plating failure: effectiveness and timing.

    Science.gov (United States)

    Megas, Panagiotis; Syggelos, Spyros A; Kontakis, Georgios; Giannakopoulos, Andreas; Skouteris, Georgios; Lambiris, Elias; Panagiotopoulos, Elias

    2009-07-01

    This retrospective, multicentre study aimed to evaluate reamed intramedullary nailing (IMN) for the treatment of 30 cases of aseptic femoral shaft non-union after plating failure. Following nailing, 29 non-unions had healed by a mean 7.93 months. In one case a hypertrophic non-union required renailing after 8 months, using a nail of greater diameter, and united within five further months. Healing times were not related to whether the fracture was open or closed, the type non-union or the type of fracture. The delay from the initial plating to intramedullary nailing had a statistically significant effect on healing time and final outcome. This treatment is cost effective and should be implemented as soon as the non-union is diagnosed.

  1. Risks of concomitant trauma to the knee in lower limb long bone shaft fractures: A retrospective analysis from a prospective study population

    Directory of Open Access Journals (Sweden)

    Brajesh Kumar

    2014-01-01

    Conclusion: One should have high index of suspicion about internal knee injuries and capsule-ligamentous injuries while dealing with femoral shaft fractures in particular. Arthroscopy of knee may safely enhance the diagnosis of simultaneous IDK. We propose that when MR imaging is not possible and when contraindication for arthroscopy does not exist, a careful clinical examination followed by arthroscopy of the knee may be considered a useful adjunct in femoral shaft fractures as it can readily confirm IDK by its ability to objectively look, probe, and distinguish fragile tissue from a normal one. Further study in larger number of subjects is needed to validate our findings.

  2. Outcome of humeral shaft fractures treated by functional cast brace

    Directory of Open Access Journals (Sweden)

    Jitendra Nath Pal

    2015-01-01

    Conclusion: Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1 st day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients.

  3. Femoral neck fractures: A prospective assessment of the pattern ...

    African Journals Online (AJOL)

    OBJECTIVE: To review the pattern of femoral neck fractures, complications and outcome following fixation with Austin-Moore endoprosthesis. METHOD: A two year prospective study in patients who had fracture of the femoral neck based on strict inclusion criteria. All the patients were treated by Austin-Moore ...

  4. [Treatment of femoral neck fracture--preference to internal fixation].

    Science.gov (United States)

    Minato, Izumi

    2011-03-01

    In the guidelines for the treatment of femoral neck fracture, prosthetic replacement is recommended in displaced one and internal fixation is in undisplaced one. However, in the long view, survived femoral head after internal fixation can be superior to prosthesis which will deteriorate as time goes by. Surgical method should be considered not only by type of fracture but general status of the patient.

  5. Femoral neck fractures complicating gaucher disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, A.B.; Jacobs, B.

    1984-09-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora.

  6. Femoral neck fractures complicating gaucher disease in children

    International Nuclear Information System (INIS)

    Goldman, A.B.; Jacobs, B.

    1984-01-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora. (orig.)

  7. Femoral neck fractures complicating gaucher disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, A B; Jacobs, B

    1984-09-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora.

  8. Risks of concomitant trauma to the knee in lower limb long bone shaft fractures: A retrospective analysis from a prospective study population.

    Science.gov (United States)

    Kumar, Brajesh; Borgohain, Bhaskar; Balasubramanian, S; Sathyanarayana, V; Muthusamy, M

    2014-01-01

    Numerous associated injuries (bony and/or soft tissue lesions) occur commonly in conjunction with fractures of the femoral shaft in young patients after high-energy injuries. Knee ligamentous injuries, historically called as the internal derangements of the knee or IDK, are mostly not visible in plain radiographs taken in the emergency and these injuries are likely to be overlooked by clinicians because first attention always goes to open wounds and radiologically visible injuries of the limb whenever a patient is received in a trauma unit. A total of 93 cases of lower limb long bone fractures were retrospectively analyzed from materials of a prospective study conducted on consecutive patients having high-velocity injuries to lower limb long bones with a view to confirm or rule out concomitant ipsilateral IDK in cases of femoral and tibial shaft fractures, that already employed a policy of focused clinical examination followed by arthroscopy of the ipsilateral knee, immediately after operative fracture fixation under the same anesthesia. The goal was to determine the incidence of concomitant internal derangement of the ipsilateral knee and to understand any value of adding arthroscopy to detect concomitant IDK in lower limb long bone fractures besides careful intraoperative examination to propose a recommendation thereof. Concomitant knee injury was found in 14 femoral fractures and 1 tibial fracture. Fifteen out of 93 (16%) such cases had concomitant knee ligamentous or meniscal injures. A total of 13 anterior cruciate and 4 posterior cruciate tears, 11 collateral ligament tears, and 10 meniscal injuries were confirmed in these 15 knees. Femoral shaft fractures were associated with a high incidence of serious ligamentous, meniscal, and chondral injury. Twelve out of 41 femoral fractures had chondral injuries (contusion), especially of the patello-femoral articulation, identifiable during arthroscopy. One should have high index of suspicion about internal knee

  9. Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report

    Directory of Open Access Journals (Sweden)

    Mantu Jain

    2013-10-01

    in chronically dislocated prosthesis, done for fracture neck of femur is a rare clinical entity. Increased stress transfers due to dislocation compounded with osteoporosis makes the shaft vulnerable to fracture even with low velocity injury as in our case. Though fixation of fracture shaft femur is clear and straightforward; management of neglected prosthesis dislocation have to be guided by patient’s level of expectations and subjective contentment to adaptation to the altered hip state which influence the overall functional outcome. Keywords: Neglected dislocation, ipsilateral femoral fracture, hip arthroplasty.

  10. Asymmetry in gait pattern following tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Læssøe, Uffe; Rasmussen, Sten

    2017-01-01

    INTRODUCTION: Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12...... months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. PATIENTS AND METHODS: The study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post......-operatively measured with a 6-metre-long pressure-sensitive mat. The mat registers footprints and present gait speed, cadence as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. RESULTS: 49 patients were included with a mean age of 43.1 years (18...

  11. Tibial shaft fracture and ankle injury - Case report

    Directory of Open Access Journals (Sweden)

    Caio Zamboni

    Full Text Available ABSTRACT The authors report on a case of tibial shaft fracture associated with ankle injury. The clinical, radiological and surgical characteristics are discussed. Assessment of associated injuries is often overlooked and these injuries are hard to diagnose. When torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injury. It is essential to make careful assessment based on clinical, radiographic, intraoperative and postoperative characteristics in order to attain functional recovery.

  12. Fracture Failure Analysis of Fuel Pump Transmission Shaft of Dual-Fuel Engine

    Directory of Open Access Journals (Sweden)

    Chen Pei-hong

    2017-01-01

    Full Text Available NTS6ZLCz-129 dual-fuel turbocharged and intercooled engine durability test at 1000h, fuel pump shaft fractured. Fracture analysis, chemical analysis, microstructure examination and finite element stress analysis were carried out on the fractured shaft. The analysis result showed that the shaft fracture cause is forging fold. By improving the forging process, the forging fold was solved, and the durability test can be carried out smoothly.

  13. Treatment of humeral shaft fractures with antegrade intramedullary locking nail.

    Science.gov (United States)

    Tsourvakas, Stefanos; Alexandropoulos, Christos; Papachristos, Ioannis; Tsakoumis, Grigorios; Ameridis, Nikolaos

    2011-12-01

    Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail (T2, Stryker) for the humeral fractures. Between 2005 and 2008, 52 fractures of the humeral shaft were treated operatively with this intramedullary nail in our department. Eight patients were polytraumatized, and four patients had an open fracture. The mean age of patients was 51.7 years. Forty-eight patients had an adequate duration of clinical follow-up (a mean of 18 months) for analysis. Complications were recorded, and the time to union was measured. Shoulder and elbow functions were assessed using the Constant Score and the Morrey Score, respectively. Forty-six fractures healed, with a mean time to clinical union of 10.3 weeks. Two patients developed pseudarthroses. There were four adverse events: two proximal screws backed out, one superficial infection at the insertion point, and one fracture at the distal end of the nail. Ninety-one percentage of patients had an excellent or good shoulder function. Five further operations were necessary: two for treatment of pseudarthroses, two for removal the backed out proximal screws, and one wound debridement for superficial infection. Antegrade humeral nailing is a valid therapeutic option for stabilization of humeral shaft fractures. By strictly adhering to the operation technique, the number and the severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional results is the rule.

  14. Bilateral impacted femoral neck fracture in a renal disease patient ...

    African Journals Online (AJOL)

    Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical ...

  15. early functional outcome of distal femoral fractures at kenyatta

    African Journals Online (AJOL)

    The leading cause was RTA, followed by falls from a height. ... Distal femoral fractures cause considerable morbidity .... as means and standard deviations. .... Anaesthesia. Spinal. 37 (80). General Anaesthesia (GA). 9 (20). Transfusion.

  16. Validation of a new classification system for interprosthetic femoral fractures.

    Science.gov (United States)

    Pires, Robinson Esteves Santos; Silveira, Marcelo Peixoto Sena; Resende, Alessandra Regina da Silva; Junior, Egidio Oliveira Santana; Campos, Tulio Vinicius Oliveira; Santos, Leandro Emilio Nascimento; Balbachevsky, Daniel; Andrade, Marco Antônio Percope de

    2017-07-01

    Interprosthetic femoral fracture (IFF) incidence is gradually increasing as the population is progressively ageing. However, treatment remains challenging due to several contributing factors, such as poor bone quality, patient comorbidities, small interprosthetic fragment, and prostheses instability. An effective and specific classification system is essential to optimize treatment management, therefore diminishing complication rates. This study aims to validate a previously described classification system for interprosthetic femoral fractures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Less invasive plate osteosynthesis in humeral shaft fractures.

    Science.gov (United States)

    Apivatthakakul, Theerachai; Phornphutkul, Chanakarn; Laohapoonrungsee, Anupong; Sirirungruangsarn, Yuddhasert

    2009-12-01

    Stable internal fixation of the humeral shaft by less invasive percutaneous plate insertion using two separate (proximal and distal) incisions, indirect reduction by closed manipulation and fixation to preserve the soft tissue and blood supply at the fracture zone. Early mobilization of the shoulder and elbow to ensure a good functional outcome. Humeral shaft fractures (classified according to AO classification as: 12-A, B, C). Humeral shaft fractures extending to the proximal or distal shaft, small or deformed medullary canal or open growth plate. Humeral shaft fractures with primary radial nerve palsy. Proximal humeral shaft fractures extending to the humeral head. Distal humeral fractures extending to the elbow joint. Two incisions proximal and distal to the fracture zone are used. A 3-cm proximal incision lies between the lateral border of the proximal part of the biceps and the medial border of the deltoid. Distally, a 3-cm incision is made along the lateral border of the biceps. The interval between biceps and brachialis is identified. The biceps is retracted medially to expose the musculocutaneous nerve. The brachialis muscle has dual innervation, the medial half being innervated by the musculocutaneous nerve and the lateral half by the radial nerve. The brachialis is split longitudinally at its midline. The musculocutaneous nerve is retracted along with the medial half of the brachialis, while the lateral half of the brachialis serves as a cushion to protect the radial nerve. A deep subbrachial tunnel is created from the distal to the proximal incision. The selected plate is tied with a suture to a hole at the tip of the tunneling instrument for pulling the plate back along the prepared track. The plate is aligned in the correct position on the anterior surface of the humerus. Traction is applied and the fracture reduced to restore alignment by image intensifier, followed by plate fixation with at least two bicortical locking screws or three bicortical

  18. Femoral Geometry in Male Patients with Atraumatic Hip Fracture - Original Investigation

    Directory of Open Access Journals (Sweden)

    Gülten Tan

    2007-03-01

    Full Text Available Aims: Hip fracture is the most serious complication of osteoporosis and the most disabling type of fracture. In this study, we aimed to compare femoral geometry in hip fractured male patients aged more than 65 years old with age matched controls. Patients and Methods: 20 male patients with a history of nontraumatic hip fracture and 19 age-matched healthy controls were included in this study. Bone mineral density of neck and trochanter of hip were measured by DEXA. In addition to BMD, an experienced radiologist measured proximal femur geometric parameters potentially involved in bone strength. Results: Mean BMDs of trochanteric region were not significantly different between groups, but mean BMDs of neck region were statistically significantly lower in the hip fractured group. Neck shaft angle and femur shaft width were the geometric parameters found to be significantly higher in the hip fractured group. The correlation between femur geometric and the anthropometric measurements was present only in the kontrol group. Conclusion: We concluded that besides femur geometric measurements, correlation between these measurements might be an important factors for the fracture risk. (From the World of Osteoporosis 2007;13:15-8

  19. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    Science.gov (United States)

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  20. Bilateral stress fractures of femoral neck in non-athletes: a report of four cases

    Directory of Open Access Journals (Sweden)

    Naik Monappa A

    2013-04-01

    Full Text Available 【Abstract】Femoral neck stress fractures (FNSFs are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers with-out underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and sub-trochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular ne-crosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in pa-tients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation. Key words: Fractures, stress; Femoral neck fractures; Coxa vara; Osteotomy

  1. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  2. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture.

    Science.gov (United States)

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-07-11

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. 2014 BMJ Publishing Group Ltd.

  3. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu

    2015-01-01

    Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  4. Management of a femoral fracture complicated by clostridial myositis

    International Nuclear Information System (INIS)

    Thomson, M.J.; Eger, C.E.

    1997-01-01

    A clinical case of clostridial myositis secondary to a comminuted femoral fracture is described. This case is unusual because, despite the severe degree of obvious muscle necrosis and gas production, the dog had minimal signs of systemic toxicity. Union of the fracture was achieved but six months postoperatively muscular contracture had resulted in permanent stifle extension

  5. Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Selahattin Ozyurek

    2015-07-01

    Full Text Available Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2 with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2 intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa fracture during primary ACL reconstruction (2. Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.

  6. Outcomes of The Isolated Closed Tibial Shaft Fractures Treated Nonsurgically

    Directory of Open Access Journals (Sweden)

    Dawood Jafari

    2011-05-01

    Full Text Available Background: Fractures of the tibia are important for their commonness and controversy in their management. Both conservative and surgical techniques have been introduced in an effort to speed time to union while minimizing the occurrence of complications. Standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization.The purpose of our study was to analyze retention of reduction after cast immobilization of simple isolated closed tibial fractures.Methods:All cases of the diagnosed isolated closed tibial shaft fracture treated non-surgically at Shafa Yahyaeian Hospital, between 2006 and 2009 were retrieved from medical records. We reviewed all medical records and radiographs of these patients to inquire about the patients’ demographic data used to analyze the outcomes of the non-surgical treatment.Results:Of the 26 patients examined, males were more commonly affected. The mean age was 27.46   (SD=7.58.The most common causes of injury were direct blow and motorcycle to pedestrian accident. Followup duration for each patient had an average of 9.12 months (SD=2.36. Using AO/OTA classification, distributed as 38.5% A1.1, 26.9% A2.1 and 34.6% A3.1 fractures. Most fractures were sustained in the lower third of the tibia (53.85%. All fractures eventually healed in an average of 13.7 weeks (SD=3.24. There was one case of delayed union in the 22nd week. In 92.3% of patients, shortening of bone was less than 1 cm, while in 7.7% patients, was more than 1.5 cm. We observed an anterior or posterior angulation > 10 ° in 2 (7.69% patients. Moreover, in 4 (15.38% patients we found varus angulation > 5°. Therefore, final deformity was observed in 8 (30.77% patients. No patient had non-union, rotational malalignment of more than 10 degrees, an infection, or a compartment syndrome.Conclusion : Our non-surgical treatment’s outcomes were not satisfactory, despite applying all principles for conservative treatment and

  7. Radionuclide scintimetry for diagnosis of complications following femoral neck fracture

    International Nuclear Information System (INIS)

    Alberts, K.A.; Dahlborn, M.; Hindmarsh, J.; Soederborg, B.; Ringertz, H.

    1984-01-01

    A scintimetric study using Tc-99m MDP was made of 54 patients with delayed union, nonunion, or late segmental collapse of the femoral head, 4-92 months after femoral neck fracture. In radiographically verified collapse, the radionuclide uptake ratio between the femoral head on the fractured and on the intact side (HHR) was significantly higher than in fractures resulting in delayed union or nonunion. On the basis of scintimetric and radiographic findings, the patients with healing disturbances could be divided into three groups, characterized by the following features: (1) Satisfactory post-reduction position of the fracture without subsequent redisplacement and a high HHR, which as a rule turned out to be delayed union; (2) The same radiographic pattern but with a lower HHR, which in most cases resulted in nonunion; (3) Inadequate reduction or early redisplacement of the fracture with a high HHR, which resulted in nonunion. The fractional precision in discriminating between different types of disturbed fracture healing by means of skeletal scintimetry was 0.86 in this study. This non-invasive and technically simple method would therefore be a valuable complement to radiography in the assessment of healing, more than 4 months after fracture of the femoral neck. (author)

  8. 99mTc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    International Nuclear Information System (INIS)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong

    1985-01-01

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head

  9. {sup 99m}Tc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong [Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    1985-02-15

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head.

  10. Transfracture abduction osteotomy: A solution for nonunion of femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Jairamchander Pingle

    2014-01-01

    femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO. Materials and Methods: Over a period of 35 years (1974-2008, 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008, All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years. Results were analyzed in terms of radiological union at six months. Average followup was five years and six months. Results: Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°. Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore′s pins. These were reopened and cancellous screws were inserted in the same tracks. Conclusions: Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.

  11. Implementation of a flaw model to the fracturing around a vertical shaft

    CSIR Research Space (South Africa)

    Van de Steen, B

    2003-04-01

    Full Text Available -scale excavations. The simulated fracture pattern around a vertical shaft is compared to the fracturing around a shaft at a depth of 3400 m. The simulations suggest that wedge-shaped zones, called dog-ears, a reformed by a progressive splitting-like failure...

  12. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  13. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    International Nuclear Information System (INIS)

    Kaushik, Abhishek; Sankaran, Balu; Varghese, Mathew

    2010-01-01

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  14. Postoperative hemoglobin level in patients with femoral neck fracture

    OpenAIRE

    Nagra, Navraj; van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward

    2018-01-01

    Objective: The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.Methods: Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.Results: There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative D...

  15. Avascular necrosis associated with nailing of femoral neck fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.; Hansson, L.I.

    1983-01-01

    Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. SR 85 -scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures. (author)

  16. Avascular necrosis associated with nailing of femoral neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Stroemqvist, B; Hansson, L I [Department of Orthopaedic Surgery, University Hospital in Lund, Sweden

    1983-01-01

    Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. Sr/sup 85/-scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures.

  17. Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia

    Directory of Open Access Journals (Sweden)

    Dhammapal Sahebrao Bhamare

    2013-01-01

    Full Text Available Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.

  18. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  19. Management of Femoral Shaft Fractures in a Tertiary Centre, South ...

    African Journals Online (AJOL)

    This work is distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in ... oblique, accounting for70% of cases. ... demographic data (age, sex, occupation), cause of.

  20. Radiographic features of teriparatide-induced healing of femoral fractures

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    Youngwoo Kim

    2015-12-01

    Full Text Available Teriparatide is a drug that is used to increase bone remodeling, formation, and density for the treatment of osteoporosis. We present three cases of patients with a femoral insufficiency fracture. The patients were administered teripatatide in an attempt to treat severe osteoporosis and to enhance fracture healing. We found several radiographic features around the femoral fractures during the healing period. 1 Callus formation was found at a very early stage in the treatment. Teriparatide substantially increased the unusually abundant callus formation around the fracture site at 2 weeks. Moreover, this callus formation continued for 8 weeks and led to healing of the fracture. 2 Abundant callus formation was found circumferentially around the cortex with a ‘cloud-like’ appearance. 3 Remodeling of the teriparatide-induced callus formation was found to be part of the normal fracture healing process. After 1 year, normal remodeling was observed on plain radiographs. These findings indicate that teriparatide can be used as an adjuvant therapy in the management of femoral insufficiency fractures.

  1. [Treatment of periprosthetic femoral fractures after total hip arthroplasty with specially constructed retrograde hollow nails].

    Science.gov (United States)

    Szalay, G; Meyer, C; Mika, J; Schnettler, R; Thormann, U

    2014-12-01

    Treatment of periprosthetic fractures by implantation of a specially constructed, retrograde hollow nail which fits over the tip of the prosthesis and becomes locked on it. Periprosthetic femoral fractures with firmly anchored prosthesis shaft after total hip arthroplasty of types B1 and C according to the Vancouver classification. Loosened prosthesis (type B2/B3) and trochanteric fractures (type A). Broken or damaged prosthesis, florid inflammation and soft tissue injuries in the operation field, contracted knee joint, advanced deformation in the knee joint and distal femur, enclosed prosthesis and general contraindications. In a supine position the periprosthetic fracture is exposed via a lateral access. For cemented prostheses the cement is removed around the tip of the prosthesis (at least 2-3 cm) and medullary cavity. Arthrotomy with flexion of the knee joint and marking of the nail entry point. Drill the medullary cavity, retrograde introduction of the nail, visually fit the nail over the tip of the prosthesis and lock the nail with the prosthesis. If necessary use additional spongiosaplasty or also placement of additional cerclages depending on fracture type and size of the defect zone. Lock the nail distally. Use intraoperative radiological imaging to control correct positioning and length of the nail. Close the wound layer by layer with placement of suction drainage devices and dressing. Partial loading for 6 weeks with a subsequent pain-adapted loading gradient until full loading is possible. If selective partial loading is not possible, a decision must be made in individual cases as to whether the intraoperative findings allow immediate full loading. From 2004 to 2011 a total of 25 periprosthetic femoral fractures in 25 patients were treated in 2 locations using specially constructed slotted hollow nails. Within the framework of a retrospective study 20 of these patients (16 female and 4 male; average age 77.2 [72-84] years) were clinically and

  2. Quality of life in old patients with proximal femoral fractures

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    T A Raskina

    2012-01-01

    Full Text Available Objective: to study quality of life in Kemerovo old patients with proximal femoral fractures. Patients and methods. Quality of life in osteoporotic fractures was analyzed in 219 patients (173 women and 46 men who had sustained the injury in January 2004 to December 2008. Results. In the patients with hip fractures, the lowest (41.94+31.16 scores values were recorded by the physical functioning scale reflecting the degree to which their health limited the performance of physical exercises (self-service, walking, going upstairs, weight carriage, etc.. The role functioning and life activity scales showed the highest values (50.96+19.04 and 51.44+26.51 scores, respectively. The mean value of the physical component scale was 46.42+28.26 scores. That of the psychological component scale was 49.56+19.55 scores. Conclusion. The patients with proximal femoral fractures were found to have lower scores on all SF-36 dimensions.

  3. Femoral neck stress fractures (fnsf) in military recruits

    International Nuclear Information System (INIS)

    Majeed, N.U.; Naqvi, A.N.; Majeed, H.

    2012-01-01

    Objective: To identify patterns of Femoral Neck Stress Fractures (FNSF), its presentation and outcome of its treatment in PMA (Pakistan Military Academy) cadets. These findings would help suggest guidelines for their appropriate management. Study design: Case Series Place and duration of study: CMH Abbottabad and CMH Rawalpindi from May 2005 to January 2008. Materials and Methods: Twenty cases (20 hips in 18 patients) of FNSF were included in the study. Only male cadets from Pakistan Military Academy (PMA) were included. Diagnosis was made clinically and was confirmed by radiographs or bone scan. Incomplete fractures were managed conservatively where as complete fractures were fixed surgically. Results: All compression fractures healed conservatively where as tension fractures needed surgical fixation in all the cases, except one where fracture remained incomplete. Rest of tension fractures converted from incomplete fractures to complete fractures and hence needed surgical stabilization. There was no problem of avascular necrosis of femoral head (AVNFH) in any patient. Conclusion: FNSF are uncommon injuries with potentially serious complications and are difficult to diagnose clinically. When diagnosed early and managed appropriately, they carry good prognosis. (author)

  4. Unstable femoral neck fractures in children - A new treatment option

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    Pruthi K

    2006-01-01

    Full Text Available Background : Femoral neck fractures in children are an uncommon but difficult situation. The aim of our study was to evaluate clinical results of closed reduction internal fixation and primary valgus osteotomy fixed with a tension band wire loop in high angled pediatric femoral neck fractures. Methods : In a prospective nonrandomized study conducted at 2 centres, sixteen children and adolescents with a Pauwel type 2/3 fracture neck femur were taken as participants. The femoral neck fractures were stabilized using closed reduction and internal fixation (6.5 mm noncannulated screw and a primary valgus osteotomy fixed with a tension band wire loop preferably within 24-36 hours of injury. Patients were evaluated to determine complications, clinical and radiological outcome. Results : At a mean post operative follow up of 5 years, union was achieved in all cases. Three patients had AVN and one developed coxavara. Results were evaluated using IOWA hip scores. Thirteen patients had an excellent result while 3 patients had a good result. Conclusion : Use of this technique holds promise in treating these difficult unstable fractures. Although results from a larger series are still awaited yet the use of this technique can safely be extended to stable fractures also, to minimize the incidence of complications as nonunion and AVN.

  5. Surgical blood order equation in femoral fracture surgery

    NARCIS (Netherlands)

    Kajja, I.; Bimenya, G. S.; Eindhoven, G. B.; ten Duis, H. Jan; Sibinga, C. T. S.

    Aim: This study aimed at establishing the clinical utility of the surgical blood order equation (SBOE) in patients undergoing femoral fracture surgery. Background: A blood ordering schedule defines the perioperative blood use in elective surgery. It lists the number of units of blood required for

  6. Treatment of femoral neck fracture by Moore Prosthesis in Cotonou ...

    African Journals Online (AJOL)

    Treatment of femoral neck fracture by Moore Prosthesis in Cotonou. AHM Akue, M Lawson, S Madougou, R Zannou, J Padonou. Abstract. Keywords: Benin; hip; Moore prosthesis; results. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  7. fibular osteosynthesis of neglected femoral neck fracture in a young

    African Journals Online (AJOL)

    As soon as a diagnosis of non-displaced fracture of his right hip was made he discharged himself ... in dogs that cortical grafts provided structural support to the necrotic femoral head preventing its collapse ... possibility of future osteoarthritis of the index hip and the need for regular follow-up. In conclusion, the use of ...

  8. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases.

    Science.gov (United States)

    Korkmaz, Mehmet Fatih; Erdem, Mehmet Nuri; Disli, Zeliha; Selcuk, Engin Burak; Karakaplan, Mustafa; Gogus, Abdullah

    2014-01-01

    In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification and the American Society of Anesthesiologists' (ASA) physical status classification (ASA grade). Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. The mean age of the patients was 77.66 years (range: 37-98 years), and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range: 12-75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture.

  9. Fracturing of revision of a cobalt-chrome femoral head after fracturing of a ceramic femoral head, with diffuse metallosis. Case report

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    Pedro Miguel Dantas Costa Marques

    2013-04-01

    Full Text Available We presente a case of a fracture of a cobalt-chrome femoral head after revision of a hip total prosthesis with ceramic femoral head fracture. During surgery we found the cobalt-chrome femoral head fracture, wear of the polyethylene and massive metallosis in muscular and cartilaginous tissue. Both femoral stem and acetabular cup were stable and without apparent wearing. After surgical debridement, we promoted the substitution of the femoral head and the acetabular polyethylene by similar ones. After 12 months of follow-up, the patient has no pain complaints, function limit or systemic signs associated with malign metallosis

  10. Modified Pauwels' intertrochanteric osteotomy in neglected femoral neck fractures in children: a report of 10 cases followed for a minimum of 5 years.

    Science.gov (United States)

    Magu, Narender Kumar; Singh, Roop; Sharma, Ashwini Kumar; Ummat, Vikas

    2007-04-01

    To evaluate the role of a modified Pauwels' intertrochanteric osteotomy (MPIO) in neglected femoral neck fractures in children. Prospective study with retrospective analysis. Tertiary care Postgraduate Institute of Medical Sciences. Ten children (8 males, 2 females) with an average age of 10.2 years with neglected femoral neck fractures were seen from 1990 to 1998. A femoral neck fracture was considered neglected when no proper medical treatment was instituted for at least 1 month following the fracture. Nonunion was accompanied by coxa vara and resorption of the femoral neck in 9 patients; a 10th patient had a neglected femoral neck fracture for 1 month without coxa vara. Three patients at time of presentation with Delbet Type II displaced fractures with associated nonunion and coxa vara (2 with Ratliff Type III and 1 with Type I) also had avascular necrosis using plain radiographic criteria of increased density. Modified Pauwels' intertrochanteric osteotomy. The children were immobilized in a hip spica for 6-10 weeks postoperatively and weightbearing was started after hip spica removal. Fracture healing, neck-shaft angle, avascular necrosis, and functional outcome. Patients were followed for an average of 8.2 years (range 5-12 years). All patients had union of their fracture within an average of 16.6 weeks (12-20 weeks) and of the osteotomy site within 8.2 weeks (7-9 weeks). Radiologic signs of avascular necrosis disappeared completely in the 3 patients who presented with avascular necrosis. In 1 patient with a preoperatively viable femoral head, radiologic signs of Ratliff Type I avascular necrosis appeared between 60 and 98 weeks. This radiologic finding became normal again, indicating viability of the femoral head somewhere between 98 to 205 weeks of follow-up. Postoperatively, an average of 135-degree neck-shaft angle was achieved (range 125-160 degrees). The average preoperative neck-shaft angle was 104.4 degrees (range 92-120 degrees) and on the normal hip

  11. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

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    Korkmaz MF

    2014-04-01

    Full Text Available Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF classification and the American Society of Anesthesiologists' (ASA physical status classification (ASA grade. Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years, and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range

  12. [Treatment of avascular necrosis of femoral head after femoral neck fracture with pedicled iliac bone graft].

    Science.gov (United States)

    Wang, Benjie; Zhao, Dewei; Guo, Lin; Yang, Lei; Li, Zhigang; Cui, Daping; Tian, Fengde; Liu, Baoyi

    2011-05-01

    To explore the effectiveness of pedicled iliac bone graft transposition for treatment of avascular necrosis of femoral head (ANFH) after femoral neck fracture. Between June 2002 and December 2006, 22 cases (22 hips, 16 left hips and 6 right hips) of ANFH after femoral neck fracture were treated with iliac bone graft pedicled with ascending branch of the lateral femoral circumflex vessels. There were 18 males and 4 females with an age range from 28 to 48 years (mean, 37.5 years). The time from injury to internal fixation was 2-31 days, and all fractures healed within 12 months after internal fixation. The ANFH was diagnosed at 15-40 months (mean, 22 months) after internal fixation. The ANFH duration was 3-11 months (mean, 8 months). According to Association Research Circulation Osseous (ARCO) staging system, 2 hips were classified as stage IIa, 3 hips as stage IIb, 3 hips as stage IIc, 3 hips as stage IIIa, 7 hips as stage IIIb, and 4 hips as stage IIIc. The preoperative Harris hip score (HHS) was 64.10 +/- 5.95. All incisions healed by first intention and the patients had no complication of lung embolism, sciatic nerve injury, lower limb deep venous thrombosis, and numbness and pain of donor site. All patients were followed up 2.5 to 6.3 years (mean, 4.8 years). The fracture healing time was 8-12 months, and no femoral neck fracture recurred. The HHS was 90.20 +/- 5.35 at last follow-up, showing significant difference when compared with the preoperative value (t = -18.447, P = 0.000). The hip function were excellent in 11 hips, good in 10 hips, fair in 1 hip, and the excellent and good rate was 95.5%. Four hips were radiographically progressed in ARCO staging, 18 hips remained stable with a stable rate of 81.8%. Pedicled iliac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization, sufficient cancellous bone supply, and relatively simple procedure.

  13. [SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE].

    Science.gov (United States)

    Tang, Yanfeng; Liu, Youwen; Zhu, Yingjie; Li, Jianming; Li, Wuyin; Li, Qiyi; Jia, Yudong

    2015-11-01

    To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage IIIb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Surgical hip dislocation approach can not only protect the residual vessels of the

  14. Proximal femoral fractures: Principles of management and review of literature

    Science.gov (United States)

    Mittal, Ravi; Banerjee, Sumit

    2012-01-01

    Purpose The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. Methods: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. Results and conclusions: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems. PMID:25983451

  15. Bilateral femoral supracondylar stress fractures in a cross country runner.

    Science.gov (United States)

    Ross, Kate; Fahey, Mark

    2008-08-01

    Several high-risk factors lead to stress fractures. They include excessive training in athletes leading to overuse injuries, nutritional deficiencies, and endocrine disorders. While stress fractures are common, bilateral stress fractures are rarely seen. Few cases have been reported of bilateral femoral stress fractures in young athletes. This article presents a case of a 14-year-old cross country runner with a bilateral femoral supracondylar stress fracture. He presented with bilateral supracondylar stress fractures from running. The patient followed a strict vegan diet, but his parents stated that, to their knowledge, he was getting adequate protein and calcium. Treatment consisted of decreased activity to pain-free levels with acetaminophen for pain. Low-impact conditioning such as swimming and bicycling was allowed. Hamstring and quadricep stretching was suggested. Nutritional consultation was obtained to ensure appropriate nutrition on a vegan diet. At 1-month follow-up, he was pain free and allowed to proceed with a gradual return to running activities. In this case, the onset of a new workout routine was intolerable for this patient's low bone density, causing insufficiency fractures. Appropriate vegan diets were not associated with stress fracture in our literature review. He may have had an inadequate diet prior to this injury. As in this case, full recovery can be made after this rest period, and the patient may return to his or her original activity safely. In young athletes, diet and nutrition must be kept in mind.

  16. Self-designed femoral neck guide pin locator for femoral neck fractures.

    Science.gov (United States)

    Xia, Shengli; Wang, Ziping; Wang, Minghui; Wu, Zuming; Wang, Xiuhui

    2014-01-01

    Closed reduction and fixation with 3 cannulated screws is a widely accepted surgery for the treatment of femoral neck fractures. However, how to obtain optimal screw placement remains unclear. In the current study, the authors designed a guide pin positioning system for femoral neck fracture cannulated screw fixation and examined its application value by comparing it with freehand guide needle positioning and with general guide pin locator positioning provided by equipment manufacturers. The screw reset rate, screw parallelism, triangle area formed by the link line of the entry point of 3 guide pins, and maximum vertical load bearing of the femoral neck after internal fixation were recorded. As expected, the triangle area was largest in the self-designed positioning group, followed by the general positioning group and the freehand positioning group. The difference among the 3 groups was statistically significant (P.05). The authors’ self-designed guide pin positioning system has the potential to accurately insert cannulated screws in femoral neck fractures and may reduce bone loss and unnecessary radiation.

  17. [Trochanteric femoral fractures: anatomy, biomechanics and choice of implants].

    Science.gov (United States)

    Bonnaire, F; Lein, T; Bula, P

    2011-06-01

    The objective of any surgical care of a trochanteric femoral fracture should be the achievement of a stable osteosynthesis that allows early full weight-bearing mobilisation of the patient, because long-term immobilisation soon becomes a vital threat to the affected patients who are usually elderly with correlating comorbidities. The anatomical references of the proximal femur and the structure of the hip joint contain some specifics that play an essential role in the incurrence of a trochanteric femoral fracture and the planning of the osteosynthesis as well. With reposition and fracture stabilisation particular importance must be attached to the collo-diaphyseal and the antetorsion angle so that they do not interfere with the functional interaction of the hip and knee joint. Uncomplex trochanteric fractures ordinarily stabilise sufficiently after reposition so that even an extramedullary implant can ensure full weight-bearing stability. With evermore distal fracture course and intertrochanteric comminution zone, rotational instability and pivot transfer of the fracture area to lateral and caudal are followed by an increase of the dislocating forces. These kinds of fractures (A2 and A3 according to the AO/ASIF classification) profit from an intramedullary and rotationally stable osteosynthesis. Basically primary total hip arthroplasty is a potential option for surgical care of a trochanteric fracture in elderly patients with relevant coxarthrosis. However this procedure can only be recommended in cases of a stable uncomplex fracture. The more the medial interlocking of the proximal femur is destroyed the more difficult it will be to primarily implant a total hip prosthesis with good offset and without a varus and rotational failure in the fracture zone.The current studies in the main show disadvantages due to increased complications in these patients, so that in cases of an unstable trochanteric fracture a primary osteosynthesis should be performed followed by

  18. A Case of Femoral Fracture in Klippel Trenaunay Syndrome

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    Sam Nahas

    2014-01-01

    Full Text Available We present a case of Klippel Trenaunay syndrome (KTS who presented with severe bilateral knee osteoarthritis (OA. Preoperative planning was commenced for a total knee replacement (TKR. Whilst on the waiting list the patient suffered a fall and sustained a complete femoral diaphysis fracture. Conservative management in the form of skin traction was initially chosen as significant extra- and intramedullary vascular malformations posed an increased risk of perioperative bleeding. This failed to progress to union, and so open reduction and internal fixation was performed. This subsequently resulted in on-going delayed union, which was subsequently managed with low intensity pulsed ultrasound (LIPUS, otherwise known as Exogen (Bioventus. exogen. Secondary exogen, 2012. There are only two previous documented cases of femoral fracture in KTS. This is the first report of a patient with this rare syndrome receiving this treatment. We discuss the management of fracture in this challenging group of patients.

  19. Proximal Femoral Geometry and the Risk of Fractures: Literature Review

    Directory of Open Access Journals (Sweden)

    N.V. Grygorieva

    2016-02-01

    Full Text Available This article presents the literature review of the impact of the upper third of the femur geometry (hip axis length, femoral neck angle, inter-trochanteric length, horizontal offset, thickness of the cortical bone, etc. on the risk of fractures. The article demonstrates the capabilities of techniques for measurement of hip geometry, namely conventional X-ray of pelvic bones, dual-energy X-ray absorptiometry, computed tomography. Possible correlation is shown between some genetic markers and features of the geometry of the upper third of the femur. Also, there are presented the results of own researches of age and sex characteristics of proximal hip geometry parameters in patients without fractures, as well as in patients of older age groups with internal and extraarticular femoral fractures.

  20. Subchondral stress fracture of femoral head in a healthy adult

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    Anand Ashish

    2010-01-01

    Full Text Available Subchondral fracture of the femoral head is an uncommon entity and usually occurs as an insufficiency fracture associated with poor bone quality or as a fatigue fracture in young military recruits. This condition should be considered in the differential diagnosis of acute hip pain in young patients along with transient osteoporosis and avascular necrosis of the hip. We report a case of acute onset hip pain in an asymptomatic healthy adult in which the diagnosis was made by magnetic resonance imaging and the patient responded well to conservative treatment.

  1. Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

    Directory of Open Access Journals (Sweden)

    David Walmsley

    2014-01-01

    Full Text Available Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.

