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Sample records for proximal femur fractures

  1. Total hip arthroplasty after failed treatment of proximal femur fracture.

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    Tetsunaga, Tomonori; Fujiwara, Kazuo; Endo, Hirosuke; Noda, Tomoyuki; Tetsunaga, Tomoko; Sato, Toru; Shiota, Naofumi; Ozaki, Toshifumi

    2017-03-01

    Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures. We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment. Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p fractures requires consideration of complication risk and incorrect femoral neck anteversion.

  2. Osteosynthesis of a periprosthetic fracture of the proximal femur with the distal femur LISS system

    DEFF Research Database (Denmark)

    Tarnowski, Jan Robert; Holck, Kim

    2008-01-01

    In this case report, we show how it is possible to perform osteosynthesis using minimal invasive techniques instead of conventional methods. In this instance the osteosynthesis was performed on a patient in poor general condition who had presented a periprosthetic fracture of the proximal femur. ...

  3. Concomitant physeal fractures of the distal femur and proximal tibia

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    Sferopoulos, N.K. [Aristotle University of Thessaloniki, Department of Pediatric Orthopaedics, Thessaloniki (Greece)

    2005-07-01

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

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

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    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.

  5. Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur.

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    Hey, Hwee Weng Dennis; Sng, Weizhong Jonathan; Lim, Joel Louis Zongwei; Tan, Chuen Seng; Gan, Alfred Tau Liang; Ng, Jun Han Charles; Kagda, Fareed H Y

    2015-12-01

    Bone mineral density scans are currently interpreted based on an average score of the entire proximal femur. Improvements in technology now allow us to measure bone density in specific regions of the proximal femur. The study attempts to explain the pathophysiology of neck of femur (NOF) and intertrochanteric/basi-cervical (IT) fractures by correlating areal BMD (aBMD) scores with fracture patterns, and explore possible predictors for these fracture patterns. This is a single institution retrospective study on all patients who underwent hip surgeries from June 2010 to August 2012. A total of 106 patients (44 IT/basi-cervical, 62 NOF fractures) were studied. The data retrieved include patient characteristics and aBMD scores measured at different regions of the contralateral hip within 1 month of the injury. Demographic and clinical characteristic differences between IT and NOF fractures were analyzed using Fisher's Exact test and two-sample t test. Relationship between aBMD scores and fracture patterns was assessed using multivariable regression modeling. After adjusted multivariable analysis, T-Troc and T-inter scores were significantly lower in intertrochanteric/basi-cervical fractures compared to neck of femur fractures (P = 0.022 and P = 0.026, respectively). Both intertrochanteric/basi-cervical fractures (mean T.Tot -1.99) and neck of femur fractures (mean T.Tot -1.64) were not found to be associated with a mean T.tot less than -2.5. However, the mean aBMD scores were consistently less than -2.5 for both intertrochanteric/basi-cervical fractures and neck of femur fractures. Gender and calcium intake at the time of injury were associated with specific hip fracture patterns (P = 0.002 and P = 0.011, respectively). Hip fracture patterns following low energy trauma may be influenced by the pattern of reduced bone density in different areas of the hip. Intertrochanteric/basi-cervical fractures were associated with significantly lower T-Troc and T-Inter scores

  6. Physical therapy in the postoperative of proximal femur fracture in elderly. Literature review

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    Carneiro,Mariana Barquet; Alves,Débora Pinheiro Lédio; Mercadante, Marcelo Tomanik

    2013-01-01

    The proximal femoral fracture in the elderly is a serious public health problem. Surgical treatment of this fracture is used to reduce morbidity, together with postoperative physical therapy. The objective was to conduct a systematic review of physical therapy protocols in postoperative for fractures of the proximal femur in elderly. We selected randomized controlled trials in elderly in the past 10 years, in Portuguese and English. There were 14 articles in the literature. Physical therapy h...

  7. A Skeletal Traction Technique for Proximal Femur Fracture Management in an Austere Environment.

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    Lidwell, David; Meghoo, Colin A

    2016-01-01

    Skeletal traction is a useful technique for managing proximal femur fractures in austere environments where fracture stabilization for this injury is difficult. We present a technique and a construct appropriate for field use that facilitates patient evacuation, and we provide guidelines for the use of this technique by an advanced medical provider managing these injuries. The objectives of this article are to enable to reader to (1) recognize the role of skeletal traction in managing proximal femur fractures in an austere environment, (2) identify the key steps in placing transfemoral skeletal traction pins, and (3) identify options and requirements for building a traction construct in resource-limited environments. 2016.

  8. Unusual proximal femur fracture in children treated with PHILOS plate and review of literature

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    Mukesh Kumar

    2017-01-01

    Full Text Available Fractures of the hip are uncommon in children with incidence is less than 1% in all paediatrics fracture. It requires careful attention because of the incidence of complications is high. There is no consensus over ideal treatment of each group, but there are different options for each group has been described in literature, we report a case of unusual proximal femur fracture in ten-year-old girl which is not described in literature in best of our knowledge. A 10 years old girl was brought to us with pain in right hip joint and inability to bear weight on right lower limb after road traffic accident (child was hit by a car while walking on the road. Evaluated and found to have fracture of proximal femur. fracture was fixed with long PHILOS plate, which united in eight weeks duration, implant was removed at 10 month. At present after 14 months, she is able to perform her routine activities comfortably. and her Harris hip score is 95. We propose to add this type of fracture as 5th type of Delbet's classification as the fracture pattern in my patient was not fitting in any group of Delbet's classification and it belongs to proximal femur group and anatomically this fracture pattern was next to type IV fracture. Uncommon fracture of hip in children can be expected, this type of fracture can be added as 5th type in Delbet's classification. Long term outcome and ideal treatment yet to be described.

  9. Acetabular Protrusio and Proximal Femur Fractures in Patients With Osteogenesis Imperfecta.

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    Trehan, Samir K; Morakis, Emmanouil; Raggio, Cathleen L; Twomey, Kristin D; Green, Daniel W

    2015-09-01

    Osteogenesis imperfect (OI) is a genetic disorder characterized by increased bone fragility, frequent fractures, and extremity deformities among other clinical findings. A frequent radiographic finding in OI patients is acetabular protrusio (AP). We hypothesized that AP incidence would be significant in OI patients and highest among type III OI patients, who have a more severe disease phenotype. In addition, we hypothesized that there would be a correlation between AP and proximal femur fracture incidence. We retrospectively reviewed radiographs and medical records of 49 patients with OI evaluated at our institution. Demographic information and modified Sillence classification were recorded. AP was diagnosed using previously published radiographic criteria using the center-edge angle of Wiberg, acetabulum relative to the iliopectineal line, teardrop figure relative to the ilioischial (Kohler) line, and acetabulum relative to the ilioischial (Kohler) line. Medical record and radiographs were reviewed for evidence of proximal femur or acetabulum fracture. Associations between OI type, AP, and fracture incidence were examined with χ or Fisher exact tests. In this series of 49 OI patients, the overall incidence of AP was 55.1% (27/49) with the highest incidence among patients with type III OI (70.6%). There was an increased incidence of proximal femur, and particularly femoral neck, fractures among patients with AP compared with patients with normal hip anatomy. Overall, patients with AP had a 30% increased risk for proximal femur and acetabulum fractures (P=0.03). AP is a common deformity in OI patients (55.1%) and particularly type III OI (70.6%). Patients with AP have an increased risk for proximal femur fractures and particularly femoral neck fractures. This novel finding adds to the growing body of literature on clinical implications of AP in OI patients. Level IV-Retrospective case series.

  10. Integrated remodeling-to-fracture finite element model of human proximal femur behavior.

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    Hambli, Ridha; Lespessailles, Eric; Benhamou, Claude-Laurent

    2013-01-01

    The purpose of this work was to develop an integrated remodeling-to-fracture finite element model allowing for the combined simulation of (i) simulation of a human proximal femur remodeling under a given boundary conditions, (ii) followed by the simulation of its fracture behavior (force-displacement curve and fracture pattern) under quasi-static load. The combination of remodeling and fracture simulation into one unified model consists in considering that the femur properties resulting from the remodeling simulation correspond to the initial state for the fracture prediction. The remodeling model is based on phenomenological one based on a coupled strain and fatigue damage stimulus. The fracture model is based on continuum damage mechanics in order to predict the progressive fracturing process which allows to predict the fracture pattern and the complete force-displacement curve under quasi-static load. To prevent mesh-dependence that generally affects the damage propagation rate, regularization technique was applied in the current work. To investigate the potential of the proposed unified remodeling-to-fracture model, we performed remodeling simulations on a 3D proximal femur model for a duration of 365 days under five different daily loading conditions followed by a side fall fracture simulation reproducing previously published experimental tests (de Bakker et al. (2009), case C, male, 72 years old). We show here that the implementation of an integrated remodeling-to-fracture model provides more realistic prediction strategy to assess the bone remodeling effects on the fracture risk of bone. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur

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    Gumieiro, David Nicoletti [UNESP; Pereira,Gilberto José Cação; Minicucci, Marcos Ferreira [UNESP; Ricciardi, Carlos Eduardo Inácio; Damasceno, Erick Ribeiro; Funayama, Bruno Schiavoni [UNESP

    2015-01-01

    OBJECTIVE: To assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture.METHODS: Consecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed...