  2. Titanium elastic nailing in pediatric femoral diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Singh Roop

    2006-01-01

    Full Text Available Background: The need for operative fixation of pediatric femoral fractures is increasingly being recognised in the present decade. The conventional traction and casting method for management of pediatric femoral fractures is giving way for the operative stabilisation of the fracture. Methods : Thirty five pediatric patients in age group 6-14 years with diaphyseal femoral fractures were stabilised with two titanium nails. Patients were followed up clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al. Technical problems and complications associated with the procedure were also analysed. Results : Overall results observed were excellent in 25, satisfactory in 8 and poor in 2 patients. Hospital time averaged 12.30 days in the series. All the fractures healed with an average time to union of 9.6 (6-14.4 weeks. Return to school was early with an average of 7.8 weeks. The soft tissue discomfort near the knee produced by the nails ends was the most common problem encountered. Shortening was observed in three cases and restriction of knee flexion in 5 patients. There was no delayed union, infection or refractures. Per operative technical problems included failure of closed reduction in 2 cases and cork screwing of nails in one case. Conclusion : We believe that with proper operative technique and aftercare TENs may prove to be an ideal implant for pediatric femoral fracture fixation. The most of the complication associated with the procedure are infact features of inexact technique and can be eliminated by strictly adhering to the basic principles and technical aspects.

  3. Epidemiology of metatarsal stress fractures versus tibial and femoral stress fractures during elite training.

    Science.gov (United States)

    Finestone, Aharon; Milgrom, Charles; Wolf, Omer; Petrov, Kaloyan; Evans, Rachel; Moran, Daniel

    2011-01-01

    The training of elite infantry recruits takes a year or more. Stress fractures are known to be endemic in their basic training and the clinical presentation of tibial, femoral, and metatarsal stress fractures are different. Stress fracture incidence during the subsequent progressively more demanding training is not known. The study hypothesis was that after an adaptation period, the incidence of stress fractures during the course of 1 year of elite infantry training would fall in spite of the increasingly demanding training. Seventy-six male elite infantry recruits were followed for the development of stress fractures during a progressively more difficult training program composed of basic training (1 to 14 weeks), advanced training (14 to 26 weeks), and unit training (26 to 52 weeks). Subjects were reviewed regularly and those with clinical suspicion of stress fracture were assessed using bone scan and X-rays. The incidence of stress fractures was 20% during basic training, 14% during advanced training and 23% during unit training. There was a statistically significant difference in the incidence of tibial and femoral stress fractures versus metatarsal stress fractures before and after the completion of phase II training at week 26 (p=0.0001). Seventy-eight percent of the stress fractures during phases I and II training were either tibial or femoral, while 91% of the stress fractures in phase III training were metatarsal. Prior participation in ball sports (p=0.02) and greater tibial length (p=0.05) were protective factors for stress fracture. The study hypothesis that after a period of soldier adaptation, the incidence of stress fractures would decrease in spite of the increasingly demanding elite infantry training was found to be true for tibial and femoral fractures after 6 months of training but not for metatarsal stress fractures. Further studies are required to understand the mechanism of this difference but physicians and others treating stress fractures

  4. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture.

    Science.gov (United States)

    Min, Byung-Woo; Kim, Sung-Jin

    2011-05-18

    The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. We evaluated the incidence of avascular necrosis of the femoral head with the use of contemporary techniques for femoral neck fracture fixation. We then sought to determine what potential risk factors influenced the development of avascular necrosis.Between 1990 and 2005, one hundred sixty-three intracapsular femoral neck fractures in 163 patients were treated with internal fixation at our level-I trauma center. All patients were monitored until conversion to total hip arthroplasty or for a minimum of 2 years postoperatively. Ten patients (10 hips) died and 7 patients (7 hips) were lost to follow-up. The remaining 146 patients (146 hips) had a mean 5.2 years of follow-up (range, 3 months to 17 years). The incidence of avascular necrosis was 25.3% (37 hips). The average time to diagnosis of avascular necrosis was 18.8 months (range, 3-47 months). Patient sex, age, interval from injury to surgery, and mechanism of injury were statistically not associated with the development of avascular necrosis. The quality of fracture reduction, adequacy of fixation, degree of displacement, and comminution of the posterior cortex were significantly associated. After we controlled for patient and radiographic characteristics, multivariate analyses indicated that the important predictors for avascular necrosis are poor reduction (odds ratio=13.889) and initial displacement of the fracture (odds ratio=4.693). Copyright 2011, SLACK Incorporated.

  5. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo

    2014-01-01

    Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients with no exp......Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients...... with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features...... a minor to a major feature. The association with specific diseases and drug exposures was removed from the minor features, because it was considered that these associations should be sought rather than be included in the case definition. Studies with radiographic review consistently report significant...

  6. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures.

    Science.gov (United States)

    Ito, Juji; Takakubo, Yuya; Sasaki, Kan; Sasaki, Junya; Owashi, Kazuya; Takagi, Michiaki

    2015-05-01

    Lag screw cut-out is one of the major postoperative complications on femoral trochanteric fractures. However, precise analyses of excessive sliding and lag screw cut-out were limited. The purpose of this study was to investigate the factors that induce this unfavorable event. From April 2010 to April 2013, 226 patients were operated in our institute using a short femoral nail. Among them, 177 patients (29 males and 148 females) with a mean age of 84 years (60-97 years), who were followed up >3 months, were included in this study. The postoperative sliding distance, fracture type (AO/OTA classification), tip-apex distance (TAD), reduction pattern in the postoperative X-ray (antero-posterior and lateral views), bone quality (canal flare and cortical indices), walking ability at the time of pre-injury and final follow-up, and complications were investigated retrospectively. The mean sliding distance was 3.7 mm, and one cut-out case (0.6 %) was observed. The sliding distance of the AO/OTA 31-A2 fractures was significantly longer than that of the A1 fractures (p fractures, an accurate reduction in the lateral view at surgery is important, particularly in unstable fractures.

  7. Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population.

    Science.gov (United States)

    Cho, Yoon-Je; Kang, Kyung-Chung; Chun, Young-Soo; Rhyu, Kee Hyung; Kim, Sang-Jun; Jang, Tae-Su

    2018-05-03

    There still remains controversy on the pathomechanism of atypical femoral fracture (AFF). The angle of lateral bowing and bone mineral density showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. In addition to the use of bisphosphonate, mechanical factors might play important roles in the occurrence of AFFs. Although AFF could be divided into subtrochanteric and diaphyseal fracture according to the location of fractures, there is a lack of evidence regarding differences between two fractures and etiology of the occurrence. The aim of study is to determine differences between atypical subtrochanteric and diaphyseal fracture in Korean population. Between February 2010 and March 2015, 51 AFFs in 40 patients were included in this study. Their medical records were retrospectively reviewed. The AFF patients satisfied all the diagnostic criteria of the 2014 revised edition of the ASMBR. To analyze the differences according to the location of fracture, the AFFs were divided into subtrochanteric (n = 16) and diaphyseal (n = 35) fracture groups. The following factors were compared between two groups: patients' demographics, underlying diseases, laboratory findings (serum-25(OH) VitD3, osteocalcin, c-telopeptide, ALP, Ca, and P), bone mineral density (BMD), duration of bisphosphonate (BP) usage, and lateral bowing of the femur at time of the fracture. All AFFs happened in female patients (mean age, 73.8 years) who have received bisphosphonate treatments except three patients. The mean duration of bisphosphonate usage was 95.3 months. Between the two groups, demographic data (age, height, weight, and BMI), underlying diseases, laboratory findings, hip BMD, and duration of BP treatment were comparable to each other (p > 0.05). However, the subtrochanteric fracture group showed higher FNSBA (femoral neck shaft bowing angle, p group. Angle of lateral bowing (FNSBA) and spine BMD showed significant differences between

  8. Femoral Shaft Torsion in Injured and Uninjured Ballet Dancers and Its Association with Other Hip Measures: A Cross-sectional Study.

    Science.gov (United States)

    Hafiz, Eliza; Hiller, Claire E; Nicholson, Leslie L; Nightingale, Elizabeth J; Grimaldi, Alison; Refshauge, Kathryn M

    2016-03-01

    Low range femoral torsion, termed "lateral shaft torsion," has been associated with greater range of hip external rotation and turnout in dancers. It is also hypothesized that achieving greater turnout at the hip minimizes torsion at the knee, shank, ankle, and foot, and consequently reduces incidence of lower limb injuries. The primary aims of this study were to investigate: 1. differences in range of femoral shaft torsion between dancers with and without lower limb injuries; and 2. the relationship between femoral shaft torsion, hip external rotation range, and turnout. A secondary aim was to examine the relationship between femoral shaft torsion and other hip measures: hip strength, lower limb joint hypermobility, hip stability, and foot progression angle, as explanatory variables. Demographic, dance, and injury data were collected, along with physical measures of femoral shaft torsion, hip rotation range of motion, and turnout. Hip strength, control, lower limb hypermobility, and foot progression angle were also measured. Eighty female dancers, 50 with lower limb injury (20.7 ± 4.8 years of age) and 30 without lower limb injury (17.8 ± 4.1 years of age), participated in the study. There was no difference in range of femoral shaft torsion between the groups (p = 0.941). Femoral shaft torsion was weakly correlated with range of hip external rotation (r = -0.034, p = 0.384) and turnout (r = -0.066, p = 0.558). Injured dancers had a significantly longer training history than non-injured dancers (p = 0.001). It was concluded that femoral shaft torsion does not appear to be associated with the overall incidence of lower limb injury in dancers or to be a primary factor influencing extent of turnout in this population.

  9. Evaluation in femoral neck fracture scintimetry: modes of region of interest selection and influence on results

    Energy Technology Data Exchange (ETDEWEB)

    Holmberg, S.; Mesko, L.; Stroemqvist, B.; Thorngren, K.G.

    1985-04-01

    Different sized ROIs within the femoral head and different modes of calculation were used in (/sup 99m/Tc)MDP scintimetry after femoral neck fracture. In preoperative scintimetry, correction for increased trochanteric uptake gave the best discrimination, whereas in postoperative scintimetry the direct ratio fractured/intact femoral head was superior. The change in ROI size had little influence.

  10. Evaluation in femoral neck fracture scintimetry: modes of region of interest selection and influence on results

    International Nuclear Information System (INIS)

    Holmberg, S.; Mesko, L.; Stroemqvist, B.; Thorngren, K.G.

    1985-01-01

    Different sized ROIs within the femoral head and different modes of calculation were used in [/sup 99m/Tc]MDP scintimetry after femoral neck fracture. In preoperative scintimetry, correction for increased trochanteric uptake gave the best discrimination, whereas in postoperative scintimetry the direct ratio fractured/intact femoral head was superior. The change in ROI size had little influence

  11. A FUNCTIONAL EVALUATION STUDY OF DISTAL FEMORAL FRACTURES FIXED WITH DISTAL FEMORAL LOCKING PLATE

    Directory of Open Access Journals (Sweden)

    Manikumar C. J

    2017-04-01

    Full Text Available BACKGROUND Fractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. MATERIALS AND METHODS In this study, 20 patients with closed fracture of distal femur were studied. All the cases were treated at the Department of Orthopaedics, Rangaraya Medical College/Government General Hospital, Kakinada, Andhra Pradesh, between November 2013 and November 2015. The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer’s scoring system. 1 RESULTS Twenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients

  12. Postoperative hemoglobin level in patients with femoral neck fracture.

    Science.gov (United States)

    Nagra, Navraj S; Van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward M

    2016-01-01

    The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture. Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored. There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative Day 5 Hb levels (pmeasurement, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p=0.046). The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2. Relying on the Day 1 hemoglobin level could be detrimental to patient care. We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.

  13. Study of relation between Neck Shaft Angle (NSA and mineral density of the femoral head among old post menopausal women in east part of mazandaran province

    Directory of Open Access Journals (Sweden)

    Majid Malekzadeh Shafaroudi

    2016-09-01

    Full Text Available Background: Diversity in Proximal Femur Geometric Parameters (PFGPs will be led to frequency changes in hip fractures. The purpose of the present study is to investigate of the relation between Bone Mineral Density (BMD in proximal femur with Neck Shaft Angle (NSA in both of osteoporotic and normal groups among old postmenopausal women in eastern part of Mazandaran province as a appropriate indicator to predict hip fractures occurance. Materials and Methods: Among 5103 postmenopausal women reffered to bone densitometry center, for 221 postmenopausal women who had inclusion criteria to this study, simultaneously by using densitometry system and completing a standard questionnaire, history of disease and demographic information including body mass index (BMI were recorded for each patient. Obtained information from densitometers was analyzed by the statistical software SPSS version 16 and Pearson correlation coefficient test was used. Results: Geometric parameters of 221 post-menopausal women aged 50 to 60 were analyzed. The mean of neck shaft angle (NSA were recorded for osteoporotic group 121.55 and for control group 121.44. Pearson correlation coefficient t-test results showed a negative significant correlation between mineral density in the femoral neck in osteoporotic group and NSA (P<0.05. Considering the effect of weight and BMI in strength and bone density in the femoral neck, the mean of BMI and weight in osteoporotic group was lower compared to control group. Conclusion: according to the findings of this study, NSA is effective in predicting of the proximal femur BMD in osteoporotic group.

  14. Preoperative sup(99m)Tc-MDP scintimetry of femoral neck fractures

    International Nuclear Information System (INIS)

    Holmberg, S.; Thorngren, K.-G.

    1984-01-01

    Preoperative sup(99m)Tc-MDP-scintimetry was performed in 117 patients with femoral neck fractures. Scintimetry was shown to be superior to visual evaluation. The ratio was calculated of the uptake in the femoral head of the fractured side over that in the unfractured side, with compensation for the increased trochanteric femoral activity found on the fractured side. A ratio above 0.90 correlated well with uneventful healing in both undisplaced and displaced fractures. Preoperative scintimetry is of great value in the choice of primary treatment of femoral neck fractures. (author)

  15. Threading the Needle: Intrapelvic Displacement of a Femoral Neck Fracture through the Obturator Foramen

    Directory of Open Access Journals (Sweden)

    Gautham Prabhakar

    2018-01-01

    Full Text Available Despite timely and appropriate management, displaced femoral neck fractures are often devastating injuries for the young patient. The risk of negative sequelae is further amplified with increasing displacement and vertical fracture patterns. Open anatomic reduction with rigid internal fixation is essential to maximize the healing potential in displaced fractures of the femoral neck. Successful primary osteosynthesis of significantly displaced femoral neck fractures in the young patient has been reported in the literature. We present a unique case of open reduction and internal fixation of a high-energy femoral neck fracture with extrusion of the head through the obturator foramen into the pelvis without associated acetabular or pelvic injury.

  16. Percutaneous Kirschner wire (K-wire) fixation for humerus shaft fractures in children: A treatment concept.

    Science.gov (United States)

    Sahu, Ramji Lal

    2013-09-01

    Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Humeral shaft fractures in children can be treated by immobilisation alone. A small number of fractures are unable to be reduced adequately or maintained in adequate alignment, and these should be treated surgically. In the present study, Kirschner wires (K-wire) were used to achieve a closed intramedullary fixation of humeral shaft fractures. The objective of this study was to evaluate the efficacy of intramedullary K-wires for the treatment of humeral shaft fracture in children. This prospective study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from June 2005 to June 2010. Sixty-eight children with a mean age of 7.7 years (range, 2-14 years) were recruited from Emergency and out patient department having closed fracture of humerus shaft. All patients were operated under general anaesthesia. All patients were followed for 12 months. Out of 68 patients, 64 patients underwent union in 42-70 days with a mean of 56 days. Complications found in four patients who had insignificant delayed union which were united next 3 weeks. Intramedullary K-wires were removed after an average of 5 months without any complications. The results were excellent in 94.11% and good in 5% children. This technique is simple, quick to perform, safe and reliable and avoids prolonged hospitalization with good results and is economical.

  17. Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures.

    Science.gov (United States)

    Kumar, Sanjiv; Anand, Tushar; Singh, Sudhir

    2014-11-01

    Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. Prospective randomized study in a tertiary care hospital. Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.

  18. Augmentation of proximal femoral nail in unstable trochanteric fractures

    Directory of Open Access Journals (Sweden)

    Gadegone Wasudeo M.

    2017-01-01

    Full Text Available Introduction: Biomechanically proximal femoral nail (PFN is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3 and 37 cases of AO 31 A3 (3.1, 3.2, 3.3. Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5, Z effect (n = 1, infection (n = 2, and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40 in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.

  19. Femoral neck-shaft angle and climate-induced body proportions.

    Science.gov (United States)

    Child, Stephanie L; Cowgill, Libby W

    2017-12-01

    Declination in femoral neck-shaft angle (NSA) is commonly linked to an increased level of physical activity during life. More recently, however, research suggests that lower NSA might also be explained, in part, as the mechanical consequence of differences in ecogeographic body proportions. This study tests the proposed link between NSA and climatic-induced body proportions, using relative body mass (RBM), throughout the course of development. NSA and RBM were collected for 445 immature remains from five geographic locations. NSA and RBM were standardized for age-effects. ANOVA was used to examine when population differences emerged in both NSA and RBM. Regression analyses were used to examine the pattern of relationship between NSA and RBM. Populations differ significantly in NSA and RBM before skeletal maturity, and these differences occur early in life. While both NSA and RBM change over the course of development, no significant relationship was found between NSA and RBM for any sample, or any age category (p = .244). Individuals who have relatively greater relative body mass do not necessarily have lower NSA. Population differences in NSA were found to be variable, while differences in RBM remained consistent across the developmental span. Taken together, these results suggest that regardless of body proportions, the degree of declination of NSA is presumed to be similar among individuals with similar gait and ambulatory behaviors. Conversely, populations differ in RBM from birth, and these differences are consistent throughout development. These two measures likely are responsive to diffing stimuli, and any potential relationship is likely complex and multifactorial. © 2017 Wiley Periodicals, Inc.

  20. A STUDY OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES TREATED BY TROCHANTERIC FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Sreenivasa Neikar

    2017-11-01

    Full Text Available BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital, Vijayanagara Institute of Medical Sciences, Bellary, from February 2015 to September 2016. RESULTS The age distribution was from 40 to 80 years. The largest group of patients were from 61 to 70 years. The average age was 60.5 years. The number of male patients in our series was 20 (66.7% and female was 10 (33.3%. Right side was affected in 11 cases (36.7% and left side in 19 cases (63.3%. Good reduction was achieved in 23 patients (76.7%. Acceptable reduction was achieved in 7 (23.3% patients due to severe comminution. In our study, 25 patients (83.33% had no complications. We encountered one intraoperative complication in the form of greater trochanter splintering, while inserting the nail. In our study, we encountered following postoperative complications. We noticed one case of delayed union, one case of Z effect and 2 cases of varus malunion. CONCLUSION We conclude that short trochanteric femoral nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed leading to high rate of bone union and minimal soft tissue damage especially for Asian patients with relatively small femora.

  1. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...... of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants....

  2. Periprosthetic femoral fracture within two years after total hip replacement:

    DEFF Research Database (Denmark)

    Thien, T. M.; Chatziagorou, G.; Garellick, G.

    2014-01-01

    BACKGROUND: We used the Nordic Arthroplasty Register Association database to evaluate whether age, sex, preoperative diagnosis, fixation, and implant design influence the risk of revision arthroplasty due to periprosthetic fracture within two years from operation of a primary total hip replacement....... METHODS: Included in the study were 325,730 cemented femoral stems and 111,899 uncemented femoral stems inserted from 1995 to 2009. Seven frequently used stems (two cemented stems [Exeter and Lubinus SP II] and five uncemented stems [Bi-Metric, Corail, CLS Spotorno, ABG I, and ABG II]) were specifically...... studied. RESULTS: The incidence of revision at two years was low: 0.47% for uncemented stems and 0.07% for cemented stems. Uncemented stems were much more likely to have this complication (relative risk, 8.72 [95% confidence interval, 7.37 to 10.32]; p

  3. Treatment of periprosthetic femoral fractures of the knee.

    Science.gov (United States)

    Ehlinger, Matthieu; Adam, Philippe; Abane, Lamine; Rahme, Michel; Moor, Beat Kaspar; Arlettaz, Yvan; Bonnomet, François

    2011-09-01

    We report a continuous series of periprosthetic femoral fractures after knee arthroplasty treated with a locking plate. We hypothesize that minimally invasive surgery and immediate weight-bearing improve functional recovery. From June 2002 to December 2008, 15 patients with 16 fractures were treated. Median age was 81 years. The autonomy level according to the mobility score of Parker and Palmer showed a median of 5 (0-9). Osteosynthesis was performed mainly through a minimally invasive approach using a locking compression plate. The rehabilitation protocol consisted of immediate mobilization and, whenever possible, immediate unrestricted weight-bearing. Five patients died during follow-up, more than 1 year after osteosynthesis. Their results were included. Autonomy and mobility were preserved with a median postoperative score of 4 (0-9) according to Parker and Palmer. The consolidation rate was 93.8%, which was obtained within 10 weeks. There were no mechanical or infectious complications. Fourteen cases were treated with minimally invasive surgery without fracture exposition; the remaining 2 required a slightly more extended approach. Full weight-bearing occurred 10 times; 20-kg partial weight-bearing was advised twice; and on 4 occasions, no weight-bearing was allowed for 6 weeks. Osteosynthesis with a minimally invasive bridge-plating technique is effective in the treatment of periprosthetic, distal femoral fractures without component loosening. Immediate full weight-bearing is possible if certain rules are respected. The surgical management presented herein is beneficial for these challenging fractures, and it may help reduce the complication rate and improve functional outcome.

  4. A STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMORAL FRACTURES BY DISTAL FEMORAL LOCKING COMPRESSION PLATE OSTEOSYNTHESIS

    Directory of Open Access Journals (Sweden)

    Dema Rajaiah

    2016-08-01

    Full Text Available AIMS AND OBJECTIVES To study the fractures of distal end of femur and the mechanism of injury in distal end femur fractures, the advantages and disadvantages of open reduction and internal fixation of distal end femur fractures by distal femoral locking compression plate osteosynthesis and to analyse the outcome in terms of range of Knee motion, time to union, and limb shortening. RESULTS The mean age of patient is 44 years, 85% are males, road traffic accidents account for majority (80%, right side involved in 70%, Muller’s type C fracture is common, good range of movements is seen 90% of cases and union occurred in 95% in 5 months. The results were assessed using Neer’s score, seven (35% patients had excellent results, eight (40% patients had good results, four (20% patients had fair results and one (5% patient had poor result. CONCLUSION From our study, we conclude that DF-LCP is a safe and reliable implant and has shown excellent to satisfactory results in majority of intra-articular fractures (AO type C. Fixation with locking compression plate showed more effectiveness in severely osteoporotic bones, shorter operative stay, faster recovery, faster union rates and excellent functional outcome.

  5. Case report: AVN of the femoral head five year follow-up of the combination of ipsilateral femoral neck and sub-trochanteric fracture.

    Science.gov (United States)

    Zhang, Wei; Zhu, Feng; Dong, Hanqing; Xu, Yaozeng

    2016-04-01

    To our knowledge, the type of combination of ipsilateral femoral neck and sub-trochanteric fracture is rare. And the long term follow-up is seldom been reported. A 60 year old woman suffered from a traffic accident. We gave her the intramedullary nail treatment for the combination of ipsilateral femoral neck and sub-trochanteric fracture, and the fracture indeed cured after one year and there is no clue of necrosis of the femoral head, but after 5 years, there is an evidence of necrosis of the femoral head. Combination of ipsilateral femoral neck and sub-trochanteric fracture should be kept in mind. Patients with this unusual fracture should be kept under surveillance for longer than might be thought currently to be necessary for there is a possibility of necrosis of the femoral head, even a nondisplaced femoral neck fracture.

  6. Efficacy and Safety of Interlocked Intramedullary Nailing for Open Fracture Shaft of Tibia

    International Nuclear Information System (INIS)

    Ahmad, N.; Awan, A. S.; Sultan, S.; Saifullah, K.; Afridi, S. A.; Afridi, S. K.; Lodhi, F. S.

    2016-01-01

    Background: Due to increasing population and changing human habits the number of accidents and high energy trauma is rising. Management of open fracture tibia is a complex problem and is a challenge for both orthopaedic and plastic surgeons. The study was carried out to ascertain the efficacy and safety of interlocked intra-medullary nailing for open shaft tibial fractures in patients presenting at or after 24 hr of injury. Methods: In this descriptive case series, over a period of 6 moths, 163 consecutive cases of open fracture of tibial shaft were reviewed in terms of clinical profile, time of presentation, and gender distribution. Results: In this study mean age was 30±0.02 years. Males comprised 85 percent of study population while 15 percent were females. Gustilo-I type fracture and Gustilo-II type fracture was diagnosed in 90 percent and 10 percent patients respectively. Thirty three percent patients had wound infection while fracture union was found in 15 percent cases. Moreover interlocked intramedullary nailing for open fracture shaft of tibia was safe in 80 percent patients while this procedure was effective in 85 percent. Conclusion: Un-reamed, interlocked intra-medullary nailing may be considered as a suitable option for treatment of open fractures of tibia. (author)

  7. A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture

    OpenAIRE

    Stenvall, M.; Olofsson, B.; Lundstr?m, M.; Englund, U.; Borss?n, B.; Svensson, O.; Nyberg, L.; Gustafson, Y.

    2006-01-01

    Introduction This study evaluates whether a postoperative multidisciplinary, intervention program, including systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications, could reduce inpatient falls and fall-related injuries after a femoral neck fracture. Methods A randomized, controlled trial at the orthopedic and geriatric departments at Ume? University Hospital, Sweden, included 199 patients with femoral neck fracture...

  8. The “communication line” suggests occult posterior malleolar fracture associated with a spiral tibial shaft fracture

    International Nuclear Information System (INIS)

    Hou Zhiyong; Zhang Liping; Zhang Qi; Yao Shuangquan; Pan Jinshe; Irgit, Kaan; Zhang Yingze

    2012-01-01

    Objectives: To demonstrate radiographical characteristics of the relationship between distal spiral tibial shaft fractures and associated occult posterior malleolar fractures (PMF) that confirmed by CT and MRI. Materials and methods: X-rays for a ninety-six patients with spiral tibia fracture and associated PMF were reviewed. All patients additionally had an ankle CT. Patients with a negative CT scans underwent an ankle MRI. Radiographic observations included fracture location, characteristics, and a presence of a fracture line between the two injuries. Results: The spiral tibia fracture line was contiguous with PMF in 89 of 96 cases after evaluation with the CT and MRI. The line connecting the two injuries, which occurs between the medial inferior apex of the spiral tibia fracture line and the posterior superior apex of the PMF was identified as the “communication line”. In 47 of the 89 conjunction fractures, the “communication line” was detectable preoperatively and in 12 cases postoperatively by anteroposterior radiograph. By using the CT and MRI scans, we found that no “communication line” was present in only 7 cases. Conclusion: It is important to understand the nature of the association between distal spiral tibial shaft fractures and occult posterior malleolar fractures for optimal stabilization of the fracture and for appropriate rehabilitation. The “communication line” is a useful diagnostic clue for early recognition the occult PMF and alerts a closer evaluation of the lateral view and further CT examination.

  9. Femoral neck fractures after removal of hardware in healed trochanteric fractures.

    Science.gov (United States)

    Barquet, Antonio; Giannoudis, Peter V; Gelink, Andrés

    2017-12-01

    Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFARIHTF and series of TF with cases of FNFARIHTF due to pain or discomfort published between inception of journals to December 2016 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of FNFARIHTF, with the objective of establishing the eventual risk factors, mechanisms and pathoanatomy, clinical presentation and diagnosis, treatment and prevention. Part II analyzed series of TF which included cases of FNFARIHTF for assessing the incidence of femoral neck fractures in this condition. Overall 24 publications with 45 cases of FNFARIHTF met the inclusion criteria. We found that the only prevalent factors for FNFARIHTF were: 1) preexisisting systemic osteoporosis, as most patients were older and elder females, with lower bone mineral density and bone mass; 2) local osteoporosis as a result of preloading by the fixation device in the femoral neck, leading to stress protection, reducing the strain at the neck, and increasing bone loss and weakness; and 3) the removal of hardware from the femoral neck, with reduction of the failure strength of the neck. The femoral neck fractures were spontaneous, i.e. not related to trauma or

  10. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation A study on synthetic bones

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    Korhan Ozkan

    2015-01-01

    Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures.

  11. The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis

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    Christoph Kolja Boese

    2016-01-01

    Full Text Available Background. The femoral neck-shaft angle (NSA is of high importance for the diagnostics and treatment of various conditions of the hip. However, rotational effects limit its precision and applicability using plain radiographs. This study introduces a novel method to measure the femoral NSA: the modified NSA (mNSA, possibly being less susceptible against rotational effects compared to the conventional NSA. Patients and Methods. The method of measurement is described and its applicability was tested in 400 pelvis computed tomography scans (800 hips. Age- and gender-dependent reference values are given and intra- and interrater reliability are analyzed. Results. The mean age of all 400 patients (800 hips was 54.32 years (18–100, SD 22.05 years. The mean mNSA was 147.0° and the 95% confidence interval was 146.7°–147.4°. Differences of the mNSA between sexes, age groups, and sides were nonsignificant. The absolute difference between NSA and mNSA was 16.3° (range 3–31°; SD 4.4°; the correlation was high (0.738; p<0.001. Overall, the intra- and interrater reliability were excellent for the mNSA. Interpretation. We introduced a novel concept for the analysis of the neck-shaft angle. The high reliability of the measurement has been proven and its robustness to hip rotation was demonstrated.

  12. Short-term outcome of patients with closed comminuted femoral ...

    African Journals Online (AJOL)

    Short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary sign nail at Muhimbili Orthopaedic Institute in Tanzania. Billy T. Haonga, Felix S. Mrita, Edmundo E. Ndalama, Jackline E. Makupa ...

  13. Early detection by sup(99m)Tc-Sn-pyrophosphate scintigraphy of femoral head necrosis following medial femoral neck fractures

    International Nuclear Information System (INIS)

    Greiff, J.; Lanng, S.; Hoeilund-Carlsen, P.F.; Karle, A.K.; Uhrenholdt, A.

    1980-01-01

    A selected series of 24 patients with displaced medial femoral neck fracture, treated with closed reduction and osteosynthesis with cancellous bone screws (ASIF), were investigated. During an observation period of 6 to 26 months, serial hip joint scintigraphies were performed and compared with serial X-ray examinations. At the first scintigraphic examination performed on average 5-6 weeks after the fracture, two separate investigators found a decreased amount of activity or no activity in the femoral head of 10 and 8 patients, respectively. At the second scintigraphic examination performed on average 11.1 weeks after the fracture both investigators found no activity or a decreased amount of activity in 8 patients. This figure declined to 7 during the following period, because one patient with decreased activity was recorded as having normal activity 15 months after the fracture. These 7 patients all developed radiological signs of femoral head collapse on average 16.3 months after the fracture (range 5-26 months), whereas their scintigrams displayed decreased or absent tracer uptake on average 1.2 months after the fracture (P<0.01). None of the patients with initially normal or increased uptake later showed decreased or absent uptake during the study and none developed radiological collapse. It may be concluded that absent or decreased uptake of sup(99m)Tc-Sn-pyrophosphate in the femoral head following medial femoral neck fracture indicates femoral head necrosis and a high risk of late segmental collapse, whereas normal or increased uptake implying preserved blood supply means that late segmental collapse will probably never develop. (author)

  14. Finite element analysis of the equivalent stress distribution in Schanz screws during the use of a femoral fracture distractor

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    Vincenzo Giordano

    Full Text Available ABSTRACT To evaluate the mechanical stress and elastic deformation exercised in the thread/shaft transition of Schanz screws in assemblies with different screw anchorage distances in the entrance to the bone cortex, through the distribution and location of tension in the samples. An analysis of 3D finite elements was performed to evaluate the distribution of the equivalent stress (triple stress state in a Schanz screw fixed bicortically and orthogonally to a tubular bone, using two mounting patterns: (1 thread/shaft transition located 20 mm from the anchorage of the Schanz screws in the entrance to the bone cortex and (2 thread/shaft transition located 3 mm from the anchorage of the Schanz screws in entrance to the bone cortex. The simulations were performed maintaining the same direction of loading and the same distance from the force vector in relation to the center of the hypothetical bone. The load applied, its direction, and the distance to the center of the bone were constant during the simulations in order to maintain the moment of flexion equally constant. The present calculations demonstrated linear behavior during the experiment. It was found that the model with a distance of 20 mm between the Schanz screws anchorage in the entrance to the bone cortex and the thread/shaft transition reduces the risk of breakage or fatigue of the material during the application of constant static loads; in this model, the maximum forces observed were higher (350 MPa. The distance between the Schanz screws anchorage at the entrance to the bone cortex and the smooth thread/shaft transition of the screws used in a femoral distractor during acute distraction of a fracture must be farther from the entrance to the bone cortex, allowing greater degree of elastic deformation of the material, lower mechanical stress in the thread/shaft transition, and minimized breakage or fatigue. The suggested distance is 20 mm.

  15. Minimally invasive plating osteosynthesis for mid-distal third humeral shaft fractures.

    Science.gov (United States)

    Lian, Kejian; Wang, Lei; Lin, Dasheng; Chen, Zhiwen

    2013-08-01

    Mid-distal third humeral shaft fractures can be effectively treated with minimally invasive plating osteosynthesis and intramedullary nailing (IMN). However, these 2 treatments have not been adequately compared. Forty-seven patients (47 fractures) with mid-distal third humeral shaft fractures were randomly allocated to undergo either minimally invasive plating osteosynthesis (n=24) or IMN (n=23). The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. Intraoperative measurements included blood loss and operative time. Clinical outcome measurements included fracture healing, radial nerve recovery, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. Functional outcome was satisfactory in both groups. Mean American Shoulder and Elbow Surgeons score and Mayo score were both better for the minimally invasive plating osteosynthesis group than for the IMN group (98.2 vs 97.6, respectively, and 93.5 vs 94.1, respectively; Pshaft fractures. Minimally invasive plating osteosynthesis is more suitable for complex fractures, especially for radial protection and motion recovery of adjacent joints, compared with IMN for simple fractures. Copyright 2013, SLACK Incorporated.

  16. MONOLATERAL LOW-INVASIVE TREATMENT OF HUMERAL SHAFT FRACTURE IN CHILDREN

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    V. P. Kuzmin

    2012-01-01

    Full Text Available Humeral fractures in children are from 4 up to 10% of the general number of child fractures. Recently the trend is marked to expansion of indications to operative treatment despite of mainly conservative treatment of humeral shaft fractures. The experience of humeral shaft fractures operative treatment with use of Ender nails was analyzed. 8 humeral bones were treated with use of 2 nails, 15 humeral bones - with use of 1 nail only. The good and excellent results were received in both groups of patients. At the same time group with monolateral osteosynthesis (with 1 nail had statistically significant (p<0,01 decreasing of surgery time (average difference 16 min, and also it had statistically significant (p <0,001 decreasing of X-ray exposition time (average difference 23 sec in comparison with group where the osteosynthesis was done with use of 2 nails. The results received in study show necessity of the further work for this direction.

  17. Study of Ender’s Nailing in Shaft Femur Fractures of Older Children

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    Ladani HG

    2014-12-01

    Full Text Available Background: Fractures in shaft femur in children are relatively common. Various methods of treating these fractures starting from non operative to methods like closed intramedullary nailing are at our disposal. Traditionally non operative methods are acceptable and find wide acceptance even today in very young children. However in older children certain problems are encountered like failure to control angulation and shortening, prolonged immobilization which causes very much discomfort & the overgrowth phenomenon. In view of above difficulties, closed intramedullary nailing was attempted in older children and adolescents. I have tried to study 23 cases of shaft femur fractures in older children treated by Ender’s nails. Methodology: 22 pts., out of which one having bilateral # shaft femur (total 23 #s with age ranging from 7 to 16 yrs. were studied. 3 pts. having polio limbs studied separately. Fracture was in upper third shaft femur in 5 pts., middle third in 13 pts., lower third in 3pts. & involving more than one region in 2 pts. Fracture was transverse in 6 pts., spiral in 3 pts., oblique in 12 pts.& comminuted in 2 pts.. Results: Average union time was 10 weeks except in polio pts. where it was delayed. No nonunion, no infection. Excellent hip & knee movements in almost all pts. Out of 20 pts. ( except polio pts. limb length was equal in 17 pts., one pt. was having 1 cm. lengthening & 2 pts. were having shortening ( 1cm. & 2 cm.. Conclusion: Results of this study strongly favor the use of Ender’s nailing in shaft femur fractures in older children. Second surgery of implant removal is mandatory. Closed reduction can usually be achieved if surgery is performed earlier.

  18. Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification.

    Science.gov (United States)

    Shoda, Etsuo; Kitada, Shimpei; Sasaki, Yu; Hirase, Hitoshi; Niikura, Takahiro; Lee, Sang Yang; Sakurai, Atsushi; Oe, Keisuke; Sasaki, Takeharu

    2017-01-01

    Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

  19. Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.

    Science.gov (United States)

    Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

    2014-07-24

    The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

  20. Postoperative malrotation of humeral shaft fracture after plating compared with intramedullary nailing.

    Science.gov (United States)

    Li, Ying; Wang, Cheng; Wang, Manyi; Huang, Lei; Huang, Qiang

    2011-09-01

    We supposed difference of rotation alignment of postoperative humeral shaft fracutres between open reduction and internal fixation (ORIF) and intramedullay nailing (IMN) could be identified and the difference might influence the involved shoulder. This study evaluated and compared the extent of malrotation and shoulder function after humeral shaft fractures treated operatively with IMN or ORIF. Fifty humeral shaft fractures were randomly allocated into 2 groups. Group I underwent antegrade IMN and group II underwent ORIF. Malrotation was measured postoperatively by computed tomography scan (CT). Fracture union and functional outcomes were recorded at 12 months. The final analysis comprised 45 patients. Group I had lower functional scores than group II (P shaft fracture. The study can provide baseline data for larger series and longer follow-up periods. Patients who underwent IMN had lower functional scores and a decreased range of motion postoperatively and also had a greater degree of malrotation than the ORIF group, which had none. The degree of malrotation correlated with a decreased range of motion and may possibly be a reason for degenerative arthritis at long-term follow-up. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  1. Rehabilitation in peripheral non femoral fractures: a review.

    Science.gov (United States)

    Mangone, Giuseppe; Postiglione, Marco; Pasquetti, Pietro

    2010-01-01

    This paper is a short review of the available information on peripheral non femoral fractures (PNFF) which are strictly related to osteoporosis. Particular attention is focused on wrist fractures in view of their frequent occurrence as indicated by world wide statistics. Of special interest is the definition of risk groups (old age), risk areas (developed countries) and risk factors. Reference is made to 2008 WHO guidelines for fracture risk assessment. PNFF are a serious concern to health authorities because their high incidence in constant growth, causes a serious burden on the health budget. The pathway of patient care is described, from initial evaluation (including bone fragility, multi-morbidity and risk factors) to specific diagnosis and treatment. The multiplicity of etiological factors involved requires multidisciplinary approach. This aspect justifies the importance given to rehabilitation, which is the longest part of patient care and is strictly connected to preventive measures. There is ample reference to falls, to exercises, to appropriate sports, to complications and to active and passive mobilization. The paper suggests research in areas related to PNFF, to health economics, epidemiology, prevention, health education, training and multidisciplinary coordination.

  2. Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach.

    Science.gov (United States)

    Kumar, B S; Soraganvi, P; Satyarup, D

    2016-03-01

    Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure. Method: A prospective study was conducted in the Department of Orthopaedics, PESIMSR, Kuppam, Andhra Pradesh, from August 2012 to August 2015 with a total of 54 patients who were operated with anteromedial plate osteosynthesis were included in the study. Rodriguez- Merchan criteria was used to grade the functional outcome. Results: Of the 54 patients, 28 (58.85%) were in the age group of 30-40 years. The most common fracture pattern identified was A3 type (48.14%).The mean (± SD) duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes. The time taken for the fracture to unite was less than 16 weeks in the majority or 50 patients (92.59%). Four (7.40%) patients had delayed union. There was no incidence of iatrogenic radial nerve palsy. Rodriguez - Merchan criteria showed that 37(68.51%) of the patients had good and 12 (22.22%) had excellent functional outcome.

  3. Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach

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    Kumar BS

    2016-03-01

    Full Text Available Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure. Method: A prospective study was conducted in the Department of Orthopaedics, PESIMSR, Kuppam, Andhra Pradesh, from August 2012 to August 2015 with a total of 54 patients who were operated with anteromedial plate osteosynthesis were included in the study. RodriguezMerchan criteria was used to grade the functional outcome. Results: Of the 54 patients, 28 (58.85% were in the age group of 30-40 years. The most common fracture pattern identified was A3 type (48.14%.The mean (+ SD duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes. The time taken for the fracture to unite was less than 16 weeks in the majority or 50 patients (92.59%. Four (7.40% patients had delayed union. There was no incidence of iatrogenic radial nerve palsy. Rodriguez – Merchan criteria showed that 37(68.51% of the patients had good and 12 (22.22% had excellent functional outcome.

  4. Ball-joint versus single monolateral external fixators for definitive treatment of tibial shaft fractures.

    Science.gov (United States)

    Beltsios, Michail; Mavrogenis, Andreas F; Savvidou, Olga D; Karamanis, Eirineos; Kokkalis, Zinon T; Papagelopoulos, Panayiotis J

    2014-07-01

    To compare modular monolateral external fixators with single monolateral external fixators for the treatment of open and complex tibial shaft fractures, to determine the optimal construct for fracture union. A total of 223 tibial shaft fractures in 212 patients were treated with a monolateral external fixator from 2005 to 2011; 112 fractures were treated with a modular external fixator with ball-joints (group A), and 111 fractures were treated with a single external fixator without ball-joints (group B). The mean follow-up was 2.9 years. We retrospectively evaluated the operative time for fracture reduction with the external fixator, pain and range of motion of the knee and ankle joints, time to union, rate of malunion, reoperations and revisions of the external fixators, and complications. The time for fracture reduction was statistically higher in group B; the rate of union was statistically higher in group B; the rate of nonunion was statistically higher in group A; the mean time to union was statistically higher in group A; the rate of reoperations was statistically higher in group A; and the rate of revision of the external fixator was statistically higher in group A. Pain, range of motion of the knee and ankle joints, rates of delayed union, malunion and complications were similar. Although modular external fixators are associated with faster intraoperative fracture reduction with the external fixator, single external fixators are associated with significantly better rates of union and reoperations; the rates of delayed union, malunion and complications are similar.

  5. A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures.

    Science.gov (United States)

    Jenkins, Paul J; Ramaesh, Rishikesan; Pankaj, Pankaj; Patton, James T; Howie, Colin R; Goffin, Jérôme M; Merwe, Andrew van der; Wallace, Robert J; Porter, Daniel E; Simpson, A Hamish

    2013-10-01

    The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head. 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head. The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head. The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

  6. FEMORAL NECK FRACTURES GARDEN I AND II: EVALUATION OF THE DEVIATION IN LATERAL VIEW.

    Science.gov (United States)

    Leonhardt, Natália Zalc; Melo, Lucas da Ponte; Nordon, David Gonçalves; Silva, Fernando Brandão de Andrade E; Kojima, Kodi Edson; Silva, Jorge Santos

    2017-01-01

    To evaluate the rate of deviation in the lateral radiographic incidence in patients with femoral neck fracture classified as non-diverted in the anteroposterior view (Garden I and II). Nineteen selected patients with femoral neck fractures classified as Garden I and II were retrospectively evaluated, estimating the degree of deviation in the lateral view. Fifteen cases (79%) presented deviations in lateral view, with a mean of 18.6 degrees (±15.5). Most fractures of the femoral neck classified as Garden I and II present some degree of posterior deviation in the X-ray lateral view. Level of Evidence III, Retrospective Comparative Study.

  7. Bilateral atypical insufficiency fractures of the proximal tibia and a unilateral distal femoral fracture associated with long-term intravenous bisphosphonate therapy: a case report

    Directory of Open Access Journals (Sweden)

    Imbuldeniya Arjuna

    2012-02-01

    Full Text Available Abstract Introduction Atypical insufficiency fractures of the femur in patients on long-term bisphosphonate therapy have been well described in recent literature. The majority of cases are associated with minimal or no trauma and occur in the subtrochanteric or diaphyseal region. Case presentation We describe the case of a 76-year-old British Caucasian woman who presented initially to an emergency department and then to her primary care physician with a long-standing history of bilateral knee pain after minor trauma. Plain radiographs showed subtle linear areas of sclerosis bilaterally in her proximal tibiae. Magnetic resonance imaging confirmed the presence of insufficiency fractures in these areas along with her left distal femur. There are very few reports of atypical insufficiency fractures involving the tibia in patients on long-term bisphosphonate therapy and this appears to be the only documented bilateral case involving the metaphyseal regions of the proximal tibia and distal femur. Conclusion In addition to existing literature describing atypical fractures in the proximal femur and femoral shaft, there is a need for increased awareness that these fractures can also occur in other weight-bearing areas of the skeleton. All clinicians involved in the care of patients taking long-term bisphosphonates need to be aware of the growing association between new onset lower limb pain and atypical insufficiency fractures.

  8. Fracture of the acetabulum with femoral artery injury presenting late: A case report

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    Sivaprasad Kalyanasundaram

    2016-02-01

    Full Text Available This study reports a rare case of both column acetabulum fracture with femoral artery injury that presented late and was managed with arterial reconstruction and fracture fixation.A thirty-one year old man sustained both column acetabular fracture on the left in a motor vehicle accident. On admission there was no obvious neuro-vascular deficit. During surgery for the fracture after 7 days of the injury the femoral artery was found to be severely crushed with no blood flow. The anterior column of the acetabulum was stabilised followed by resection and reconstruction of the femoral artery. The post-operative period was uneventful and he was discharged normally. At 6 months from injury the fractures had united well with excellent limb circulation and good lower limb function.Femoral artery injury with acetabular fracture is rare and late presentations are unreported hitherto. The results of fracture stabilisation and vessel reconstruction seem to be excellent. Literature of similar injuries is reviewed. Keywords: Acetabular fractures, Both column fractures, Anterior column fractures, Vascular injury, Femoral artery injury

  9. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation.

    Science.gov (United States)

    Simon, A-L; Apostolou, N; Vidal, C; Ferrero, E; Mazda, K; Ilharreborde, B

    2018-02-01

    Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. IV.

  10. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

    Science.gov (United States)

    Simon, A.-L.; Apostolou, N.; Vidal, C.; Ferrero, E.; Mazda, K.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. Methods All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. Results A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. Conclusions This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. Level of Evidence IV PMID:29456750

  11. Subtrochanteric and Distal Femur Fractures in a Patient with ...

    African Journals Online (AJOL)

    This study reports the surgical management for this rare case and the treatment ... car accident and presented closed femoral shaft fracture associated with a ... to fix the distal femur fracture, enhancing the construction stability [Figures 4 and 5].

  12. Pre-bent elastic stable intramedullary nail fixation for distal radial shaft fractures in children.

    Science.gov (United States)

    Ge, Yi-hua; Wang, Zhi-gang; Cai, Hai-qing; Yang, Jie; Xu, Yun-lan; Li, Yu-chan; Zhang, Yu-chen; Chen, Bo-chang

    2010-08-01

    To investigate the functional and radiographic outcomes of pre-bent elastic stable intramedullary nail in treatment of distal radial shaft fractures in children. From January 2006 to December 2008, 18 children with distal radial shaft fracture were treated by close reduction and internal fixation with a pre-bent elastic stable intramedullary nail. The age range was from 5 years to 15 years, with an average of 9 years and 8 months. The minimum follow-up was 12 months. All fractures maintained good alignment postoperatively, and 94.4% (17/18) of the patients regained a full range of rotation of the forearm. One patient has limitation of rotation to less than 10°, this had improved by final follow-up. Complications included soft tissue irritation at the site of nail insertion in one patient and transient scar hypersensitivity in another. Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children. © 2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

  13. Management of open fractures of the tibial shaft in multiple trauma

    Directory of Open Access Journals (Sweden)

    Stanislaw Boltuc

    2008-01-01

    Full Text Available Background: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Materials and Methods: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years. The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8-10 days after the trauma. Results: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8% males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. Conclusion: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8-10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture.

  14. Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report.

    Science.gov (United States)

    Chun, Young Soo; Juh, Hyung Suk; Cho, Yoon Je; Rhyu, Kee Hyung

    2015-09-01

    Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.

  15. Fractures of the shafts of the radius and ulna

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C.

    1985-01-01

    Although the clinical presentation of fracture of the forearm bones is usually quite obvious, thorough radiologic examination of the radius and ulna and adjacent wrist and elbow joints is mandatory. Standard views of the forearm of the patient include the AP and lateral projections. The degree of shortening, angulation, rotation, and comminution should be noted. The selected films must be long enough to include the adjacent elbow and wrist joints

  16. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report

    Directory of Open Access Journals (Sweden)

    Bogdan Deleanu

    2016-02-01

    Conclusion: The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

  17. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible?

    Science.gov (United States)

    Concha, Juan M; Sandoval, Alejandro; Streubel, Philipp N

    2010-12-01

    Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracture management. We evaluated the reproducibility of this technique in a regional hospital. Thirty-five patients underwent MIPO of humerus shaft fractures. Fifteen patients had an open fracture, six a preoperative radial nerve palsy, and nine a concomitant thoracic, musculoskeletal or vascular injury. At an average 12-month follow-up, 91% of fractures healed after a mean of 12 weeks (range, 8-16). Two infections occurred. Final alignment averaged 4° of varus (range, 5° of valgus to 20° of varus). Active elbow ROM averaged 114° (range, 60-135°) and was less than 100° in nine elbows. Five of six preoperative radial nerve injuries recovered spontaneously. Healing and infection rates in this study are consistent with those reported in the literature. Lower elbow ROM and higher fracture angulation at healing were nevertheless found. MIPO is technically demanding and requires adequate intraoperative imaging and surgical experience in order to obtain adequate fracture alignment. Brachialis muscle scarring and inadequate postoperative rehabilitation may be involved in limited elbow range of motion.

  18. [Midterm follow-up results on Asian femoral intramedullary nail for the treatment of segmental and comminuted femoral fractures].

    Science.gov (United States)

    Li, Lang; Gao, Feng; Huang, Qi; Li, Qiang; Xie, Lin; Zhang, Bin

    2016-06-01

    To investigate midterm follow-up results on Asian femoral intramedullary nail in treating segmental and comminuted femoral fractures. Between June 2011 and October 2012,16 patients with segmental and comminuted femoral fractures were treated with minimally invasive reset and Asian femoral intramedullary nail under extension table. Among them, there were 10 males and 6 females aged from 21 to 49 years old with an average of 34.5 years old; the time from injury to operation ranged from 3 to 24 d with an average of 9.1 d. There were 6 cases were type C1,2 cases were type C2 and 8 cases were type C3 according to AO classification. X-ray of femoral segment at 3,6 and 12 months after operation were applied for evaluating fracture healing. Harris score of hip joint and HSS score of knee joint were used to evaluate postoperative function. All patients were followed up from 24 to 36 months with an average of 28.4 months. Operative time was from 88 to 112 min with an average of 90.7 min; blood loss ranged from 150 to 200 ml with an average of 188.75 ml; the time of fracture healing was from 5 to 9 months with an average of 5.4 months. All incision were healed at stage I. No loosening, breakage of internal fixation and displacement of fracture were occurred. There were no significant differences in Harris score of hip joint at 3, 6 and 12 months after operation (F = 0.07, P = 0.893 > 0.05), 10 cases obtained excellent results, 5 good and 1 moderate. There was no obvious meaning in HSS score of knee joint (F = 0.08,P = 0.876 > 0.05), 9 cases obtained excellent results, 6 good and 1 poor. Asian femoral intramedullary nail could treat segmental and comminuted femoral fractures by using variety of less invasive ways,which has advantages of less trauma, quick recovery of function and satisfied midterm following-up results. But long term following-up effects remains to be seen.

  19. Study of the anatomical position of the femoral nerve by magnetic resonance imaging in patients with fractured neck of femur: relevance to femoral nerve block.

    LENUS (Irish Health Repository)

    Mehmood, Shehzad

    2012-01-31

    STUDY OBJECTIVE: To determine the anatomical location of the femoral nerve in patients who have sustained fracture of the neck of femur, and its relevance to femoral nerve block technique. DESIGN: Prospective, observational clinical study. SETTING: Orthopedic and Radiology departments of a regional hospital. SUBJECTS: 10 consecutive adult ASA physical status II and III patients (mean age, 78.5 yrs) and 4 adult healthy volunteers. INTERVENTIONS: A T1 magnetic resonance imaging scan was performed of both upper thighs in patients and healthy volunteers successfully. MEASUREMENTS: The distance (mm) between the midpoint of the femoral artery and the midpoint of the femoral nerve, and the distance of the femoral nerve from the skin was measured at the mid-inguinal ligament, the pubic tubercle, and at the mid-inguinal crease. Data are shown as means (SD). Differences between both sides were compared using paired Student\\'s t-tests. P < 0.05 was significant. MAIN RESULTS: In patients the mean distance (mm) between the midpoint of the femoral nerve from the midpoint of femoral artery at the mid-inguinal crease on the fractured and non-fractured sides was 10.7 and 11.0, respectively (P = 0.87). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the mid-inguinal ligament on the fractured and non-fractured sides was 9.64 and 12.5, respectively (P = 0.03). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the pubic tubercle on the fractured and non-fractured sides was 8.74 and 10.49, respectively (P = 0.18). CONCLUSIONS: Blockade of the femoral nerve may be easier to perform at the mid-inguinal crease in patients with fractured neck of femur.

  20. Fixation of femoral capital physeal fractures with 7.0 mm cannulated screws in five bulls

    International Nuclear Information System (INIS)

    Wilson, D.G.; Crawford, W.H.; Stone, W.C.; Frampton, J.W.

    1991-01-01

    Salter-Harris type I fractures of the femoral capital physis were repaired in five Holstein bulls with three 7.0 mm cannulated screws placed in lag fashion. Radiographically at months 7 to 10, the fractures were healed and there was periarticular bone production on the femoral necks and the dorsal acetabular rims. Four bulls had normal gaits, and one bull had muscle atrophy and barely detectable lameness

  1. Elastic nailing of tibia shaft fractures in young children up to 10 years of age.

    Science.gov (United States)

    Heo, Jeong; Oh, Chang-Wug; Park, Kyeong-Hyeon; Kim, Joon-Woo; Kim, Hee-June; Lee, Jong-Chul; Park, Il-Hyung

    2016-04-01

    Although tibia shaft fractures in children usually have satisfactory results after closed reduction and casting, there are several surgical indications, including associated fractures and soft tissue injuries such as open fractures. Titanium elastic nails (TENs) are often used for pediatric tibia fractures, and have the advantage of preserving the open physis. However, complications such as delayed union or nonunion are not uncommon in older children or open fractures. In the present study, we evaluated children up to 10 years of age with closed or open tibial shaft fractures treated with elastic nailing technique. A total of 16 tibia shaft fractures treated by elastic nailing from 2001 to 2013 were reviewed. The mean patient age at operation was 7 years (range: 5-10 years). Thirteen of 16 cases were open fractures (grade I: 4, grade II: 6, grade IIIA: 3 cases); the other cases had associated fractures that necessitated operative treatments. Closed, antegrade intramedullary nailing was used to insert two nails through the proximal tibial metaphysis. All patients were followed up for at least one year after the injury. Outcomes were evaluated using modified Flynn's criteria, including union, alignment, leg length discrepancies, and complications. All fractures achieved union a mean of 16.1 weeks after surgery (range: 11-26 weeks). No patient reported knee pain or experienced any loss of knee or ankle motion. There was a case of superficial infection in a patient with grade III open fracture. Three patients reported soft tissue discomfort due to prominent TEN tips at the proximal insertion site, which required cutting the tip before union or removing the nail after union. At the last follow-up, there were no angular or rotational deformities over 10° in either the sagittal or coronal planes. With the exception of one case with an overgrowth of 15 mm, no patient showed shortening or overgrowth exceeding 10mm. Among final outcomes, 15 were excellent and 1 was

  2. Rotational Mal-Alignment after Reamed Intramedullary Nailing for tibial shaft fracture.

    Science.gov (United States)

    Khan, Sher Baz; Mohib, Yasir; Rashid, Rizwan Haroon; Rashid, Haroonur

    2016-10-01

    Intra-medullary (IM) nailing is standard of care for unstable tibial shaft fractures. Malrotation is very common but it is under-recognised, inpart because of variation in normal anatomy and partly due to difficulty in accurately assessing rotation. This study was planned to evaluate the frequency of rotational mal-alignment after reamed tibia IMnailing. This cross-sectional study was conducted at Aga khan University Hospital, Karachi, and comprised patients with tibia shaft fractures managed with IMnailing from January to December 2014. All the patients were assessed intra-operatively for rotational alignment using the knee and ankle fluoroscopic images. There were 81 patients with a mean age of 38±16.9 years. There were 64(79%) male patients. Overall the incidence of malrotation was in 20(24.7%) cases. Rotational mal-alignment is one of the preventable complications after IMnailing which can be assesed intra-operatively under fluoroscope.

  3. COMPARATIVE STUDY BETWEEN TITANIUM ELASTIC NAILING (TENS AND DYNAMIC COMPRESSION PLATING (DCP IN THE TREATMENT OF FEMORAL DIAPHYSEAL FRACTURES IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Ramasubba Reddy

    2015-08-01

    Full Text Available BACKGROUND : Orthopaedic surgeons have long maintained that all children who have sustained a diaphyseal fracture of femur recover with c onservative treatment, given the excellent remodeling ability of immature bone in children. Angulations, shortenings and malrotations are not always corrected by conservative treatment. Of many surgical options, titanium elastic nailing has been the newer implant which is being used regularly. Although good results have been reported with elastic intramedullary nails, plate fixation continues to be a viable alternative in surgical treatment of femoral shaft fractures. However there are not many studies comp aring the efficiency of titanium elastic nailing and plating for femoral diaphyseal fractures in pediatric age group. AIM : The present study aims to compare the surgical management of diaphyseal fractures of femur in children with Dynamic Compression Plati ng versus Titanium Elastic Nailing. DESIGN : This is a prospective study . MATERIALS AND METHODS : This prospective study was conducted in a tertiary hospital. Patients who presented to the out - patient department and casualty of the hospital with femoral diap hyseal fractures during April 2012 to June 2014 were considered for the study. Subjects fulfilling the predetermined inclusion and exclusion criteria were included in the study. STATISTICAL METHODS : Fisher Exact test, Chi - Square Test, Student t test (Two t ailed, independent . RESULTS : Patients in the age group of 6 - 14 years were considered for the study, Patients were divided into two groups and treated with DCP/TENS. The duration of surgery, hospital stay, and, amount of blood loss was minimal in TENS grou p. Callus was seen early in TENS group. Radiological union was early in TENS group by 2 - 3 weeks. Outcome was better in patients treated with TENS (Excellent - 70%; Satisfactory – 30%; Poor - 0% in comparison to DCP (Excellent - 70%; Satisfactory - 25%; Poor - 5%. CO NCLUSION : TENS

  4. Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Jia-Guo Zhao

    Full Text Available There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF, intramedullary nail (IMN fixation, and minimally invasive percutaneous osteosynthesis (MIPO. We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.MEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs with 95% confidence intervals (CIs to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.Seventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03-0.37 or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69. Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20. There were no significant differences among the three procedures in nonunion, delayed union, and infection.Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.

  5. Minimally invasive plate osteosynthesis of humeral shaft fractures: a technique to aid fracture reduction and minimize complications.

    Science.gov (United States)

    Shin, Sang-Jin; Sohn, Hoon-Sang; Do, Nam-Hoon

    2012-10-01

    To introduce a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for acute displaced humeral shaft fractures and to evaluate the clinical and radiological outcomes. : Prospective clinical series study. University hospital. Twenty-one patients with acute displaced humeral shaft fractures were treated by MIPO with a modified fracture reduction technique. A narrow 4.5/5.0-mm locking compression plate was applied to the anterior aspect of the humerus. Fracture reduction and manipulation were performed using a plate and drill bits. The operating time, time to union, humeral alignment, and functional outcome of the shoulder and elbow joints were evaluated using the University of California Los Angeles shoulder score and Mayo elbow performance score. No patient experienced a neurological complication. Bony union was obtained in 20/21 patients at a mean 17.5 weeks postoperatively. Eighteen patients had excellent and 3 patients had good results in the University of California Los Angeles score. The average Mayo elbow performance score was 97.5. Two patients were converted to an open reduction during operation due to a failure of MIPO. There was 1 nonunion and 1 malunion in this series. Although the MIPO technique for humeral shaft fractures is technically demanding, satisfactory clinical outcomes in terms of bony union and shoulder and elbow function can be obtained using the modified fracture reduction method. Potential postoperative complications, such as malreduction and nonunion, must be considered. Appropriate surgical indications, a thorough understanding of the neurovascular anatomy and skillful surgical technique, are needed to reduce potential complications.

  6. Treatment of humeral shaft fractures using antegrade nailing: functional outcome in the shoulder.

    Science.gov (United States)

    Patino, Juan Martin

    2015-08-01

    The purpose of this study was to evaluate shoulder outcomes and function after humeral shaft fractures treated with antegrade nailing. Thirty patients with acute humeral shaft fractures who underwent antegrade locked intramedullary nailing were retrospectively studied. Range of motion (ROM) of the affected shoulder was evaluated, comparing it with the nonaffected shoulder, radiologic position of the nails, complications, and need for a second surgery. The study enrolled 20 men and 10 women (average age, 41.9 years). The average follow-up was 35.8 months. The average shoulder elevation averaged 157°, internal rotation was variable (reaching the sacroiliac joint to T7), and external rotation averaged 75°. Elbow flexion-extension ROM averaged 133° (115°-145°). According to the Rodriguez-Merchan criteria, 12 patients achieved excellent results (40%), 7 good (20%), and 6 fair (23.3%); poor results were found in 5 cases (16.6%). Twelve patients achieved full mobility of the shoulder, whereas 18 had some loss of motion, with significant differences between the affected and nonaffected shoulders (P = .001). Decreased shoulder ROM is common after antegrade nailing of humeral shaft fractures. Avoidance of nail impingement can improve final outcomes. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Combined three-part humeral anterior fracture-dislocation and humeral shaft fracture treated with one-stage long stem shoulder hemiarthroplasty in an active elderly patient

    Directory of Open Access Journals (Sweden)

    Herzberg Guillaume

    2017-01-01

    Full Text Available Introduction: Injuries combining a humeral head fracture-dislocation and a shaft fracture of the ipsilateral humerus are very rare. They should be separated from extended fractures of the humeral head to the shaft [1]. Case report: We present the case of an active 84-year-old man who sustained a three-part fracture-dislocation of the proximal humerus combined with a long spiral humeral middle third diaphyseal fracture, after a ski fall. We were unable to find a similar case in the literature. He was treated with a long stem hemiarthroplasty, associated with screw osteosynthesis of the long spiral shaft fracture. The result after 30 months of follow-up was excellent, with good shoulder range of motion, good bone integration of the prosthesis and uneventful healing of the fracture. Conclusion: This treatment allowed this intrepid elderly patient to recover a normal quality of life, including driving his car and to return to skiing.

  8. MANAGEMENT OF ENDOCRINE DISEASE: Atypical femoral fractures: risks and benefits of long-term treatment of osteoporosis with anti-resorptive therapy.

    Science.gov (United States)

    Adler, Robert A

    2018-03-01

    Modern osteoporosis treatment began in the mid-1990s with the approval of amino-bisphosphonates, anti-resorptive agents that have been shown to decrease osteoporotic fracture risk by about half. In 2005, the first cases of atypical femoral fractures (AFF), occurring in the shaft of the femur, were reported. Since then, more cases have been found, leading to great concern among patients and a dramatic decrease in bisphosphonate prescribing. The pathogenesis and incidence of AFF are reviewed herein. Management and an approach to prevention or early detection of AFF are also provided. Denosumab, a more recently approved anti-resorptive medication has also been associated with AFF. Long-term management of osteoporosis and prevention of fracture are challenging in light of this serious but uncommon side effect, yet with an aging population osteoporotic fracture is destined to increase in frequency. © 2018 European Society of Endocrinology.

  9. The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Forearm Shaft Fracture Pearls and Pitfalls.

    Science.gov (United States)

    Herman, Martin J; Simon, Matthew; Mehlman, Charles T

    2017-11-01

    Pediatric forearm shaft fractures are the third most common fracture in children, and the forearm is the third most mobile joint in the body (with a nearly 180 degree arc of motion). The goals of treatment are aimed squarely at achieving satisfactory anatomic alignment (within defined parameters) as the consequences of malunion can be permanent forearm stiffness and deformity. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention has become increasingly common in older children. This article will offer evidence and experience-based tips intended to benefit the community orthopedic surgeon caring for children during the course of their on-call duties.

  10. Radius crossover sign: an indication of malreduced radius shaft greenstick fractures.

    Science.gov (United States)

    Wright, Patrick B; Crepeau, Allison E; Herrera-Soto, José A; Price, Charles T

    2012-06-01

    Radius shaft greenstick fractures in children can be a challenging injury to treat because angulation and rotational alignment are difficult to assess. In this report, we describe a simple method for analyzing the deformity and identifying rotational and angular malalignment. This technique involves analyzing the forearm radiographs as 2 segments, proximal and distal, and assuring that the rotational position of each matches the other. We present 3 cases of proximal radius greenstick fractures in malalignment to demonstrate the radius crossover sign. Identifying the radius crossover sign, and proceeding with further closed reduction may prevent deformity that could otherwise result in a significant loss of forearm motion. Level V.

  11. [True/Flex intramedullary nailing for forearm shaft fractures. Long-term results].

    Science.gov (United States)

    Trlica, J; Počepcov, I; Kočí, J; Frank, M; Holeček, T; Dědek, T

    2012-01-01

    Presentation of technical experience and the clinical and functional results of intramedullary fixation of forearm shaft fractures. Between January 1994 and December 2009, a total of 96 patients with 144 radial and/or ulnar fractures (ulna, 33; radius,15; both, 48) were treated by nailing (True/Flex®). According to the AO classification there were 22-A, 22-B and 22-C type fractures in 39 (41%), 44 (46%) and 13 (13%).cases, respectively. Of these, 82 (85%) were closed (types: 0, 48; I, 33; II, 1) and 14 (15%) were open (types: I, 13; II, 1; III, 0) fractures. Seventy-eight patients (81%) were followed up and their functional outcomes were evaluated according to the criteria of Anderson et al. The average interval between the operation and final follow-up was 28 months (15 to 96 months) The average time to surgery was 2.2 days (0 to 25 days). Early complications were recorded in 4% of the patients (1x bursitis olecrani; 1x end cup replacement; 1x bending of nails) and late complications in 15% (5x non-union; 2x delay union; 4x bursitis olecrani; 1x ruptured tendon). Bone healing was achieved in 95% of the cases and took on average 16 weeks (7 to 34 weeks). No infection, refracture or synostosis occurred. Primary loss of reduction was recorded in four cases due to distraction in one, bent nails in two and a wrong size of the implant in one; secondary loss of reduction was found in three cases, with two cases of radius shortening and one 10°malrotation. No primary malrotation was recorded, but secondary loss of alignment was seen in the distal part of the radius and the proximal part of the ulna. Functional results according to the Anderson criteria were excellent and good in 87% of the cases. Intramedullary mailing provides good stability to mid- and distal-third shaft fractures of the ulna and mid- and proximalthird shaft fractures of the radius, particularly in AO type A and type B fractures. The technical aspects of the method are analysed in detail in this paper

  12. [Fracture Type and Injury-to-Surgery Interval as Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Intracapsular Femoral Neck Fracture].

    Science.gov (United States)

    Popelka, O; Skála-Rosenbaum, J; Bartoška, R; Waldauf, P; Krbec, M; Džupa, V

    2015-01-01

    The aim of the study was to investigate the occurrence of avascular necrosis (AVN) of the femoral head following the osteosynthesis of intracapsular fracture of the femoral neck in relation to the time interval between injury and surgery and the type of fracture. The data of patients with intracapsular fractures of the femoral neck surgically treated in the period from 2001 to 2011 were reviewed. Of 1555 patients treated for this fracture, 125 (7%) underwent osteosynthesis. The evaluated group included 115 patients who came for examination at one-year follow-up. There were 59 (52%) women and 56 (48%) men. Dynamic hip screw (DHS) osteosynthesis with an anti-rotation screw was performed in 103 patients and lag-screw osteosynthesis involving three parallel cannulated cancellous screws was employed in 12 patients. The patients were allocated to groups according to the injury-to-surgery interval and to sub-groups on the basis of the Garden classification of femoral fracture stage. In the group of 58 patients treated within 6 h of injury, AVN developed in 10 (17%). When the type of fracture was considered, 4% of the non-displaced fractures and 30% of the displaced fractures developed AVN. The patients with Garden stage I and II (non-displaced) fractures treated within 6 h of injury had a significantly lower risk of AVN development than those with Garden stage III or IV (displaced) fractures. The group treated between 6 and 24 post-injury hours comprised 21 patients, of whom four (19%) had AVN. In non-displaced and displaced fracture sub-groups, 25% of the patients in the former and 16% in the latter had AVN. The stage of displacement had no effect on AVN development. The two groups together (patients treated by 24 h) had a significantly lower AVN incidence than the patients treated after 24 h (p = 0.0025). In this group of 36 patients, 16 had AVN (44%) and the fracture stage made no significant difference (p = 0.6985; nondisplacement sub-group, 41%; displacement sub

  13. The shaft fractures of the radius and ulna in children: current concepts.

    Science.gov (United States)

    Sinikumpu, Juha-Jaakko; Serlo, Willy

    2015-05-01

    The incidence of forearm shaft fractures in children has increased in recent years. They are challenging to treat and they can result in several long-lasting complications. The treatment of children's fractures needs to be individualized to their needs. Nonoperative care will be satisfactory for young, preschool children and it is primarily treatment in stable fractures of children at every age. Injury mechanism must be understood to perform appropriate closed reduction. Immobilization using a long-arm cast needs to be focused against the deforming muscle forces - in particular those that rotate - in the forearm, keeping the bones in alignment until bone healing. Operative stabilization by elastic stable intramedullary nailing is the primarily method of treatment in cases of unstable fractures, in particular, in children between preschool age and adolescence. For older children near to skeletal maturity, a rigid plate and screw fixation will be justified. The most common complication after closed treatment is worsening of the alignment and need for repetitive interventions. elastic stable intramedullary nailing results usually in good outcome, and range of forearm rotation is the main feature determining the clinical result. In this article, we report the current concept of paediatric shaft fractures in the radius and ulna.

  14. Computer-assisted three-dimensional correlation between the femoral neck-shaft angle and the optimal entry point for antegrade nailing.

    Science.gov (United States)

    Anastopoulos, George; Chissas, Dionisios; Dourountakis, Joseph; Ntagiopoulos, Panagiotis G; Magnisalis, Evaggelos; Asimakopoulos, Antonios; Xenakis, Theodore A

    2010-03-01

    Optimal entry point for antegrade femoral intramedullary nailing (IMN) remains controversial in the current medical literature. The definition of an ideal entry point for femoral IMN would implicate a tenseless introduction of the implant into the canal with anatomical alignment of the bone fragments. This study was undertaken in order to investigate possible existing relationships between the true 3D geometric parameters of the femur and the location of the optimum entry point. A sample population of 22 cadaveric femurs was used (mean age=51.09+/-14.82 years). Computed-tomography sections every 0.5mm for the entire length of femurs were produced. These sections were subsequently reconstructed to generate solid computer models of the external anatomy and medullary canal of each femur. Solid models of all femurs were subjected to a series of geometrical manipulations and computations using standard computer-aided-design tools. In the sagittal plane, the optimum entry point always lied a few millimeters behind the femoral neck axis (mean=3.5+/-1.5mm). In the coronal plane the optimum entry point lied at a location dependent on the femoral neck-shaft angle. Linear regression on the data showed that the optimal entry point is clearly correlated to the true 3D femoral neck-shaft angle (R(2)=0.7310) and the projected femoral neck-shaft angle (R(2)=0.6289). Anatomical parameters of the proximal femur, such as the varus-valgus angulation, are key factors in the determination of optimal entry point for nailing. The clinical relevance of the results is that in varus hips (neck-shaft angle shaft angle between 120 degrees and 130 degrees , the optimal entry point lies just medially to the trochanter tip (at the piriformis fossa) and the use of stiff implants is safe. In hips with neck-shaft angle over 130 degrees the anatomical axis of the canal is medially to the base of the neck, in a "restricted area". In these cases the entry point should be located at the insertion of the

  15. Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review

    Directory of Open Access Journals (Sweden)

    Flávia Vieira Guimarães Hartmann

    Full Text Available Abstract Background: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5 cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. Objective: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. Methods: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Results: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture

  16. Operative Versus Conservative Management of Displaced Tibial Shaft Fracture in Adolescents.

    Science.gov (United States)

    Kinney, Matthew C; Nagle, David; Bastrom, Tracey; Linn, Michael S; Schwartz, Alexandra K; Pennock, Andrew T

    2016-01-01

    Displaced tibial shaft fractures are common in adolescent patients, yet there is no standardized management strategy. We compared surgical fixation and closed reduction and casting (CRC) of these fractures to assess treatment outcomes and determine predictors of failure. We retrospectively reviewed all patients aged 12 to 18 who presented with a displaced tibial shaft fracture that required reduction over an 8-year period. Exclusion criteria included open fractures and lack of follow-up to radiographic union or to 6 months from the index procedure. Fractures were initially treated based on surgeon preference either with CRC or with immediate intramedullary nailing. Seventy-four patients met inclusion criteria: 57 were initially managed with CRC and 17 with operative fixation. Radiographic healing was defined as bridging of 3 cortices and adequacy of final alignment was defined as 20% (odds ratio=7.8, Palignment (92.5% vs. 72.4%, P=0.10) but required longer hospitalization (5.4 vs. 1.9 d, P<0.001) and had a higher incidence of anterior knee pain (20% vs. 0%, P<0.01). There was no significant difference between groups with respect to time to healing. Treatment outcomes between initial operative fixation and closed reduction of displaced tibia fractures in adolescents are similar, but patients must be counseled about the high failure rates with CRC. Predictors of CRC failure include initial fracture displacement and the presence of a fibula fracture-these variables should be considered when selecting a treatment method. Level III-Therapeutic study.

  17. Atypical femoral neck stress fracture in a marathon runner: a case report and literature review.

    LENUS (Irish Health Repository)

    2012-02-01

    BACKGROUND: Femoral neck stress fractures are relatively rare and may present as sports-related injuries. The presentation is variable, and prompt diagnosis facilitates the earliest return to pre-morbid functional activity levels. Delayed detection may precipitate femoral non-union or avascular necrosis, resulting in long-term functional deficit. AIMS: We present the case of a basicervical femoral neck stress fracture occurring in a 23-year-old marathon runner. The pathophysiology and practical management issues related to this unusual injury pattern are discussed. CONCLUSION: The growing interest in amateur athletic activities should raise the index of suspicion for stress fractures of the femoral neck in healthy adults with atypical hip pain. Increased levels of patient education and physician awareness can reduce the incidence of long-term morbidity in cases of this unusual sports-related injury.

  18. A Review of Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty

    Science.gov (United States)

    Marsland, Daniel; Mears, Simon C.

    2012-01-01

    Periprosthetic fractures of the femur in association with total hip arthroplasty are increasingly common and often difficult to treat. Patients with periprosthetic fractures are typically elderly and frail and have osteoporosis. No clear consensus exists regarding the optimal management strategy because there is limited high-quality research. The Vancouver classification facilitates treatment decisions. In the presence of a stable prosthesis (type-B1 and -C fractures), most authors recommend surgical stabilization of the fracture with plates, strut grafts, or a combination thereof. In up to 20% of apparent Vancouver type-B1 fractures, the femoral stem is loose, which may explain the high failure rates associated with open reduction and internal fixation. Some authors recommend routine opening and dislocation of the hip to perform an intraoperative stem stability test to rule out a loose component. Advances in plating techniques and technology are improving the outcomes for these fractures. For fractures around a loose femoral prosthesis (types B2 and 3), revision using an extensively porous-coated uncemented long stem, with or without additional fracture fixation, appears to offer the most reliable outcome. Cement-in-cement revision using a long-stem prosthesis is feasible in elderly patients with a well-fixed cement mantle. It is essential to treat the osteoporosis to help fracture healing and to prevent further fractures. We provide an overview of the causes, classification, and management of periprosthetic femoral fractures around a total hip arthroplasty based on the current best available evidence. PMID:23569704

  19. Incorporating in vivo fall assessments in the simulation of femoral fractures with finite element models

    NARCIS (Netherlands)

    Zijden, A.M. van der; Janssen, D.W.; Verdonschot, N.J.J.; Groen, B.E.; Nienhuis, B.; Weerdesteijn, V.G.M.; Tanck, E.J.M.

    2015-01-01

    Femoral fractures are a major health issue. Most experimental and finite element (FE) fracture studies use polymethylmethacrylate cups on the greater trochanter (GT) to simulate fall impact loads. However, in vivo fall studies showed that the femur is loaded distally from the GT. Our objective was

  20. Bilateral Stress Fractures of the Femoral Neck from Renal Osteomalacia: A Case Report

    Directory of Open Access Journals (Sweden)

    S Sengupta

    2008-04-01

    Full Text Available A rare case of spontaneous bilateral stress fractures of femoral neck leading to coxa vara in a young female with history of chronic renal disease and secondary osteomalacia is described. Once the underlying disease was controlled, the fracture was treated by valgus osteotomy with good result.