  12. Emergency treatment of proximal femural fracture within 48h: The

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    Pellegrino Ferrara

    2017-09-01

    Full Text Available Objective: To study the main aspects of osteoporotic emergency fracture of the hip in the Umbria Region in the years 2006-2011. Methods: The study was conducted from January 1 of 2006 to December 31 of 2011, and included only patients over 49 years of age. Patients who did not habitually reside in the region were excluded. They were collected in each based on the following data: age, sex, place of residence (urban or rural, time of the year, fractured side, type of trauma, history of fracture contralateral and perioperative mortality. Results: From 2006 to 2011, a progressive increase in the number of femoral fracture admissions in regional hospitals was observed, equal to 4.73% per annum. The incidence went from 6.8 to 8.1 for 1.000 ultra-65th residents. The most affected age groups are those between 75-84 years and 85- 94 years. Conclusions: The epidemiology of osteoporotic hip fracture in the Umbria Region follows a pattern similar to that of other Italian regions. The in-hospital mortality of these patients is partly determined by age and number of complications they suffer during admission. The impact of economic resources on patients who break the osteoporotic hip justifies the implementation of programs for the prevention of osteoporosis and fractures.

  13. Fractures around a previous fixation of proximal femur. A simple solution to a complex problem.

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    Fernando Manuel Bidolegui

    2016-05-01

    Full Text Available The number of hip fractures in the elderly growth with the increase in life expectancy. Therefore meet with a femur fractured, distal to a previously  implant fixation used in intertrochanteric femur fractures as dynamic hip screw or fixed angle plate, is not an uncommon scenario despite year mortality of hip fracture of 30 to 50%. Given this situation, we used a retrograde intramedullary nail associated with extracting screws percutaneously prior implant. We present 8 cases in patients with an average age of 85.6 years, 5 female and 3 male with a time from the proximal femur fixation to the  new fracture average 3.5 years. Will we track 36 months and we evaluated postoperative mobility and pain getting a consolidation of the fracture in all cases. We found this technique effective; capable of achieving stable fixation without adding morbidity due to the possibility of overlapping two implants decreasing the possibility of potential new interimplantes fracture.

  14. Pre-operative traction for fractures of the proximal femur.

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    Parker, M J; Handoll, H H G

    2003-01-01

    Pre-operative traction following an acute hip fracture remains standard practice in some hospitals. To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered. We searched the Cochrane Musculoskeletal Injuries Group's specialised register (February 2003), the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 8), CINAHL (1982 to February 2003), the National Research Register Issue 1, 2003, conference proceedings and reference lists of articles. Date of most recent search: February 2003. All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery. Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. Eight randomised trials, mainly of moderate quality, involving a total of 1349 predominantly elderly patients, were identified and included in the review. The inclusion in this review update of a newly available trial resulted in no important change in the results or conclusions. Seven trials compared traction with no traction. Although no data pooling was possible, overall these provided no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly. From the evidence available, the routine use of

  15. Identify fracture-critical regions inside the proximal femur using statistical parametric mapping.

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    Li, Wenjun; Kornak, John; Harris, Tamara; Keyak, Joyce; Li, Caixia; Lu, Ying; Cheng, Xiaoguang; Lang, Thomas

    2009-04-01

    We identified regions inside the proximal femur that are most strongly associated with hip fracture. Bone densitometry based on such fracture-critical regions showed improved power in discriminating fracture patients from controls. Hip fractures typically occur in lateral falls, with focal mechanical failure of the sub-volumes of tissue in which the applied stress exceeds the strength. In this study, we describe a new methodology to identify proximal femoral tissue elements with highest association with hip fracture. We hypothesize that bone mineral density (BMD) measured in such sub-volumes discriminates hip fracture risk better than BMD in standard anatomic regions such as the femoral neck and trochanter. We employed inter-subject registration to transform hip QCT images of 37 patients with hip fractures and 38 age-matched controls into a voxel-based statistical atlas. Within voxels, we performed t-tests between the two groups to identify the regions which differed most. We then randomly divided the 75 scans into a training set and a test set. From the training set, we derived a fracture-driven region of interest (ROI) based on association with fracture. In the test set, we measured BMD in this ROI to determine fracture discrimination efficacy using ROC analysis. Additionally, we compared the BMD distribution differences between the 29 patients with neck fractures and the 8 patients with trochanteric fractures. By evaluating fracture discrimination power based on ROC analysis, the fracture-driven ROI had an AUC (area under curve) of 0.92, while anatomic ROIs (including the entire proximal femur, the femoral neck, trochanter and their cortical and trabecular compartments) had AUC values between 0.78 and 0.87. We also observed that the neck fracture patients had lower BMD (p=0.014) in a small region near the femoral neck and the femoral head, and patients with trochanteric fractures had lower BMD in trochanteric regions such as in the internal calcar septum (p=0

  16. Participation of osteoporosis in femoral neck fracture; Bone mineral measurement of proximal femur using quantitative computed tomography

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    Mizuno, Naoto (Gifu Prefectural Tajimi Hospital (Japan))

    1989-10-01

    Quantitative computed tomography (QCT) was used to measure bone mineral contents of the proximal femur. First, 62 specimens of cancellous bones of the proximal femur obtained at operation were burnt for mineral determination after preoperative QCT measurement to evaluate the relationship between QCT values and ash weight. The findings indicated that QCT measurement of proximal femur was as useful as that of the lumbar spine. Next, 10 groups of 50 men and 50 women ranging in age from the 5th to the 9th decade were tested to define the control mean and range of QCT mineral content of proximal femur, to compare with 32 cases of femoral neck fracture. In women with femoral neck fracture, QCT values of the femoral neck were less than those of the same normal age group except for cases of medial fracture in the 9th decade. This measurement might provide an index for fracture risk. (author).

  17. A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

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    Lee, Jong Seok; Yoo, Beong Gyu [Wonkwang Health Science College, Iksan (Korea, Republic of); Kim, Keung Sik [Yonsei University Yong Dong Severance Hospital, Seoul (Korea, Republic of)

    2000-04-15

    There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine.

  18. Pathological fractures of the proximal femur due to solitary bone cyst: classification, methods of treatment.

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    Miu, A

    2015-01-01

    Fractures are a very important issue in a child's orthopedic pathology. Neglected a good amount of time, being considered "not too serious", or "rare", having better and faster healing methods and not leaving sequels, like in the case of adults, a child's fractures remain an important chapter of traumatology in general. Because of the raising prevalence of child osteoarticular traumas, as well as new less invasive treatment methods, this theme is always to date. The paper analyzes particular cases of bone fractures that appeared due to minor traumas, on bones with a high brittleness, localized especially on the long bones. Although these fractures on a pathological bone can be seen at all levels of the human skeleton, this paper focuses on fractures located in the proximal third part of the femur. A group of children admitted in the Pediatric Orthopedic Department of "M.S. Curie" Hospital-Bucharest with this diagnostic, were analyzed between 2009 and 2013.

  19. QCT of the proximal femur--which parameters should be measured to discriminate hip fracture?

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    Museyko, O; Bousson, V; Adams, J; Laredo, J -D; Engelke, K

    2016-03-01

    For quantitative computed tomography (QCT), most relevant variables to discriminate hip fractures were determined. A multivariate analysis showed that trabecular bone mineral density (BMD) of the trochanter with "cortical" thickness of the neck provided better fracture discrimination than total hip integral BMD. A slice-by-slice analysis of the neck or the inclusion of strength-based parameters did not improve fracture discrimination. For QCT of the proximal femur, a large variety of analysis parameters describing bone mineral density, geometry, or strength has been considered. However, in each given study, generally just a small subset was used. The aim of this study was to start with a comprehensive set and then select a best subset of QCT parameters for discrimination of subjects with and without acute osteoporotic hip fractures. The analysis was performed using the population of the European Femur Fracture (EFFECT) study (Bousson et al. J Bone Min Res: Off J Am Soc Bone Min Res 26:881-893, 2011). Fifty-six female control subjects (age 73.2 ± 9.3 years) were compared with 46 female patients (age 80.9 ± 11.1 years) with acute hip fractures. The QCT analysis software MIAF-Femur was used to virtually dissect the proximal femur and analyze more than 1000 parameters, predominantly in the femoral neck. A multivariate best-subset analysis was used to extract the parameters best discriminating hip fractures. All results were adjusted for age, height, and weight differences between the two groups. For the discrimination of all proximal hip fractures as well as for cervical fractures alone, the measurement of neck parameters suffices (area under the curve (AUC) = 0.84). Parameters characterizing bone strength are discriminators of hip fractures; however, in multivariate models, only "cortical" cross-sectional area in the neck center remained as a significant contributor. The combination of one BMD parameter, trabecular BMD of the trochanter, and one geometry

  20. Structural patterns of the proximal femur in relation to age and hip fracture risk in women

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    Carballido-Gamio, Julio; Harnish, Roy; Saeed, Isra; Streeper, Timothy; Sigurdsson, Sigurdur; Amin, Shreyasee; Atkinson, Elizabeth J.; Therneau, Terry M.; Siggeirsdottir, Kristin; Cheng, Xiaoguang; Melton, L. Joseph; Keyak, Joyce; Gudnason, Vilmundur; Khosla, Sundeep; Harris, Tamara B.; Lang, Thomas F.