  1. Management strategy for symptomatic bisphosphonate-associated incomplete atypical femoral fractures.

    Science.gov (United States)

    Saleh, Anas; Hegde, Vishal V; Potty, Anish G; Schneider, Robert; Cornell, Charles N; Lane, Joseph M

    2012-07-01

    Long-term bisphosphonate use has often been associated with atypical femoral fractures. These fractures evolve from incomplete femoral fractures. A previous study demonstrated that the presence of a radiolucent line in an incomplete fracture can indicate a high risk of progression to complete fracture. The aim of this study is to present a management strategy for symptomatic bisphosphonate-associated incomplete atypical femoral fractures. Specific study questions include the following: (1) Is there a difference in the prognosis of these fractures based on the presence or absence of a radiolucent fracture line? (2) Can treatment with teriparatide assist in clinical/radiographic healing of these incomplete fractures? (3) Is there a characteristic biochemical profile in these patients? We retrospectively examined all femur radiographs ordered by the metabolic bone disease service at our hospital between July 1, 2006 and July 1, 2011 and identified 10 patients with a total of 14 incomplete fractures. Nine patients received bisphosphonates for a mean duration of 10 ± 5 years (range, 4-17). The mean follow-up since the time of diagnosis was 20 ± 11 months (range, 6-36 months). Five fractures did not have a radiolucent fracture line and were treated conservatively with partial weight-bearing restrictions and pharmacologic therapy. All five of these fractures healed with conservative management. Nine fractures had a radiolucent fracture line, and only two of these were treated successfully with conservative management including teriparatide. Six of the eight patients with a radiolucent line elected for surgical prophylaxis after 3 months of conservative management, whereas one patient underwent surgical prophylaxis without a trial of conservative management. Regarding the biochemical profiles, bone turnover markers for our patient cohort were in the lower quartile. Fractures without a radiolucent line appear to respond to conservative management and not

  2. Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

    OpenAIRE

    Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

    2017-01-01

    [Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, pre...

  3. A case of incomplete atypical femoral fracture with histomorphometrical evidence of osteomalacia.

    Science.gov (United States)

    Tsuchie, Hiroyuki; Miyakoshi, Naohisa; Nishi, Tomio; Abe, Hidekazu; Segawa, Toyohito; Shimada, Yoichi

    2015-01-01

    Roughly half of the femoral fracture patients diagnosed with AFF according to the criteria suggested by a task force of the American Society for Bone and Mineral Research (ASBMR) have not undergone bisphosphonate (BP) therapy. One suspected cause of such fractures is severe bone loss due to osteomalacia, but the pathogenesis remains unknown. We report a case of an 84-year-old woman with AFF not treated by BP therapy, in whom underlying osteomalacia was histologically diagnosed. The involvement of femoral curvature and spino-pelvic malaligment in the fracture in the present case was considered.

  4. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail.

    Science.gov (United States)

    Chou, Po-Hsin; Lin, Hsi-Hsien; Su, Yu-Pin; Chiang, Chao-Ching; Chang, Ming-Chau; Chen, Chuan-Mu

    2017-06-01

    Infected nonunion of the femoral shaft is uncommon, and usually presents with challenging therapeutic and reconstructive problems. There are still controversies over treating infected nonunion of the femoral shaft. The purposes of this retrospective study were to review the treatment outcomes and describe a staged protocol for spontaneous wound healing. Six patients with chronic femoral shaft infected-nonunion from October 2002 to September 2010 were included in this retrospective study. Serial plain films and triple films of lower legs were performed to evaluate the alignment of the treated femoral shaft and bony union following our staged protocol of Ilizarov distraction osteogenesis and intramedullary nailing. An average bone defect of 7 cm was noted after staged osteotomy. Mean follow-up was 87.5 (range, 38-133) months. Union was achieved in all six patients, with an average external fixation time of 6.8 (range, 5-11) months. There was no reinfection. One complication of a 4-cm leg discrepancy was noted, with an initial shortening of 15 cm. The mean knee ranges of motion (ROM) before staged protocols and at final follow-up were 64.2±8.6 (range, 60-75)° and 53.3±9.3 (range, 40-65)°, respectively. The ROM at the knee joint statistically decreased following staged protocols. In the treatment of chronic femur osteomyelitis, the staged protocol of Ilizarov distraction osteogenesis followed by intramedullary nailing was safe and successful, and allowed for union, realignment, reorientation, and leg-length restoration. With regard to the soft tissue, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage. Copyright © 2017. Published by Elsevier Taiwan LLC.

  5. Radiation-induced femoral neck fracture in patients cured of cervical carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Lukowska, K; Zomer-Drozda, J; Kielbinska, S [Instytut Onkologii, Warsaw (Poland)

    1976-01-01

    In the years 1948-1967 8275 patients with cervical carcinoma in various grades of progression were treated at the Institute of Oncology in Warsaw by radiotherapy from external fields. Five-year survival without signs of recurrence was obtained in 4204 cases, 3863 of them were irradiated from external fields with X-rays under conventional conditions, while 341 received Co/sup 60/ radiotherapy. In 43 patients treated with X-rays and radium and regarded as cured radiological evidence of femoral neck fracture was obtained. These patients account for 1.1% of all cured patients. In the group treated with Co/sup 60/ radiation in only 1 case femoral neck fracture was observed (0.3%). In the group of cured patients with femoral neck fracture the method of irradiation from external fields, the age, clinical course, radiological appearance of radiation-induced changes and the method of fracture management were analysed.

  6. Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postopera...... fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.......OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months...... postoperatively after intramedullary nailing of tibial shaft fracture. METHODS: A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed...

  7. Idiopathic New Bone Formation in the Femoral Shafts of a Cynomolgus Monkey (Macaca fascicularis)

    OpenAIRE

    Lee, Jae-il; Kim, Young-suk; Kim, Myung-Jin; Hong, Sung-Hyeok

    2008-01-01

    A 6.5-y-old cynomolgus monkey was referred to the Veterinary Medical Teaching Hospital at Chungnam National University for suspected bone fracture. The monkey had been reared singly in a cage at a laboratory facility. An animal caretaker incidentally found a bone fragment protruding through the skin of the right leg. Radiographic examination revealed 2 new bone fragments clearly distinguishable from the original femurs; the fragments seemed to be inserted into both femurs. One of the new bone...

  8. COMPARATIVE STUDY OF KUNTSCHER’S NAIL VS. INTERLOCKING NAILING FOR FEMORAL ISTHMUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar Roy

    2017-05-01

    Full Text Available BACKGROUND Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for non-comminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus k-nail in such fractures. MATERIALS AND METHODS 40 cases of noncomminuted femoral isthmus fractures treated with interlocking nailing and K-nail from April 1, 2015, to December 1, 2016, were reviewed. Radiological and clinical union rates, bony alignment, complication and knee function were investigated. RESULTS There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with K-nail is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. CONCLUSION We therefore conclude that unlocked nailing is still useful for the management of noncomminuted isthmus fractures of the femur.

  9. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome....... We investigated the importance of an intact lateral femoral wall as a factor in postoperative fracture displacement after fixation with a sliding compression hip screw. METHODS: Two hundred and fourteen consecutive patients with an intertrochanteric fracture were treated with a 135 degrees sliding...... compression hip screw with a four-hole side-plate between 2002 and 2004. The fractures were classified on preoperative radiographs according to the AO/OTA classification system. The status of the greater and lesser trochanters, the integrity of the lateral femoral wall, and the position of the implant were...

  10. Do post-operative changes of neck-shaft angle and femoral component anteversion have an effect on clinical outcome following uncemented total hip arthroplasty?

    Science.gov (United States)

    Müller, M; Abdel, M P; Wassilew, G I; Duda, G; Perka, C

    2015-12-01

    The accurate reconstruction of hip anatomy and biomechanics is thought to be important in achieveing good clinical outcomes following total hip arthroplasty (THA). To this end some newer hip designs have introduced further modularity into the design of the femoral component such that neck-shaft angle and anteversion, which can be adjusted intra-operatively. The clinical effect of this increased modularity is unknown. We have investigated the changes in these anatomical parameters following conventional THA with a prosthesis of predetermined neck-shaft angle and assessed the effect of changes in the hip anatomy on clinical outcomes. In total, 44 patients (mean age 65.3 years (standard deviation (SD) 7); 17 male/27 female; mean body mass index 26.9 (kg/m²) (SD 3.1)) underwent a pre- and post-operative three-dimensional CT scanning of the hip. The pre- and post-operative neck-shaft angle, offset, hip centre of rotation, femoral anteversion, and stem alignment were measured. Additionally, a functional assessment and pain score were evaluated before surgery and at one year post-operatively and related to the post-operative anatomical changes. The mean pre-operative neck-shaft angle was significantly increased by 2.8° from 128° (SD 6.2; 119° to 147°) to 131° (SD 2.1; 127° to 136°) (p = 0.009). The mean pre-operative anteversion was 24.9° (SD 8; 7.9 to 39.1) and reduced to 7.4° (SD 7.3; -11.6° to 25.9°) post-operatively (p shaft angles was found with a significant decrease of the post-operative anteversion and slight increase of the neck-shaft angles, but without any impact on clinical outcome. ©2015 The British Editorial Society of Bone & Joint Surgery.

  11. Dislocation of total hip replacement in patients with fractures of the femoral neck.

    Science.gov (United States)

    Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

    2009-04-01

    Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. We included 713 consecutive hips in a series of 698 patients (573 females) who had undergone a primary total hip replacement (n = 311) for a non-pathological, displaced femoral neck fracture (Garden III or IV) or a secondary total hip replacement (n = 402) due to a fracture-healing complication after a femoral neck fracture. We used Cox regression to evaluate factors associated with prosthetic dislocation after the operation. Age, sex, indication for surgery, the surgeon's experience, femoral head size, and surgical approach were tested as independent factors in the model. The overall dislocation rate was 6%. The anterolateral surgical approach was associated with a lower risk of dislocation than the posterolateral approach with or without posterior repair (2%, 12%, and 14%, respectively (p replacement in patients with femoral neck fractures.

  12. Removal of a broken guide wire entrapped in a fractured femoral neck

    Directory of Open Access Journals (Sweden)

    ZHU Qing-hua

    2013-08-01

    Full Text Available 【Abstract】Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS. Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV frac-ture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotat-ing around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the bro-ken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixa-tion was easily finished. The patient had an uneventful re-covery without avascular necrosis of femoral head or non-union of the fracture at one year’s follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful. Key words: Femoral neck fractures; Bones wires; Complications

  13. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

    Directory of Open Access Journals (Sweden)

    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  14. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients.

    Science.gov (United States)

    Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki

    2009-10-10

    Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  15. The fracture sites of atypical femoral fractures are associated with the weight-bearing lower limb alignment.

    Science.gov (United States)

    Saita, Yoshitomo; Ishijima, Muneaki; Mogami, Atsuhiko; Kubota, Mitsuaki; Baba, Tomonori; Kaketa, Takefumi; Nagao, Masashi; Sakamoto, Yuko; Sakai, Kensuke; Kato, Rui; Nagura, Nana; Miyagawa, Kei; Wada, Tomoki; Liu, Lizu; Obayashi, Osamu; Shitoto, Katsuo; Nozawa, Masahiko; Kajihara, Hajime; Gen, Hogaku; Kaneko, Kazuo

    2014-09-01

    Atypical femoral fractures (AFFs) are stress-related fractures that are speculated to associate with long-term treatment with bisphosphonates for osteoporosis. A history of AFF is a high risk factor for the development of a subsequent AFF in the same location of the contralateral femur, suggesting that a patient's individual anatomical factor(s) are related to the fracture site of AFFs. In this study, we investigated the radiographs of fourteen AFFs (four bilateral fractures among ten patients) treated at six hospitals associated with our university between 2005 and 2010. The fracture site and standing femorotibial angle (FTA), which reflects the mechanical axis of the lower limb, were measured on weight-bearing lower limb radiographs. The fracture site and FTA of patients with typical femoral fractures (TFF) were compared to those of patients with AFFs. The correlations were examined using Spearman's rank correlation coefficients. The fracture locations in the femora were almost the same in the patients with bilateral AFFs. There was a positive correlation between the fracture site and the standing FTA in the patients with AFFs (r=0.82, 95% confidence interval; 0.49 to 0.94), indicating that the larger the standing FTA (varus alignment), the more distal the site of the fracture in the femur. The FTA of the patients with atypical diaphyseal femoral fracture were significantly larger compared to that of those with not only atypical subtrochanteric fractures but also TFFs. In conclusion, the fracture sites of AFFs are associated with the standing lower limb alignment, while those of TFFs are not. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. FUNCTIONAL RECOVERY AFTER MINIMALLY INVASIVE OSTEOSYNTHESIS IN FRACTURES OF THE SHAFT OF THE RADIUS AND ULNA

    Directory of Open Access Journals (Sweden)

    A. N. Chelnokov

    2016-01-01

    Full Text Available Introduction. Closed intramedullary nailing and external fixation are minimally invasive treatment options in radial and ulnar shaft fractures. We found no comparative studies of these methods in the current literature. Objective. A comparative analysis of both methods in radial and ulnar shaft fractures treated by closed intramedullary nailing and external fixation. Material and methods. 63 patients with forearm shaft fractures treated by closed intramedullary nailing (group I; 24 patients treated by external fixation (group II. All patients were operated within 30 days after injury. Postoperatively, all patients were evaluated clinically (range of motion of elbow and wrist, rotation of the forearm and radiologically. Disability of the Arm, Shoulder and Hand (DASH score was used to assess the functional status and quality of life. Results. The average time of radiological bone union in the group I and group II was 12,6 ± 1,4 weeks. and 12,7 ± 0,6 weeks, accordingly. Statistically significant differences in range of motion in the elbow and wrist occurred in 1 month after the surgery with the advantage in Group I. Restoration of rotation was faster in Group I up to 1 year after surgery. DASH scores in 2 month after the surgery were 11,2±1,96 in the nailing group (as in healthy population and 45,2±6,7 in the external fixation group. In 6 months after surgery the subjective assessment of the quality of life did not differ in both groups. Conclusion. Both minimally invasive methods of surgical stabilization provide restoration of anatomy of the forearm and complete functional recovery in final outcome, but closed intramedullary nailing results with significantly more rapid restoration of range of motions and quality of life measures.

  17. Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management

    Directory of Open Access Journals (Sweden)

    Narender Kumar Magu

    2014-01-01

    Full Text Available Background: Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term "small head or inadequate size femoral head" objectively for its prognostic significance. Materials and Methods: 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. Results: The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm. Proximal fragment volume of >43 cu cm was termed adequate size (type I and of ≤43 cu cm as small femoral head (type II. Fractures which united (n = 54 had a relatively large average head size (59 cu cm when compared to fractures that did not (n = 16, which had a small average head size (49 cu cm and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05. Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05. Conclusion: Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective

  18. Lateral Cortical Thickening and Bone Heterogeneity of the Subtrochanteric Femur Measured With Quantitative CT as Indicators for Early Detection of Atypical Femoral Fractures in Long-Term Bisphosphonate Users.

    Science.gov (United States)

    Lee, Seung Hyun; Lee, Young Han; Suh, Jin-Suck

    2017-10-01

    The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-naïve patients with no history of femoral fracture using quantitative CT (QCT). Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naïve patients. The lateral cortical thickness index (CTI) and the mean BMD (BMD mean ) and SD of the BMD (BMD SD ) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test. Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naïve group (median, 0.21) (p = 0.009). The lateral cortex BMD SD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm 3 ) than the BP users without a femoral fracture (median, 39.27 mg/cm 3 ; p = 0.049) and the BP-naïve group (median, 31.02 mg/cm 3 ; p = 0.037). There was no significant difference among groups in lateral cortex BMD mean , BMD mean and BMD SD of the entire cross-sectional area, and femoral neck-shaft angle. Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMD SD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naïve patients.

  19. Spatial Differences in the Distribution of Bone Between Femoral Neck and Trochanteric Fractures.

    Science.gov (United States)

    Yu, Aihong; Carballido-Gamio, Julio; Wang, Ling; Lang, Thomas F; Su, Yongbin; Wu, Xinbao; Wang, Manyi; Wei, Jie; Yi, Chen; Cheng, Xiaoguang

    2017-08-01

    There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case-control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel-based morphometry (VBM) and surface-based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface-based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for

  20. Risk Factors and Clinical Evaluation of Superficial Femoral Artery Stent Fracture: Prote'ge'GPS Stent

    International Nuclear Information System (INIS)

    Lee, Da Un; Kim, Jae Kyu; Jung, Hye Doo; Huh, Tae Wook; Yim, Nam Yeol; Oh, Hyun jun; Choi, Soo Jin Na; Chang, Nam Kyu

    2010-01-01

    To evaluate the occurrence of superficial femoral artery stent fractures, the risk factors of stent fracture, and the relationship between fractures and clinical findings. Of the 38 patients who underwent treatment with Prote'ge'GPS stenting due to arterial occlusions on the superficial femoral artery, 17 also underwent a clinical analysis. Forty-three stents were inserted in the 17 superficial femoral arteries, ranging between 15 and 50 cm in length, with a mean treated length of 26.4 cm (15-50 cm). A fracture was evaluated by taking a PA and lateral simple radiography, as well as a follow-up evaluation accompanied with a CT angiography, DSA, and a color Doppler sonography. The examination involved the assessment of the difference between bone fractures due to length, placement, and frequency. Fractures occurred in 13 of 43 stents (30.2%). A total of 10 (71.4%) occurred in the upper third, compared to 4 (28.6%) in the lower third of the superficial femoral artery. In addition, 10 stents (71.4%) had a single strut fracture, whereas 4 (28.6%) had multiple strut fractures. A stent fracture occurred more frequently when the stents and lesions were longer (p=0.021, 0.012) and the stents were inserted near the joint. However, there was no significant relationship between stent numbers and the fractures (p=0.126). When the stents were inserted along the popliteal artery, a stent fracture occurred more frequently in the lower third of the artery. The stent fractures did not significantly influence the patency rate of the stented artery (p=0.44) Prote'ge'GPS stents in the superficial femoral artery revealed a considerable number of fractures and the fracture frequency showed a significant relationship with the length of stents and lesions. The closer stent insertion was to the joints, the more frequently fractures occurred. There were no evident significant relationships between the presence of stent fractures and the patency of the stented arteries

  1. Hip dislocation following the treatment of femoral neck fracture: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2010-01-01

    Full Text Available Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.

  2. Closed reduction, internal fixation with quadratus femoris muscle pedicle bone grafting in displaced femoral neck fracture

    Directory of Open Access Journals (Sweden)

    Chaudhuri Sibaji

    2008-01-01

    Full Text Available Background: Management of femoral neck fracture is still considered as an unsolved problem. It is more evident in displaced fractures where this fracture is considered as some sort of vascular insult to the head of the femur. We have used closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting in fresh displaced femoral neck fractures. Materials and Methods: From April 1996 to December 2004 we operated 73 consecutive patients of displaced femoral neck fracture in the age group of 24 to 81 years, mean age being 54.6 years. The patients were operated within one week of injury, the mean delay being 3.6 days. Closed reduction internal fixation along with quadratus femoris muscle pedicle bone grafting was done in all cases. They were followed up for an average period of 5.6 years (range 2-11 years. Results: Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 53, good in 12, fair in six and poor in two patients. Bony union occurred in 68 cases, no patient developed avascular necrosis (AVN till date. Conclusion: For fresh displaced femoral neck fracture in physiologically active patients closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting is a suitable option to secure union and prevent development of AVN.

  3. [Pathologic proximal femoral fractures in children in an unicameral bone cyst].

    Science.gov (United States)

    Havránek, P; Pesl, T; Bartonícek, J

    2005-01-01

    Proximal femoral fractures in children are rare, pathologic fractures being extremely rare. Despite many meanings these fractures are still "unsolved" there are some definite rules for treatment of true accidental injuries. Pathologic fractures are outstanding with their extremely rare incidence. The aim of the study is to overview a large clinical material, find out the incidence of this pathologic fracture, the extent and shape of the unicameral bone cyst (UBC), specific therapeutic approach, technical problems of eventual osteosynthesis, number of reoperations and sequels. Altogether 49 children with 50 accidental and pathologic fractures of proximal part of the femur treated in the Regional Pediatric Trauma Centre of the Department of Pediatric and Trauma Surgery, 3rd Faculty of Medicine, Charles University, Prague. Retrospective and prospective study of children (0 to 15 years of age) treated with proximal femoral accidental and pathologic fractures during the 20 year period (from August 1984 to November 2004). Classification of fractures according to Delbet and Colonna. Diagnosis of bone cyst with plain X-rays, eventually CT scans. During the 20 years period (August 1984 to November 2004) 49 children with 50 proximal femoral fractures were treated in the Department. Four patients sustained a pathologic fracture through an unicameral bone cyst. Two of these latter children were treated by an open reduction and osteosynthesis with the use of the proximal femoral AO-ASIF angled-plate and two children nonoperatively using skeletal traction because of impossibility of insertion of the osteosynthetic material without a damage of the growth plate. Subsequent operations of the UBC were necessary in these two children. All four patients recovered well without sequels. Pathologic fractures in UBC are usually treated nonoperatively and the cyst itself is treated after fracture healing. Proximal femoral impairment is the exception from this rule because of weigh bearing

  4. Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture

    Directory of Open Access Journals (Sweden)

    Robertsson Otto

    2010-08-01

    Full Text Available Abstract Background Hip dislocation after arthroplasty for femoral neck fractures remains a serious complication. The aim of our study was to investigate the dislocation rate in acute femoral neck fracture patients operated with a posterior approach with cemented conventional or dual articulation acetabular components. Methods We compared the dislocation rate in 56 consecutive patients operated with conventional (single mobility cemented acetabular components to that in 42 consecutive patients operated with dual articulation acetabular components. All the patients were operated via posterior approach and were followed up to one year postoperatively. Results There were 8 dislocations in the 56 patients having conventional components as compared to no dislocations in those 42 having dual articulation components (p = 0.01. The groups were similar with respect to age and gender distribution. Conclusions We conclude that the use of a cemented dual articulation acetabular component significantly reduces the dislocation rates in femoral neck fracture patients operated via posterior approach.

  5. Nontraumatic Fracture of the Femoral Condylar Prosthesis in a Total Knee Arthroplasty Leading to Mechanical Failure

    Directory of Open Access Journals (Sweden)

    Girish N. Swamy

    2014-01-01

    Full Text Available This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA. A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.

  6. Nontraumatic fracture of the femoral condylar prosthesis in a total knee arthroplasty leading to mechanical failure.

    Science.gov (United States)

    Swamy, Girish N; Quah, Conal; Bagouri, Elmunzar; Badhe, Nitin P

    2014-01-01

    This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.

  7. Clinical value of 64-slice spiral CT for classification of femoral neck fracture

    International Nuclear Information System (INIS)

    Zhu Jiangtao; Gong Jianping; Cai Wu; Zhu Jianbing; Chen Guangqiang; Qian Minghui

    2011-01-01

    Objective: To evaluate the clinical application of 64-slice spiral CT for classification of femoral neck fracture. Methods: The survey was comprised of 46 patients with femoral neck fractures detected with plain radiographs and CT images. Cases were randomly presented in 2 formats: plain radiographs and CT. Garden classification was queried. Modification of garden classification (nondisplaced vs displaced) was taken to compare with plain radiographs and CT in the study. Results: The results of classification for plain radiographs were 2 cases of Garden Ⅰ, 10 cases of Ⅱ, 22 cases of Ⅲ, and 12 cases of Ⅳ. Those for CT were 1 cases of Garden Ⅰ, 4 cases of Ⅱ, 26 cases of Ⅲ, and 15 cases of Ⅳ. CT improved the accuracy of Garden Classification (P<0.05). Conclusion: Garden classification using CT images shows good conformation with results of surgery. 64-Slic CT is better plain radiographs for Garden classification of femoral neck fracture. (authors)

  8. Location of civilian ballistic femoral fracture indicates likelihood of arterial injury.

    Science.gov (United States)

    Gitajn, Leah; Perdue, Paul; Hardcastle, John; O'Toole, Robert V

    2014-10-01

    We evaluated whether the location of a ballistic femoral fracture helps predict the presence of arterial injury. We hypothesized that fractures located in the distal third of the femur are associated with a higher rate of arterial injury. We conducted a retrospective review of electronic medical records at our level I trauma centre and found 133 consecutive patients with femoral fractures from civilian gunshots from 2002 to 2007, 14 of whom sustained arterial injury. Fracture extent was measured with computerized viewing software and recorded with a standard technique, calculating proximal, distal, and central locations of the fracture as a function of overall length of the bone. Analyses were conducted with Student's t, Chi-squared, and Fisher's exact tests. The location of any fracture line in the distal third of the femur was associated with increased risk of arterial injury (Pballistic injury is six times more likely to be associated with arterial injury and warrants careful evaluation. Our data show that fracture location can help alert clinicians to possible arterial injury after ballistic femoral fracture. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases.

    Science.gov (United States)

    Bumbasirević, Marko; Lesić, Aleksandar; Bumbasirević, Vesna; Cobeljić, Goran; Milosević, Ivan; Atkinson, Henry Dushan E

    2010-04-01

    This single center retrospective study reviews the management and outcomes of 117 consecutive patients with humeral shaft fractures and associated radial nerve palsy (RNP) treated over a 20-year period (1986-2006). A total of 101 fractures were managed conservatively and 16 fractures underwent external fixation for poor bony alignment. Sixteen grade 1 and 2 open fractures underwent wound toileting alone. No patients underwent initial radial nerve exploration or opening of the fracture sites. All patients achieved clinical and radiological bony union at a mean of 8 weeks (range 7-12 weeks). There were no complications or pin tract infections in the operated patients. A total of 111 cases had initial spontaneous RNP recovery at a mean of 6 weeks (range 3-24 weeks) with full RNP recovery at a mean of 17 weeks (range 3-70 weeks) post-injury. Fourteen patients had no clinical/EMG signs of nerve activity at 12 weeks and 6 subsequently failed to regain any radial nerve recovery; 2 had late explorations and the lacerated nerves underwent sural nerve cable neurorraphy; and 4 patients underwent delayed tendon transposition 2-3 years after initial injury, with good/excellent functional outcomes. Humeral fractures with associated RNP may be treated expectantly. With low rates of humeral nonunion, 95% spontaneous nerve recovery in closed fractures and 94% in grade 1 and 2 open fractures, one has the opportunity of waiting. If at 10-12 weeks there are no clinical/EMG signs of recovery, then nerve exploration/secondary reconstruction is indicated. Late tendon transfers may also give good/excellent functional results.

  10. [Manipulative reduction and small splint fixation combined with micromovement exercise for treatment of humeral shaft fractures].

    Science.gov (United States)

    Tang, Hao-chen; Xiang, Ming; Chen, Hang; Hu, Xiao-chuan; Yang, Guo-yong

    2016-01-01

    To investigate the therapeutic efficacy of bone-setting manipulative reduction and small splint fixation combined with micro-movement theory exercise for treatment of humeral shaft fractures. From March 2011 to February 2014, 64 cases of humeral shaft fractures were treated by bone-setting manipulative reduction and small splint fixation including 28 males and 36 females with an average age of 38.1 years old ranging from 22 to 67 years old. According to the classification of AO/OTA, there were 10 cases of type A1, 12 cases of type A2,11 cases of type A3,10 cases of type B1,12 cases of type B2, 7 cases of type B3, 2 cases of type C1, 1 case of type C2, 1 case of type C3. After close reduction early functional exercise performed according to micro-movement theory. All patients had no other parts of the fractures, neurovascular injury, and serious medical problems. Patients were followed up for fracture healing, shoulder and elbow joint function recovery, and curative effect. All patients were followed up from 10 to 12 months with an average of 10.3 months. Of them, 2 cases had a small amount of callus growth at 3 months after close reduction, so instead of operation; 2 cases appeared radial nerve symptoms after close reduction ,so instead of operation. Other patients were osseous healing, the time was 8 to 12 weeks with an average of 10.2 weeks. After osseous healing, according to Constant-Murley score system ,the average score was (93.5 ± 3.2) points, the result was excellent in 29 cases, good in 29 cases, fair in 6 cases, excellent and good rate was 90.3%; according to the Mayo score system, the average score was (93.7 ± 4.2) points, the result was excellent in 35 cases, good in 23 cases, fair in 6 cases, excellent and good rate was 91.9%. Bone-setting manipulative reduction and small splint fixation combined with micromovement theory exercise for treatment of humeral shaft fractures has advantage of positive effect, easy and inexpensive method, the treatment has

  11. Bone density in relation to failure in patients with osteosynthesized femoral neck fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Lauritsen, Jens

    2011-01-01

    Background The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still......,2 (75,4-79,0). Failure is defined as revision surgery or new fracture. Results 69 patients had a t-score (total hip) below -2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,5 % (44,7 %), at 2 years 45,4 % (60,0 %) and at end of follow-up 49,6 % (62...

  12. Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric ? ??

    OpenAIRE

    Santos, Leandro Em?lio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brand?o; Soares, Eduardo Augusto Marques

    2014-01-01

    Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed.

  13. Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: grading the evidence through a meta-analysis.

    Directory of Open Access Journals (Sweden)

    JianXiong Ma

    Full Text Available There is a debate regarding the choice of operative intervention in humeral shaft fractures that require surgical intervention. The choices for operative interventions include intramedullary nailing (IMN and dynamic compression plate (DCP. This meta-analysis was performed to compare fracture union, functional outcomes, and complication rates in patients treated with IMN or DCP for humeral shaft fractures and to develop GRADE (Grading of Recommendations, Assessment, Development, and Evaluation-based recommendations for using the procedures to treat humeral shaft fractures. A systematic search of all the studies published through December 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and Cochrane Central databases. The randomized controlled trials (RCTs and quasi-RCTs that compared IMN with DCP in treating adult patients with humeral shaft fractures and provided data regarding the safety and clinical effects were identified. The demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Ten studies that included a total of 448 patients met the inclusion criteria. The results of a meta-analysis indicated that both IMN and DCP can achieve similar fracture union with a similar incidence of radial nerve injury and infection. IMN was associated with an increased risk of shoulder impingement, more restriction of shoulder movement, an increased risk of intraoperative fracture comminution, a higher incidence of implant failure, and an increased risk of re-operation. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DCP may be superior to IMN in the treatment of humeral shaft fractures. Because of the low quality evidence currently available, high-quality RCTs are required.

  14. [Intramedullary nailing combined with cannulated screw in treating femoral condyles fractures].

    Science.gov (United States)

    Shen, Guo-Qing; Zhang, Hao; Long, Da-Fu; Li, Zheng-Wen; Tan, Ying-Dong

    2017-07-25

    To observe the clinical effects of retrograde intramedullary nailing and cannulated screws in the treatment of femoral condylar fracture. From June 2009 to June 2015, 13 patients with femoral condyles fracture were treated by retrograde intramedullary nailing and cannulated screws including 6 males and 7 females with an average age of 46.1 years old ranging from 16 to 76 years old. There were 10 cases of closed fractures, 3 cases of open fraetures. According to AO classification criteriam, 4 cases were type C1, 7 cases were type C2, 2 cases were type C3. Postoperative reduction of fracture and the knee joint function recovery were observed. All patients were followed up for 12 to 36 months with a mean of 24 months. X-ray examination showed that the union time of fracture was 18 to 24 weeks, 21 weeks on average. There were no cases of loosening, breakage of internal fixators and re-fracture. Hospital for Special Surgery(HSS) knee score was 90.07±4.99 at 1 year after the operation. The clinical efficacy for retrograde intramedullary nailing and cannulated screw for the treatment of femoral condyles fracture was excellent. It can improve the anatomical reattachment rate and reduce the complications and promote the knee functional recovery.

  15. Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

    Science.gov (United States)

    Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

  16. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report.

    Science.gov (United States)

    Deleanu, Bogdan; Prejbeanu, Radu; Vermesan, Dinu; Honcea, Lucian; Mioc, Mihail Lazar; Tsiridis, Eleftherios; Predescu, Vlad

    2016-02-01

    The avascular necrosis of the femoral head represents the death of bone tissue due to the lack of blood supply. The disease has a progressive evolution and left untreated leads to femoral head collapse and severe arthritis. We present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. At 2 years after surgery the patient developed an incipient avascular necrosis of the femoral head. Despite the good positioning of the implant, we considered that the source of the pain was an intolerance of the implant, and thus we removed it. After implant removal, the patient was kept under observation and conservative treatment, to prevent further damage to the right hip and allow the healing to occur. At 6 months after the gamma nail was removed the X-rays revealed advanced avascular necrosis of the femoral head and secondary osteoarthritis on the right hip. The patient underwent surgery with an uncemented total hip arthroplasty. There are a few discussions regarding the avascular necrosis of the femoral head. These discussions may include the predisposing risk factors, the treatment of choice and the postoperative complications. The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

  17. Clinical and radiographic outcomes of femoral head fractures: excision vs. fixation of fragment in Pipkin type I: what is the optimal choice for femoral head fracture?

    Science.gov (United States)

    Park, Kyung-Soon; Lee, Keun-Bae; Na, Bo-Ram; Yoon, Taek-Rim

    2015-07-01

    In this work, we present relatively long-term results of femoral head fractures with a specific focus on Pipkin type I fractures. Fifty-nine femoral head fractures were treated according to modified Pipkin's classification as follows: type I, small fragment distal to the fovea centralis (FC); type II, large fragment distal to the FC; type III, large fragment proximal to the FC; type IV, comminuted fracture. There were 15 cases of type I, 28 of type II, 9 of type III, and 7 of type IV fractures. Conservative treatment with skeletal traction was performed in 4 type II cases, excision of the fragment in 15 type I and 10 type II cases, fixation of the fragment in 14 type II and all 9 type III cases, and total hip replacement in all 7 type IV cases. The overall clinical and radiographic outcomes were evaluated using previously published criteria, focusing on the results in Pipkin type I fractures with relatively large fragments. Based on Epstein criteria, in type II fractures, excellent or good clinical results were seen in 6 of 10 patients (60.0 %) treated by excision of the fragment and 12 of 14 patients (85.7 %) treated by internal fixation (p = 0.05). Also, excellent or good radiologic results were seen in 4 of 10 (40.0 %) patients treated by excision of the fragment and 12 of 14 (85.7 %) patients treated by internal fixation (p = 0.03). Even in Pipkin type I fractures, if the fragment is large (modified Pipkin type II), early reduction and internal fixation can produce good results.

  18. MR findings in cases of suspected impacted fracture of the femoral neck

    International Nuclear Information System (INIS)

    Stiris, M.G.; Lilleaas, F.G.

    1997-01-01

    Purpose: To evaluate MR imaging of the hip in patients with a clinically suspected impacted fracture of the femoral neck in cases where conventional plain films show negative or equivocal findings. Material and Methods: Twenty-seven such patients were prospectively examined by MR imaging with a 1.0 T unit, within 24 hours of admittance to hospital. A coronal T1-weighted turbo spin-echo sequence (n=27), and a coronal STIR sequence (n=25) or a coronal T2-weighted turbo spin-echo fast saturation sequence (n=2) were used. The evaluations were made by 2 radiologists with experience in musculoskeletal radiology. Results: There were 6 patients with a petrochanteric fracture, 2 without and 4 with slight displacement. Five patients had an impacted fracture of the femoral neck, and 3 had a fracture of the superior pubic bone. Of 2 patients with advanced arthrosis, i had an impacted femoral neck fracture and the other a nondisplaced intertrochanteric fracture. There was 1 patient who had sustained a nondisplaced acetabular fracture with increased joint fluid and muscle contusions. Three patients had muscle contusions only. Two patients had bone marrow contusions only, while 2 others with advanced coxarthrosis had increased joint fluid only. Three patients showed normal findings. Our findings led to emergency surgery in 13 cases, and conservative measures directed to the specific MR findings in 14 patients. Conclusion: MR imaging should be the first modality of choice in examining patients with a clinically suspected impacted fracture of the femoral neck where conventional films show negative or equivocal findings. (orig.)

  19. MR findings in cases of suspected impacted fracture of the femoral neck

    Energy Technology Data Exchange (ETDEWEB)

    Stiris, M.G.; Lilleaas, F.G. [Aker Hospital, Oslo (Norway). Dept. of Diagnostic Radiology

    1997-09-01

    Purpose: To evaluate MR imaging of the hip in patients with a clinically suspected impacted fracture of the femoral neck in cases where conventional plain films show negative or equivocal findings. Material and Methods: Twenty-seven such patients were prospectively examined by MR imaging with a 1.0 T unit, within 24 hours of admittance to hospital. A coronal T1-weighted turbo spin-echo sequence (n=27), and a coronal STIR sequence (n=25) or a coronal T2-weighted turbo spin-echo fast saturation sequence (n=2) were used. The evaluations were made by 2 radiologists with experience in musculoskeletal radiology. Results: There were 6 patients with a petrochanteric fracture, 2 without and 4 with slight displacement. Five patients had an impacted fracture of the femoral neck, and 3 had a fracture of the superior pubic bone. Of 2 patients with advanced arthrosis, i had an impacted femoral neck fracture and the other a nondisplaced intertrochanteric fracture. There was 1 patient who had sustained a nondisplaced acetabular fracture with increased joint fluid and muscle contusions. Three patients had muscle contusions only. Two patients had bone marrow contusions only, while 2 others with advanced coxarthrosis had increased joint fluid only. Three patients showed normal findings. Our findings led to emergency surgery in 13 cases, and conservative measures directed to the specific MR findings in 14 patients. Conclusion: MR imaging should be the first modality of choice in examining patients with a clinically suspected impacted fracture of the femoral neck where conventional films show negative or equivocal findings. (orig.).

  20. Percutaneous clamping of spiral and oblique fractures of the tibial shaft: a safe and effective reduction aid during intramedullary nailing.

    Science.gov (United States)

    Collinge, Cory A; Beltran, Michael J; Dollahite, Henry A; Huber, Florian G

    2015-06-01

    The reduction of tibial shaft fractures during intramedullary nailing is important if limb alignment is to be restored and successful clinical outcomes are expected. We have used a percutaneously applied (or open) clamp or clamps to achieve and maintain reduction during nailing of all amendable tibial shaft fractures. In this article, we describe the technique and preliminary results comparing closed, simple spiral and oblique tibial shaft fractures (OTA 42-A1 and A2) managed with percutaneous clamp-assisted nailing (CAN) versus nailing using manual reduction (MRN) held by the surgical team. In the MRN group, there were an increased fracture gap (P = 0.04) and trends toward malalignment (P = 0.07) and healing time (P = 0.06) compared with the CAN group. There were also trends in clinical; no wound complications occurred in either group. We have found that percutaneous CAN of closed, simple spiral and oblique tibial shaft fractures seems safe and allows for early predictable union with reproducible alignment compared with nailing using MRN.

  1. Clinic research on the treatment for humeral shaft fracture with minimal invasive plate osteosynthesis: a retrospective study of 128 cases.