    2013-01-01

    Fractures of the proximal femur are the most devastating outcome of osteoporosis. It is generally understood that age-related changes in hip structure confer increased risk, but there have been few explicit comparisons of such changes in healthy subjects to those with hip fracture. In this study, we used quantitative computed tomography and tensor-based morphometry (TBM) to identify three-dimensional internal structural patterns of the proximal femur associated with age and with incident hip fracture. A population-based cohort of 349 women representing a broad age range (21–97 years) were included in this study, along with a cohort of 222 older women (mean age 79±7 years) with (n=74) and without (n=148) incident hip fracture. Images were spatially normalized to a standardized space, and age- and fracture-specific morphometric features were identified based on statistical maps of shape features described as local changes of bone volume. Morphometric features were visualized as maps of local contractions and expansions, and significance was displayed as Student’s t-test statistical maps. Significant age-related changes included local expansions of regions low in volumetric bone mineral density (vBMD) and local contractions of regions high in vBMD. Some significant fracture-related features resembled an accentuated aging process, including local expansion of the superior aspect of the trabecular bone compartment in the femoral neck, with contraction of the adjoining cortical bone. However, other features were observed only in the comparison of hip fracture subjects with age-matched controls including focal contractions of the cortical bone at the superior aspect of the femoral neck, the lateral cortical bone just inferior to the greater trochanter, and the anterior intertrochanteric region. Results of this study support the idea that the spatial distribution of morphometric features is relevant to age-related changes in bone and independently to fracture risk. In

  1. Development of a balanced experimental-computational approach to understanding the mechanics of proximal femur fractures.

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    Helgason, B; Gilchrist, S; Ariza, O; Chak, J D; Zheng, G; Widmer, R P; Ferguson, S J; Guy, P; Cripton, P A

    2014-06-01

    The majority of people who sustain hip fractures after a fall to the side would not have been identified using current screening techniques such as areal bone mineral density. Identifying them, however, is essential so that appropriate pharmacological or lifestyle interventions can be implemented. A protocol, demonstrated on a single specimen, is introduced, comprising the following components; in vitro biofidelic drop tower testing of a proximal femur; high-speed image analysis through digital image correlation; detailed accounting of the energy present during the drop tower test; organ level finite element simulations of the drop tower test; micro level finite element simulations of critical volumes of interest in the trabecular bone. Fracture in the femoral specimen initiated in the superior part of the neck. Measured fracture load was 3760N, compared to 4871N predicted based on the finite element analysis. Digital image correlation showed compressive surface strains as high as 7.1% prior to fracture. Voxel level results were consistent with high-speed video data and helped identify hidden local structural weaknesses. We found using a drop tower test protocol that a femoral neck fracture can be created with a fall velocity and energy representative of a sideways fall from standing. Additionally, we found that the nested explicit finite element method used allowed us to identify local structural weaknesses associated with femur fracture initiation. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  2. Fractures of the proximal femur: correlates of radiological evidence of osteoporosis

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    Patel, Salil H.; Murphy, Kieran P. [Johns Hopkins School of Medicine, Radiology, Baltimore, Maryland (United States)

    2006-04-15

    Fractures of the proximal femur are common sequelae of osteoporosis, and are responsible for significant morbidity and mortality in elderly patients worldwide. Plain film radiographic assessment methods to assess for fracture risk may be of particular value. The authors present the results of biomechanical testing, radiographic imaging, and histologic exam of 20 embalmed human bone specimens, with implications for clinical correlation of radiologic findings. Authors assessed bone architecture using the Singh Index, using a blinded 3-rater system to reduce bias and measure intra-observer reliability. After loading to failure with ultimate tensile strength (UTS), bone specimens were assessed by fracture location type and by trabecular bone volume (TBV). Singh scoring was performed with Inter-Class Correlation of 0.80 (F=0.24, by ICC Portney Model 2). A statistically-significant difference among the UTS distributions was noted for UTS by Fracture Site (F=4.49, p=0.026, by ANOVA). No significant association of Singh Index with TBV, or TBV with UTS, was observed, although a trend toward greater UTS with higher Singh grade was observed. The authors propose that the Singh Index is a valuable and reliable indicator which may reflect structural integrity in trabecular bone. Fracture site along the femur is associated with tensile strength. The authors, in the light of these findings, address the promise and potential impact of prophylactic hip augmentation in populations at risk for femoral neck pathology. (orig.)

  3. Assessment of the individual fracture risk of the proximal femur by using statistical appearance models.

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    Schuler, Benedikt; Fritscher, Karl D; Kuhn, Volker; Eckstein, Felix; Link, Thomas M; Schubert, Rainer

    2010-06-01

    Standard diagnostic techniques to quantify bone mineral density (BMD) include dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography. However, BMD alone is not sufficient to predict the fracture risk for an individual patient. Therefore, the development of tools, which can assess the bone quality in order to predict individual biomechanics of a bone, would mean a significant improvement for the prevention of fragility fractures. In this study, a new approach to predict the fracture risk of proximal femora using a statistical appearance model will be presented. 100 CT data sets of human femur cadaver specimens are used to create statistical appearance models for the prediction of the individual fracture load (FL). Calculating these models offers the possibility to use information about the inner structure of the proximal femur, as well as geometric properties of the femoral bone for FL prediction. By applying principal component analysis, statistical models have been calculated in different regions of interest. For each of these models, the individual model parameters for each single data set were calculated and used as predictor variables in a multilinear regression model. By this means, the best working region of interest for the prediction of FL was identified. The accuracy of the FL prediction was evaluated by using a leave-one-out cross validation scheme. Performance of DXA in predicting FL was used as a standard of comparison. The results of the evaluative tests demonstrate that significantly better results for FL prediction can be achieved by using the proposed model-based approach (R = 0.91) than using DXA-BMD (R = 0.81) for the prediction of fracture load. The results of the evaluation show that the presented model-based approach is very promising and also comparable to studies that partly used higher image resolutions for bone quality assessment and fracture risk prediction.

  4. Surgical Treatment of Undisplaced Femur Neck Fractures in Dementia Patients Using Proximal Femoral Nail Antirotation.

    Science.gov (United States)

    Park, Bong-Ju; Cho, Hong-Man; Min, Woong-Bae

    2015-09-01

    People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. We studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-to-severe dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured. In walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final follow-up. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union. We found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g., those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.

  5. 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

  6. Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur?

    Science.gov (United States)

    Koval, Kenneth J; Oh, Chong K; Egol, Kenneth A

    2008-01-01

    The standard radiographic series for evaluation of a suspected hip fracture in most centers includes an anteroposterior (AP) radiograph of the pelvis, as well AP and cross-table lateral views of the hip. The natural femoral neck anteversion, as well as the fracture deformity, however, may make accurate fracture classification difficult. We have noted that inexperienced physicians sometimes misclassify hip fractures based on the initial radiographic series, which may lead to errors both in surgical planning and implant choice. At our institution, we routinely obtain a physician-assisted traction-internal rotation radiograph of the affected hip in all fractures of the proximal femur. The purpose of the current study was to examine the usefulness of the traction-internal rotation radiograph for the classification of hip fractures by junior residents in our department. Forty-seven sets of complete radiographs (AP pelvis, AP hip, cross-table lateral, traction- internal rotation views) of patients who sustained a proximal femur fracture were identified. Fifteen first year orthopaedic residents (PGY2) individually reviewed the cases and classified them as one of six possible choices: 1. nondisplaced femoral neck fracture, 2. displaced femoral neck fracture, 3. stable intertrochanteric fracture, 4. unstable intertrochanteric fracture, 5. intertrochanteric fracture with subtrochanteric extension, or 6. subtrochanteric fracture. Each fracture case was classified after first reviewing the standard hip series (AP pelvis, AP hip, and cross-table lateral). A traction-internal rotation radiograph was then added to each case, and any changes in the initial classification were noted. The resident's classification was then compared with those of the senior investigators (KJK, KAE), who used all four views for classification. Reviewing a traction-internal rotation radiograph led to a statistically significant increase in agreement between the resident and senior investigators

  7. Using a statistical appearance model to predict the fracture load of the proximal femur

    Science.gov (United States)

    Schuler, Benedikt; Fritscher, Karl D.; Kuhn, Volker; Eckstein, Felix; Schubert, Rainer

    2009-02-01

    Nowadays clinical diagnostic techniques like e.g. dual-energy X-ray absorptiometry are used to quantify bone quality. However, bone mineral density alone is not sufficient to predict biomechanical properties like the fracture load for an individual patient. Therefore, the development of tools, which can assess the bone quality in order to predicting individual biomechanics of a bone, would mean a significant improvement for the prevention of fractures. In this paper an approach to predict the fracture load of proximal femora by using a statistical appearance model will be presented. For this purpose, 96 CT-datasets of anatomical specimen of human femora are used to create statistical models for the prediction of the individual fracture load. Calculating statistical appearance models in different regions of interest by using principal component analysis (PCA) makes it possible to use geometric as well as structural information about the proximal femur. By regressing the output of PCA against the individual fracture load of 96 femora multi-linear regression models using a leave-one-out cross validation scheme have been created. The resulting correlations are comparable to studies that partly use higher image resolutions.

  8. The Outcome in Early Cases of Treatment of Subtrochanteric Fractures with Proximal Femur Locking Compression Plate

    Directory of Open Access Journals (Sweden)

    U Gunadham

    2014-07-01

    Full Text Available The objective of this study was to evaluate the outcome in early treatment of subtrochanteric fractures with proximal femur locking compression plate (PF-LCP.The patients included in this study were those with subtrochanteric fractures (AO type 32A-C treated with PF-LCP (Synthes between Jan 2009 and Jun 2011. The patient characteristics and details of clinical conditions were obtained from records. Clinical and radiographic follow-ups were done at one, two, four and 6 months intervals, and at one year. The primary outcome studied included fracture union and functional ambulatory status. Twenty-six patients were included in the study, 19 of whom were male with a mean age of 42.4 years. Fourteen patients (53.9% had sustained AO type 32B fractures, the majority in motor vehicle accidents. Twenty-two fractures (84.6% achieved union, while sixpatients (23.1% had complications such as broken plate, varus collapse, and broken screw. Four patients (15.4% underwent a second operation. At the end of the follow-ups, 25 patients (96.2% were community ambulators. We conclude that PF-LCP is an effective alternative treatment for subtrochanteric fractures when properly performed.

  9. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Qing-Hua, E-mail: ddqinghua-tian@163.com; He, Cheng-Jian, E-mail: tianhechengjian@163.com; Wu, Chun-Gen, E-mail: 649514608@qq.com; Li, Yong-Dong, E-mail: tianliyongdong@163.com; Gu, Yi-Feng, E-mail: tianyifenggu@163.com; Wang, Tao, E-mail: tianandwangtao@163.com; Xiao, Quan-Ping, E-mail: tianxiaoquanping@163.com; Li, Ming-Hua, E-mail: tianminghuali@163.com [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China)

    2016-01-15

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.

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

    Science.gov (United States)

    Magu, Narender Kumar; Magu, Sarita; Rohilla, Rajesh Kumar; Batra, Amit; Jaipuria, Abhishek; Singh, Amanpreet

    2014-09-01

    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. 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. 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 femoral head size (type I and type II) is proposed. Osteosynthesis should be the preferred method of treatment in type I and osteotomy or prosthetic replacement is the method of choice for

  11. The impact of proximal femur geometry on fracture type--a comparison between cervical and trochanteric fractures with two parameters.

    Science.gov (United States)

    Panula, J; Sävelä, M; Jaatinen, P T; Aarnio, P; Kivelä, S-L

    2008-01-01

    Only a few studies have tested the ability of proximal femur geometry parameters to discriminate between cervical hip fractures and those of the trochanter. The main objective of this study was to evaluate the geometrical differences between these two fracture types by measuring the neck shaft angle (NSA) and the femoral neck axis length (FNAL). We also compared the distributions of these parameters and the distributions of fracture type by gender. A retrospective analysis was made in a population-based material of 428 hip fractures collected during a two-year period from 1999 to 2000 (323 women and 105 men aged 65 years or older). NSA and FNAL were manually measured from pelvic radiographs. No significant differences in NSA or FNAL were found between cervical and trochanteric hip fractures in women or in men. Men had significantly higher NSA and FNAL than women. Age was not related to these geometrical parameters. The distributions by fracture type were similar in both genders. The different pathogenesis of cervical and trochanteric hip fractures cannot be explained by NSA or FNAL. A standardized measurement setup is needed when evaluating the role of hip geometry in fracture patients.

  12. Epidemiology of fractures of the proximal third of the femur in elderly patients ☆

    Directory of Open Access Journals (Sweden)

    Daniel Daniachi

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVE: This was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo. METHODS: The subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the treatment instituted and the intra-hospital mortality rate were evaluated. RESULTS: The 113 patients included in the study presented a mean age of 79 years. The ratio between the sexes was three women to each man. Only 30.4% of the patients reported having osteoporosis and only 0.9% had had treatment for the disease. Low-energy trauma was the cause of 92.9% of the fractures. Femoral neck fractures accounted for 42.5% of the fractures and trochanteric fractures, 57.5%. Five patients did not undergo operations; 39 underwent joint replacement; and 69 underwent osteosynthesis. The mean length of hospital stay was 13.5 days and the mean length of waiting time until surgery was 7 days. The intra-hospital mortality rate was 7.1%. CONCLUSION: The patients attended at this institution presented an epidemiological profile similar to what is found in the Brazilian literature. Chronic kidney failure is a significant factor with regard to intra-hospital mortality. Preventive measures such as early diagnosis and treatment of osteoporosis and regular physical activity practices were not implemented.

  13. Femur fracture repair - discharge

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000166.htm Femur fracture repair - discharge To use the sharing features on this page, please enable JavaScript. You had a fracture (break) in the femur in your leg. It ...

  14. Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur

    DEFF Research Database (Denmark)

    Haubro, M; Stougaard, C; Torfing, T

    2015-01-01

    and a resident in orthopaedic surgery. Sensitivity and specificity were estimated with MRI as the golden standard. Kappa value was used to assess level of agreement in both MRI and CT finding. RESULTS: 15 fractures of the proximal femur were found (7 intertrochanteric-, 3 femoral neck and 5 fractures......OBJECTIVE: To estimate sensitivity and specificity of CT and MRI examinations in patients with fractures of the proximal femur. To determine the interobserver agreement of the modalities among a senior consulting radiologist, a resident in radiology and a resident in orthopaedics surgery. MATERIALS...... AND METHODS: 67 patients (27 males, 40 females, mean age 80.5) seen in the emergency room with hip pain after fall, inability to stand and a primary X-ray without fracture were evaluated with both CT and MRI. The images were analysed by a senior consulting musculoskeletal radiologist, a resident in radiology...

  15. Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

    Science.gov (United States)

    Gavaskar, Ashok S; Chowdary, Naveen T

    2013-03-15

    Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score. Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up. The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

  16. proximal femur geometry in the adult kenyan femur and its ...

    African Journals Online (AJOL)

    implications considering that the implants used to treat fractures in the proximal femur would usually traverse the neck and lodge in the femoral head. A very narrow neck may not allow adequate implant placement especially for those implants that employ two proximal locking screws. This has been shown, in a study by ...

  17. A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail

    Directory of Open Access Journals (Sweden)

    Kumar M

    2017-11-01

    Full Text Available INTRODUCTION: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN. MATERIALS AND METHODS: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. RESULTS: Average duration of union was 17.08 weeks (range 13 to 32 weeks, union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. CONCLUSION: The long PFN is a reliable implant for sub-trochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

  18. The risk assessment of pathological fracture in the proximal femur using a CT-based finite element method.

    Science.gov (United States)

    Kawabata, Yusuke; Matsuo, Kosuke; Nezu, Yutaka; Kamiishi, Takayuki; Inaba, Yutaka; Saito, Tomoyuki

    2017-09-01

    Patients who have lytic bone lesions in their proximal femurs are at risk for pathological fracture. Lesions with high fracture risk are surgically treated using prophylactic osteosynthesis, whereas low-risk lesions are treated conservatively. However, it is difficult to discriminate between high- and low-risk lesions based on clinical and radiographic findings. The computed tomography (CT)-based finite element (FE) models are useful for predicting the fracture load on proximal femoral lytic lesions. FE models were constructed from the quantitative CT scans of the femurs using software that created individual bone shapes and density distributions. Three independent observers measured the lesion size, Mirels' score, and thickness of the proximal femur along the horizontal plane. The predictive risk values of the proximal femur measured using the CT-based FE analysis were statistically compared. The patients were divided into two groups (high and low risk). The mean fracture load was significantly higher in the high-risk group than in the low-risk group (5395 ± 525 N, 2622 ± 364 N, respectively, p = 0.0003). No significant differences in age, body weight, lesion size or Mirels' score were observed between groups. However, the thickness of the medial cortex in the high-risk group according to the FE analysis was significantly thinner than that in the low-risk group. Furthermore, the medial cortex thickness was positively correlated with the predicted fracture load. An optimal cut-off value of 3.67 mm for the thickness of the inner cortex resulted in 100% sensitivity and 75.1% specificity values for classifying the patients based on their fracture risk. Our findings indicate that the FE method is useful for the prediction of the pathological fracture. This method shows a versatile potential for the prediction of pathological fracture and might aid in judging the optimal treatment to prevent fracture. Copyright © 2017 The Japanese Orthopaedic Association

  19. Recurrent Proximal Femur Fractures in a Teenager With Osteogenesis Imperfecta on Continuous Bisphosphonate Therapy: Are We Overtreating?

    Science.gov (United States)

    Vasanwala, Rashida F; Sanghrajka, Anish; Bishop, Nicholas J; Högler, Wolfgang

    2016-07-01

    Long-term bisphosphonate (BP) therapy in adults with osteoporosis is associated with atypical femoral fractures, caused by increased material bone density and prolonged suppression of bone remodeling which may reduce fracture toughness. In children with osteogenesis imperfecta (OI), long-term intravenous BP therapy improves bone structure and mass without further increasing the already hypermineralized bone matrix, and is generally regarded as safe. Here we report a teenage girl with OI type IV, who was started on cyclical intravenous pamidronate therapy at age 6 years because of recurrent fractures. Transiliac bone biopsy revealed classical structural features of OI but unusually low bone resorption surfaces. She made substantial improvements in functional ability, bone mass, and fracture rate. However, after 5 years of pamidronate therapy she started to develop recurrent, bilateral, nontraumatic, and proximal femur fractures, which satisfied the case definition for atypical femur fractures. Some fractures were preceded by periosteal reactions and prodromal pain. Pamidronate was discontinued after 7 years of therapy, following which she sustained two further nontraumatic femur fractures, and continued to show delayed tibial osteotomy healing. Despite rodding surgery, and very much in contrast to her affected, untreated, and normally mobile mother, she remains wheelchair-dependent. The case of this girl raises questions about the long-term safety of BP therapy in some children, in particular about the risk of oversuppressed bone remodeling with the potential for microcrack accumulation, delayed healing, and increased stiffness. The principal concern is whether there is point at which benefit from BP therapy could turn into harm, where fracture risk increases again. This case should stimulate debate whether current adult atypical femoral fracture guidance should apply to children, and whether low-frequency, low-dose cyclical, intermittent, or oral treatment

  20. Uncommon Floating Knee in a Teenager: A Case Report of Ipsilateral Physeal Fractures in Distal Femur and Proximal Tibia.