    Science.gov (United States)

    Chen, H; Hu, X; Yang, G; Xiang, M

    2017-04-01

    Minimal invasive plate osteosynthesis (MIPO) is one of the most important techniques in the treatment for humeral shaft fractures. This study was performed to evaluate the efficacy of MIPO technique for the treatment for humeral shaft fractures. We retrospectively evaluated 128 cases with humeral shaft fractures that were treated with MIPO technique from March 2005 to August 2008. All the patients were followed up by routine radiological imaging and clinical examinations. Constant-Murley score and HSS elbow joint score were used to evaluate the treatment outcome. The average duration of the surgery was 60 min (range 40-95 min) without blood transfusion. All fractures healed without infection. All cases recovered carrying angle except four cases with 10°-15° cubitus varus. After the average follow-up of 23 (13-38) months, satisfactory function was achieved according to Constant-Murley score and HSS elbow joint score. Constant-Murley score was 80 on average (range 68-91). According to HSS elbow joint score, there were 123 cases of excellent clinical outcome and five cases of effective outcome. It seems to be a safe and effective method for managing humeral shaft fractures with MIPO technique.

  2. Risk factors for trochanteric and femoral neck fracture.

    Science.gov (United States)

    Díaz, A R; Navas, P Z

    The differences between the two main types of fracture of proximal end of the femur, trochanteric and cervical fractures, are still a subject of study, and could be the key to a better understanding of its pathophysiology and prevention. The aim of this study is to determine whether epidemiological differences in the distribution of risk factors associated with hip fracture exist between these two entities. A descriptive cross-sectional study of 428 patients over the age of 65 admitted for trochanteric or cervical fractures in 2015, in which gender, age, previous diagnosis, external causes associated with fracture and place of the event were recorded. There were 220 patients with a cervical fracture (51.4%) and 208 patients with a trochanteric fracture (48.6%). The average age was higher in the trochanteric fracture, observing a constant increase with age only in women with trochanteric fractures. Cervical fracture showed a significant association with cerebrovascular disease (p=0.039) and trochanteric fracture with accidental falls (p=0.047) and presence of 5-9 previous diseases (p=0.014). A regression analysis maintained this association in the case of a cerebrovascular disease (OR 2.6, 95%CI 1.1-6.4) and the presence of 5-9 diseases (OR 1.5, 95%CI 1.1-2.3). Trochanteric fractures are associated with women patients of more advanced ages, 5-9 previous diseases and accidental falls. Cerebrovascular disease shows a higher prevalence in cervical fractures. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Avascularity of the femoral head following intracapsular fracture: a comparative scintigraphic and bioptic study

    Energy Technology Data Exchange (ETDEWEB)

    Hoilund-Carlsen, P F; Widding, A; Uhrenholdt, A; Christoffersen, P; Grieff, J [Copenhagen Univ. (Denmark)

    1980-03-01

    Bioptic and scintigraphic methods of diagnosing avascular necrosis of the femoral head following intracapsular fracture of the femoral neck were compared. During operative treatment of patients, biospy samples of bone marrow were taken from the femoral head about 2 hours after the intravenous injection of sup(99m)Tc-Sn-pyrophosphate; histological examination of the biopsies were also performed. Scintigrams of the femoral head using sup(99m)Tc-pyrophosphate were performed 2 days, 7 days and 6 weeks post-operatively. The biopsies confirmed no morphological changes being apparent in the first few days. The biopsy samples indicated two groups of patients with either high or low activity in the femoral head. However, it was concluded that the use of bone-seeking radionuclides with this technique might be more reliable. Scintigraphic trends divided the patients into three groups, one with persistently normal, another with varying, and a third with decreased activity in the femoral head. It was concluded that very early scintigraphy is probably not the method of choice since the images were often difficult to interpret. For the present, assessment of the viability of the femoral head should rest upon scintigraphic examinations performed about 6 weeks or 3 months after the injury.

  4. Can introduction of an uncemented, hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures be recommended?

    DEFF Research Database (Denmark)

    Hansen, Søren Kring; Brix, Michael; Birkelund, Lasse

    2010-01-01

    The role of uncemented fully hydroxyapatite coated hemiarthroplasties for the treatment of displaced femoral neck fractures remains unclear. We investigated if complications, reoperations and mortality differed from that of cemented hemiarthroplasties. The study groups consisted of 78 cemented...... and 97 uncemented, hydroxyapatite coated hemiarthroplasties with minimum 1 year follow-up. The dislocation rate was 3% in both groups (p=0.84). Proximal femoral fracturing occurred in 1% in the cemented group and in 4% in the uncemented group (p=0.26). Reoperations were performed following 4......% of procedures in the cemented group and following 2% of procedures in the uncemented group (p=0.48). Mortality rates did not differ statistically significant between groups. Outcomes were comparable. Introduction of an uncemented hydroxyapatite coated hemiarthroplasty for treatment of displaced femoral neck...

  5. Negative magnetic resonance imaging in femoral neck stress fracture with joint effusion: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Nobutoshi; Okuyama, Koichiro; Kamo, Keiji; Chiba, Mitsuho [Akita Rosai Hospital, Department of Orthopedic Surgery, Odate, Akita (Japan); Shimada, Yoichi [Akita University School of Medicine, Department of Orthopedic Surgery, Akita (Japan)

    2016-06-15

    Femoral neck stress fracture (FNSF) is well documented in the orthopedic literature and is generally associated with strenuous activities such as long-distance running and military training. The diagnostic yield of magnetic resonance imaging (MRI) for FNSF was reported to be 100 %, and early MRI is recommended when this fracture is suspected. We encountered a 16-year-old male long-distance runner with FNSF in whom the left femoral neck showed no signal changes on MRI although an effusion was detected in the left hip joint. One month later, roentgenograms revealed periosteal callus and oblique consolidation of the left femoral neck, confirming the diagnosis of compression FNSF. Because FNSF with a normal bone marrow signal on MRI is very rare, this patient is presented here. (orig.)

  6. Bilateral insufficiency fracture of the femoral head and neck in a case of oncogenic osteomalacia.

    Science.gov (United States)

    Chouhan, V; Agrawal, K; Vinothkumar, T K; Mathesul, A

    2010-07-01

    We describe a case of oncogenic osteomalacia in an adult male who presented with low back pain and bilateral hip pain. Extensive investigations had failed to find a cause. A plain pelvic radiograph showed Looser's zones in both femoral necks. MRI confirmed the presence of insufficiency fractures bilaterally in the femoral head and neck. Biochemical investigations confirmed osteomalacia which was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphataemic osteomalacia. The level of fibroblast growth factor-23 was highly raised, indicating the cause as oncogenic osteomalacia. This was confirmed on positron-emission tomography, MRI and excision of a benign fibrous histiocytoma following a rapid recovery. The diagnosis of oncogenic osteomalacia may be delayed due to the non-specific presenting symptoms. Subchondral insufficiency fractures of the femoral head may be missed unless specifically looked for.

  7. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A. [Department of Magnetic Resonance Imaging, IDI Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Gran Via s/n, 08907, L' Hospitalet de Llobregat (Barcelona) (Spain)

    2003-08-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  8. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    International Nuclear Information System (INIS)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A.

    2003-01-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  9. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail.

    NARCIS (Netherlands)

    Schipper, I.B.; Steyerberg, E.W.; Castelein, R.M.; Heijden, F.H. van der; Hoed, P.T. den; Kerver, A.J.; Vugt, A.B. van

    2004-01-01

    The proximal femoral nail (PFN) is a recently introduced intramedullary system, designed to improve treatment of unstable trochanteric fractures of the hip. In a multicentre prospective clinical study, the intra-operative use, complications and outcome of treatment using the PFN (n = 211) were

  10. Atypical femoral fracture in an osteogenesis imperfecta patient successfully treated with teriparatide

    DEFF Research Database (Denmark)

    Holm, Jakob; Eiken, Pia; Hyldstrup, Lars

    2014-01-01

    OBJECTIVE: We report a case of a successfully healed atypical femoral fracture (AFF) following treatment with teriparatide in a patient with osteogenesis imperfecta (OI). To our knowledge, no successful treatment of AFFs with teriparatide in this subpopulation has ever been described. METHODS...

  11. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C.; Solgaard, Søren

    2017-01-01

    Background and purpose - The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Registry studies have indicated an increased risk of revision of uncemented implants due to early periprosthetic femoral fracture. In this paper, we describe the incidence and predisposing facto...

  12. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients

    Directory of Open Access Journals (Sweden)

    Bhava RJ Satish

    2013-01-01

    Conclusion: Closed reduction and cannulated cancellous screw fixation gives satisfactory functional results in large group of elderly patients. The four quadrant parallel peripheral (FQPP screw fixation technique gives good stability, allows controlled collapse, avoids fixation failure and achieves predictable bone healing in displaced femoral neck fracture in patients ≥50 years of age.

  13. Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation.

    Science.gov (United States)

    Wysocki, Robert W; Kapotas, James S; Virkus, Walter W

    2009-04-01

    Fractures of the proximal and distal one thirds of the tibial shaft have historically higher malunion rates than those of the midshaft. This retrospective case series evaluates the postoperative radiographic outcome of intramedullary nailing of proximal and distal one-third tibial shaft fractures using intraoperative two-pin external fixation, often referred to as traveling traction. Between 2000 and 2005, 15 consecutive patients with proximal third and 27 consecutive patients with distal third displaced extra-articular fractures of the tibia were treated with statically locked intramedullary nailing and supplementary intraoperative two-pin rectangular frame external fixation. The external fixation was removed once the proximal and distal locking screws were in place. The alignment of the fractures was determined using standard postoperative anteroposterior and lateral radiographs. Postoperatively, 14 of 15 patients with proximal fractures and 25 of 27 patients with distal fractures had less than 5 degrees of angular deformity in both the coronal and sagittal planes and less than 1 cm shortening. Statically locked intramedullary nailing with simultaneous intraoperative traveling traction external fixation as treatment for proximal and distal one-third extra-articular tibial shaft fractures is successful in achieving a high rate of acceptable postoperative alignment.

  14. Effectiveness of Minimally Invasive Plate Osteosynthesis (MIPO on Comminuted Tibial or Femoral Fractures

    Directory of Open Access Journals (Sweden)

    Ali Andalib

    2017-09-01

    Full Text Available Background: Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site,known as minimally invasive plate osteosynthesis (MIPO, has recently become prevalent. This study has beendesigned to assess the outcomes of this treatment for tibial and femoral comminuted fractures.Methods: A total of 60 patients with comminuted femoral or tibial fractures were operated with MIPO method in thiscross-sectional study at Alzahra university hospital in 2015. Eleven patients were excluded due to lack of adequatefollow-ups. Patients’data including union time; infection in the fractured site; hip and knee range of motion; and anymalunion or deformities like limb length discrepancy were collected after the surgery in every session.Results: Among 32 femoral and 17 tibial fractures, union was completed in48 patients, while only one patient withfemoral fracture had nonunion. The mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia(17.76±2.36 compared to 19±2.37 weeks, respectively, P=0.09. None of the patients suffered from infections or fistula.The range of motion in hip and knee remained intact in approximately all patients. Malunion happened in 3 patients; 100internal rotation in 1 patient; and 1cm limb shortening in 2 patients.Conclusion: According to the result of this study, MIPO is a simple and effective method of fixation with a high rateof union as well as minimal complications for comminuted fractures of long bones. Infection is rare, and malunion orany deformity is infrequent. MIPO appears to be a promising and safe treatment alternative for comminuted fractures.

  15. Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures – a systematic review

    Directory of Open Access Journals (Sweden)

    Flávia Vieira Guimarães Hartmann

    2017-01-01

    Full Text Available Background: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5 cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. Objective: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. Methods: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Results: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also

  16. Does femoral offset recover and affect the functional outcome of patients with displaced femoral neck fracture following hemiarthroplasty?

    Science.gov (United States)

    Ji, Hyung-Min; Won, Seok-Hyung; Han, Jun; Won, Ye-Yeon

    2017-06-01

    Restoring preoperative horizontal femoral offset (FO) promised good functional outcome in patients receiving total hip arthroplasty. However, relatively little was known regarding the clinical relevance of restoring the offset in patients with bipolar hemiarthroplasty to treat displaced femoral neck fracture. Therefore, the objective of this study was to evaluate postoperative FO accurately and verify its relation with functional outcome. One hundred elderly patients who received bipolar hemiarthroplasty to treat displaced femoral neck fracture were identified. Preoperative CT scanning of contralateral hip joint and reconstruction of images led to rotation-free FO. By referencing postoperative implant specification and comparing to measured values in Picture Archive and Communication System, rotation-free postoperative FO and the amount of change were acquired. Postoperative Harris Hip Score (HHS) and Modified Barthel Index (MBI) were evaluated to measure functional outcome at 12-month after the surgery. Patients with significant FO change were identified. Multiple regression analysis was conducted to determine if the FO change might independently affect the outcome regardless of confounding factors. The mean preoperative offset was 37.4±2.5 increased by 12.7±9.6% after the surgery. Only 25.0% of postoperative offset after hemiarthroplasty was changed within ±5% of preoperative offset. A total of 45.0% of postoperative offset changed within ±10% while 77.0% of postoperative offset changed within ±20%. 23% of patients whose FO changed more than 20% showed significantly worse outcome score than the patients whose FO change remained within ±20% of initial value. Mean MBI and HHS were negatively correlated with FO change. After adjusting for confounding factors, significant correlation remained between modification of FO and MBI, but not between FO change and HHS (B=4.576; β=0.235; 95% confidence interval of B: 0.534 to 8.135). FO was not properly restored in 23

  17. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study

    Science.gov (United States)

    Fearon, AM; Stephens, S; Cook, JL; Smith, PN; Neeman, T; Cormick, W; Scarvell, JM

    2012-01-01

    Objective To evaluate if pelvic or hip width predisposed women to developing greater trochanteric pain syndrome (GTPS). Design Prospective case control study. Participants Four groups were included in the study: those gluteal tendon reconstructions (n=31, GTR), those with conservatively managed GTPS (n=29), those with hip osteoarthritis (n=20, OA) and 22 asymptomatic participants (ASC). Methods Anterior-posterior pelvic x-rays were evaluated for femoral neck shaft angle; acetabular index, and width at the lateral acetabulum, and the superior and lateral aspects of the greater trochanter. Body mass index, and waist, hip and greater trochanter girth were measured. Data were analysed using a one-way analysis of variance (ANOVA; posthoc Scheffe analysis), then multivariate analysis. Results The GTR group had a lower femoral neck shaft angle than the other groups (p=0.007). The OR (95% CI) of having a neck shaft angle of less than 134°, relative to the ASC group: GTR=3.33 (1.26 to 8.85); GTPS=1.4 (0.52 to 3.75); OA=0.85 (0.28 to 2.61). The OR of GTR relative to GTPS was 2.4 (1.01 to 5.6). No group difference was found for acetabular or greater trochanter width. Greater trochanter girth produced the only anthropometric group difference (mean (95% CI) in cm) GTR=103.8 (100.3 to 107.3), GTPS=105.9 (100.2 to 111.6), OA=100.3 (97.7 to 103.9), ASC=99.1 (94.7 to 103.5), (ANOVA: p=0.036). Multivariate analysis confirmed adiposity is associated with GTPS. Conclusion A lower neck shaft angle is a risk factor for, and adiposity is associated with, GTPS in women. PMID:22547561

  18. Cementless Stem for Femoral Neck Fractures in a Patient's 10th Decade of Life: High Rate of Periprosthetic Fractures.

    Science.gov (United States)

    Kabelitz, Method; Fritz, Yannick; Grueninger, Patrick; Meier, Christoph; Fries, Patrick; Dietrich, Michael

    2018-01-01

    Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B 2 ) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B 1 and 2 Vancouver A G ) were treated conservatively. One periprosthetic femoral fracture (Vancouver B 1 ) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level III, Therapeutic study.

  19. [Proximal femoral fractures in the elderly: pathogenesis, sequelae, interventions].

    Science.gov (United States)

    Runge, M; Schacht, E

    1999-08-01

    Hip fractures are a health problem of paramount importance for the individual and society. They are associated with a sharp increase of the incidence of immobility, dependency, nursing home placement, and death. In Germany, more than 100,000 elderly suffer a hip fracture every year. 90% of fractures of the proximal femur result from a fall with an impact near the hip. The kinetic energy of a fall from standing height without successful protective reactions is far above the fracture threshold of a femur in a man aged 70 and older, regardless of osteoporosis and sex. Therefore, propensity to fall and mechanisms of falling are more important in the pathogenesis of hip fracture than bone mineral density alone. The combination of age-associated gait and balance disorders, which increase the probability of falls, and age-related decreasing strength of the femur is responsible for the high incidence of hip fractures. Besides the interventions to reduce the fall frequency it is possible to decrease the number of hip fractures by a passive protection of the trochanter. An energy-shunting protector (crash helmet-like, hip padding) has been developed by Lauritzen and Lund (safehip). The protector consists of two stiff shells, sewn into special undergarment. The shells disperse the impact away from the trochanter to soft tissue, and increase the area of contact. A controlled study among nursing home residents has demonstrated a relative risk of hip fracture of 0.44 (95% CC 0.21 to 0.94) in the intervention group, i.e., the protector has reduced the number of hip fractures by more than a half. No hip fracture has happened during use of the protector. Using the protector can improve self-confidence and diminish self-restraint of physical activity, which is not rarely caused by fear of falling. Further investigations of compliance are necessary.

  20. Completed Ulnar Shaft Stress Fracture in a Fast-Pitch Softball Pitcher.

    Science.gov (United States)

    Wiltfong, Roger E; Carruthers, Katherine H; Popp, James E

    2017-03-01

    Stress fractures of the upper extremity have been previously described in the literature, yet reports of isolated injury to the ulna diaphysis or olecranon are rare. The authors describe a case involving an 18-year-old fast-pitch softball pitcher. She presented with a long history of elbow and forearm pain, which was exacerbated during a long weekend of pitching. Her initial physician diagnosed her as having forearm tendinitis. She was treated with nonsurgical means including rest, anti-inflammatory medications, therapy, and kinesiology taping. She resumed pitching when allowed and subsequently had an acute event immediately ceasing pitching. She presented to an urgent care clinic that evening and was diagnosed as having a complete ulnar shaft fracture subsequently needing surgical management. This case illustrates the need for a high degree of suspicion for ulnar stress fractures in fast-pitch soft-ball pitchers with an insidious onset of unilateral forearm pain. Through early identification and intervention, physicians may be able to reduce the risk of injury progression and possibly eliminate the need for surgical management. [Orthopedics. 2017; 40(2):e360-e362.]. Copyright 2016, SLACK Incorporated.

  1. Marine Shaft Steels (AISI 4140 and AISI 5120 Predicted Fracture Toughness by FE Simulation

    Directory of Open Access Journals (Sweden)

    Goran VUKELIC

    2017-02-01

    Full Text Available Optimal selection of material can be considered as one of the most critical steps in engineering design process. That is especially emphasized when dealing with constructions that operate in marine environment; high stresses and harsh operating conditions assert the importance of proper material characterization before its selection. This paper presents comparison of two types of steel usually used in marine shaft manufacturing, chromium-molybdenum steel AISI 4140 and chromium low-alloy steel AISI 5120. Comparison was made using numerically determined J-integral, an important fracture mechanics parameter. J-integral values are determined numerically using finite element (FE stress analysis results of compact tensile (CT and single-edge notched bend (SENB type specimens usually used in standardized J-integral experimental procedures. Obtained J values are plotted versus specimen crack growth values (Δa for different specimen geometries (a/W. Higher resulting values of J-integral for AISI 5120 than AISI 4140 can be noticed. Also, higher a/W ratios correspond to lower J-integral values of materials and vice versa. In addition to that, J-integral values obtained by using FE model of CT specimen give somewhat conservative results when compared with ones obtained by FE model of SENB specimen. Although this procedure differs from experimental analysis, results can be used a suitable fracture parameter value in fracture toughness assessment.DOI: http://dx.doi.org/10.5755/j01.ms.23.1.13823

  2. The use of interlocking prostheses for both temporary and definitive management of infected periprosthetic femoral fractures.

    Science.gov (United States)

    Konan, Sujith; Rayan, Faizal; Manketelow, Andrew R J; Haddad, Fares S

    2011-12-01

    Infected periprosthetic fractures around total hip arthroplasties are an extremely challenging problem. We describe our experience of managing infected periprosthetic femoral fractures using interlocking long-stem femoral prostheses either as temporary functional spacers or as definitive implants. The Cannulock (Orthodesign, Christchurch, United Kingdom) uncoated stem was used in 12 cases, and the Kent hip prosthesis (Biomet Merck, Bridgend, United Kingdom), in 5 cases. Satisfactory outcome was noted in all cases, and in 11 cases, revision to a definitive stem has been undertaken after successful control of infection and fracture union. The use of interlocking stems offers a relatively appealing solution for a complex problem and avoids the complications that would be associated with resection of the entire femur or the use of large quantities of bone cement. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Subchondral Impaction Fractures of the Medial Femoral Condyle in Weightlifters: A Report of 5 Cases.

    Science.gov (United States)

    Grzelak, Piotr; Podgórski, Michał Tomasz; Stefańczyk, Ludomir; Krochmalski, Marek; Domżalski, Marcin

    2016-01-01

    Although subchondral impaction fractures have already been reported in the non-weight-bearing portion of the lateral femoral condyle, this study reveals the presence of an intra-articular impaction fracture of the postero-superior region of the non-weight-bearing portion of the medial femoral condyle recognized in 5 of a group of 22 representatives of the Polish national Olympic weightlifting team, who underwent 1.5T magnetic resonance imaging examination. Articular cartilage lesions varied with regard to the type of injury and its severity ranging from healed or subchronic injuries to acute trauma. All described individuals had no clinical history of acute knee trauma and only 3 of them had minor pain symptoms. The accumulation of microtraumas occurring during participation in particular activities associated with weightlifting training seems to be responsible for the development of this type of contusion. This is the first description of impaction fracture observed in this location in professional weightlifters.

  4. Delayed fixation of displaced bilateral, atraumatic, femoral neck fractures in a patient with pregnancy related osteomalacia.

    Science.gov (United States)

    Docker, Charles; Starks, Ian; Wade, Roger; Wynn-Jones, Charles

    2011-06-01

    We present the case of a woman diagnosed with simultaneous displaced intracapsular femoral neck fractures following the birth of her second child. No traumatic event was identified. Diagnosis was delayed as the cause of her pain was thought to be non-skeletal in origin. Radiological and serological investigations were diagnostic of osteomalacia. Surgical fixation of her fractures was further delayed due to profound hypocalcaemia. Despite the delays, fixation with bilateral dynamic hip screws resulted in union with no evidence of avascular necrosis at 2 years follow-up. We believe this to be the first report of atraumatic bilateral femoral neck fractures and it shows that a good result can be achieved even in the presence of delayed fixation.

  5. Bilateral stress fracture of femoral neck in non-athlete - case report

    Directory of Open Access Journals (Sweden)

    Ubiratan Stefani de Oliveira

    Full Text Available ABSTRACT Bilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment.

  6. Bilateral Femoral Neck Fatigue Fracture due to Osteomalacia Secondary to Celiac Disease: Report of Three Cases.

    Science.gov (United States)

    Selek, Ozgur; Memisoglu, Kaya; Selek, Alev

    2015-08-01

    Bilateral non traumatic femoral neck fatigue fracture is a rare condition usually occurring secondary to medical conditions such as pregnancy, pelvic irradiation, corticosteroid exposure, chronic renal failure and osteomalacia. In this report, we present three young female patients with bilateral femoral neck fracture secondary to osteomalacia. The underlying cause of osteomalacia was Celiac disease in all patients. The patients were treated with closed reduction and internal fixation with cannulated lag screws. They were free of pain and full weight bearing was achieved at three months. There were no complications, avascular necrosis and nonunion during the follow up period. In patients with bone pain, non traumatic fractures and muscle weakness, osteomalacia should be kept in mind and proper diagnostic work-up should be performed to identify the underlying cause of osteomalacia such as celiac disease.

  7. A unique case of nontraumatic femoral neck fracture following epilepsia partialis continua

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    Karl O. Nakken

    2015-01-01

    Full Text Available People with epilepsy are more accident prone than the non-epilepsy population. Bone fractures are most often due to seizure-related falls. However, seizures themselves, in particular generalized tonic-clonic seizures, may also cause fractures, e.g. of the thoracic spine. Here, I present a man who developed focal epilepsy following a subarachnoidal hemorrhage. During a focal motor seizure with left-sided convulsions and preserved consciousness that lasted 2 hrs, he sustained a femoral neck fracture. In persons with low mineral density, as in this case, contractions associated with simple focal motor seizures may be sufficient to give rise to such a severe complication.

  8. Primary Total Hip Replacement for a Femoral Neck Fracture in a Below-Knee Amputee

    OpenAIRE

    Masmoudi, Karim; Rbai, H?di; Fradj, Ayman Ben; Sa?dena, Jecem; Boughattas, Anouar

    2016-01-01

    Introduction: Femoral neck fracture on amputated limb is an uncommon lesion and challenging to manage. Case Report: We report a case of a displaced neck fracture of the left femur in a 57-year-old female. She underwent at the age of the three a below-knee amputation of the ipsilateral limb for post traumatic ischemia. The fracture was managed by a total hip arthroplasty (THA), as a primary procedure. In this article we describe our experience of this unusual entity. Conclusion: Total hip arth...

  9. Estudo epidemiológico das fraturas femorais diafisárias pediátricas Epidemiological study of children diaphyseal femoral fractures

    Directory of Open Access Journals (Sweden)

    Cassiano Ricardo Hoffmann

    2012-04-01

    Full Text Available OBJETIVO: Avaliar as características pessoais, das fraturas e do tratamento e suas complicações em pacientes com fraturas femorais diafisárias pediátricas atendidos no Serviço de Ortopedia Pediátrica do Hospital Infantil Joana de Gusmão. MÉTODOS: Trata-se de estudo retrospectivo e transversal com população composta por pacientes com fraturas diafisárias de fêmur, com idade entre o nascimento e 14 anos e 11 meses, divididos em quatro grupos etários. As informações foram obtidas nos prontuários e transferidas para o questionário de pesquisa que apresentava variáveis pessoais, das fraturas e do tratamento e suas complicações. RESULTADOS: A população do estudo foi composta por 96 pacientes. A média de idade encontrada foi de 6,8 anos. Houve predomínio no sexo masculino, fratura fechada, lado direito, 1/3 médio e traço simples. Quanto à etiologia das fraturas, houve predomínio na amostra global de acidentes de trânsito. A maioria dos pacientes (74-77,1% apresentou fratura de fêmur como lesão isolada. Houve predomínio do tratamento conservador na faixa etária menor que seis anos e do tratamento cirúrgico na faixa etária de seis anos a 14 anos e 11 meses. As complicações observadas até a união óssea foram: discrepância, infecção e limitação de movimento. O tempo médio de consolidação foi de 9,6 ± 2,4 semanas, variando com a idade. CONCLUSÃO: As características das fraturas estudadas foram semelhantes às citadas na literatura e o tratamento empregado apresentou bom resultado. O Hospital Infantil Joana de Gusmão (HIJG tem utilizado o tratamento proposto pela literatura nas fraturas femorais diafisárias pediátricas.OBJECTIVE: To evaluate the personal, fracture, treatment and complication characteristics among patients with pediatric femoral shaft fractures attended at the pediatric orthopedic service of the Joana de Gusmão Children's Hospital. METHODS: This was a retrospective cross-sectional study

  10. Quantitative CT assessment of proximal femoral bone density. An experimental study concerning its correlation to breaking load for femoral neck fractures

    International Nuclear Information System (INIS)

    Buitrago-Tellez, C.H.; Schulze, C.; Gufler, H.; Langer, M.; Bonnaire, F.; Hoenninger, A.; Kuner, E.

    1997-01-01

    Purpose: In an experimental study, the correlation between the trabecular bone density of the different regions of the proximal femur and the fracture load in the setting of femoral neck fractures was examined. Methods: The bone mineral density 41 random proximal human femora was estimated by single-energy quanitative CT (SE-QCT). The trabecular bone density was measured at the greatest possible extracortical volume at midcapital, midneck and intertrochanteric level and in the 1 cm 3 volumes of the centres of these regions in a standardised 10 mm thick slice in the middle of the femoral neck axis (in mg/ml Ca-hydroxyl apatite). The proximal femora were then isolated and mounted on a compression/bending device under two-legged stand conditions and loaded up to the point when a femoral neck fracture occurred. Results: Statistical analysis revealed a linear correlation between the trabecular bone density and the fracture load for the greater regions, with the highest value in the maximal area of the head (coefficient factor r=0.76). Conclusion: According to our data, the measurement of the trabecular bone by SE-QCT at the femoral head is a more confident adjunct than the neck or trochanteric area to predict a femoral neck fracture. (orig.) [de

  11. Localized cortical thickening of the femoral diaphysis captured on an X-ray before alendronate therapy in two cases of atypical femoral fracture

    Energy Technology Data Exchange (ETDEWEB)

    Iizuka, Yoichi [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Shibukawa General Hospital, Department of Orthopedic Surgery, Shibukawa, Gunma (Japan); Takechi, Rumi [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Gunma Cardiovascular Center, Department of Orthopaedic Surgery, Maebashi, Gunma (Japan); Iizuka, Haku; Takagishi, Kenji [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Omodaka, Takuya [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Gunma Central Hospital, Department of Orthopedic Surgery, Maebashi, Gunma (Japan)

    2016-10-15

    We herein report two cases of atypical femoral fracture (AFF). X-ray examinations at the first visit of these two female patients showed a complete fracture of the femoral diaphysis diagnosed as an atypical femoral fracture (AFF). X-rays of these two cases also showed localized cortical thickening of the femoral diaphysis. Both patients had been taking alendronate for more than 3 years because of postmenopausal osteoporosis. We assumed that both of the fractures were associated with the long-term use of alendronate. However, we retrospectively identified localized cortical thickening of the femoral diaphysis on an X-ray taken before the alendronate therapy in both of these cases. Therefore, we suspected a pathogenesis of AFFs in which preexisting stress or an insufficient fracture unrelated to bisphosphonate (BP) therapy and subsequent suppression of bone turnover due to BP administration led to the occurrence of an AFF. The patient underwent surgery using intramedullary nails in both of these cases, followed by the administration of teriparatide, and they were able to walk without any support at the final follow-up examination. (orig.)

  12. Review of a single contemporary femoral neck fracture fixation method in young patients.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-03-01

    An intracapsular femoral neck fracture in a young patient is a rare and difficult injury to manage. The occurrence of complications following fixation is multifactorial. Initial displacement and timing and accuracy of reduction are the key factors affecting outcome. The severities of the trauma to the hip and the impact of the intracapsular hematoma also play a role, the importance of which remains poorly understood. The purpose of this study was to evaluate the high incidence of femoral neck fractures treated in our institution over a 7-month period, to record the long-term outcome of these patients, all of whom were treated with contemporary methods of internal fixation, and to highlight the reasons for this injury being termed an "orthopedic emergency" and its differences from the same injury in the elderly population. We performed a retrospective analysis of 12 cases of intracapsular femur neck fracture in patients younger than 50 years treated over 7 months in a regional trauma center. All patients underwent satisfactory reduction and fixation. Nine of the 12 patients had a good outcome at a mean follow-up of 29 months. One patient developed a nonunion of the femoral head requiring total hip arthroplasty, one developed avascular necrosis of the femoral head, and one developed partial avascular necrosis. This compares favorably with other studies.

  13. [Treatment of trochanteric fractures of the femoral bone].

    Science.gov (United States)

    Wierer, I; Pospísil, M; Holubár, J; Volf, V

    1994-01-01

    The authors present the evaluation of some most often methods of treatment of trochanteric fractures of femur. They analyze the group of 235 patients in the years 1987 - 1991 treated for fractures by the McLaughlin technique and by Ender nailing. The first method was performed on 121 people and the technique of Ender nailing on 97 people. The results and complications of these methods of osteosynthesis are presented in the paper. The experiences of the authors confirm the advantage of Ender nailing in treating fractures of the oldest injured patients. The Ender nailing method of osteosynthesis is the more advantageous, because the operation takes less time and is easier for patients. After Ender nailing, the possibility of functional rehabilitation and walking on crutches is greater. McLaughlin osteosynthesis of these fractures proved the more advantageous in younger injured patients.

  14. Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

    Science.gov (United States)

    Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

    2017-01-01

    [Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, presence of lesser trochanteric displacement, discharge destination, and walking ability were investigated. The relationship between these factors and the period from surgery to discharge was analyzed with logistic regression analysis. [Results] Age and lesser trochanteric displacement were significantly higher in the over-85-day group, and walking ability before fracture and at discharge were significantly lower in the over-85-day group. Logistic regression analysis showed that lesser trochanteric displacement and age were predictors of the length from surgery to discharge. Lesser trochanteric displacement were observed in 87.5% of these. Immediate displacement after surgery occurred in 57.8% of lesser trochanteric fractures, while 26.3% displaced 1 to 3 weeks after surgery. [Conclusion] This study revealed that lesser trochanteric displacement, higher age, and lower walking ability before fracture and at discharge were associated with longer hospitalizations in patients with femoral trochanteric fractures. Lesser trochanteric displacement were observed in 87.5% of lesser trochanteric fractures. These displacements occurred within 3 weeks after surgery in 84.1% of cases. PMID:29200639

  15. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by post-operative SPECT/CT

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sang Won; Oh, Min Young; Yoon, Seok Ho; Kim, Jin Soo; Chang, Jae Suk; Ryu, Jin Sook [Asan Medical CenterUniversity of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Ji Wan [Dept. of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-03-15

    Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2–10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

  16. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by post-operative SPECT/CT

    International Nuclear Information System (INIS)

    Han, Sang Won; Oh, Min Young; Yoon, Seok Ho; Kim, Jin Soo; Chang, Jae Suk; Ryu, Jin Sook; Kim, Ji Wan

    2017-01-01

    Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2–10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients

  17. Callus features of regenerate fracture cases in femoral lengthening in achondroplasia

    International Nuclear Information System (INIS)

    Devmurari, Kamlesh N.; Song, Hae Ryong; Modi, Hitesh N.; Venkatesh, K.P.; Ju, Kim Seung; Song, Sang Heon

    2010-01-01

    We studied the callus features seen in cases of regenerate fracture in femoral lengthening using a monolateral fixator in achondroplasia to determine whether callus types and shapes can predict the probability of callus fracture. The radiographs of 28 cases of femoral lengthening in 14 patients, 14 cases of callus fracture, and 14 cases without callus fracture were retrospectively analyzed by four observers and classified into different shapes and types in concordance with the Ru Li classification. The average lengthening of 9.4 cm (range 7.5-11.8 cm) was achieved, which was 41% (range 30-55%) of the original length and the average timing of callus fracture was 470 days (range 440-545 days) after surgery in the callus fracture group. While the average lengthening of 9.1 cm (range 8-9.7 cm) was achieved, this was 30% (range 28-32%) of the original length in the group of patients without callus fracture. The callus was atypically shaped, there was a 48% average (range 30-72%) reduction of the callus width compared with the natural width of the femur, and a lucent pathway was present in all cases of regenerate fracture. A lucent pathway was seen in all fracture cases with concave, lateral, and atypical shapes, and there was more than 30% lengthening and 30% reduction of the callus width compared with the natural width of the femur, which are the warning signs for regenerate fractures. These signs help the surgeon to predict the outcome and guide him in planning for any additional interventions. The Ru Li classification is an effective method for the evaluation of the chance of callus fracture. (orig.)

  18. Callus features of regenerate fracture cases in femoral lengthening in achondroplasia

    Energy Technology Data Exchange (ETDEWEB)

    Devmurari, Kamlesh N.; Song, Hae Ryong; Modi, Hitesh N.; Venkatesh, K.P.; Ju, Kim Seung; Song, Sang Heon [Korea University Medical College, Institute for Rare Diseases and Department of Orthopedic Surgery, Seoul (Korea)

    2010-09-15

    We studied the callus features seen in cases of regenerate fracture in femoral lengthening using a monolateral fixator in achondroplasia to determine whether callus types and shapes can predict the probability of callus fracture. The radiographs of 28 cases of femoral lengthening in 14 patients, 14 cases of callus fracture, and 14 cases without callus fracture were retrospectively analyzed by four observers and classified into different shapes and types in concordance with the Ru Li classification. The average lengthening of 9.4 cm (range 7.5-11.8 cm) was achieved, which was 41% (range 30-55%) of the original length and the average timing of callus fracture was 470 days (range 440-545 days) after surgery in the callus fracture group. While the average lengthening of 9.1 cm (range 8-9.7 cm) was achieved, this was 30% (range 28-32%) of the original length in the group of patients without callus fracture. The callus was atypically shaped, there was a 48% average (range 30-72%) reduction of the callus width compared with the natural width of the femur, and a lucent pathway was present in all cases of regenerate fracture. A lucent pathway was seen in all fracture cases with concave, lateral, and atypical shapes, and there was more than 30% lengthening and 30% reduction of the callus width compared with the natural width of the femur, which are the warning signs for regenerate fractures. These signs help the surgeon to predict the outcome and guide him in planning for any additional interventions. The Ru Li classification is an effective method for the evaluation of the chance of callus fracture. (orig.)

  19. The impact of high total cholesterol and high low-density lipoprotein on avascular necrosis of the femoral head in low-energy femoral neck fractures.

    Science.gov (United States)

    Zeng, Xianshang; Zhan, Ke; Zhang, Lili; Zeng, Dan; Yu, Weiguang; Zhang, Xinchao; Zhao, Mingdong; Lai, Zhicheng; Chen, Runzhen

    2017-02-17

    Avascular necrosis of the femoral head (AVNFH) typically constitutes 5 to 15% of all complications of low-energy femoral neck fractures, and due to an increasingly ageing population and a rising prevalence of femoral neck fractures, the number of patients who develop AVNFH is increasing. However, there is no consensus regarding the relationship between blood lipid abnormalities and postoperative AVNFH. The purpose of this retrospective study was to investigate the relationship between blood lipid abnormalities and AVNFH following the femoral neck fracture operation among an elderly population. A retrospective, comparative study was performed at our institution. Between June 2005 and November 2009, 653 elderly patients (653 hips) with low-energy femoral neck fractures underwent closed reduction and internal fixation with cancellous screws (Smith and Nephew, Memphis, Tennessee). Follow-up occurred at 1, 6, 12, 18, 24, 30, and 36 months after surgery. Logistic multi-factor regression analysis was used to assess the risk factors of AVNFH and to determine the effect of blood lipid levels on AVNFH development. Inclusion and exclusion criteria were predetermined to focus on isolated freshly closed femoral neck fractures in the elderly population. The primary outcome was the blood lipid levels. The secondary outcome was the logistic multi-factor regression analysis. A total of 325 elderly patients with low-energy femoral neck fractures (AVNFH, n = 160; control, n = 165) were assessed. In the AVNFH group, the average TC, TG, LDL, and Apo-B values were 7.11 ± 3.16 mmol/L, 2.15 ± 0.89 mmol/L, 4.49 ± 1.38 mmol/L, and 79.69 ± 17.29 mg/dL, respectively; all of which were significantly higher than the values in the control group. Logistic multi-factor regression analysis showed that both TC and LDL were the independent factors influencing the postoperative AVNFH within femoral neck fractures. This evidence indicates that AVNFH was significantly

  20. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients.

    Science.gov (United States)

    Ai, Zi-Sheng; Gao, You-Shui; Sun, Yuan; Liu, Yue; Zhang, Chang-Qing; Jiang, Cheng-Hua

    2013-03-01

    Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.