    Science.gov (United States)

    Othman, Youssef; Hassini, Lassaad; Fekih, Aymen; Aloui, Issam; Abid, Abderrazek

    2017-01-01

    The concomitance of ipsilateral physeal fractures of the distal femur and the proximal tibia is an extremely scarce entity. It is conceptually similar to floating knee in pediatric population. One case with this injury is reported in a 16-year-old teenager. He was treated surgically by close reduction and internal fixation. The diagnosis of the tibial fracture was initially missed and the fracture was seen on the post-operative radiographs. Orthopedic treatment was made for this injury. 2 years after, no angular deformity neither shortening of the limb were found. These rare injuries could have serious immediate and remote complication with a considerable functional impact. The diagnosis of proximal tibia physeal fracture could be missed in the context of a concomitant more impressive distal femur fracture. The possibility of a combination of these two injuries should then be kept in mind. Anatomic reduction should be made as soon as possible using a gentle technique and attention should be given to the diagnosis of the neurovascular complications.

  1. A MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF FRACTURES OF THE PROXIMAL FEMUR ON THE BACKGROUND OF SENILE OSTEOPOROSIS

    Directory of Open Access Journals (Sweden)

    N. V. Zagorodniy

    2016-01-01

    Full Text Available The article presents a review of published data on the problem of osteoporosis in patients older than 75 years who have had fractures of the proximal femur. We used descriptive and analytical methods. Search publications have done in accessible to free search databases. Based on our analysis, it was found: the majority of researchers in Russia and abroad are united in the opinion that this issue requires a multidisciplinary approach; surgical treatment should be initiated as early as possible after the onset of fracture, before the complications from side of the internal organs; patients with fractures on the background of senile osteoporosis should receive drugs that affect to the quantitative and qualitative components of bone.

  2. Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

    Science.gov (United States)

    Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

    The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

  3. Quantitative local topological texture properties obtained from radiographs of the proximal femur in patients with pertrochanteric and transcervical hip fractures

    Science.gov (United States)

    Boehm, H. F.; Lutz, J.; Koerner, M.; Notohamiprodjo, M.; Reiser, M.

    2009-02-01

    The incidence of osteoporosis and associated fractures becomes an increasingly relevant issue for the public health institutions of industrialized nations. Fractures of the hip represent the worst complication of osteoporosis with a significantly elevated rate of mortality. Prediction of fracture risk is a major focus of osteoporosis research and, over the years, has been approched from different angles. There exist two distinct subtypes of transcervical and pertrochanteric hip fracture that can be distinguished on the basis of the anatomical location of the injury. While the epidemiology of hip fractures has been well described, typically, little or no distinction is made between the subtypes. The object of this study was to determine whether local topological texture properties based on the Minkowski Functionals (MF) obtained from standard radiographs of the proximal femur in patients with hip fracture can be used to differentiate between the two types of fracture pattern. The texture features were extracted from standardized regions of interest (femoral head, neck, and pertrochanteric region) in clinical radiographs of the hip obtained from 90 post-menopausal women (69.8 +/- 7.9 yrs). 30 of the women had sustained pertrochanteric fractures, 30 had transcervical hip fractures and 30 were age-matched controls. We determined an optimized topological parameter MF2Dloc using an integrative filtering procedure based on a sliding-windows algorithm. Statistical relationship between the fracture type (pertrochanteric/transcervical) and the value of MF2Dloc was assessed by receiver-operator characteristic (ROC) analysis. Depending on the anatomical location of the region of interest for texture analysis correct classification of tanscervial and pertrochanteric fractures ranged from AUC = 0.79 to 0.98. In conclusion, quantitative texture properties of trabecular bone extracted from radiographs of the hip can be used to identify patients with hip fracture and to distinguish

  4. [Our view on the problem of treating patients with fractures of the proximal segment of the femur].

    Science.gov (United States)

    Ternovoi, N K; Samokhin, A V; Grebennikov, K A

    2001-01-01

    The purpose of this study is to elucidate and analyze causes of difficulties encountered in dealing with fractures of the proximal segment of the femur and to set out our idea of solving these problems. An analysis is performed of classifications, an assessment is given of studying the adequate choice of a treatment modality, an attempt is made at formulating a doctrine of delivering qualified and specialized emergency medical service to those persons having been disabled for work, which could take account of all aspects of the injury under study. Indications for hemiarthroplasty are outlined, with the policy of primary sparing the joint elements by atraumatic osteosynthesis techniques being chosen in preference to any other policy.

  5. Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Dirk, E-mail: d.mueller@uk-koeln.de [Department of Radiology, University of Cologne (Germany); Department of Radiology, Technische Universität München (Germany); Schaeffeler, Christoph, E-mail: schaeffeler@me.com [Department of Radiology, Cantonal Hospital Graubuenden, Chur (Switzerland); Department of Radiology, Cantonal Hospital Graubuenden, Chur (Switzerland); Baum, Thomas, E-mail: thomas-baum@gmx.de [Department of Radiology, Technische Universität München (Germany); Walter, Flavia, E-mail: flavia_walter2000@yahoo.de [Department of Radiology, Technische Universität München (Germany); Rechl, Hans, E-mail: rechl@tum.de [Department of Orthopaedics, Technische Universität München (Germany); Rummeny, Ernst J., E-mail: rummeny@tum.de [Department of Radiology, Technische Universität München (Germany); Woertler, Klaus, E-mail: klaus.woertler@tum.de [Department of Radiology, Technische Universität München (Germany)

    2014-10-15

    Highlights: • DCE-MRI may add information to the pathophysiology of bone marrow edema (BME) of the proximal femur. • Patients with transient bone marrow edema (TBME) or subchondral insufficiency fractures (SIF) and avascular osteonecrosis (AVN) showed different MR perfusion patterns. • Perfusion characteristics suggest different pathophysiology for AVN compared with TBME or SIF. • Diffusion weighted imaging (DWI) was not able to discriminate necrotic from edematous bone marrow. • DWI is of limited value to evaluate BME of the proximal femur. - Abstract: Purpose: To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur. Materials and methods: 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated. Results: Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (E{sub max}), slope (E{sub slope}) and time to peak (TTP) between the three patient groups (p < 0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients. Conclusion: Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology

  6. Proximal femur geometry in the adult Kenyan femur and its ...

    African Journals Online (AJOL)

    Background: Numerous orthopaedic procedures are carried out on the proximal femur. For optimal hip function, these procedures must restore the anatomy of the proximal femur to as near normal as possible. There are currently no local studies that have described in detail the normal anatomy of the proximal femur and its ...

  7. Forecasting Proximal Femur and Wrist Fracture Caused by a Fall to the Side during Space Exploration Missions to the Moon and Mars

    Science.gov (United States)

    Lewandowski, Beth E.; Myers, Jerry G.; Sulkowski, C.; Ruehl, K.; Licata, A.

    2008-01-01

    The possibility of bone fracture in space is a concern due to the negative impact it could have on a mission. The Bone Fracture Risk Module (BFxRM) developed at the NASA Glenn Research Center is a statistical simulation that quantifies the probability of bone fracture at specific skeletal locations for particular activities or events during space exploration missions. This paper reports fracture probability predictions for the proximal femur and wrist resulting from a fall to the side during an extravehicular activity (EVA) on specific days of lunar and Martian exploration missions. The risk of fracture at the proximal femur on any given day of the mission is small and fairly constant, although it is slightly greater towards the end of the mission, due to a reduction in proximal femur bone mineral density (BMD). The risk of wrist fracture is greater than the risk of hip fracture and there is an increased risk on Mars since it has a higher gravitational environment than the moon. The BFxRM can be used to help manage the risk of bone fracture in space as an engineering tool that is used during mission operation and resource planning.

  8. A Study of Inflammatory/Necrosis Biomarkers in the Fracture of the Femur Treated with Proximal Femoral Nail Antirotation

    Directory of Open Access Journals (Sweden)

    Mariapaola Marino

    2015-01-01

    Full Text Available Pertrochanteric fractures are common injuries in adults and source of morbidity and mortality among the elderly. Different surgical techniques were recommended for their treatment but undoubtedly they add an additional inflammatory trauma along the fracture itself. Many attempts to quantify the degree of approach-related trauma are carried out through measurements of systemic inflammatory parameters. In this study we prospectively analyzed laboratory data of 20 patients over eighty with pertrochanteric fracture of the femur treated with proximal femoral nail antirotation (PFNA. This is an excellent device for osteosynthesis because it can be easily and quickly inserted by a mini-incision providing stable fixation and early full mobilization. Serum tumor necrosis factor-alpha (TNF-α, interleukin-6 (IL-6, C-reactive protein (CRP, and plasma creatin kinase (CK were evaluated 1 hour preoperatively and 24 hours postoperatively. Our results show that PFNA did not induce significant increments in serum levels of inflammatory cytokines TNF-α and IL-6; CRP was elevated preoperatively in correlation with waiting time for surgery; CRP and CK showed a significant increment in the first postoperatory day; CK increment was correlated with surgical time length. We conclude that, for the markers we analyzed, PFNA shows a low biomechanical-inflammatory profile that represents an advantage over other techniques.

  9. The incidence of fracture of the proximal femur in two million Canadians from 1972 to 1984. Projections for Canada in the year 2006.

    Science.gov (United States)

    Martin, A D; Silverthorn, K G; Houston, C S; Bernhardson, S; Wajda, A; Roos, L L

    1991-05-01

    Reported increases in the number of fractures of the proximal femur in Europe are greater than can be explained by demographic changes alone. This trend was assessed in Canada by examining hospital discharge records from the provinces of Saskatchewan and Manitoba from 1972 to 1984. The annual number of first fractures of the proximal femur in persons older than 50 years of age increased 59.7% in women and 42.2% in men during this time period. In most of the five-year age groups the percentage of increase in the number of fractures exceeded the percentage of increase in population of that age group. Annual age-specific incidences (by five-year age groups) increased exponentially with age, doubling every six years, and reached a maximum value of 4% in women older than 90 years of age. Annual age-adjusted incidences increased significantly over the study period in men and women. For the whole of Canada in 1987, it is estimated that there were 13,193 first fractures of the proximal femur in women and 4610 in men, and that in the year 2006 these will rise to 22,922 and 7846, respectively. The actual increase will be considerably greater if the age-specific incidences continue to increase as they have from 1972 to 1984. The gradual decline in physical activity, which contributes to bone loss, may be one etiological factor of this trend during the last half century.