  1. Closed Tibial shaft fractures treated with the Ilizarov method: A ten year case series.

    Science.gov (United States)

    May, Jonathan David; Paavana, Thumri; McGregor-Riley, Jonathan; Royston, Simon

    2017-07-01

    To review the outcomes of patients treated with the Ilizarov method for an isolated, closed, simple diaphyseal, Tibial fracture at our institution over the last decade. The Ilizarov frame database was used to identify 76 skeletally mature patients who sustained an isolated, closed, extra-articular, simple, diaphyseal Tibial fracture; the injury also known as a "nail-able Tibial fracture." The average age of the patient was 38 (17-70). All 76 patients progressed to union. The average time until union was 148 (55-398) days. The coronal and sagittal alignment was 3° (0-17°) and 4° (0-14°) respectively. No patient suffered from compartment syndrome. No patient developed septic arthritis. No patient had documented anterior knee pain or secondary knee specialist input post frame removal. On average, there were 9(4-29) follow up appointments and 10(5-26) radiographs post frame application. There is a 59% chance of a patient having a difficulty post frame application. The malunion rate was 5%. Persisting pinsite infection post frame removal occurred in 5 patients (6.5%). Drilling of the pinsite sequestrum resolved the infection in four of these patients, giving a deep infection rate of 1.3%. The Ilizarov method has a role to play in the treatment of simple closed Tibial shaft fractures in patients who need to kneel. Patient education is a priority however; the patient must be made aware of the difficulty rate associated with the Ilizarov method when compared to the complication profile of alternative treatments. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  2. Acromioclavicular Joint Dislocation with Ipsilateral Mid Third Clavicle, Mid Shaft Humerus and Coracoid Process Fracture - A Case Report.

    Science.gov (United States)

    Sharma, Naveen; Mandloi, Avinash; Agrawal, Ashish; Singh, Shailendra

    2016-01-01

    The clavicle, humerus and acromioclavicular (AC) joint separately are very commonly involved in traumatic injuries around the shoulder. Acromioclavicular joint dislocation with distal clavicle fracture is a well recognized entity in clinical practice. AC joint dislocation with mid shaft clavicle fracture is uncommon and only few cases have been reported in literature. However, to the best of our knowledge, this is the first case report to describe an acromioclavicular dislocation with ipsilateral mid shaft clavicle, mid shaft humerus and coracoid process fracture. Fractures of the humerus and clavicle along with the acromioclavicular joint dislocation were fixed at the same setting. A 65-year-old male met with a high velocity road traffic accident. Plain radiographs showed displaced mid third clavicle fracture with acromioclavicular joint dislocation with mid shaft humerus fracture. Surgical fixation was planned for humerus with interlocking nail, clavicle with locking plate and acromioclavicular joint with reconstruction of coracoclavicular ligaments. Intraoperatively, coracoid process was found to have a comminuted fracture. The operative plan had to be changed on table as coracoclavicular fixation was not possible. So acromioclavicular joint fixation was done using tension band wiring and the coracoclavicular ligament was repaired using a 2-0 ethibond. The comminuted coracoid fracture was managed conservatively. K wires were removed at 6 weeks. Early mobilization was started. In acromioclavicular joint injuries, clavicle must be evaluated for any injury. Although it is more commonly associated with distal clavicle fractures, it can be associated with middle third clavicle fractures. As plain radiographs, AP view are most of the times insufficient for viewing integrity of coracoid process, either special views like Stryker notch or CT scan may help in diagnosing such concealed injuries. When associated with fractures of the humerus and clavicle, anatomical

  3. Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures.

    Science.gov (United States)

    Dong, Wen-Wei; Shi, Zeng-Yuan; Liu, Zheng-Xin; Mao, Hai-Jiao

    2016-12-01

    To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support. Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images. Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

  4. Bilateral Simultaneous Femoral Neck Fracture Mimicking Abdominal Pain in a Cerebral Palsy Patient

    Directory of Open Access Journals (Sweden)

    P. Mariani

    2014-01-01

    Full Text Available Simultaneous bilateral femoral neck fractures are unusual lesions, generally associated with an underlying condition which causes impaired bone mineralization, triggered by an increased bone stress. We present a 24-year-old cerebral palsy patient, who was previously evaluated in another institution due to inability to walk, interpreted as abdominal pain. No alteration in blood analysis or abdominal X-rays was found. As no response to treatment was observed, a new abdominal X-ray was taken, which incidentally depicted bilateral medial femoral neck fracture. He was referred to our practice after a resection arthroplasty was offered in another institution. After admission, bilateral one-stage THA was performed. Several reports emphasize bone disease as a major precipitating factor, and there is an increased incidence of hip fractures in chronic epilepsy, renal osteodystrophy, and chronic steroid use. Femoral head resection has been proven to be effective in immobilized patients, whereas this was not a reasonable option in this patient who presented walking ability. Despite the treatment election, primary care physicians should be aware of and alert to the possibility of fractures in patients with neurological disorders and calcium metabolism alterations. Late diagnosis of orthopedic injuries in this type of patients may lead to permanent disability.

  5. Study of healing process and prognosis of medial femoral neck fracture evaluated by bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, K [Yokohama City Univ. (Japan). Faculty of Medicine

    1981-02-01

    As to healing process and prognosis of femoral neck fracture, radionuclide bone scintigraphy using sup(99m)Tc phosphorus compound was performed and the following results were obtained. 1. In cases of osteosynthesis, scintigraphical study showed a certain serial pattern until fracture was uneventfully healed. 2. On the other hand, in cases with non-union or late segmental collapse of the head, scintigraphy revealed defect at superolateral or central area in the head. This finding could be already noted prior to roentgenographical evaluation. 3. In the study of radionuclide uptake count on the femoral head of resected specimen, the higher value was observed in the area along medial fracture edge to medial margin of the head. Histological study showed feature of increased new bone formation at the area of higher radionuclide uptake. Vascular supply through the bone marrow of the neck and superior retinacular artery was thought to play an important role for the new bone formation. 4. From the aforementioned results, sup(99m)Tc phosphorus compound scintigraphy was considered as one of the quite useful methods for early diagnosis of complications after femoral neck fracture.

  6. Free fibular strut graft in neglected femoral neck fractures in adult

    Directory of Open Access Journals (Sweden)

    Azam Md Quamar

    2009-01-01

    Full Text Available Background: Neglected femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula. The aim of this study was to assess outcome of nonvascularized fibular strut graft and cancellous screw fixation in neglected femoral neck fractures in the younger age group. Materials and Methods: Medical records of 32 patients of neglected femoral neck fracture, in the age group of 22-45 years (mean 37.8 years, operated between May 1994 to December 2001, were retrospectively reviewed. After the application of inclusion and exclusion criteria, 28 patients having three years minimum follow-up (mean 4.6 years were included. Delay between injury and operation varied from four weeks to 42 weeks (mean 16.4 weeks. Closed reduction was achieved in 17 patients; open reduction through Watson-Jones anterolateral approach was performed in the remaining 15 patients in whom closed reduction failed. The fracture was transfixed with three parallel guide wires. Appropriate sized cannulated lag screw (7 mm was then inserted in two of the wires. Selection of the third guide wire for fibula depended on the space available in both anteroposterior and lateral view. Results: Satisfactory bony union was obtained in 25 patients, of whom in four cases, the union occurred in 10-20° (mean 15° of varus. Nonunion occurred in three patients (9.37%, and aseptic necrosis occurred in another six patients (18.75%. Of the 25 patients where union was achieved, five patients showed excellent results; 14 good and six had poor functional result, as evaluated using modified Anglen criteria. Conclusion: Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative procedure for neglected femoral neck fractures in young adults. Fibula

  7. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures.

    Science.gov (United States)

    Houben, I B; Raaben, M; Van Basten Batenburg, M; Blokhuis, T J

    2018-04-09

    The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture. Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression. Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation. 3b.

  8. Sociomedical sequels and quality of life in patients of old age group with proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    T. A. Raskina

    2014-01-01

    Full Text Available The sociomedical significance of osteoporosis is determined by its sequels (vertebral and peripheral skeletal fractures that are responsible for high mortality and disability rates among persons in the old age group and accordingly for high material costs in the health care system.Objective: to study sociomedical sequels and quality of life in patients with proximal femoral fractures in the old age group.Subjects and methods. 956 patients with osteoporotic fractures were followed up. Major social sequels were traced in the patients 6, 12, and 24 months after femur fractures in relation to treatment options.Results. There were 10 (8.0% and 78 (66.7% bedridden patients in the surgical and medical treatment groups, respectively. Twenty four months after fracture, recovery of function was noted in 72 (57.6% and 32 (27.35% patients receiving surgical and medical treatment, respectively.Conclusion. The findings suggest that immediate and late sequels in patients with proximal femoral fractures depend on a treatment option.

  9. Posterior Hip Dislocation with Ipsilateral Femoral Neck Fracture ...

    African Journals Online (AJOL)

    He was managed by bipolar hemiarthroplasty as opposed to total hip athroplasty due to financial constrains. This case highlights the challenge of ... of the knee revealed a communited fracture of the pa- tella at the inferior pole (Fig. 2 2). ... Our case was managed by prosthetic replacement of the proximal femur. This was ...

  10. [Effect factors analysis of knee function recovery after distal femoral fracture operation].

    Science.gov (United States)

    Bei, Chaoyong; Wang, Ruiying; Tang, Jicun; Li, Qiang

    2009-09-01

    To investigate the effect factors of knee function recovery after operation in distal femoral fractures. From January 2001 to May 2007, 92 cases of distal femoral fracture were treated. There were 50 males and 42 females, aged 20-77 years old (average 46.7 years old). Fracture was caused by traffic accident in 48 cases, by falling from height in 26 cases, by bruise in 12 cases and by tumble in 6 cases. According to Müller's Fracture classification, there were 29 cases of type A, 12 cases of type B and 51 cases of type C. According to American Society of Anesthesiologists (ASA) classification, there were 21 cases of grade I, 39 cases of grade II, 24 cases of grade III, and 8 cases of grade IV. The time from injury to operation was 4 hours to 24 days with an average of 7 days. Anatomical plate was used in 43 cases, retrograde interlocking intramedullary nail in 37 cases, and bone screws, bolts and internal fixation with Kirschner pins in 12 cases. After operation, the HSS knee function score was used to evaluate efficacy. Ten related factors were applied for statistical analysis, to knee function recovery after operation in distal femoral fractures, such as age, sex, preoperative ASA classification, injury to surgery time, fracture type, treatment, reduction quality, functional exercise after operation, whether or not CPM functional training and postoperative complications. Wound healed by first intention in 88 cases, infection occurred in 4 cases. All patients followed up 16-32 months with an average of 23.1 months. Clinical union of fracture was achieved within 3-7 months after operation. Extensor device adhesions and the scope of activities of fracture displacement in 6 cases, mild knee varus or valgus in 7 cases and implant loosening in 6 cases. According to HSS knee function score, the results were excellent in 52 cases, good in 15 cases, fair in 10 cases and poor in 15 cases with an excellent and good rate of 72.83%. Single factor analysis showed that age

  11. The Reliability of Classifications of Proximal Femoral Fractures with 3-Dimensional Computed Tomography: The New Concept of Comprehensive Classification

    Directory of Open Access Journals (Sweden)

    Hiroaki Kijima

    2014-01-01

    Full Text Available The reliability of proximal femoral fracture classifications using 3DCT was evaluated, and a comprehensive “area classification” was developed. Eleven orthopedists (5–26 years from graduation classified 27 proximal femoral fractures at one hospital from June 2013 to July 2014 based on preoperative images. Various classifications were compared to “area classification.” In “area classification,” the proximal femur is divided into 4 areas with 3 boundary lines: Line-1 is the center of the neck, Line-2 is the border between the neck and the trochanteric zone, and Line-3 links the inferior borders of the greater and lesser trochanters. A fracture only in the first area was classified as a pure first area fracture; one in the first and second area was classified as a 1-2 type fracture. In the same way, fractures were classified as pure 2, 3-4, 1-2-3, and so on. “Area classification” reliability was highest when orthopedists with varying experience classified proximal femoral fractures using 3DCT. Other classifications cannot classify proximal femoral fractures if they exceed each classification’s particular zones. However, fractures that exceed the target zones are “dangerous” fractures. “Area classification” can classify such fractures, and it is therefore useful for selecting osteosynthesis methods.

  12. A prospective randomized study of operative treatment for noncomminuted humeral shaft fractures: conventional open plating versus minimal invasive plate osteosynthesis.

    Science.gov (United States)

    Kim, Ji Wan; Oh, Chang-Wug; Byun, Young-Soo; Kim, Jung Jae; Park, Ki Chul

    2015-04-01

    To compare the clinical and radiologic results of conventional open plating (COP) and minimally invasive plate osteosynthesis (MIPO) in the treatment of noncomminuted humeral shaft fractures. Randomized prospective study. Five level 1 trauma centers. Sixty-eight consecutive patients were randomized into 2 study groups: those treated by COP (COP group; n = 32) and those treated by MIPO (MIPO group; n = 36). Simple humeral shaft fractures (AO/OTA classification types A and B) were reduced by open reduction or closed reduction and fixed with a narrow 4.5/5.0 locking compression plate, metaphyseal locking compression plate, or proximal humeral internal locking system plate to the anterior lateral aspect of the humerus. Fracture healing time, operative time, radiation exposure time, and intraoperative nerve injury. To assess shoulder and elbow function, we used the University of California, Los Angeles (UCLA) scoring system and the Mayo elbow performance index, including the range of motion and pain. Radiographic measurements included fracture alignment, delayed union, and nonunion. Thirty-one fractures (97%) healed in the COP group within 16 weeks, whereas 36 fractures (100%) were healed in the MIPO group by 15 weeks. No significant difference was observed in the operative time or complication rates. In both groups, all fractures achieved union without malunion and with excellent functional outcomes by definition of the Mayo elbow performance index and UCLA scoring system. This study confirmed a high overall rate of union and excellent functional outcomes in both MIPO and COP groups. MIPO is equivalent to COP as a safe and effective method for simple types of humeral shaft fractures when surgery is indicated, and the surgeon is experienced in the technique. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

  13. Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures

    International Nuclear Information System (INIS)

    Shelmerdine, S.C.; Das, R.; Ingram, M.D.; Negus, S.

    2014-01-01

    Aim: To determine the potential shortfall in skeletal survey referral for children presenting with an acute non-supracondylar humeral or femoral fracture. Materials and methods: Plain radiograph reports were reviewed retrospectively using the radiology information system database over a 5 year study period (May 2008–2013) in children under 18 months of age who presented with an acute fracture. Subsequent skeletal survey referral was used as a surrogate marker for further investigation of child abuse. Application of robust meta-analysis derived probability data regarding likelihood of child abuse as a cause of non-supracondylar humeral or femoral fracture was applied. An estimation of the expected number of cases of abuse, with shortfall in skeletal survey referrals, was then calculated. Results: There were 288 fractures in 281 children. Three children presented with multiple fractures and were considered separately in the present data. The mean patient age was 10.5 months. Nine (3%) non-supracondylar humeral fractures were identified of which four cases may have been due to non-accidental injury (NAI). One (11%) of these patients was referred for a skeletal survey indicating a potential shortfall of three referrals. Twenty-five (9%) femoral fractures were identified of which 13 cases may have been due to NAI, with six (24%) referrals for skeletal surveys generated. This indicates a potential shortfall of seven referrals. Conclusion: The present study serves as a current analysis of practice within a tertiary paediatric referral centre. There appeared to be local under-investigation of NAI. Improved child protection education and awareness programmes have now been introduced. - Highlights: • Long bone fractures in non-ambulatory children carry high probability for child abuse. • Suspicion for child abuse should trigger a referral for a skeletal survey. • We examine the potential shortfall in skeletal survey referrals in such patients. • Only 11% and 24% of

  14. Nonunited humerus shaft fractures treated by external fixator augmented by intramedullary rod

    Directory of Open Access Journals (Sweden)

    Mahmoud A El-Rosasy

    2012-01-01

    Full Text Available Background: Nonunion of humeral shaft fractures after previously failed surgical treatment presents a challenging therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. It would be beneficial to combine the use of external fixation technique and intramedullary rod in the treatment of such cases. The present study evaluates the results of using external fixator augmented by intramedullary rod and autogenous iliac crest bone grafting (ICBG for the treatment of humerus shaft nonunion following previously failed surgical treatment. Materials and Methods: Eighteen patients with atrophic nonunion of the humeral shaft following previous implant surgery with no active infection were included in the present study. The procedure included exploration of the nonunion, insertion of intramedullary rod (IM rod, autogenous ICBG and application of external fixator for compression. Ilizarov fixator was used in eight cases and monolateral fixator in ten cases. The monolateral fixator was preferred for females and obese patients to avoid abutment against the breast or chest wall following the use of Ilizarov fixator. The fixator was removed after clinical and radiological healing of the nonunion, but the IM rod was left indefinitely. The evaluation of results included both bone results (union rate, angular deformity and limb shortening and functional outcome using the University of California, Los Angeles (UCLA rating scale. Results: The mean follow-up was 35 months (range 24 to 52 months. Bone union was obtained in all cases. The functional outcome was satisfactory in 15 cases (83% and unsatisfactory in 3 cases (17% due to joint stiffness. The time to bone healing averaged 4.2 months (range 3 to 7 months. The external fixator time averaged 4.5 months (range 3.2 to 8 months. Superficial pin tract infection occurred in 39% (28/72 of the pins. No cases of nerve palsy, refracture, or deep infection were encountered

  15. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    DEFF Research Database (Denmark)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistics...... underwent osteosynthesis with 2 canulated hip screws and were prescribed regular paracetamol and supplementary opioid rescue analgesia as necessary. Pilot group: 11 patients received one peroperative (30 mL=100 mg) and 6 postoperative bolus installations  (10 mL=100 mg) of open label Ropivacaine through......-74) (p=0.012).   CONCLUSION This pilot-study suggests that intraarticular application of Ropivacaine may reduce opioid requirement after osteosynthesis of femoral neck fracture. However, this is an open pilot study with few patients. We find the results promising and have initiated a double...

  16. Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

    Science.gov (United States)

    Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

    2008-03-01

    Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

  17. Dislocation of total hip replacement in patients with fractures of the femoral neck

    OpenAIRE

    Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

    2009-01-01

    Background Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. Patients and methods We included 713 consecutive hips in a series of 698 p...

  18. Osteosynthesis of femoral neck fractures: dynamic hip screw (DHS or mini-invasive Targon FN system?

    Directory of Open Access Journals (Sweden)

    A. K. Dulaev

    2015-01-01

    Full Text Available Objectives: to investigate the long-term outcomes of femoral neck fractures that were surgically fixed using various types of extramedullary implants in patients aged 65 years and younger. Material and methods: We analyzed the clinical results of surgical treatment of femoral neck fractures by extramedullary osteosynthesis in 94 patients aged 38 to 65 years old (71 women and 23 men. The patients were divided into 3 groups according to AO/ASIF fracture classification. We used different techniques of osteosynthesis: with DHS or with Targon FN. In all patients the mental status rate SPMSQ, osteoporosis degree (Singh index, general somatic status (WHO scale were evaluated in the preoperative period. We also evaluated next intraoperative parameters: duration of surgery, blood loss, quality of reduction, long of incision. In a year after surgery we assessed functional results (Harris Hip Score and analysed postoperative complications. Results: It was found the inverse correlation (r = -0,8 of total preoperative parameters (WHO scale, the Singh index and mental status SPMSQ and postoperative functional results on Harris Hip Score. With the reliability of p<0.05 the average rate of blood loss and length of skin incision were less in patients operated with Targon FN. In 12 months unsatisfactory results rate on Harris Hip Score was 12.7% in all study groups, great - 22,3%, good - 52.1%, and satisfactory - 12,9%. Complications rate in patients operated with DHS was 17,02%, and in patients operated with Targon FN - 18.1%. Conclusion: Minimally invasive osteosynthesis of femoral neck fractures (type B1 and B2 on AO/ASIF classification allows to achieve the best results in compare with DHS osteosynthesis. Revealed complications such as screw migration, false joint formation and femoral head avascular necrosis were determined by impaired surgical technique and inadequate reduction.

  19. Fracture of the femoral component after a lightning strike injury: A case report

    Directory of Open Access Journals (Sweden)

    Xavier Lizano-Díez

    2017-01-01

    Full Text Available A fracture of the stem in a total hip arthroplasty (THA is an uncommon complication. We report a case of femoral stem fracture in a 55-year-old male patient after a lightning strike. A revision was conducted using a Wagner osteotomy and a revision prosthesis. Dall-Milles cerclages were used to close the osteotomy. The postoperative evolution was satisfactory, with an immediate partial weight bearing, consolidation of the osteotomy after three months and return to daily activity without pain.

  20. Omentalisation as adjunctive treatment of an infected femoral nonunion fracture: a case report

    Directory of Open Access Journals (Sweden)

    McAlinden A

    2009-10-01

    Full Text Available Abstract A three-year-old male working border collie with an infected femoral nonunion fracture was managed in a two-stage procedure involving debridement and omentalisation, followed by stabilisation with a bone plate and an autogenous cancellous bone graft. Osseous union was documented radiographically 16 weeks after surgery. Telephone follow-up one year later revealed the dog had returned to full working function without evidence of lameness. To the authors' knowledge, this is the first clinical case described in the veterinary literature using omentalisation as an adjunct to the management of an infected, biologically inactive nonunion fracture.

  1. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures.

    LENUS (Irish Health Repository)

    Manning, Brian J

    2012-02-03

    Although it is widely accepted that aspirin will increase the risk of intra- and post-operative bleeding, clinical studies have not consistently supported this assumption. We aimed to assess the effect of pre-operative aspirin on blood loss and transfusion requirements in patients undergoing emergency fixation of femoral neck fractures. A prospective case-control study was undertaken in patients presenting with femoral neck fractures. Parameters recorded included intra-operative blood loss, post-operative blood loss, transfusion requirements and peri-operative reduction in haemoglobin concentration. Of 89 patients presenting with femoral neck fractures 32 were on long-term aspirin therapy. Pre-operative aspirin ingestion did not significantly affect peri-operative blood loss, or change in haemoglobin concentration or haematocrit. However those patients taking aspirin pre-operatively had a significantly lower haemoglobin concentration and haematocrit and were more likely to be anaemic at presentation than those who were not receiving aspirin. Patients taking aspirin were also more likely to receive blood transfusion post-operatively.

  2. Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck - 10 year study

    Directory of Open Access Journals (Sweden)

    Maini P

    2006-01-01

    Full Text Available Background : One of the most common treatments of displaced fracture of femoral neck in elderly is bipolar hemiarthroplasty. Method : Two hundred and seventy patients of displaced fracture of femoral neck were treated by bipolar hemiarthroplasty. The Mean age of the patients at the time of surgery was 69.80 years. Results : Follow up ranged between 12 months and 120 months. There were 8 cases each of acetabular erosion and protrusion with 10 cases of femoral stem loosening. Eight cases had post operative dislocation requiring open reduction. Eighteen patients got revision surgery to total hip replacement. The overall incidence of DVT/PE was 9.9% which declined after regular use of low molecular weight heparin. Eleven patients had post operative infection. There were 54.2 % excellent results, 21.0 % good results, 10.7 % fair and 3.7% poor results. Conclusion : Elderly patients with displaced fracture of neck femur are able to ambulate early after Cemented bipolar hemi arthroplasty. The complication rate is low, the component survival long and pre injury functional status is restored in majority of patients.

  3. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review

    Directory of Open Access Journals (Sweden)

    Sujit Kumar Tripathy

    2016-01-01

    Full Text Available Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%. Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

  4. Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture

    International Nuclear Information System (INIS)

    Chen, Johnathan; Abel, Mark F.; Fox, Michael G.

    2015-01-01

    Salter Harris II fractures of the distal femur are associated with a high incidence of complications, especially premature physeal closure. Many risk factors for this high rate of premature physeal closure have been proposed. More recently, entrapment of periosteum within the physis has been suggested as an additional predisposing factor for premature physeal closure. The radiographic diagnosis of entrapped soft tissues, including periosteum, can be suggested in the setting of a Salter-Harris II fracture when the fracture does not reduce and physeal widening >3 mm remains. We report a patient who sustained a distal femoral Salter-Harris II fracture following a valgus injury. The patient had persistent distal medial physeal widening >5 mm following attempted reduction. A subsequent MRI revealed a torn periosteum entrapped within the distal femoral physis. Following removal of the periosteum, the patient developed a leg length discrepancy which required physiodesis of the contralateral distal femur. We present this case to raise awareness of the importance of having a high index of suspicion of periosteal entrapment in the setting of Salter-Harris II fractures since most consider entrapped periosteum an indication for surgery. (orig.)

  5. Effects of enviromental temperature and femoral fracture on wound healing in rats.

    Science.gov (United States)

    Crowley, L V; Seifter, E; Kriss, P; Rettura, G; Nakao, K; Levenson, S M

    1977-06-01

    Femoral fracture, unilateral and bilateral, impaired the healing of dorsal skin incisions and formation of reparative granulation tissue in subcutaneously implanted polyvinyl alcohol sponges judged histologically and by breaking strengths and hydroxyproline contents, respectively, 1 week after injury in pair-fed rats kept at 22 degrees C. When rats were transferred to a room at 30 degrees C immediately after skin incision and sponge implants, with or without unilateral fracture, no differences in healing were observed between the two groups. Rats with skin incision, sponge implants, and either femoral fracture or sham-fracture excreted more urinary nitrogen than preoperatively when kept at 22 degrees. Counterpart groups transferred to a 30 degrees room right after operation excreted less urinary nitrogen than preoperatively, but because of lower food intakes postoperatively, the ratio of urinary nitrogen to food intake nitrogen was increased. With equivalent food intakes, pair-fed rats with fracture kept at 22 degrees postoperatively lost more weight and excreted more nitrogen than corresponding rats transfered to a 30 degrees room.

  6. The elderly recognizing themselves as vulnerable to falls in the concreteness of the femoral fracture.

    Science.gov (United States)

    Carvalho, César Junior Aparecido de; Bocchi, Silvia Cristina Mangini

    2017-04-01

    understand the experience of the elderly with falls followed by femoral fracture and elaborate theoretical model of this process of lived experience. qualitative research with theoretical saturation through analysis of the ninth nondirected interview of elderly who underwent such experience. Interviews were recorded, transcribed, and analyzed according to Grounded Theory. three categories emerged (sub-processes): evaluating signs and symptoms of fracture after the fall; feeling sad and insecure with the new condition; and finding oneself susceptible to fractures. From realignment of these categories (sub-processes) we could abstract the central category (process), recognizing oneself as vulnerable to falls in the concreteness of the fracture. the theoretical model considering the Symbolic Interactionism signals the implementation of continued program for fall prevention, with teaching strategies that encourage the elderly to reflect on the concreteness of contexts in which there is risk of occurring injury to their health.

  7. Is Early Appropriate Care of axial and femoral fractures appropriate in multiply-injured elderly trauma patients?

    Science.gov (United States)

    Reich, M S; Dolenc, A J; Moore, T A; Vallier, H A

    2016-09-26

    Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. Between October 2010 and March 2013, 376 consecutive skeletally mature patients with unstable fractures of the pelvis, acetabulum, thoracolumbar spine, and/or proximal or diaphyseal femur fractures were treated at a level I trauma center and were prospectively studied. Patients aged ≤30 years (n = 114), 30 to 60 years (n = 184), and ≥60 years (n = 37) with Injury Severity Scores (ISS) ≥16 and unstable fractures of the pelvis, acetabulum, spine, and/or diaphyseal femur were treated within 36 h, provided they showed evidence of adequate resuscitation. ISS, Glasgow Coma Scale (GCS), and American Society of Anesthesiologists (ASA) classification were determined. Lactate, pH, and base excess (BE) were measured at 8-h intervals. Complications included pneumonia, pulmonary embolism (PE), acute renal failure, acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), deep vein thrombosis, infection, sepsis, and death. Patients ≤30 years old (y/o) were more likely to sustain gunshot wounds (p = 0.039), while those ≥60 y/o were more likely to fall from a height (p = 0.002). Complications occurred at similar rates for patients ≤30 y/o, 30 to 60 y/o, and ≥60 y/o. There were no differences in lactate, pH, or BE at the time of surgery. For patients ≤30 y/o, there were increased overall complications if pH was <7.30 (p = 0.042) or BE <-6.0 (p = 0.049); patients ≥60 y/o demonstrated more sepsis if BE was <-6.0 (p = 0.046). EAC aims to definitively manage axial and femoral shaft fractures once patients have been adequately resuscitated to minimize complications. EAC is associated with comparable complication rates in young and elderly

  8. [New anterolateral approach of distal femur for treatment of distal femoral fractures].

    Science.gov (United States)

    Zhang, Bin; Dai, Min; Zou, Fan; Luo, Song; Li, Binhua; Qiu, Ping; Nie, Tao

    2013-11-01

    To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P > 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 +/- 2.34) weeks in the new approach group and was (13.78 +/- 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 +/- 4.2 in the new approach group, and was 89.2 +/- 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.

  9. Femoral Neck Stress Fractures in Children Younger Than 10 Years of Age.

    Science.gov (United States)

    Boyle, Matthew J; Hogue, Grant D; Heyworth, Benton E; Ackerman, Kathryn; Quinn, Bridget; Yen, Yi-Meng

    2017-03-01

    Femoral neck stress fractures are rare in healthy children, with only 9 cases previously reported. The present article reviews our institutional experience with femoral neck stress fractures in children younger than 10 years of age, to highlight the unique features of this condition. We undertook a retrospective review of clinical records of patients who had been treated at our institution for an idiopathic femoral neck stress fracture between 2000 and 2014. To focus on children rather than adolescents, the World Health Organization's definition of adolescent as a person between 10 and 19 years of age was used; we thereby limited our analysis to patients younger than 10 years of age. The study included 6 patients (3 males, 3 females) treated for an idiopathic femoral neck stress fracture, with a mean age at diagnosis of 7.7 years (range, 5.2 to 8.9 y). All patients presented with a limp, which worsened with activity and had persisted for a mean of 5 weeks (range, 2 to 9 wk). None of the patients had experienced an increase in activity level or sporting volume before symptom onset. On examination, 3 patients experienced pain with terminal hip flexion and 3 patients demonstrated pain-free hip range of motion. Plain radiography demonstrated inferior femoral neck cortical disruption, suggesting a compression-type stress fracture mechanism. The diagnosis was confirmed by cross-sectional imaging in all cases. All patients were initially treated with 6 to 8 weeks of non-weight-bearing followed by 4 to 6 weeks of partial weight-bearing, leading to complete healing in 4 patients. Two patients demonstrated incomplete healing and were managed with spica casting for an additional 6 weeks. Our case series illustrates the unique features of this rare condition in children, with a history and examination profile distinct from those of adolescents and adults. Compliance with weight-bearing restrictions is difficult in this population and hip spica casting may be required to permit

  10. New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures.

    Science.gov (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu

    2017-01-01

    Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be

  11. Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia; Prieto-Alhambra, Daniel

    2016-01-01

    OBJECTIVES: To determine the skeletal safety and efficacy of long term (≥10 years) alendronate use in patients with osteoporosis. DESIGN: Open register based cohort study containing two nested case control studies. SETTING: Nationwide study of population of Denmark. PARTICIPANTS: 61 990 men...... ratio (MPR, a proxy for compliance) >80%) compared with poor adherence (MPR

  12. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis.

    Science.gov (United States)

    Yang, Liqing; Sun, Yuefeng; Li, Ge

    2018-06-14

    Optimal surgical approach for tibial shaft fractures remains controversial. We perform a meta-analysis from randomized controlled trials (RCTs) to compare the clinical efficacy and prognosis between infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures. PubMed, OVID, Embase, ScienceDirect, and Web of Science were searched up to December 2017 for comparative RCTs involving infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures. Primary outcomes were blood loss, visual analog scale (VAS) score, range of motion, Lysholm knee scores, and fluoroscopy times. Secondary outcomes were length of hospital stay and postoperative complications. We assessed statistical heterogeneity for each outcome with the use of a standard χ 2 test and the I 2 statistic. The meta-analysis was undertaken using Stata 14.0. Four RCTs involving 293 participants were included in our study. The present meta-analysis indicated that there were significant differences between infrapatellar and suprapatellar intramedullary nail regarding the total blood loss, VAS scores, Lysholm knee scores, and fluoroscopy times. Suprapatellar intramedullary nailing could significantly reduce total blood loss, postoperative knee pain, and fluoroscopy times compared to infrapatellar approach. Additionally, it was associated with an improved Lysholm knee scores. High-quality RCTs were still required for further investigation.

  13. Trochanteric fragility fractures : Treatment using the cement-augmented proximal femoral nail antirotation.

    Science.gov (United States)

    Neuerburg, C; Mehaffey, S; Gosch, M; Böcker, W; Blauth, M; Kammerlander, C

    2016-06-01

    Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients. Trochanteric fragility fractures (type 31-A1-3). Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures. Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i. e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM™ V(+) into the femoral head-neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level. Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients. A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60 % of patients achieved the mobility level prior to trauma.

  14. Functional Outcome After Antegrade Femoral Nailing : A Comparison of Trochanteric Fossa Versus Tip of Greater Trochanter Entry Point

    NARCIS (Netherlands)

    Moein, Chloe Ansari; ten Duis, Henk-Jan; Oey, Liam; de Kort, Gerard; van der Meulen, Wout; Vermeulen, Karin; van der Werken, Christiaan

    Objectives: This study was performed to explore the relationship between entry point-related soft tissue damage in antegrade femoral nailing and the functional outcome in patients with a proximal third femoral shaft fracture. Design: Retrospective clinical trial. Setting: Level I university trauma

  15. Bilateral avascular necrosis of the femoral head following asynchronous postictal femoral neck fractures: a case report and review of the literature.

    Science.gov (United States)

    Venkatadass, K; Avinash, M; Rajasekaran, S

    2018-05-01

    Bilateral avascular necrosis (AVN) following postictal bilateral fracture neck of the femur is a rare occurrence. Here, we report a case of bilateral AVN of the femoral head following an asynchronous bilateral postictal fracture neck of the femur. A 16-year-old autistic boy presented with left hip pain following an episode of seizures and radiographs showed Delbet type II fracture neck of the left femur. This was treated by closed reduction and cancellous screw fixation and skeletal traction for 6 weeks. At 3 months, follow-up radiograph showed union of the fracture, but he had developed segmental AVN with collapse of the head. At 8 months, the patient presented with pain in the right hip following another episode of seizures and radiograph of the pelvis showed a fresh Delbet type II fracture neck of the right femur with established AVN of the left femoral head. He underwent closed reduction and cancellous screw fixation of the right hip and implant exit of the left hip. At the 6-month follow-up after this surgery, his radiograph of the pelvis showed AVN with collapse and extrusion of the femoral head on the right side as well. Literature review shows an increased risk of fracture neck of the femur among epileptics. The incidence of AVN is maximum in Delbet type I, followed by Delbet type II and type III in that order. Although there are no clear guidelines on the management of post-traumatic AVN of the femoral head, the majority have reported that most of them will eventually develop arthritis and will require total hip replacement at a later date. Upon extensive literature search, no case report of bilateral fracture neck of the femur with bilateral AVN was found and hence this case was reported.

  16. [Preliminary analysis of total cost and life quality for elder patients with femoral neck fracture].

    Science.gov (United States)

    Liu, Haonan; He, Liang; Zhang, Guilin; Gong, Xiaofeng; Li, Ning

    2015-09-01

    To analyze the total cost and life quality of the femoral neck fracture patients who received different surgery and supplement comprehensive data of osteoporotic fracture. One hundred and five patients above 60-year old who were diagnosed femoral neck fracture and received operation in Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital were admitted into our study from August 2013 to December. According to the type of surgery there were 52 and 53 cases in internal fixation (IF) group and hemiarthroplasty (HA) group respectively. At first we collected the medical expense of the patients before and during hospitalization. And then the 1-year medical and non-medical expenses were collected by the cost diary ever 3 months after discharge. At the last follow-up we evaluated the life quality by the EuroQol-5 Dimensions (EQ-5D) and calculated the total cost. Outcome All the patients completed the operation successfully. No nonunion or delayed union cases in IF group, and no cases received revision surgery in both groups. The total average cost was 59 584.9 yuan including 79.1% medical cost and 20.9% non-medical cost. The primary treatment cost accounts for 84.1% of the medical cost. The cost for home care accounts for 90.7% of the non-medical care. The total and medical cost of IF group just account for 40.3% and 38.5% of the HA group and the non-medical showed no significant difference between the 2 groups (P>0.05). In addition the data of life quality and walking capability also showed no significant difference. The main cost for the femoral neck fracture is medical expense in 1-year follow-up. Both surgeries can provide satisfactory outcome, however IF may be more cost-effective compared to the HA because of the less total cost.

  17. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Takahiro; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi [Kyushu Central Hospital, Department of Orthopaedic Surgery, Fukuoka-city (Japan); Yamamoto, Takuaki [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Fukuoka-city (Japan)

    2014-06-15

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction. (orig.)

  18. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria

    International Nuclear Information System (INIS)

    Hamada, Takahiro; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi; Yamamoto, Takuaki

    2014-01-01

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction. (orig.)

  19. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria.

    Science.gov (United States)

    Hamada, Takahiro; Yamamoto, Takuaki; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi

    2014-06-01

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction.

  20. A study on management of extracapsular trochanteric fractures by proximal femoral nail

    Directory of Open Access Journals (Sweden)

    K Ramaprathap Reddy

    2016-01-01

    Full Text Available Background: Trochanteric fractures of femur like intertrochanteric and subtrochanteric fractures are a leading cause of hospital admissions in elderly people. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilizations such as bed sores, deep vein thrombosis, and respiratory infections. This study is done to analyze the surgical management of trochanteric fractures of the femur using a proximal femoral nail (PFN. Methodology: This is a prospective study of 40 cases of trochanteric and subtrochanteric fractures admitted to Government General Hospital, Vijayawada, Andhra Pradesh. Cases were taken according to inclusion and exclusion criteria, i.e., patients with trochanteric fractures femur above the age of 20 years. Medically unsuitable, open fractures and patients not willing for surgery were excluded from the study. Results: Forty percentage of cases were admitted due to slip and fall and with a slight predominance of the right side. Out of 40 cases, 26 were trochanteric, and 14 were subtrochanteric. In trochanteric class, 37.5% were body and griffin Type 2, in subtrochanteric class 12.5% were sinsheimer Type 3a and 10% were 2b. Out of 30 remaining cases, 25 were trochanteric, and 05 were subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 90% cases in subtrochanteric fractures. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of pertrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier, and exactly performed osteosynthesis.