  10. Pre-operative traction for fractures of the proximal femur in adults.

    Science.gov (United States)

    Parker, M J; Handoll, H H G

    2006-07-19

    Following a hip fracture, traction may be applied to the injured limb before surgery. To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006), EMBASE (1988 to 2006 Week 11), CINAHL (1982 to March 2006), the UK National Research Register (Issue 1, 2006), conference proceedings and reference lists of articles. All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery. Both authors independently assessed trial quality and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, data were pooled. Ten randomised trials, mainly of moderate quality, involving a total of 1546 predominantly elderly patients with hip fractures, were identified and included in the review. Nine trials compared traction with no traction. Although limited data pooling was possible, overall this provided no evidence of benefit from traction, either in the relief of pain before surgery or ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly. From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential

  11. Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: the osteoporotic fractures in men (MrOS) study.

    Science.gov (United States)

    Yang, Lang; Burton, Annabel C; Bradburn, Mike; Nielson, Carrie M; Orwoll, Eric S; Eastell, Richard

    2012-11-01

    This prospective case-cohort study aimed to map the distribution of bone density in the proximal femur and examine its association with hip fracture. We analyzed baseline quantitative computed tomography (QCT) scans in 250 men aged 65 years or older, which comprised a randomly-selected subcohort of 210 men and 40 cases of first hip fracture during a mean follow-up period of 5.5 years. We quantified cortical, trabecular, and integral volumetric bone mineral density (vBMD), and cortical thickness (CtTh) in four quadrants of cross-sections along the length of the femoral neck (FN), intertrochanter (IT), and trochanter (TR). In most quadrants, vBMDs and CtTh were significantly (p fracture, we merged the two quadrants in the medial and lateral aspects of the FN, IT, and TR. At most sites, QCT measurements were associated significantly (p fracture, the hazard ratio (HR) adjusted for age, body mass index (BMI), and clinical site for a 1-SD decrease ranged between 2.28 (95% confidence interval [CI], 1.44-3.63) to 6.91 (95% CI, 3.11-15.53). After additional adjustment for total hip (TH) areal BMD (aBMD), trabecular vBMDs at the FN, TR, and TH were still associated with hip fracture significantly (p fracture significantly (p > 0.05) better than TH aBMD. With an area under the receiver operating characteristic curve (AUC) of 0.901 (95% CI, 0.852-0.950), the regression model combining TH aBMD, age, and trabecular vBMD predicted hip fracture significantly (p fracture risk and highlight trabecular vBMD at the FN and TR as an independent risk factor. Copyright © 2012 American Society for Bone and Mineral Research.

  12. Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options.

    Science.gov (United States)

    Cirnigliaro, C M; Myslinski, M J; La Fountaine, M F; Kirshblum, S C; Forrest, G F; Bauman, W A

    2017-03-01

    Persons with spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have severe bone loss below the level of lesion associated with increased risk of long-bone fractures. The pattern of bone loss in individuals with SCI differs from other forms of secondary osteoporosis because the skeleton above the level of lesion remains unaffected, while marked bone loss occurs in the regions of neurological impairment. Striking demineralization of the trabecular epiphyses of the distal femur (supracondylar) and proximal tibia occurs, with the knee region being highly vulnerable to fracture because many accidents occur while sitting in a wheelchair, making the knee region the first point of contact to any applied force. To quantify bone mineral density (BMD) at the knee, dual energy x-ray absorptiometry (DXA) and/or computed tomography (CT) bone densitometry are routinely employed in the clinical and research settings. A detailed review of imaging methods to acquire and quantify BMD at the distal femur and proximal tibia has not been performed to date but, if available, would serve as a reference for clinicians and researchers. This article will discuss the risk of fracture at the knee in persons with SCI, imaging methods to acquire and quantify BMD at the distal femur and proximal tibia, and treatment options available for prophylaxis against or reversal of osteoporosis in individuals with SCI.

  13. Double plating in Vancouver type B1 periprosthetic proximal femur fractures: A biomechanical study.

    Science.gov (United States)

    Wähnert, Dirk; Grüneweller, Niklas; Gehweiler, Dominic; Brunn, Benjamin; Raschke, Michael J; Stange, Richard

    2017-02-01

    Periprosthetic hip fractures are an increasing problem in modern orthopedic and trauma surgery. Many options for the operative treatment are available to the surgeon ranging from modern variable angular systems to standard plates, screws, and cerclages. However, there is no gold standard and therefore, the aim of this study, was to investigate the biomechanical characteristics of double plating versus a lateral standard plate in a Vancouver B1 fracture model. Ten 4th generation composite femora were used to implant cementless total hip prosthesis and create Vancouver B1 periprosthetic fractures. Afterwards, the osteotomies were fixed using the locking compression plate in combination with the locking attachment plate (LCP, LAP, DePuy Synthes, Solothurn, Switzerland)-group I. Group II additionally achieved a 5-hole 4.5/5.0 mm LCP anteriorly. Each construct was cyclically loaded to failure in axial compression. Axial construct stiffness was 50.87 N/mm (SD 1.61) for group I compared to 738.68 N/mm (SD 94.8) for group II, this difference was statistically significant (p = 0.016). The number of cycles to failure was also significant higher for group II (2,375 vs. 13,000 cycles; p = 0.016). Double plating can significantly increase construct stiffness and stability, and thus, is an option in the treatment of complex periprosthetic fractures, in revision surgery and for patients with the inability to partial weight bear. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:234-239, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly.

    Science.gov (United States)

    Yu, Weiguang; Zhang, Xinchao; Zhu, Xingfei; Hu, Jun; Liu, Yunjiang

    2016-01-15

    The purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails anti-rotation-Asia (PFNA-IIs) or InterTan nails (ITs). Between January 1, 2012, and June 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study. The only intervention was ITs or PFNA-IIs of the unstable trochanteric femur fractures. Follow-up was at 1, 3, 6, and 12 months postoperatively and yearly thereafter. Intraoperative variables and postoperative complications were compared between the two groups. Eight patients died, six were too infirmed for follow-up, and seven were lost during follow-up, leaving 147 patients meeting the criteria were evaluated at a mean follow-up of 20 months (range 16-26 months). Significant differences were observed between the two groups regarding local complications (IT, n = 10 vs. PFNA-II, n = 20), varus collapse of the head/neck or femoral shaft fractures at the tip of the nail (IT, n = 1 vs. PFNA-II, n = 8), femoral neck shortening (IT, 4.4 ± 1.1 mm vs. PFNA-II, 7.4 ± 2.4 mm), fracture healing time (IT, 14.7 ± 2.1 weeks vs. PFNA-II, 15.7 ± 2.4 weeks), femoral shaft fractures (IT, n = 0 vs. PFNA-II, n = 4), rotational loss of reduction (IT, n = 0 vs. PFNA-II, n = 9), lateral cortex fractures of the proximal femur or lateral greater trochanter fractures (IT, n = 8 vs. PFNA-II, n = 1), operative time (IT, 71.9 ± 6.8 min vs. PFNA-II, 52.3 ± 4.0 min), intraoperative blood loss (IT, 190.6 ± 6.0 mL vs. PFNA-II, 180.9 ± 10.8 mL), fluoroscopy time (IT, 5.0 ± 0.48 min vs. PFNA-II, 2.8 ± 0.33 min), hospital stay (IT, 9.65 ± 0.95 days vs. PFNA-II, 8.58 ± 0.93 days), cut-out (IT, n = 0 vs. PFNA-II, n = 6), and tip-apex distance (IT, 26.7 ± 0.91 mm vs. PFNA-II, 23.2 ± 1.22 mm). No significant differences existed for the other observation indexes (p > 0.05). The IT nail may have more advantage for

  15. INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

    OpenAIRE

    Zhang, Hui; Zeng, Xianshang; Zhang, Nan; Zeng, Dan; Xu, Ping; Zhang, Lili; Chen, Deng; Yu, Weiguang; Zhang, Xinchao

    2017-01-01

    Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair wi...

  16. COMPARATIVE STUDY BETWEEN PROXIMAL FEMORAL NAILING AND DYNAMIC HIP SCREW IN THE MANAGEMENT OF INTERTROCHANTERIC FRACTURES OF FEMUR

    Directory of Open Access Journals (Sweden)

    Penugonda Ravi Shankar

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES : To determine the rate of union, complications, operative risks and functional outcomes in intertrochanteric fractures treated with DHS and PFN , To compare the results obtained and To compare the effectiveness of DHS and PFN in treatment of intertrochanteric fractures. RESULTS : In the present series of 24 cases of Intertrochanteric fractures were treated by proximal femoral nailing and dynamic hip screw, 12 cases in each. Out of 24 there were 13 male and 11 female. Minimum age was 36 years, maximum age 76 years with mean age of 59.25 years. Slip and fall accounted for 75% of cases. BOYD and GRIFFIN type II fracture accounted for 58.3% of cases. Mean duration of hospital stay was 26 days in both PFN and DHS groups. Length of incision was small 5 - 6cm in PFN group compared to 10 - 12cm in DHS group. Mean external blood loss 150ml in PFN group and 315 ml in DHS group. Mean time for full weight bearing was 11.5 weeks for PFN group and 14.3 weeks for DHS group. Radiological union was 12.3 weeks in PFN group and 15.5 weeks in DHS group. Good to excellent results were seen in 91.7% of cases in PFN group and 75% in DHS group. CONCLUSION : From the study, we consider PFN as better alternative to DHS in the treatment of intertrochanteric fractures but is technically difficult procedure and requires more expertise compared to DHS.As learning curve of PFN procedure is steep, with experience gained from each case operative time, radiation exposure and intraoperative complications can be reduced in each case of PFN

  17. Anatomia radiográfica da região proximal do fêmur: correlação com a ocorrência de fraturas Radiographic anatomy of the proximal femur: correlation with the occurrence of fractures

    Directory of Open Access Journals (Sweden)

    Robinson Esteves Santos Pires

    2012-01-01

    Full Text Available OBJETIVO: Avaliar se existe correlação entre parâmetros radiográficos da anatomia da região proximal do fêmur e a ocorrência de fraturas. MÉTODOS: Trezentas e cinco radiografias digitais da bacia foram analisadas na incidência ântero-posterior. Destas radiografias, vinte e sete apresentavam fratura do colo femoral ou transtrocantérica. Os parâmetros anatômicos analisados foram: Largura do colo femoral (LCF, comprimento do colo femoral (CCF, comprimento do eixo femoral (CEF, ângulo cérvico-diafisário (ACD, distância entre as lágrimas acetabulares (DLA e a distância grande trocânter- sínfise púbica (DGTSP.Foram analisadas, comparativamente, as radiografias com e sem fratura da região proximal do fêmur, para verificar se existem parâmetros radiográficos que estão associados com maior probabilidade de ocorrência de fratura do colo femoral ou transtrocantérica. RESULTADOS: Não foi encontrada diferença entre os parâmetros anatômicos dos grupos com e sem fratura na região proximal do fêmur. CONCLUSÃO: Não foi encontrada nenhuma associação entre alterações anatômicas na região proximal do fêmur e maior susceptibilidade à ocorrência de fraturas. Nível de evidência IV, Estudo Transversal.OBJECTIVE: To evaluate the correlation between radiographic parameters of the proximal femur anatomy and fractures. METHODS: Three hundred and five digital x-rays of the pelvis were analyzed in the anteroposterior view. Of these x-rays, twenty-seven showed femoral neck or transtrochanteric fractures. The anatomical parameters analyzed were: femoral neck width (FNW, femoral neck length (FNL, femoral axis length (FAL, cervicodiaphyseal angle (CDA, acetabular tear-drop distance (ATD and great trochanter-pubic symphysis distance (GTPSD. The analysis was performed by comparing the results of the x-rays with and without proximal femoral fracture, to establish a correlation between them. RESULTS: No differences were found between

  18. INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis.

    Science.gov (United States)

    Zhang, Hui; Zeng, Xianshang; Zhang, Nan; Zeng, Dan; Xu, Ping; Zhang, Lili; Chen, Deng; Yu, Weiguang; Zhang, Xinchao

    2017-08-01

    Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair with either a PFNA-II or IT. Follow-up assessments were performed 1, 3, 6, 9, and 12 months postoperatively and every year thereafter. All implant position changes were noted. Patient-related functional outcomes were evaluated based on the Harris hip score. Results In total, 174 patients with osteoporosis (IT, n = 86; PFNA-II, n = 88) were evaluated during a mean follow-up period of 40 months (range, 38-60 months). An increased risk of femoral shaft fracture after implant removal was observed at month 9 of follow-up in 0.0% and 4.4% of the IT and PFNA-II groups, respectively. This difference remained over time with rates of 1.1% and 6.8%, respectively, at the last follow-up. Conclusion The IT nail appears to be a reliable implant in the management of IFFs (AO/OTA Type 3.1A1.1-A2.3) in elderly patients with primary osteoporosis.

  19. Dedifferentiated chondrosarcoma of right proximal femur

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    Sachin A Badge

    2016-01-01

    Full Text Available Dedifferentiated chondrosarcoma (DDCS comprises approximately 10% of all chondrosarcomas. The tumor generally occurs after the age of 50 years, with equal distribution among males and females. It is most often located in the bones of the pelvis, the proximal femur or humerus, the distal femur, and the ribs. Regardless of treatment, the prognosis is ominous with 90% of patients dying with distant metastases within 2 years. We report a case of DDCS of right proximal femur in a 73-year-old woman. The most important factors affecting survival are early recognition of the radiographic features, adequate histological sampling, and wide-margin resection of the lesion. So for the correct histopathological diagnosis the biopsy sample should be adequate to visualize both cartilaginous and noncartilaginous sarcomatous component which helps to increase the survival of patients before the distant metastasis occurs.

  20. Fraturas proximais do fêmur em idosos: qual o melhor tratamento? Proximal fracture of the femur on the elderly: what's the best treatment?

    Directory of Open Access Journals (Sweden)

    Lygia Paccini Lustosa

    2009-01-01

    Full Text Available As fraturas proximais do fêmur em idosos representam um sério problema dentro do contexto da saúde pública, devido aos elevados custos econômicos para o tratamento e as suas consequências, assim como pela alta taxa de morbidade e mortalidade. O objetivo desse estudo foi discutir quais os tratamentos mais indicados para esse tipo de fratura, em idosos, por meio de uma revisão da literatura. As bases de dados pesquisadas foram MEDLINE, COCHRANE e PEDro. Os critérios de inclusão foram estudos publicados nos últimos sete anos; nos idiomas português, inglês e espanhol; realizados em seres humanos, sem distinção de gênero e com idade maior que 60 anos; estudos com desenho metodológico de ensaios clínicos, ensaios clínicos aleatorizados e revisões sistemáticas com e sem meta-análise. Foram encontrados sete artigos e após a análise pode se afirmar que não existe um tratamento específico para as fraturas proximais do fêmur em idosos. O tratamento normalmente indicado na maioria dessas fraturas é cirúrgico e requer envolvimento fisioterápico para uma reabilitação adequada. Apesar da dificuldade de comparação entre os estudos, foi observado que uma equipe de profissionais da saúde parece promover uma reabilitação mais efetiva, além de prevenir complicações.The proximal fractures of the femur on the elderly represent a serious problem inside the public health context, because of the high economic costs needed for the treatment and it's consequence, as the high taxes of morbidity and mortality. The goal of this study was to discuss, through a literature revision, which is the most indicated treatment for the proximal fractures of the femur, on the elderly. The researched data bases were MEDLINE, COCHRANE and PEDro. The inclusion criterions were published studies on the last seven years, only on the Portuguese, English and Spanish languages, accomplished on human beings, with no genre distinction and with ages above 60

  1. The impact of care pathways for patients with proximal femur fracture: rationale and design of a cluster-randomized controlled trial

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    Vanhaecht Kris

    2012-05-01

    Full Text Available Abstract Background Proximal femur fracture (PFF is associated with considerable morbidity and mortality. The European Quality of Care Pathway (EQCP study on PFF (NCT00962910 was designed to determine how care pathways (CP for hospital treatment of PFF affect consistency of care, adherence to evidence-based key interventions, and clinical outcome. Methods/Design An international cluster-randomized controlled trial (cRCT will be performed in Belgium, Ireland, Italy and Portugal. Based on power analyses, a sample of 44 hospital teams and 437 patients per arm will be included in the study. In the control arm, usual care will be provided. Experimental teams will implement a care pathway which will include three active components: a formative evaluation of quality and organization of the care setting, a set of evidence-based key interventions, and support of the development and implementation of the CP. Main outcome will be the six-month mortality rate. Discussion The EQCP study constitutes the first international cRCT on care pathways. The EQCP project was designed as both a research and a quality improvement project and will provide a real-world framework for process evaluation to improve our understanding of why and when CP can really work. Trial registration number NCT00962910

  2. Does Fracture Affect the Healing Time or Frequency of Recurrence in a Simple Bone Cyst of the Proximal Femur?

    National Research Council Canada - National Science Library

    Cha, Soo Min; Shin, Hyun Dae; Kim, Kyung Cheon; Park, Jung Woo

    2014-01-01

    ... fracture in terms of (1) healing time, (2) frequency and timing of recurrence, and (3) complications.From 1995 to 2005, 54 patients diagnosed with femoral simple bone cysts were treated and followed for a minimum of 8 years...

  3. Cesarean Section and Femur Fracture: A Rare Complication

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    Eyup Zengin

    2013-08-01

    Full Text Available Femoral fracture due to birth trauma which is rare, can ocur during cesarean section. This case represents a new born delivered by cesarean section for breech presentation who sustained proximal fracture of the femur. Then newborn was treated with immobilization in bryant traction. Bryant%u2019s traction for 3 weeks in hospital is a safe method for the treatment of femoral fractures in neonates,and the outcome is good.