  1. Development of femoral bone fracture model simulating muscular contraction force by pneumatic rubber actuator.

    Science.gov (United States)

    Sen, Shin; Ando, Takehiro; Kobayashi, Etsuko; Miyamoto, Hideaki; Ohashi, Satoru; Tanaka, Sakae; Joung, Sanghyun; Park, Il-Hyung; Sakuma, Ichiro

    2014-01-01

    In femoral fracture reduction, orthopedic surgeons must pull distal bone fragments with great traction force and return them to their correct positions, by referring to 2D-fluoroscopic images. Since this method is physically burdensome, the introduction of robotic assistance is desirable. While such robots have been developed, adequate control methods have not yet been established because of the lack of experimental data. It is difficult to obtain accurate data using cadavers or animals because they are different from the living human body's muscle characteristics and anatomy. Therefore, an experimental model for simulating human femoral characteristics is required. In this research, human muscles are reproduced using a McKibben-type pneumatic rubber actuator (artificial muscle) to develop a model that simulates typical femur muscles using artificial muscles.

  2. Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures

    DEFF Research Database (Denmark)

    Eschen, Jacob; Kring, Søren; Brix, Michael

    2012-01-01

    discouraged their use. There is limited evidence for the use of modern uncemented femoral stems in the treatment of DFNF, and we wished to investigate the clinical and radiographic performance of an uncemented hydroxyapatite coated hemiarthroplasty at 2-year follow-up. Patients and methods: We included 97...... consecutive patients who had an uncemented, hydroxyapatite coated hemiarthroplasty (Corail, Depuy) inserted during a 1-year period. Due to unwillingness or cognitive impairment (n = 6) and death before follow-up (n = 44), a total of 47 patients (39 females) with a mean age of 81 years were available. Results......-up. Conclusion: The results suggest that an uncemented hydroxyapatite coated hemiarthroplasty can be used to treat displaced intracupsular femoral neck fractures with good clinical and radiographic outcomes at short term follow-up....

  3. Assessment of bone quality in the isolated femoral head for intracapsular fractures of the femoral head. Analysis of bone architecture using micro-CT and pQCT, and comparison with extracapsular fractures

    International Nuclear Information System (INIS)

    Sando, Masaru

    2003-01-01

    Block sections were prepared from the five locations, central portion, superior portion, inferior portion, anterior portion, and posterior portion, of the region around the fracture of the femoral head isolated from 21 patients (16 patients with intracapsular fracture, 5 patients with extracapsular fracture). Cancellous bone microstructure, cortical bone thickness, and bone density were evaluated and analyzed for differences in the mechanism from which intracapsular versus extracapsular fracture and fragility developed. The method of evaluating the bone architecture differed from conventional bone histomorphometry of hard tissues and involved non-invasive micro-CT measurements, while the bone density was measured by peripheral quantitative computed topography (pQCT). The results indicate that in comparison to patients with extracapsular fractures, patients with intracapsular fractures showed significant decreases in the trabecular thickness of superior and posterior portions in the cancellous bone. The cortical bone thickness was significantly decreased in the superior portion. Bone density was significantly decreased in the superior portion, while in the extracapsular fracture group density tended to be lower in the inferior, anterior, and posterior portions, although this was not statistically significant. Although there have been previous studies on the bone quality of the femoral head isolated from intracapsular fracture of the femoral head, most reports are of two-dimensional analysis of coronal sections. As far as we are aware, there have been no previous reports comparing individual locations to extracapsular fractures. In view of the various reports that bone density is lower in the extracapsular fracture compared to the intracapsular fracture, we speculate that extracapsular fracture results from the effects of external forces on decreased bone density, while in the intracapsular fracture type, thinning of the superior portion of the cortical bone creates

  4. [Osteoarthritic changes in hip joint in patients with fractures of femoral neck].

    Science.gov (United States)

    Kravtsov, Vladimir; Saranga, Dan; Kidron, Debora

    2013-06-01

    Fractures of proximal femur are common among elderly people. They are associated with considerable morbidity and mortality. Identification of etiopathogenetic factors associated with fractures might facilitate prevention. Osteoporosis is commonly present in the heads of femurs. The prevalence of osteoarthritic changes in hip joints is controversial. Some authorities report low prevalence and even speculate on the protective effect of osteoarthritis against fractures. The goal of the study was to examine the association between osteoarthritic changes (radiologic and histologic) and fractures of the neck of the femur. The patient population included 41 patients undergoing replacement of femoral head for subcapital fracture; their ages ranged from 61 - 93 years of age. Radiologic criteria for osteoarthritis included: (a)narrowing of joint space (b) subchondral sclerosis (c) deformation of head of femur (d) subchondra cysts and (e] osteophytes. Osteoarthritic changes, usually mild, were present in 22 (54%) patients, regardless of age and gender The frequency of radioLogical changes was similar to the general population. HistoLogic findings included subchondral fibrosis and subchondral cysts. Mild subchondral fibrosis was present in 78% of cases. The findings support lack of association between osteoarthritic changes in hip joint and fracture of proximal femur, without a protective effect.

  5. Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, Kenyu; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Sonoda, Kazuhiko; Kubo, Yusuke; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2016-01-15

    The objective of this study was to investigate the common sites of subchondral insufficiency fractures of the femoral head (SIF) based on three-dimensional (3-D) reconstruction of MR images. In 33 hips of 31 consecutive patients diagnosed with SIF, 3-D reconstruction of the bone, fracture, and acetabular edge was performed using MR images. These 3-D images were used to measure the fractured areas and clarify the positional relationship between the fracture and degree of acetabular coverage. The fractured area in the anterior portion was significantly larger than in the posterior area. In 11 cases, the fractures contacted the acetabular edge and were distributed on the lateral portion. The indices of acetabular coverage (center-edge angle and acetabular head index) in these cases were less than the normal range. In the remaining 22 cases, the fractures were apart from the acetabular edge and distributed on the mediolateral centerline of the femoral head. The majority of these cases had normal acetabular coverage. The common site of SIF is the anterior portion. In addition, two types of SIF are proposed: (1) Lateral type: the contact stress between the acetabular edge and lateral portion of the femoral head causes SIF based on the insufficient acetabular coverage, and (2) Central type: the contact stress between the acetabular surface and the mediolateral center of the femoral head causes SIF independent from the insufficiency of acetabular coverage. These findings may be useful for considering the treatment and prevention of SIF. (orig.)

  6. [Early results of proximal femoral fractures treated with FENIX modular hemiarthroplasty].

    Science.gov (United States)

    Görski, Radosław; Górecki, Andrzej; Olszewski, Paweł; Biedrzycki, Jerzy; Skowronek, Paweł

    2010-01-01

    The article discusses preliminary clinical results in patients with proximal femoral fractures treated with hemiarthroplasty using a FENIX implant. The study group comprised 41 subjects aged 69 to 97 (median age 82.3 year). The follow-up study provided data on 26 subjects (63.4%), among which 15 attended the check-up, 5 subjects refused to visit at the Department and 6 subjects were reported as deceased. Median follow-up period amounted to 6.8 month (1 to 22 months). General hospitalization-related complications occurred in 8 patients (19.5%). During hospitalization no deaths occurred, in the deceased group 3 patients died within 12 months after surgery, while another 3 died after the twelve-month postoperative period (median of 13.3%). According to Merle d'Aubigne-Postel score favorable long-term results were observed in 9 patients (59.9%), 13 patients regained the level of motor function similar to the functional ability prior to fracture. The need to postpone the surgery due to general health status and impaired pre-operative motor function are significant negative prognostic factors. The results obtained were compared with previous efficacy studies on femoral fracture treatment using an Austin-Moore implant. Functional ability and self-reliance was higher in the FENIX group. FENIX arthroplasty effectively helps patients regain self-reliance and motor function thanks to its modular characteristics and anatmoical construction.

  7. Minimally invasive plate osteosynthesis for humeral shaft fracture: a reproducible technique with the assistance of an external fixator.

    Science.gov (United States)

    Lee, Hyun-Joo; Oh, Chang-Wug; Oh, Jong-Keon; Apivatthakakul, Theerachai; Kim, Joon-Woo; Yoon, Jong-Pil; Lee, Dong-Joo; Jung, Jae-Wook

    2013-05-01

    Minimally invasive plate osteosynthesis (MIPO) has become a popular option for treatment of humeral shaft fractures. However, indirect reduction might risk unpromising results, with mal-alignment/mal-union or nonunion. The purpose of this study was to describe a reproducible MIPO technique that used an external fixator during the procedure as a tool for reduction and maintenance, and to assess the outcomes in patients with humeral shaft fracture. Of 31 consecutive cases of humeral shaft fracture in 30 patients, 29 were included in this study. There were seven simple (type A) and 22 comminuted (type B or C) fractures. After the insertion of one Schanz pin on each proximal and distal humerus, a provisional reduction was achieved by connecting the pins with a monolateral external fixator. The MIPO procedure was then performed over the anterior aspect of the humerus. To evaluate the efficacy of the provisional reduction by external fixator, coronal and sagittal alignments were assessed. We also assessed bony and functional results, including complications, from this technique. There was no case of mal-union >10°, and mean angulation was 1.3° (range 0°-9°) in the coronal plane and 1.2° (range 0°-8°) in the sagittal plane. Twenty-eight of 29 fractures were united, including three delayed unions, with a mean union time of 19.1 weeks (range 12.3-38.4 weeks) and a mean follow-up of 20.8 months (range 13.5-31.0 months). There was one hypertrophic nonunion that healed after fixing with two additional screws. Except one patient with associated injury in the elbow, all patients recovered to pre-injury joint motion. There were two cases of postoperative radial nerve palsy that both recovered completely. We attributed them to manipulation, and not to the Schanz pins or plate fixation. Surgical treatment of humeral shaft fractures with external fixator-assisted reduction and MIPO resulted in excellent reductions and high union rates.

  8. Reassessment of osteoporosis-related femoral fractures and economic burden in Saudi Arabia.

    Science.gov (United States)

    Sadat-Ali, Mir; Al-Dakheel, Dakheel A; Azam, Md Q; Al-Bluwi, Mohammed T; Al-Farhan, Mohammed F; AlAmer, Hussein A; Al-Meer, Zakaria; Al-Mohimeed, Abdallah; Tabash, Ibrahim K; Karry, Maher O; Rassasy, Yaseen M; Baragaba, Mohammed A; Amer, Ahmed S; AlJawder, Abdallah; Al-Bouri, Kamil M; ElTinay, Mohammed; Badawi, Hamed A; Al-Othman, Abdallah A; Tayara, Badar K; Al-Faraidy, Moaad H; Amin, Ahmed H

    2015-01-01

    The current study reassesses the prevalence of fragility fractures and lifetime costs in the Eastern Province of Saudi Arabia. Forty-two percent (391) of the fractures were at the neck of the femur, and 38.6 % (354) were inter-trochanteric fractures. The overall incidence was assessed to be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). A National Fracture Registry and osteoporosis awareness programs are recommended. Proximal femur fragility fractures are reported to be increasing worldwide due to increased life expectancy. The current study is carried out to assess the incidence of such fractures in the Eastern Province of Saudi Arabia and to assess the costs incurred in managing them annually. Finally, by extrapolating the data, the study can calculate the overall economic burden in Saudi Arabia. The data of fragility proximal femur fractures was collected from 24 of 28 hospitals in the Eastern Province. The data included age, sex, mode of injury, type of fracture, prescribed drug (and its cost), and length of hospital stay. Population statistics were obtained from the Department of Statistics of the Saudi Arabian government Web site. Twenty-four hospitals (85 %) participated in the study. A total of 780 fractures were sustained by 681 patients. Length of stay in the hospital averaged 23.28 ± 13.08 days. The projected fracture rate from all the hospitals would be 917 (an incidence of 5.81/1000), with a total cost of SR68.77 million. Further extrapolation showed that the overall incidence could be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). Osteoporosis-related femoral fractures in Saudi Arabia are significant causes of morbidity besides incurring economic burden. We believe that a National Fracture Registry needs to be established, and osteoporosis awareness programs should be instituted in every part of Saudi Arabia so that these patients can

  9. Bilateral femoral neck fractures resulting from pregnancy-associated osteoporosis showed bone marrow edema on magnetic resonance imaging.

    Science.gov (United States)

    Kasahara, Kyoko; Kita, Nobuyuki; Kawasaki, Taku; Morisaki, Shinsuke; Yomo, Hiroko; Murakami, Takashi

    2017-06-01

    Femoral neck fractures resulting from pregnancy-associated osteoporosis is a rare condition. Herein, we report an undoubted case of pregnancy-associated osteoporosis in a 38-year-old primiparous patient with pre-existing anorexia nervosa who suffered bilateral femoral neck fractures in the third trimester and early post-partum period. Magnetic resonance imaging revealed femoral neck fractures as well as diffuse marrow edema involving both femoral heads, which are considered under ordinary circumstances as characteristic imaging findings of transient osteoporosis of the hip. Based on our experience, we propose that pregnancy-associated osteoporosis might be present in femoral neck fractures attributed to transient osteoporosis of the hip in pregnancy. Conversely, bone status should be carefully and accurately estimated in cases of potential transient osteoporosis of the hip in pregnancy to reduce future fracture risk. © 2017 The Authors Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.

  10. Real frequency of ordinary and atypical sub-trochanteric and diaphyseal fractures in France based on X-rays and medical file analysis.

    Science.gov (United States)

    Beaudouin-Bazire, Constance; Dalmas, Noémie; Bourgeois, Julie; Babinet, Antoine; Anract, Philippe; Chantelot, Christophe; Farizon, Frédéric; Chopin, Florence; Briot, Karine; Roux, Christian; Cortet, Bernard; Thomas, Thierry

    2013-03-01

    Atypical sub-trochanteric and femoral shaft fractures have been reported in patients treated with bisphosphonates. Their incidence has been determined from registered data analysis using international codes. Therefore, the aim of our study was to estimate the real frequency of typical and atypical sub-trochanteric or diaphyseal fractures, based on radiological and clinical data compared to registered data. In the registers of three large French University Hospitals, patients identified with International Classification of Diseases, 10th Revision diagnosis codes for sub-trochanteric or diaphyseal fracture were selected. Frequencies of ordinary and atypical fractures were calculated after both registered data, radiological and clinical files analysis. Among the 4592 patients hospitalized for a femoral fracture over 5 years, 574 were identified to have had a sub-trochanteric or femoral shaft fracture. 47.7% of the sub-trochanteric and femoral shaft fractures were misclassified, predominantly in the sub-trochanteric fractures subset. 12 patients had an atypical fracture (4% of the sub-trochanteric and femoral shaft fractures) and 11 fractures presented radiological features of atypical fractures, whereas clinical files analysis revealed they were pathological or traumatic fractures. Atypical fractures frequency is very low. Because of their low frequency and the unreliability of registered databases, the risk of atypical fractures is very difficult to estimate retrospectively. A prospective study is needed to clarify the risk factors associated with these fractures. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  11. Is the lateral radiograph necessary for the management of intra-capsular proximal femoral fractures?

    International Nuclear Information System (INIS)

    Korim, Muhammad Tawfiq; Mohan Reddy, Venthurla Ram; Gibbs, David; Wildin, Clare

    2012-01-01

    Aims: To investigate if a lateral hip radiograph is always needed in the management of intra-capsular proximal femoral fractures. Furthermore, we sought to evaluate if a radiographer could accurately identify cases in which the lateral radiograph is not required. Methods: All patients who underwent surgical management of an intra-capsular proximal femoral fracture over a 3 month period at our unit were identified. Radiographs were reviewed by 6 observers: 2 consultant orthopaedic surgeons, 2 registrars, and 2 radiographers. Initially the observers viewed the AP radiographs alone and classified the fractures into displaced, undisplaced, or unclear categories. They were then shown the lateral view and asked for a diagnosis and management plan. Comparison of diagnosis and management based on AP views alone, and AP in-combination with a lateral view was made. Results: 90 patients were included; the mean age was 80.8 years with a range of 42–100 years. 73 underwent arthroplasty and 17 had internal fixation. All observers, including the radiographer were able to make a surgical decision in 90% of the cases based on AP views alone. Lateral radiographs improved the diagnostic accuracy by 6%. The availability of the lateral view did not alter the management in patients where the AP clearly demonstrated a displaced fracture. Conclusion: Elderly patients with a displaced intra-capsular fracture identifiable on the AP do not require a lateral radiograph. Such patients can be accurately identified by the radiographer. Patient discomfort experienced during positioning for the lateral view would be avoided, and a financial saving made.

  12. Avascular necrosis of the femoral head following trochanteric fractures in adults: a systematic review.

    Science.gov (United States)

    Barquet, Antonio; Mayora, Gabriel; Guimaraes, Joao Matheus; Suárez, Roberto; Giannoudis, Peter V

    2014-12-01

    Avascular necrosis of the femoral head (ANFH) following trochanteric fractures (TFx) is infrequent. The causal relationship between ANFH and TFx remains controversial. Although several major risk factors for ANFH have been proposed, most of them remain under discussion. In this study we undertook a systematic review of the literature to investigate the incidence of AVN, risk factors and outcomes following Tfx fixation. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of ANFH and series of TFx with or without cases of ANFH published between inception of journals to December 2013 were eligible for inclusion. Relevant information was divided in two sections. Part I: included the analysis of detailed case reports of ANFH, either published isolated or included in series of TFx, with the objective of establishing potential risk factors, clinical and radiological presentation, time to development, treatment and outcome of this complication. Part II: analyzed series of TFx, which included cases of ANFH with or without details of aetiology, treatment modalities and outcomes, with the objective of assessing the incidence of ANFH in TFx. Overall 80 articles with 192 cases of ANFH after TFx met the inclusion criteria. The most probable developmental pathway appears to be a disruption of the extra osseous arterial blood supply to the femoral head. Suggested risk factors included high-energy trauma with fracture comminution and displacement, and an atypical course of the fracture line, more proximal, at the base of the neck. Most cases were diagnosed within the first two years after fracture. The clinical and radiological features appear to be similar to those of idiopathic avascular necrosis of the femoral head. The incidence of AVFH with a minimum of 1-year follow-up was calculated 0.95%, and with a minimum 2-year follow-up it was 1.37%. Total hip replacement was the mainstay of treatment. The

  13. Internal fixation and muscle pedicle bone grafting in femoral neck fractures

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    Gupta A

    2008-01-01

    Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

  14. Angiographic findings of demineralised bone matrix grafts in femoral fracture repair in canines*

    International Nuclear Information System (INIS)

    Kumar, R.V.S.; Ramakrishna, O.

    2000-01-01

    Demineralised bone matrix implants and autogenous cancellous bone grafts were evaluated in femoral fracture repair with bone loss in canines, and compared to untreated animals. Angiograms were taken at 3,6,9 and 12 weeks post- operatively using conrary-420 as contrast medium. Early angiograms showed leakage of contrast medium into soft tissue. Grafted groups showed slight hypervascularity and enhanced capillary network. At 12 Weeks the same groups observed nearly normal persistent vascular supply. Early establishment of cortices continuity and draining of contrast medium via extraosseous veins was observed in demineralized bone matrix implanted groups

  15. Bilateral subcapital femoral neck fractures secondary to transient osteoporosis during pregnancy: a case report.

    Science.gov (United States)

    Emami, Mohammad Jafar; Abdollahpour, Hamid Reza; Kazemi, Ali Reza; Vosoughi, Amir Reza

    2012-08-01

    Transient osteoporosis during pregnancy is a rare, self-limiting disease. We report on a 36-year-old woman who had bilateral subcapital femoral neck fractures during the 6th month of pregnancy. The diagnosis was made 4 days after delivery, because radiography was declined by the patient for fear of radiation. Fixation was not feasible owing to bone resorption, and 2-stage bipolar hemiarthroplasty was therefore performed. Magnetic resonance imaging is the best non-invasive investigative tool for pregnant women with hip pain. Early detection can prevent complications and resorting to major surgeries.

  16. Flexible Intramedullary Nailing for Paediatric Shaft of Femur Fractures – Does the Number of Nails Alter the Outcome?

    Directory of Open Access Journals (Sweden)

    B Kanthimathi

    2011-07-01

    Full Text Available BACKGROUND: The use of flexible intramedullary nailing, allowing micro movement at the fracture site, results in excellent outcomes regardless of the number of nails used. We undertook analysis of the outcomes of flexible nailing with reference to the number of nails used. METHODS: Twenty patients with diaphyseal femur fracture aged 5-15 years were treated with retrograde flexible intramedullary nailing. The number of nails varied from single to multiple. The results were analysed with regard to the number of nails used. RESULTS: The mean patient age was 7.9 years; patients were followed up for a mean duration of 13.2 months. Those with two and three nails had similar results. CONCLUSION: A minimum of two flexible nails is needed for optimal fixation in paediatric femur shaft fractures. Also, limiting the number of implants to two is cost effective, decreases operative time, reduces radiation exposure and offers equal results to that of three nails.

  17. Osteoporosis among hospitalized patients with proximal femoral fractures in Assiut University Trauma Unit, Egypt.

    Science.gov (United States)

    Farouk, Osama; Mahran, Dalia G; Said, Hatem G; Alaa, Mohamed M; Eisa, Amr; Imam, Hisham; Said, G Z

    2017-12-01

    The study was done to investigate osteoporosis prevalence in 275 hip fracture admissions at the Trauma Unit of Assiut University Hospitals and associated factors, which are understudied in our locality. Prevalence was 74.9%. Female sex, older age, low body mass index, and fall on the ground were associated with osteoporosis. This study aims to identify osteoporosis prevalence in hip fracture admissions at the Trauma Unit of Assiut University Hospitals and to study the independent correlates of osteoporosis-related fracture. A prospective cross-sectional study was carried out in 275 hip fracture patients admitted to the Trauma Unit of Assiut University Hospitals from January through December 2014 of both sexes aged 50 years and older. Exclusion criteria were polytrauma, major accidents, and history of chronic conditions and long-term medication associated with osteoporosis risk increase and bilateral hip fractures. For every patient, weight, height, and bone mineral density by dual-energy x-ray absorptiometry (DEXA) were recorded. Tests of significance for non-parametric data were used. The questionnaire included sociodemographic characteristics, dietary habits, lifestyle factors such as smoking and physical activity, and female obstetric and gynecological factors. Mean age was 70.82 ± 11.02 SD; 51.6% were males and 8.4% were obese. Fall on ground was in 81.1% of fractures. Osteoporosis (femoral neck T score ≤ -2.5 SD) prevalence was 74.9%. By univariable analysis, significant correlates were female gender, older age, normal BMI, and fall on the ground. Milk and cheese daily intake was significantly associated with lower prevalence of osteoporosis. In a multivariable logistic regression model, female sex, older age, low BMI, and fall on the ground were associated with osteoporosis. Osteoporosis prevalence is high among hip fracture patients and associated with female sex, increase in age, low BMI, and fall on ground. Strategies to prevent osteoporosis are

  18. Treatment options for unstable trochanteric fractures: Screw or helical proxima femoral nail.

    Science.gov (United States)

    Bajpai, Jeetendra; Maheshwari, Rajesh; Bajpai, Akansha; Saini, Sumit

    2015-01-01

    To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN. The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2&31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2&A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk inde- pendently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN. Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening>1 cm buttrochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.

  19. Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression

    Energy Technology Data Exchange (ETDEWEB)

    Hackney, Lauren A.; Joseph, Gabby B.; Link, Thomas M. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Lee, Min Hee [University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Vail, Thomas P. [University of California, Department of Orthopaedic Surgery, San Francisco, CA (United States)

    2016-06-15

    To characterize the morphology and imaging findings of femoral head subchondral insufficiency fractures (SIF), and to investigate clinical outcomes in relation to imaging findings. Fifty-one patients with hip/pelvis magnetic resonance (MR) images and typical SIF characteristics were identified and reviewed by two radiologists. Thirty-five patients had follow-up documentation allowing assessment of clinical outcome. Subgroup comparisons were performed using regression models adjusted for age and body mass index. SIF were frequently associated with cartilage loss (35/47, 74.5 %), effusion (33/42, 78.6 %), synovitis (29/44, 66 %), and bone marrow oedema pattern (BMEP) (average cross-sectional area 885.7 ± 730.2 mm{sup 2}). Total hip arthroplasty (THA) was required in 16/35 patients, at an average of 6 months post-MRI. Compared to the THA cohort, the non-THA group had significantly (p < 0.05) smaller overlying cartilage defect size (10 mm vs. 29 mm), smaller band length ratio and fracture diameters, and greater incidence of parallel fracture morphology (p < 0.05). Male gender and increased age were significantly associated with progression, p < 0.05. SIF were associated with synovitis, cartilage loss, effusion, and BMEP. Male gender and increased age had a significant association with progression to THA, as did band length ratio, fracture diameter, cartilage defect size, and fracture deformity/morphology. (orig.)

  20. Progression of a fracture site impaction as a prognostic indicator of impacted femoral neck fracture treated with multiple pinning.

    Science.gov (United States)

    Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p articulo-trochanteric distance index between 6 weeks and 3 months (p articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.

  1. Femoral nerve damage (image)

    Science.gov (United States)

    The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

  2. How elderly patients with femoral fracture develop pressure sores in hospital.

    Science.gov (United States)

    Versluysen, M

    1986-01-01

    The routine hospital management of 100 consecutive elderly patients was studied to determine the reason for the high incidence of pressure sores among patients admitted to hospital for femoral fractures. Of these patients, 66 developed sores, 83% occurring by the fifth day in hospital. This was due to the long periods that patients were immobilised on high pressure surfaces in the casualty department, wards, and theatres before repair of the fracture and restoration of their weight bearing function. Sores are not simply a ward or nursing problem, but an unintended consequence of hospital treatment. To reduce the incidence of sores elderly patients should be treated on low pressure patient support systems from the point of entry to hospital until mobility is restored. PMID:3085827

  3. The application of PRP combined with TCP in repairing avascular necrosis of the femoral head after femoral neck fracture in rabbit.

    Science.gov (United States)

    Zhang, X-L; Wang, Y-M; Chu, K; Wang, Z-H; Liu, Y-H; Jiang, L-H; Chen, X; Zhou, Z-Y; Yin, G

    2018-02-01

    In view of the high occurrence of avascular necrosis of the femoral head (ANFH) after femoral neck fracture and the difficulties in the treatment, our work aimed to explore the effects of platelet-rich plasma (PRP) combined with tri-calcium phosphate (TCP) on the repair of ANFH after femoral neck fracture and to provide reference for clinical treatment. Thirty New Zealand white rabbits were randomly divided into control group, TCP group, and PRP+TCP group. The rabbit ANFH model was established and femoral head tissues were collected. HE staining was used for histological observation. Image analysis and statistical analysis were used to calculate the New Bone Area fraction (NBA %). The levels of bone morphogenetic protein (BMP)-7, transforming growth factor (TGF)-β1, basic fibroblast growth factor (bFGF), interleukin (IL)-6 and tumor necrosis factor (TNF)-a in serum were detected by Enzyme-Linked ImmunoSorbent Assay (ELISA). The new bone area of TCP group was significantly lower than that of PRP+TCP group (pPRP+TCP groups (pPRP+TCP group was higher than that in TCP group. TCP and PRP+TCP can both significantly reduce the content of IL-6 and TNF-a (pPRP+TCP group compared with the TCP group at 8 weeks after injection. PRP combined with TCP, which can promote new bone formation and inhibit inflammatory response, showed higher efficiency in repairing ANFH than internal fixation alone.

  4. Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric

    Directory of Open Access Journals (Sweden)

    Tânia Maria da Silva Mendonça

    2008-01-01

    Full Text Available OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years, 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36 at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.

  5. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

    Directory of Open Access Journals (Sweden)

    D D Baksi

    2016-01-01

    Full Text Available Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8-30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG were excluded. Thus, out of 244 patients, 208 (85.3% untreated nonunion and 36 (14.7% following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN femoral head was found histologically in 135 (54.3% and radiologically in 48 (19.7% patients. The patients were operated by open reduction of fracture

  6. Treatment of open tibial shaft fracture with soft tissue and bone defect caused by aircraft bomb--case report.

    Science.gov (United States)

    Golubović, Zoran; Vidić, Goran; Trenkić, Srbobran; Vukasinović, Zoran; Lesić, Aleksandar; Stojiljković, Predrag; Stevanović, Goran; Golubović, Ivan; Visnjić, Aleksandar; Najman, Stevo

    2010-01-01

    Aircraft bombs can cause severe orthopaedic injuries. Tibia shaft fractures caused by aircraft bombs are mostly comminuted and followed by bone defects, which makes the healing process extremely difficult and prone to numerous complications. The goal of this paper is to present the method of treatment and the end results of treatment of a serious open tibial fracture with soft and bone tissue defects resulting from aircraft bomb shrapnel wounds. A 26-year-old patient presented with a tibial fracture as the result of a cluster bomb shrapnel wound. He was treated applying the method of external bone fixation done two days after wounding, as well as of early coverage of the lower leg soft tissue defects done on the tenth day after the external fixation of the fracture. The external fixator was removed after five months, whereas the treatment was continued by means of functional plaster cast for another two months. The final functional result was good. Radical wound debridement, external bone fixation of the fracture, and early reconstruction of any soft tissue and bone defects are the main elements of the treatment of serious fractures.

  7. [Clinical analysis of LPFP, PFNA and BPH in treating femoral intertrochanteric fractures in elderly patients].

    Science.gov (United States)

    Zhu, Li-Jun; Li, Xiao-Fei; Liu, Chao; Lyu, Cheng-Yu

    2017-07-25

    To evaluate the clinical results of locking proximal femur plate(LPFP), proximal femoral nail antirotation(PFNA) and bipolar hemiarthroplasty(BPH) in the treatment of femoral intertrochanteric fractures in elderly patients. Retrospective analysis of the 86 elderly patients with femoral intertrochanteric fractures during June 2011 and August 2016 were enrolled in this study. The patients were divided into 3 groups: 26 cases in LPFP group included 10 males and 16 females with an average age of (72.54±4.78) years old, 5 cases of type II of Evans, 12 cases of type III and 9 cases of type IV; 39 cases in PFNA group included 17 males and 22 females with an average age of 74.41±5.65, 11 cases of type II, 18 cases of type III and 10 cases of type IV; 21 cases in BPH group included 9 males and 12 females with an average age of 76.23±6.97, 1 case of type II, 10 cases of type III and 10 cases of type IV. The data of three groups were collected for statistical analysis on the following aspects: operation time, intraoperative blood loss, the length of hospital stay, postoperative complications and Harris score of the hip joint function. The wound healed well and no complication occurred. Eighty-four cases were follow-up, while 2 cases were lost, the follow-up rate was 97.6%. The patients were followed up for 22 to 41 months with an average of 26.3 months. For comparison of operation time and time of the hospital stay, BPH group was shorter than the LPFP and PFNA group( F =19.782, 21.981, P BPH group was less blood loss than the LPFP and PFNA group( F =12.976, P 0.05). For comparison of the postoperative complications, LPFP group was higher than BHP and PFNA group( F =30.976, P 0.05). For comparison of the Harris score of the hip joint at 1 year after operation, BPH and PFNA group were both higher than LPFP group( F =19.692, P BPH and PFNA group ( t =4.971, P >0.05). For elder patient with femoral intertrochanteric fracture, BPH could be the best optional for the shorter

  8. Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN Versus Dynamic Hip Screw(DHS

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    Cyril Jonnes

    2016-01-01

    Full Text Available Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral nail (PFN, in Type II intertrochanteric fractures (Boyd and Griffin classification. This study was done to compare the functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures.   Methods: From October 2012 to March 2015, a prospective comparative study was done where 30 alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris Hip Score and radiological findings were compared at 3, 6, and 12 months postoperatively. Results: The average age of the patients was 60 years. In our series we found that patients with DHS had increased intraoperative blood loss (159ml, longer duration of surgery (105min, and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (73ml, shorter duration of surgery (91min, and allowed early mobilization. The average limb shortening in DHS group was 9.33 mm as compared with PFN group which was only 4.72 mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups. Conclusion: PFN is better than DHS in type II inter-trochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.

  9. Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture.

    Science.gov (United States)

    Goode, H. F.; Burns, E.; Walker, B. E.

    1992-01-01

    OBJECTIVE--To evaluate the contribution of specific nutritional deficiencies (as indicated by zinc; vitamin A, C, and E; albumin; and haemoglobin concentrations) to the risk of pressure sores. DESIGN--Observational cohort study. SETTING--St James's University Hospital, Leeds. SUBJECTS--21 elderly patients presenting consecutively to the orthopaedic unit with femoral neck fracture. MAIN OUTCOME MEASURE--Full thickness epidermal break over a pressure bearing surface. RESULTS--10 patients (48%) developed a pressure sore during their hospital stay. Indices of zinc status and concentrations of albumin, haemoglobin, and vitamins A and E were similar in patients who developed a pressure sore and those who did not. Mean leucocyte vitamin C concentration, however, was 6.3 (SD 2.2) micrograms/10(8) cells in patients who developed a pressure sore as compared with 12.8 (4.6) micrograms/10(8) cells in patients who did not. CONCLUSIONS--Low concentrations of leucocyte vitamin C appear to be associated with subsequent development of pressure sores in elderly patients with femoral neck fractures. PMID:1458073

  10. Treatment for Trochanteric Fracture of the Femur with Short Femoral Nail: A Comparison between the Asian Intramedullary Hip Screw (IMHS) and the Conventional IMHS.

    Science.gov (United States)

    Kawaji, Hidemi; Uematsu, Takuya; Oba, Ryosuke; Satake, Yoshihiko; Hoshikawa, Naoya; Takai, Shinro

    2016-01-01

    We usually use short femoral nails for the treatment of trochanteric fracture of the femur. In this retrospective study, we investigated and compared the clinical results of the conventional intramedullary hip screw (IMHS) and the Asian IMHS, which is a redesigned version of the former. The subjects were 42 patients; 21 treated with the Asian IMHS and 21 were treated with the conventional IMHS. From the clinical records, we retrospectively investigated the patients' age, sex, in-hospital waiting period for operation, operating time, intraoperative blood loss, walking ability before fracture and at discharge, and complication pertaining to the operation. The 21 patients (4 men and 17 women) receiving the Asian IMHS and the 21 patients (5 men and 16 women) receiving the conventional IMHS did not differ significantly in mean age, sex ratio, preoperative waiting period, mean postoperative hospital stay, mean operation time, or mean intraoperative blood loss. Among patients receiving the Asian IMHS, the complications of intraoperative fractures of the femur developed in 3 patients and breakage of the implant occurred in 1 patient. No complications occurred in patients receiving the conventional IMHS. Compared with the conventional IMHS, the Asian IMHS is smaller, has increased variations in the shaft/neck angle of the lag screw, and has a titanium-alloy construction, allowing magnetic resonance imaging. The intraoperative fracture may have occurred because of the configuration of the distal interlocking screw in the Asian IMHS. Breakage of the implant likely occurred because the nail was too small in diameter, and too short in length for the unstable AO 31-A3 fracture. If careful attention is paid to the configuration of its distal interlocking screw intraoperatively and a nail of appropriate size is selected, the Asian IMHS is better suited than the conventional IMHS for treating Japanese patients, who generally have a small physique, because of its many variations in

  11. Development and application of computer assisted optimal method for treatment of femoral neck fracture.

    Science.gov (United States)

    Wang, Monan; Zhang, Kai; Yang, Ning

    2018-04-09

    To help doctors decide their treatment from the aspect of mechanical analysis, the work built a computer assisted optimal system for treatment of femoral neck fracture oriented to clinical application. The whole system encompassed the following three parts: Preprocessing module, finite element mechanical analysis module, post processing module. Preprocessing module included parametric modeling of bone, parametric modeling of fracture face, parametric modeling of fixed screw and fixed position and input and transmission of model parameters. Finite element mechanical analysis module included grid division, element type setting, material property setting, contact setting, constraint and load setting, analysis method setting and batch processing operation. Post processing module included extraction and display of batch processing operation results, image generation of batch processing operation, optimal program operation and optimal result display. The system implemented the whole operations from input of fracture parameters to output of the optimal fixed plan according to specific patient real fracture parameter and optimal rules, which demonstrated the effectiveness of the system. Meanwhile, the system had a friendly interface, simple operation and could improve the system function quickly through modifying single module.

  12. Opioid Usage During Admission in Hip Fracture Patients-The Effect of the Continuous Femoral Nerve Block

    DEFF Research Database (Denmark)

    Helsø, Ida; Jantzen, Christopher; Lauritzen, Jes Bruun

    2016-01-01

    INTRODUCTION: The aim of this study was to investigate whether there was a difference in opioid usage during admission for hip fracture patients with continuous femoral nerve block (cFNB) when compared to patients nonfemoral nerve block (nFNB). METHODS AND MATERIALS: Patients were identified from...... the local database on all hip fracture patients admitted to Bispebjerg University Hospital, Denmark. Four hundred fifty-six hip fracture patients were included during the period September 2008 to October 2010. RESULTS: Three hundred sixty-six hip fracture patients had cFNB. The mean time with cFNB was 3...

  13. Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle.

    Science.gov (United States)

    Parry, Joshua A; Barrett, Ian; Schoch, Bradley; Yuan, Brandon; Cass, Joseph; Cross, William

    2018-04-01

    To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout. Retrospective comparative study. Level I trauma center. Patients treated with a CMN for unstable pertrochanteric femur fractures (OTA/AO 31-A2.2 and 31-A2.3) between 2005 and 2014. CMN fixation. NSA reduction and lag screw cutout. Patients fixed with a nail angle less than their native NSA were less likely to have good reductions [17% vs. 60%, 95% confidence interval (CI), -63% to -18%; P = 0.0005], secondary to more varus reductions (41% vs. 10%, 95% CI, 9%-46%; P = 0.01) and more fractures with ≥4 mm of displacement (63% vs. 35%, 95% CI, 3%-49%; P = 0.03). The cutout was not associated with the use of a nail angle less than the native NSA (60% vs. 76%, 95% CI, -56% to 18%; P = 0.5), varus reductions (60% vs. 32%, 95% CI, -13% to 62%; P = 0.3), or poor reductions (20% vs. 17%, 95% CI, -24% to 44%; P = 1.0). The fixation of unstable pertrochanteric hip fractures with a nail angle less than the native NSA was associated with more varus reductions and fracture displacement but did not affect the lag screw cutout. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  14. Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team.

    Science.gov (United States)

    VandenBerg, James; Osei, Daniel; Boyer, Martin I; Gardner, Michael J; Ricci, William M; Spraggs-Hughes, Amanda; McAndrew, Christopher M

    2017-06-01

    To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team. Retrospective cohort study. A single level 1 trauma center. Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015. Flap coverage for open tibia shaft fractures treated before ("preintegration") and after ("postintegration") implementation of an integrated orthopaedic trauma/microsurgical team. Time from index injury to flap coverage. The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9-8.1) preintegration, and 6 days (95% confidence interval, 4.6-7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23). After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  15. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years.

    Science.gov (United States)

    Song, Hyung Keun; Choi, Ho June; Yang, Kyu Hyun

    2016-12-01

    The aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. We conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50-97 years), with a mean follow-up of 21.4 months (range, 12-64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. FIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p15° (B1.1.2) compared to patients with 15° are reasonable candidates for primary arthroplasty due to high risk of FIT. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Close Intramedullary Interlocking Nailing Versus Locking Compression Plating In the Treatment of Closed Fracture Shaft of the Tibia.

    Science.gov (United States)

    Kundu, I K; Datta, N K; Chowdhury, A Z; Das, K P; Tarik, M M; Faisal, M A

    2016-07-01

    Fracture of tibial shaft is the commonest site of long bone fractures due to its superficial location involving young or middle-age people. Proper management is an important issue regarding the future effective movements. In this study patients were grouped in closed Intra medullary interlocking nailing and locking compression plating. Post-operative follow up at 2 weeks, 6 weeks, 12 weeks and 3 months thereafter up to 6 months were done. Each of the patients was evaluated clinically and radiologically by tucker criteria of Tuker et al. Patients were assessed for pain on full weight bearing and kneeling, shortening and range of motion of knee and ankle joints. Radiological assessment for union of fracture, alignment of fracture and angulations and position of nail and screws and infection were observed during follow up. A total number of 32 patients were selected but only 27 patients were available for follow up for a period of 6 months. They were grouped into Group A, consisting of 15 patients who took the treatment in the form of closed intramedullary interlocking nailing and Group B, consisting of 12 patients those underwent ORIF with locking compression plating. In both of the groups Motor Vehicle Accident was the main mechanism of trauma. Fracture involving the middle 3rd of the tibia is common in both the groups. During post-operative follow up, four patients in Group A complained anterior knee pain, one patient in Group B had superficial infection, most of the patients had no restriction of movement in the ankle and knee joints and a single patient in Group B showed 1.5cm shortening of the lower limb. Period of hospital stay and fracture union time were less in Group A, which was statistically significant. Both groups showed excellent result with minimum complications. So this study permits to conclude that close IM interlocking nailing and open reduction and internal fixation by locking compression plating is equally effective for the management of close

  17. Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures? A biomechanical analysis in cadaveric bone.

    Science.gov (United States)

    Hawks, Michael A; Kim, Hyunchul; Strauss, Joseph E; Oliphant, Bryant W; Golden, Robert D; Hsieh, Adam H; Nascone, Jason W; O'Toole, Robert V

    2013-10-01

    We assessed the biomechanical performances of a trochanteric lag screw construct and a traditional inverted triangle construct in the treatment of simulated Pauwels type 3 femoral neck fractures. An inverted triangle construct (three 7.3-mm cannulated screws placed in inverted triangle orientation) and a trochanteric lag screw construct (two 7.3-mm cannulated screws placed across the superior portion of the femoral neck and one 4.5-mm lag screw placed perpendicular to the fracture in superolateral to inferomedial orientation) were tested in nine matched pairs of non-osteoporotic human cadaveric femora. We used a previously described vertically oriented femoral neck fracture model and testing protocol that incrementally loaded the constructs along the mechanical axis of the femur to 1400 N. Specimens that survived incremental loading underwent cyclic loading. Apparent construct stiffness, force at 3mm of displacement, and survival of incremental loading were recorded. The trochanteric lag screw group had a 70% increase in stiffness (261 N/mm [29 standard deviation] versus 153 N/mm [16 standard deviation]; P=0.026) and a 43% increase in force required for displacement (620 N versus 435 N; P=0.018) compared with the inverted triangle group. One trochanteric lag screw and no inverted triangle specimen survived incremental loading. A trochanteric lag screw construct applied to vertically oriented femoral neck fractures provides marked improvement in mechanical performance compared with the inverted triangle construct. © 2013.

  18. Large diameter metal on metal total hip replacement for femoral neck fractures with neurological conditions A retrospective assessment

    Directory of Open Access Journals (Sweden)

    Jia Li

    2014-01-01

    Conclusion: We believe the use of L-MoM can diminish the rate of instability or dislocation, after operation. The L-MoM is an option for patients with Parkinson′s disease and poliomyelitis with femoral neck fracture.

  19. Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series

    Directory of Open Access Journals (Sweden)

    Rahul M Salunkhe

    2012-01-01

    Full Text Available Context: Inter-trochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure with internal fixation with dynamic hip screw has been found to be high, especially in osteoporotic bones. Revision osteo-synthesis is technically demanding and leads to complications. Aim: To assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis. Settings and Design: A Case series of 50 cases. Materials and Methods: We divided these fractures into three groups and accordingly the prosthesis was used. Group 1- intact calcar and lesser trochanter non-communited-AMP type of bipolar prosthesis, Group 2- fracture of calcar - Thompson′s type of bipolar prosthesis with calcar reconstruction, Group 3- group 2 + instability of postero-medial wall-modular type bipolar prosthesis with lesser trochanter and calcar reconstruction. Greater trochanter, calcar, and lesser trochanter were reconstructed with encirclage, tension band wiring, fashioned bone graft, or bone cement collar accordingly. Results: In our study of 50 cases with mean age 79.57 years, 20 cases were type 1, 19 type 2, and 11 type 3 fractures. The average Harris hip score was 79. Excellent to fair results were obtained at follow-up in 46 (92% and in 4 (8% results were poor. The mean Harris hip score was 83 (good in Group- I, 79 (Fair in Group- II, and 72 (Fair in Group- III patients. Average hospital stay was 12.5 days. There were four cases of superficial operative site infection which were treated with short course of oral antibiotics. Four cases died of medical complications, earliest being 3 months, and latest being 18 months. No case of loosening of the prosthesis, break in the cement or sinking of prosthesis was seen.

  20. Bilateral Incomplete Atypical Femoral Fracture due to Long-Term Bisphosphonate Use: A Case Report

    Directory of Open Access Journals (Sweden)

    Sibel Başaran

    2017-08-01

    Full Text Available Although the overall safety profile of bisphosphonates (BP is favorable, adverse effects associated with long-term use have came up during recent years. In this report, a case of bilateral incomplete atypical femoral fracture (AFF due to prolonged BP use was presented. A 69-year-old patient, who has been in surgical menopause for 20 years and was started on BP following vertebral fracture almost 10 years ago, was admitted with thigh pain, which was increased two weeks ago. On physical examination, she had antalgic gait, increased thoracic kyphosis and tenderness to percussion over the thoracolumbar region. Lateral cortical thickness in the subtrochanteric region of both femurs and cortical radiolucency on the left femur were observed on plain radiography. Loss of height in L3 and L4 vertebrae was detected on vertebral radiography. Serum 25-hydroxy vitamin D [25(OHD], parathyroid hormone, alkaline phosphatase and calcium levels, along with osteoporosis markers were all within the normal ranges. As the patient was diagnosed with AFF, BP therapy was terminated and vitamin D-calcium supplementation was continued. Since she did not have severe pain, conservative management (limited weight bearing, using a walking stick was recommended for 3 months. Teriparatide therapy was started and she was discharged with recommendations. AFF, which is a rare disorder, should be kept in mind in patients on long-term BP treatment who are admitted with thigh pain and, necessary interventions should be tailored before the occurrence of complete fracture.

  1. A PROSPECTIVE STUDY ON FUNCTIONAL OUTCOME OF HUMERUS SHAFT FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH DYNAMIC COMPRESSION PLATE AND SCREWS

    Directory of Open Access Journals (Sweden)

    Vidyadhar S. Donimath

    2017-12-01

    Full Text Available BACKGROUND Fracture of the humerus shaft accounts to 3% to 5% of all fractures. Majority of the fractures are unstable due to distraction force of the gravity in the upper limb and strong muscle contraction leading to displacement. Internal fixation and early mobilisation is more stressed on than splinting and prolonged immobilisation to allow earlier mobilisation and rapid return to work. The aim of the study was to study the union rates and the functional outcome and complications associated with shaft humerus fractures in KIMS Hospital. MATERIALS AND METHODS A prospective study which was carried out from October 2015 to September 2017 in Karnataka Institute of Medical Sciences, Hubballi, Karnataka State, India. In this study period, 25 cases of fracture shaft of the humerus were treated by open reduction and internal fixation using DCP. Skeletally mature patients with fresh humerus diaphysis fractures were included in the study. Pathological fractures and Tscherne grade 2 and above, Gustilo Anderson type2 and above were excluded from the study. RESULTS In our series of 25 cases, there were 21 men and 4 women with average age of 42.5 years. Sixteen (64% cases were due to RTA and with predominance of right side. Transverse fractures were most common that is 15 (60% patients. Eleven (31% cases were having associated injuries. 92% of the fractures united with good to excellent outcome. There were 2 (8% cases of non-union due to infection and comminution. CONCLUSION Open reduction and internal fixation with dynamic compression plate is still the standard treatment of choice for fracture shaft of humerus achieving excellent to good functional outcome.

  2. Shaft-Condylar Angle for surgical correction in neglected and displaced lateral humeral condyle fracture in children.

    Science.gov (United States)

    Mulpruek, Pornchai; Angsanuntsukh, Chanika; Woratanarat, Patarawan; Sa-Ngasoongsong, Paphon; Tawonsawatruk, Tulyapruek; Chanplakorn, Pongsthorn

    2015-09-01

    To assess the outcome after using the Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fractures in children presented 3-weeks after injury. Ten children, with delayed presentation of a displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain a smooth articular surface with an intraoperative SCA of nearly 40° and nearest-anatomical carrying angle. They were allocated into two groups according to the postoperative SCA [Good-reduction group (SCA=30-50°), and Bad-reduction group (SCA50°)] and the final outcomes were then compared. All fractures united without avascular necrosis. The Good-reduction group (n=7) showed a significant improvement in final range of motion and functional outcome compared to the Bad-reduction group (n=3) (p=0.02). However, there was no significant difference in pain, carrying angle and overall outcome between both groups. SCA is a possible intraoperative reference for sagittal alignment correction in late presented displaced lateral humeral condyle fractures.

  3. Shared human-chimpanzee pattern of perinatal femoral shaft morphology and its implications for the evolution of hominin locomotor adaptations.

    Directory of Open Access Journals (Sweden)

    Naoki Morimoto

    Full Text Available Acquisition of bipedality is a hallmark of human evolution. How bipedality evolved from great ape-like locomotor behaviors, however, is still highly debated. This is mainly because it is difficult to infer locomotor function, and even more so locomotor kinematics, from fossil hominin long bones. Structure-function relationships are complex, as long bone morphology reflects phyletic history, developmental programs, and loading history during an individual's lifetime. Here we discriminate between these factors by investigating the morphology of long bones in fetal and neonate great apes and humans, before the onset of locomotion.Comparative morphometric analysis of the femoral diaphysis indicates that its morphology reflects phyletic relationships between hominoid taxa to a greater extent than taxon-specific locomotor adaptations. Diaphyseal morphology in humans and chimpanzees exhibits several shared-derived features, despite substantial differences in locomotor adaptations. Orangutan and gorilla morphologies are largely similar, and likely represent the primitive hominoid state.These findings are compatible with two possible evolutionary scenarios. Diaphyseal morphology may reflect retained adaptive traits of ancestral taxa, hence human-chimpanzee shared-derived features may be indicative of the locomotor behavior of our last common ancestor. Alternatively, diaphyseal morphology might reflect evolution by genetic drift (neutral evolution rather than selection, and might thus be more informative about phyletic relationships between taxa than about locomotor adaptations. Both scenarios are consistent with the hypothesis that knuckle-walking in chimpanzees and gorillas resulted from convergent evolution, and that the evolution of human bipedality is unrelated to extant great ape locomotor specializations.

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

    Science.gov (United States)

    Christie, J; Howie, C R; Armour, P C

    1988-03-01

    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.

  5. Influence of bone density and surgical treatment choice on failure of femoral neck fracture

    DEFF Research Database (Denmark)

    Viberg, Bjarke

    (bipolar vs. unipolar), cement, coating, and stem design In the literature there seems to be no difference in risk of failure when comparing unipolar HA with bipolar HA, the surgical approach, or the surgeons experience. However, there is an increased risk of failure associated with lower patient age, male...... gender, and with some uncemented stem designs. One of the papers in thesis finds a higher failure rate for older uncemented HA compared to cemented HA, especially after 5-10 years. The uncemented HA do not seem to benefit from hydroxy-apatite coating when failure rates for the uncemented HA were compared...... to those of the cemented HA. Generally, in studies assessing failure, the sample sizes are too small to detect small risk of increased failure, since the increased mortality in femoral neck fracture patients are not taken into account....

  6. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome

    Energy Technology Data Exchange (ETDEWEB)

    Plett, Sara K.; Hackney, Lauren A.; Heilmeier, Ursula; Nardo, Lorenzo; Zhang, Chiyuan A.; Link, Thomas M. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); Yu, Aihong [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Beijing (China)

    2015-12-15

    To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures, bone marrow infarct, osteochondritis dissecans, or underlying tumor. Two board-certified musculoskeletal radiologists classified morphologic findings including lesion diameter, associated bone marrow edema pattern, and associated cartilage/meniscus damage. Electronic medical charts were evaluated for symptoms, risk factors, and longitudinal outcomes, including total knee arthroplasty (TKA). Imaging characteristics were correlated with clinical findings, and comparison of outcome groups was performed using a regression model adjusted for age. The majority of patients with FCIF were women (64.4 %, 47/73), on average 10 years older than men (66.28 ± 15.86 years vs. 56.54 ± 10.39 years, p = 0.005). The most common location for FCIF was the central weight-bearing surface of the medial femoral condyle; overlying full thickness cartilage loss (75.7 %, 53/70) and ipsilateral meniscal injury (94.1 %, 64/68) were frequently associated. Clinical outcomes were variable, with 23.9 % (11/46) requiring TKA. Cartilage WORMS score, adjacent cartilage loss, and contralateral meniscal injury, in addition to decreased knee range of motion at presentation, were significantly associated with progression to TKA (p < 0.05). FCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression. (orig.)

  7. The Direct Anterior Approach Does Not Increase Return to Function Following Hemiarthroplasty for Femoral Neck Fracture.

    Science.gov (United States)

    Carlson, Victor R; Ong, Alvin C; Orozco, Fabio R; Lutz, Rex W; Duque, Andres F; Post, Zachary D

    2017-11-01

    The purpose of this study was to evaluate functional outcomes for hemiarthroplasty using a direct anterior approach or a direct lateral approach for femoral neck fracture. This retrospective review used data collected from a single institution between 2006 and 2016. Eighty-five and 75 consecutive patients who underwent hemiarthroplasty via a direct anterior approach and a direct lateral approach, respectively, met inclusion criteria. All patients with femoral neck fractures were treated by 1 of 2 fellowship-trained orthopedic surgeons using the direct anterior approach or the direct lateral approach to hemiarthroplasty. Disposition, ambulation, and other perioperative surgical outcomes were compared between the cohorts. Compared with the direct lateral cohort, the direct anterior cohort had a shorter mean operative time (2.4 minutes, P<.01), a shorter mean length of hospital stay (2.7 days, P<.01), and a smaller mean decrease in hemoglobin postoperatively (0.7 g/dL, P<.01). No significant difference was observed between the cohorts for postoperative disposition, the number of feet ambulated on the second postoperative day, or the prevalence of ambulatory decline at 4- to 6-week and 4- to 6-month follow-up visits. Compared with the direct lateral approach, the direct anterior approach may benefit patients by small, but statistically significant, improvements in blood loss, surgical time, and length of hospital stay after hemiarthroplasty. However, the direct anterior approach does not appear to decrease the likelihood of transfer to a skilled nursing facility postoperatively or accelerate return to preoperative function. [Orthopedics. 2017; 40(6):e1055-e1061.]. Copyright 2017, SLACK Incorporated.

  8. Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

    Directory of Open Access Journals (Sweden)

    Tanaka Motoyuki

    2012-08-01

    Full Text Available Abstract We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249

  9. Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

    Science.gov (United States)

    2012-01-01

    We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249 PMID:22906214

  10. Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures

    Directory of Open Access Journals (Sweden)

    A. P. Barabash

    2013-01-01

    Full Text Available The comparative analysis of the results of the surgical treatment of 130 patients with closed comminuted unilateral diaphyseal femoral fractures, including assessment of anatomic functional outcomes of treatment according to the technique of the standardized investigations in traumatology and orthopedy and determination of quality of life according to SF-36 method is carried out. Osteosynthesis with the help of external fixation devices was performed in 36 patients, intramedullary interlocking osteosynthesis - in 57 patients, compression plating - in 37 patients. Level of anatomic functional rehabilitation of the patients in the early postoperative period made up 69-79 %, 6 months later increased up to 74-92%, and after the expiration of 12 months the level of rehabilitation reached 85-99%. During the treatment quality of life concerning physical component was within the limits from 36,8 up to 55,5 %, and concerning mental component - 54,3-60,8 %. After the expiration of a year increase in the parameters of physical and mental components up to 55,7 - 59,8 % and 57,2-65,8 % is detected respectively. In the group where the transosseous osteosynthesis technique was applied we got 93,7-95 % of positive outcomes, with the average disability period of 212,3±18,1 days. In 47,2 % of cases the following complications are observed: knee contracture - 7; inflammation of the soft tissues located near the transosseous fixators - 5 (13,9%; shortening of the limb less than 5% of its length - 3; false joint formation - 1; fracture union with formation of varus deformity in the femoral bone - 1. When using intramedullary interlocking osteosynthesis we had positive results in 96,5 % of cases, with the average period of disability 176±17,8 days. In 10,5 % cases the following complications are observed: suture sinus - 1(1,75 %; femoral osteomyelitis - 1; break of the design - 1; false joint formation - 1; knee contracture - 1; shortening of the limb less than 5

  11. Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur

    Directory of Open Access Journals (Sweden)

    Rachel Cherian Koshy

    2010-01-01

    Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

  12. The bridge crane mechanism shaft reliability calculating in case of the fatigue fracture parameters correlation

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    Krutitskiy M.N.

    2016-03-01

    Full Text Available The method of statistical tests examines the impact of the correlation of the parameters of fatigue-such as the durability of the shaft mechanism of an overhead traveling crane for General use is under consideration in this article. It is be-lieved that the normal and shear stresses together affect the overall durability of the shaft. There may be a correlation between endurance limits and coefficients of block similarity of loading. To calculate resource used corrected linear theory of fatigue damage accumulation. Parameters on the reliability are computed after building the function, the reli-ability function directly or through private functions the reliability function for each type of stress.

  13. A new angle and its relationship with early fixation failure of femoral neck fractures treated with three cannulated compression screws.

    Science.gov (United States)

    Zhang, Y L; Zhang, W; Zhang, C Q

    2017-04-01

    The Pauwels angle has been used widely, however an accurate evaluation of this angle is difficult because of deformity of the affected lower extremity. Therefore we designed a new measurement of the orientation of femoral neck fracture and applied this in a retrospective study to assess: (1) its reproducibility, (2) its advantages compared with the Pauwels angle, (3) its relationship with the short-term prognosis treated with three cannulated compression screws. This new measurement is reproducible and has some reference meaning for the treatment of femoral neck fractures. Two hundred and twenty-eight patients with femoral neck fractures treated with three cannulated compression screws were retrospectively analyzed. The VN angle, which was the angle between the fracture line and the vertical of the neck axis, and the Pauwels angle were measured respectively. The method of ICC was performed to assess the reproducibility of the two angles, and the absolute value of difference in pre-operative and post-operative radiographs was used to evaluate the uniformity of the two angles. These fractures were divided into four groups according to VN angle (VN50°) were respectively 0%, 1.46% (95% CI: 1.42-1.50) and 36.24% (95% CI: 34.93-37.54). The VN angle has a good inter-rater reproducibility, a higher reliability than the Pauwels angle and is closely related to the short-term prognosis of femoral neck fractures treated with cannulated compression screws. Level IV, retrospective diagnostic study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Influence of bone mineral density and hip geometry on the different types of hip fracture.

    Science.gov (United States)

    Li, Yizhong; Lin, Jinkuang; Cai, Siqing; Yan, Lisheng; Pan, Yuancheng; Yao, Xuedong; Zhuang, Huafeng; Wang, Peiwen; Zeng, Yanjun

    2016-01-01

    The aim of this study was to assess the influence of bone mineral density and hip geometry on the fragility fracture of femoral neck and trochanteric region. There were 95 menopausal females of age ≥ 50 years with fragility fracture of hip, including 55 cases of femoral neck fracture and 40 cases of trochanteric fracture. Another 63 non-fractured females with normal bone mineral density (BMD) were chosen as control. BMD, hip axis length, neck-shaft angle and structural parameters including cross surface area, cortical thickness and buckling ratio were detected and compared. Compared with control group, the patients with femoral neck fracture or trochanteric fractures had significantly lower BMD of femoral neck, as well as lower cross surface area and cortical thickness and higher buckling ratio in femoral neck and trochanteric region. There were no significant differences of BMD and structural parameters in the femoral neck fracture group and intertrochanteric fracture group. Hip axis length and neck-shaft angle were not significantly different among three groups. The significant changes of BMD and proximal femur geometry were present in the fragility fracture of femoral neck and trochanteric region. The different types of hip fractures cannot be explained by these changes.

  15. Influence of bone mineral density and hip geometry on the different types of hip fracture

    Directory of Open Access Journals (Sweden)

    Yizhong Li

    2016-01-01

    Full Text Available The aim of this study was to assess the influence of bone mineral density and hip geometry on the fragility fracture of femoral neck and trochanteric region. There were 95 menopausal females of age ≥ 50 years with fragility fracture of hip, including 55 cases of femoral neck fracture and 40 cases of trochanteric fracture. Another 63 non-fractured females with normal bone mineral density (BMD were chosen as control. BMD, hip axis length, neck-shaft angle and structural parameters including cross surface area, cortical thickness and buckling ratio were detected and compared. Compared with control group, the patients with femoral neck fracture or trochanteric fractures had significantly lower BMD of femoral neck, as well as lower cross surface area and cortical thickness and higher buckling ratio in femoral neck and trochanteric region. There were no significant differences of BMD and structural parameters in the femoral neck fracture group and intertrochanteric fracture group. Hip axis length and neck-shaft angle were not significantly different among three groups. The significant changes of BMD and proximal femur geometry were present in the fragility fracture of femoral neck and trochanteric region. The different types of hip fractures cannot be explained by these changes.

  16. Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation?

    Science.gov (United States)

    Lichstein, Paul M; Kleimeyer, John P; Githens, Michael; Vorhies, John S; Gardner, Michael J; Bellino, Michael; Bishop, Julius

    2018-04-24

    A well-reduced femoral neck fracture is more likely to heal than a poorly reduced one, and increasing the quality of the surgical exposure makes it easier to achieve anatomic fracture reduction. Two open approaches are in common use for femoral neck fractures, the modified Smith-Petersen and Watson-Jones; however, to our knowledge, the quality of exposure of the femoral neck exposure provided by each approach has not been investigated. (1) What is the respective area of exposed femoral neck afforded by the Watson-Jones and modified Smith-Petersen approaches? (2) Is there a difference in the ability to visualize and/or palpate important anatomic landmarks provided by the Watson-Jones and modified Smith-Petersen approaches? Ten fresh-frozen human pelvi underwent both modified Smith-Petersen (utilizing the caudal extent of the standard Smith-Petersen interval distal to the anterosuperior iliac spine and parallel to the palpable interval between the tensor fascia lata and the sartorius) and Watson-Jones approaches. Dissections were performed by three fellowship-trained orthopaedic traumatologists with extensive experience in both approaches. Exposure (in cm) was quantified with calibrated digital photographs and specialized software. Modified Smith-Petersen approaches were analyzed before and after rectus femoris tenotomy. The ability to visualize and palpate seven clinically relevant anatomic structures (the labrum, femoral head, subcapital femoral neck, basicervical femoral neck, greater trochanter, lesser trochanter, and medial femoral neck) was also recorded. The quantified area of the exposed proximal femur was utilized to compare which approach afforded the largest field of view of the femoral neck and articular surface for assessment of femoral neck fracture and associated femoral head injury. The ability to visualize and palpate surrounding structures was assessed so that we could better understand which approach afforded the ability to assess structures that

  17. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    DEFF Research Database (Denmark)

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael

    2009-01-01

    BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral...... radiographs and investigated its association with later reoperation. PATIENTS AND METHODS: A consecutive series of 113 patients, > or = 60 years of age with undisplaced (Garden I-II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs...... and able to predict reoperation in patients with undisplaced (Garden I-II) femoral neck fractures....

  18. High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate.

    Science.gov (United States)

    Wirtz, C; Abbassi, F; Evangelopoulos, D S; Kohl, S; Siebenrock, K A; Krüger, A

    2013-06-01

    Stable reconstruction of proximal femoral (PF) fractures is especially challenging due to the peculiarity of the injury patterns and the high load-bearing requirement. Since its introduction in 2007, the PF-locking compression plate (LCP) 4.5/5.0 has improved osteosynthesis for intertrochanteric and subtrochanteric fractures of the femur. This study reports our early results with this implant. Between January 2008 and June 2010, 19 of 52 patients (12 males, 7 females; mean age 59 years, range 19-96 years) presenting with fractures of the trochanteric region were treated at the authors' level 1 trauma centre with open reduction and internal fixation using PF-LCP. Postoperatively, partial weight bearing was allowed for all 19 patients. Follow-up included a thorough clinical and radiological evaluation at 1.5, 3, 6, 12, 24, 36 and 48 months. Failure analysis was based on conventional radiological and clinical assessment regarding the type of fracture, postoperative repositioning, secondary fracture dislocation in relation to the fracture constellation and postoperative clinical function (Merle d'Aubigné score). In 18 patients surgery achieved adequate reduction and stable fixation without intra-operative complications. In one patient an ad latus displacement was observed on postoperative X-rays. At the third month follow-up four patients presented with secondary varus collapse and at the sixth month follow-up two patients had 'cut-outs' of the proximal fragment, with one patient having implant failure due to a broken proximal screw. Revision surgeries were performed in eight patients, one patient receiving a change of one screw, three patients undergoing reosteosynthesis with implantation of a condylar plate and one patient undergoing hardware removal with secondary implantation of a total hip prosthesis. Eight patients suffered from persistent trochanteric pain and three patients underwent hardware removal. Early results for PF-LCP osteosynthesis show major

  19. Taylor spatial frame in the treatment of open tibial shaft fractures

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    Al-Sayyad Mohammed

    2008-01-01

    Full Text Available Background: The Taylor spatial frame (TSF is a modern multiplanar external fixator that combines the ease of application and computer accuracy in the reduction of fractures. A retrospective review of our prospective TSF database for the use of this device for treating open tibial fractures in pediatric, adolescent, and adult patients was carried out to determine the effectiveness and complications of TSF in the treatment of these fractures. Materials and Methods: Nineteen male patients with open tibial fractures were included. Of these fractures, 10 were Gustilo Type II, five were Gustilo Type IIIA (two had delayed primary closure and three had split thickness skin grafting, and four were Gustilo Type IIIB (all had rotational flaps. Twelve of our patients presented immediately to the emergency room, and the remaining seven cases presented at a mean of 3 months (range, 2.2-4.5 months after the initial injury. The fractures were located in proximal third (n=1, proximal/middle junction (n=2, middle third (n=3, middle/distal junction (n=8, distal third (n=3, and segmental fractures (n=2. Patients were of an average age of 26 years (range, 6-45years. Mean duration of follow-up was 3.5 years. Results: All fractures healed over a mean of 25 weeks (range, 9-46 weeks. All were able to participate in the activities of daily living without any difficulty and most were involved in sports during the last follow-up. Postoperative complications included pin tract infection in 12 patients. Conclusion: The TSF is an effective definitive method of open tibial fracture care with the advantage of early mobilization, ease of soft tissue management through gradual fracture reduction, and the ability to postoperatively manipulate the fracture into excellent alignment.

  20. Fixation of supraglenoid tubercle fractures using distal femoral locking plates in three Warmblood horses.

    Science.gov (United States)

    Frei, Sina; Fürst, Anton E; Sacks, Murielle; Bischofberger, Andrea S

    2016-05-18

    Three horses that were presented with supraglenoid tubercle fractures were treated with open reduction and internal fixation using distal femoral locking plates (DFLP). Placing the DFLP caudal to the scapular spine in order to preserve the suprascapular nerve led to a stable fixation, however, it resulted in infraspinatus muscle atrophy and mild scapulohumeral joint instability (case 1). Placing the DFLP cranial to the scapular spine and under the suprascapular nerve resulted in a stable fixation, however, it resulted in severe atrophy of the supraspinatus and infraspinatus muscles and scapulohumeral joint instability (case 2). Placing the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage site resulted in the best outcome (case 3). Only a mild degree of supraspinatus and infraspinatus muscle atrophy was apparent, which resolved quickly and with no effect on scapulohumeral joint stability. In all cases, fixation of supraglenoid tubercle fractures using DFLP in slightly different techniques led to stable fixations with good long-term outcome. One case suffered from a mild incisional infection and plates were removed in two horses. Placement of the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage prevented major nerve damage. Further cases investigating the degree of muscle atrophy following the use of the DFLP placed in the above-described technique are justified to improve patient outcome.

  1. Comparison of cannulated screw and dynamic hip screw for the treatment of femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Mehmet Gem

    2015-09-01

    Full Text Available Objective: We aimed to compare the results of surgeries for intracapsular femoral neck fractures with cannulated screws(CS and dynamic hip screw(DHS, due to lack of evidence which implant for internal fixation of femoral neck fractures is better . Methods: In our clinic between September 2005 and November 2009, 38 patients were operated with intracapsular transcervical fracture of collum femoris between17 to 65 years of age. Eighteen were operated with DHS(47.4% and 20 were operated with CS fixation(52.6%. Results: 16 patients (42.1% were female and 22 (57.9% were male and the mean age was 37.13 (17-65 years. The mean duration of follow-up was 18.05 (2-57 months. 26 patients were operated in 1st -3rd day (68.4%, 9 patients were operated in 4 to 7 day (23.7%, 3 patients were operated in after 7th day (7.9%. In the DHS group, 9 (50% patients had avascular necrosis (AVN, 6 (33.3% patients had implant failure, 3 (16.7% patients had delayed union, 5 (27.8% patients had nonunion, 1 (5.6% patient had infection, and 1 (5.6% patient had myositis ossificans. According to the criteria of Salvati Wilson hip joint assessment, in the DHS group 8 patients (44.4% were very good, 5 patients (27.8% were good, 5 patients (27.8% were moderate. Salvati score was evaluated as average of 28 points (16-40. İn the CS group, 8 (40% patients had AVN, 1 (5% had delayed union, 3 (15% of the cases had nonunion and 1 (5% patients infection was detected. According to the criteria of the Salvati-Wilson, in the CS group13 (65% of them are very good, 5 (25% were good, 2 (10% were assessed as moderate. Salvati score was evaluated as average of 33 points (18-40. In the CS group none of the patients had implant failure, in the DHS group 6 patients had implant failure (33.3% (p<0,05. Conclusion: Except for the high rate of implant failure detection in the DHS group method, no significant difference between complications and functional results between two groups. J Clin Exp Invest

  2. Partial resection of fibula in treatment of ununited tibial shaft fractures

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    Butt Mohd Farooq

    2006-01-01

    Full Text Available Background : In management of fracture of both tibia and fibula, intact fibula may delay union of tibial fractures. Method : Twenty five cases of ununited fractures of tibia were managed between 1997 and 2004, by partial fibulectomy done after 20 weeks after fracture and a POP cast given for 4 weeks which was changed to a PTB cast and weight bearing encouraged at the earliest. Result : All fractures united at an average time of 14 weeks (range 6 to 20 weeks after partial fibulectomy with acceptable alignment in coronal and sagittal planes. There was no neurovascular complication, limitation of joint motion or problem at the osteotomy site. Conclusion : Partial fibulectomy is a viable option in the management of tibial delayed and non-union.

  3. Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint.

    Science.gov (United States)

    Yasuda, Tomohiro; Obara, Shu; Hayashi, Junji; Arai, Masayuki; Sato, Kaoru

    2017-06-01

    Intramedullary nail fixation is a common treatment for tibial-shaft fractures, and it offers a better functional prognosis than other conservative treatments. Currently, the primary approach employed during intramedullary nail insertion is the semiextended position is the suprapatellar approach, which involves a vertical incision of the quadriceps tendon Damage to the patellofemoral joint cartilage has been highlighted as a drawback associated with this approach. To avoid this issue, we perform surgery using the patellar eversion technique and a soft sleeve. This method allows the articular surface to be monitored during intramedullary nail insertion. We arthroscopically assessed the effect of this technique on patellofemoral joint cartilage. The patellar eversion technique allows a direct view and protection of the patellofemoral joint without affecting the patella. Thus, damage to the patellofemoral joint cartilage can be avoided. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsoe, Rasmus; Laessoe, Uffe

    2016-01-01

    was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs......INTRODUCTION:To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture. MATERIALS AND METHODS:The design was a prospective, follow-up cohort study. QOL...... compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P strength during knee...

  5. Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures

    Science.gov (United States)

    Kabelitz, Method; Fritz, Yannick; Grueninger, Patrick; Meier, Christoph; Fries, Patrick

    2018-01-01

    Background: Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. Methods: We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. Results: We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B2) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B1 and 2 Vancouver AG) were treated conservatively. One periprosthetic femoral fracture (Vancouver B1) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Conclusion: Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level of Evidence: Level III, Therapeutic study. PMID:29623237

  6. The quality of life after a femoral neck fracture in elderly patients: a comparative study between internal fixation and arthroplasties

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    Dennis Sansanovicz

    2017-01-01

    Full Text Available Introduction: The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surgery in these cases. Conclusion: Further studies are needed to define which is the best surgical treatment option.

  7. Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures: Lateral Decubitus Position or Traction Table.

    Science.gov (United States)

    Sonmez, Mesut Mehmet; Camur, Savas; Erturer, Erden; Ugurlar, Meric; Kara, Adnan; Ozturk, Irfan

    2017-03-01

    The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures. Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction. The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups. The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.

  8. Postoperative stroke after hemiarthroplasty for femoral neck fracture: a report of 2 cases and review of literature.

    Science.gov (United States)

    Ding, David Yi; Christoforou, Dimitrios; Turner, Garth; Tejwani, Nirmal C

    2014-06-01

    Femoral neck fractures in the elderly comprise a significant number of orthopedic surgical cases at a major trauma center. These patients are immediately incapacitated, and surgical fixation can help increase mobility, restore independence, and reduce morbidity and mortality. However, operative treatment carries its own inherent risks including infections, deep vein thromboses, and intraoperative cardiovascular collapse. Cerebrovascular stroke is a relatively uncommon occurrence after hip fractures. We present 2 cases with unusual postoperative medical complication after cemented hip hemiarthroplasty for femoral neck fracture that will serve to illustrate an infrequent but very serious complication. Case 1 was a 73-year-old man with a Garden IV femoral neck fracture who underwent a right hip unipolar cemented hemiarthroplasty under general anesthesia. After uneventful surgery, he developed neurological deficits, and a postoperative noncontrast head computed tomography showed a right medial thalamic infarct. Case 2 was an 82-year-old man with a Garden IV femoral neck fracture who underwent a right hip unipolar cemented hemiarthroplasty under general anesthesia. After uneventful surgery, the patient became hemodynamically unstable. A postoperative noncontrast head computed tomography showed a large evolving left middle cerebral artery stroke. General anesthesia in the setting of decreased cardiac function (decreased ejection fraction and output) carries the risk for ischemic injury to the brain from decreased cerebral perfusion. Risk factors including advanced age, history of coronary artery disease, atherosclerotic disease, and atrial fibrillation increase the risk for perioperative stroke. Furthermore, it is known that during the cementing of implants, microemboli can be released, which must be considered in patients with preoperative heart disease. As a result, consideration of using a noncemented implant or cementing without pressurizing in this clinical scenario

  9. Ingenious method of external fixator use to maintain alignment for nailing a proximal tibial shaft fracture.

    Science.gov (United States)

    Behera, Prateek; Aggarwal, Sameer; Kumar, Vishal; Kumar Meena, Umesh; Saibaba, Balaji

    2015-09-01

    Fractures of the tibia are one of the most commonly seen orthopedic injuries. Most of them result from a high velocity trauma. While intramedullary nailing of tibial diaphyseal fractures is considered as the golden standard form of treatment for such cases, many metaphyseal and metaphyseal-diaphyseal junction fractures can also be managed by nailing. Maintenance of alignment of such fractures during surgical procedure is often challenging as the pull of patellar tendon tends to extend the proximal fragment as soon as one flexes the knee for the surgical procedure. Numerous technical modifications have been described in the literature for successfully nailing such fractures including semi extended nailing, use of medial plates and external fixators among others. In this study, it was aimed to report two cases in which we used our ingenious method of applying external fixator for maintaining alignment of the fracture and aiding in the entire process of closed intramedullary nailing of metaphyseal tibial fractures by the conventional method. We were able to get good alignment during and after the closed surgery as observed on post-operative radiographs and believe that further evaluation of this technique may be of help to surgeons who want to avoid other techniques.

  10. Tibia Shaft Fractures in Adolescents: How and When Can They be Managed Successfully With Cast Treatment?

    Science.gov (United States)

    Ho, Christine A

    2016-06-01

    Despite the increasing popularity of operative treatment in adolescent tibia fractures, casting remains a viable first-line treatment. Because the selection bias in published reports does not allow direct comparison between casting and flexible nail treatment of closed pediatric tibia fractures, it is unclear whether flexible nailing offers any advantages over casting. This overview discusses parameters of acceptable alignment, indications, techniques for successful reduction and casting, subsequent inpatient and outpatient management including wedging of casted tibia fractures, expected outcomes, and comparison of casting with flexible nailing. As with any orthopaedic procedure, careful attention to patient selection, indications, and detail facilitates successful cast treatment in this older pediatric population.

  11. Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head

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    Sonoda, Kazuhiko; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Kubo, Yusuke; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2016-11-15

    Our aims were to investigate the imaging appearance of subchondral insufficiency fracture (SIF) of the femoral head based on fat-suppressed T2-weighted MRI, and evaluate its correlation with the clinical outcomes following conservative treatment. We retrospectively evaluated 40 hips in 37 patients with SIF of the femoral head (12 males and 25 females; mean age 55.8 years, range 22-78 years). MRI examinations were performed within 3 months after the onset of hip pain. Using fat-suppressed T2-weighted imaging, we evaluated the hips for the intensity of the subchondral bone (corresponding to the area superior to the low intensity band on T1-weighted images) as well as bone marrow edema, joint effusion, and presence of the band lesion. We then correlated the intensity of the subchondral bone with clinical outcomes. The hips were classified into three types based on subchondral intensity on fat-suppressed T2-weighted images: type 1 (21 hips) showed high intensity, type 2 (eight hips) showed heterogeneous intensity, and type 3 (11 hips) showed low intensity. The mean period between pain onset and MRI examination was significantly longer for type 2 hips than for type 1. Healing rates were 86 % for type 1, 75 % for type 2, and 18 % for type 3. SIF cases were classified into three types based on subchondral intensity on fat-suppressed T2-weighted imaging performed within 3 months after pain onset. Type 3 SIF tended to be intractable to conservative treatment compared to type 1 and type 2. (orig.)

  12. Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component

    DEFF Research Database (Denmark)

    Gromov, K; Bersang, A; Nielsen, C S

    2017-01-01

    ratio were recorded post-operatively. Periprosthetic fractures were