  4. Incidencia y factores de riesgo de la fractura de fémur proximal por osteoporosis Incidence of and risk factors associated with fractures of the proximal femur due to osteoporosis

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    María Teresa Mosquera

    1998-04-01

    Full Text Available Todos los años se producen en el mundo más de un millón de fracturas de fémur proximal, sobre todo en personas de edad avanzada. Dado el continuo envejecimiento de las poblaciones, las fracturas aumentarán año tras año y constituirán un problema cada vez más grave de salud pública. Se espera que el mayor aumento de dichas fracturas ocurra en América Latina alrededor del 2050. Teniendo en cuenta que cerca de 70% de las fracturas atraumáticas en personas mayores de 45 años de edad se deben a osteoporosis, se diseñó un estudio de casos y controles en la ciudad de Mar del Plata, Argentina, para conocer la incidencia de fracturas de fémur proximal por osteoporosis y los factores de riesgo asociados. Entre el 1 de agosto de 1992 y el 31 de julio de 1993 se registraron todos los casos de fracturas de fémur proximal por osteoporosis en personas mayores de 50 años de edad que acudieron a cualquiera de los 30 centros de salud públicos y privados de la ciudad. Se registró un total de 246 casos. La tasa de incidencia por 100 000 habitantes en la población mayor de 50 años fue de 259 en mujeres y de 92 en varones, con una relación de 2,8:1. La incidencia fue siempre mayor a mayor edad y sobre todo a partir de los 75 años. Los factores asociados con aumento del riesgo de fractura de fémur proximal con significación estadística fueron: antecedentes de enfermedades neurológicas, consumo de psicofármacos, consumo de alcohol, fracturas previas, enfermedades cardiovasculares y menor consumo de lácteos. No se observaron diferencias entre los casos y los controles con respecto a edad de inicio de la menopausia, peso, talla, actividad previa, hábito de fumar o exposición al sol, como así tampoco en el porcentaje de mujeres que habían tenido ooforectomías.Every year more than one million fractures of the proximal femur occur in the world, especially in older persons. Given the continuous aging experienced by populations, such

  5. [Atypical fractures of the femur: apropos of 3 clinical cases].

    Science.gov (United States)

    Sanduloviciu, Maria; Stoll, Delphine; Lamy, Olivier; Krieg, Marc-Antoine; Aubry-Rozier, Bérengère

    2014-08-06

    Osteoporosis is an increasing public health problem. The bisphophonates are the most useful treatment used through the world to prevent osteoporotic fractures. Their large prescription revealed an unpredictable side effect: the atypical fracture. These fractures appear in the subtrochanteric or diaphysal femoral proximal site, spontaneously or after a low trauma, and could be bilateral. X-rays shows a transversal or oblique fracture with a spur in the cortex and with a diffuse thickening of the cortical of the proximal femur. Expert's recommendations are current in progress to well understand and managed this problem. Here we report three cases of atypical femur fractures occurred in our Centre of bone diseases with some management and treatment propositions.

  6. The Effect of Cement Placement on Augmentation of the Osteoporotic Proximal Femur

    OpenAIRE

    Sutter, Edward G.; Wall, Simon J.; Mears, Simon C; Belkoff, Stephen M.

    2010-01-01

    Femoroplasty, the augmentation of the proximal femur, has been shown in biomechanical studies to increase the energy required to produce a fracture and therefore may reduce the risk of such injuries. The purpose of our study was to test the hypotheses that: (1) 15 mL of cement was sufficient to mechanically augment the proximal femur, (2) there was no difference in augmentation effect between cement placement in the intertrochanteric region and in the femoral neck, and (3) cement placement in...

  7. A case of acute bilateral femur fracture with vascular injury

    Directory of Open Access Journals (Sweden)

    Slavisa Zagorac

    2016-01-01

    Full Text Available The femoral fractures remain the great challenge for orthopedic surgeons regarding time of fixation and appropriate fixation techniques. There is a bimodal distribution of fractures occurring most frequently in young males after high-energy trauma (motor vehicle accidents and in elderly females after falls from standing. Young patients with femoral fracture are under the great risk of multiple injuries. Hence, the great significance is optimal time of fixation. We present a case of unusual pattern of injury and fixation technique of bilateral proximal femur fracture associated with vascular injury, with very satisfied outcome.

  8. In vivo measurements of ultrasound transmission through the human proximal femur.

    Science.gov (United States)

    Barkmann, Reinhard; Laugier, Pascal; Moser, Urs; Dencks, Stefanie; Klausner, Michael; Padilla, Frédéric; Haiat, Guillaume; Heller, Martin; Glüer, Claus-C

    2008-07-01

    Quantitative ultrasound (QUS) measurements can be used to estimate osteoporotic fracture risk. The commonly used variables are the speed of sound (SOS) and the frequency dependent sound attenuation (broadband ultrasound attenuation, [BUA]) of a wave propagating through the bone, preferably the calcaneus. The technology, so far, is less suitable for direct measurement in vivo at the spine or the femur for prediction of bone mineral density (BMD) or fracture risk at the main osteoporotic fracture sites. To improve the clinical performance of QUS, we built a device for direct QUS measurements at the human femur in vivo. In vivo images of ultrasound transmission at one of the main fracture sites, the proximal femur, could be acquired. The estimated precision of SOS measurements of 0.5% achieved at the femur is comparable with the precision of peripheral QUS devices.

  9. Proximal humeral fractures

    OpenAIRE

    Mauro, Craig S.

    2011-01-01

    Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percuta...

  10. Increased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of Fracture Risk Assessment Tool and Garvan estimates in postmenopausal women.

    Science.gov (United States)

    Kral, Rita; Osima, Marit; Borgen, Tove T; Vestgaard, Roald; Richardsen, Elin; Bjørnerem, Åshild

    2017-01-01

    The Fracture Risk Assessment Tool (FRAX) and Garvan Calculator have improved the individual prediction of fracture risk. However, additional bone measurements that might enhance the predictive ability of these tools are the subject of research. There is increasing interest in cortical parameters, especially cortical porosity. Neither FRAX nor Garvan include measurements of cortical architecture, important for bone strength, and providing independent information beyond the conventional approaches. We tested the hypothesis that cortical parameters are associated with fracture risk, independent of FRAX and Garvan estimates. This nested case-control study included 211 postmenopausal women aged 54-94 years with nonvertebral fractures, and 232 controls from the Tromsø Study in Norway. We assessed FRAX and Garvan 10-year risk estimates for fragility fracture, and quantified femoral subtrochanteric cortical porosity, thickness, and area from computed tomography images using StrAx1.0 software. Per standard deviation higher cortical porosity, thinner cortices, and smaller cortical area, the odds ratio (95% confidence interval) for fracture was 1.71 (1.38-2.11), 1.79 (1.44-2.23), and 1.52 (1.19-1.95), respectively. Cortical porosity and thickness, but not area, remained associated with fracture when adjusted for FRAX and Garvan estimates. Adding cortical porosity and thickness to FRAX or Garvan resulted in greater area under the receiver operating characteristic curves. When using cortical porosity (>80th percentile) or cortical thickness (20%), 45.5% and 42.7% of fracture cases were identified, respectively. Using the same cutoffs for cortical porosity or thickness combined with Garvan (threshold >25%), 51.2% and 48.3% were identified, respectively. Specificity for all combinations ranged from 81.0-83.6%. Measurement of cortical porosity or thickness identified 20.4% and 17.5% additional fracture cases that, were unidentified using FRAX alone, and 16.6% and 13.7% fracture

  11. Increased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of Fracture Risk Assessment Tool and Garvan estimates in postmenopausal women.

    Directory of Open Access Journals (Sweden)

    Rita Kral

    Full Text Available The Fracture Risk Assessment Tool (FRAX and Garvan Calculator have improved the individual prediction of fracture risk. However, additional bone measurements that might enhance the predictive ability of these tools are the subject of research. There is increasing interest in cortical parameters, especially cortical porosity. Neither FRAX nor Garvan include measurements of cortical architecture, important for bone strength, and providing independent information beyond the conventional approaches. We tested the hypothesis that cortical parameters are associated with fracture risk, independent of FRAX and Garvan estimates. This nested case-control study included 211 postmenopausal women aged 54-94 years with nonvertebral fractures, and 232 controls from the Tromsø Study in Norway. We assessed FRAX and Garvan 10-year risk estimates for fragility fracture, and quantified femoral subtrochanteric cortical porosity, thickness, and area from computed tomography images using StrAx1.0 software. Per standard deviation higher cortical porosity, thinner cortices, and smaller cortical area, the odds ratio (95% confidence interval for fracture was 1.71 (1.38-2.11, 1.79 (1.44-2.23, and 1.52 (1.19-1.95, respectively. Cortical porosity and thickness, but not area, remained associated with fracture when adjusted for FRAX and Garvan estimates. Adding cortical porosity and thickness to FRAX or Garvan resulted in greater area under the receiver operating characteristic curves. When using cortical porosity (>80th percentile or cortical thickness (20%, 45.5% and 42.7% of fracture cases were identified, respectively. Using the same cutoffs for cortical porosity or thickness combined with Garvan (threshold >25%, 51.2% and 48.3% were identified, respectively. Specificity for all combinations ranged from 81.0-83.6%. Measurement of cortical porosity or thickness identified 20.4% and 17.5% additional fracture cases that, were unidentified using FRAX alone, and 16.6% and 13

  12. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    -displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... 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...

  13. Retrograde Intramedullary Nailing for Distal Femur Fracture with Osteoporosis

    OpenAIRE

    Kim, Jihyeung; Kang, Seung-baik; Nam, Kyungpyo; Rhee, Seung Hwan; Won, Jong Won; Han, Hyuk-Soo

    2012-01-01

    Background The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. Methods Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and manag...

  14. Evaluation of the geriatric co-management for patients with fragility fractures of the proximal femur (Geriatric Fracture Centre (GFC) concept): protocol for a prospective multicentre cohort study.

    Science.gov (United States)

    Joeris, Alexander; Hurtado-Chong, Anahí; Hess, Denise; Kalampoki, Vasiliki; Blauth, Michael

    2017-07-12

    Treatment of fractures in the elderly population is a clinical challenge due partly to the presence of comorbidities. In a Geriatric Fracture Centre (GFC), patients are co-managed by a geriatrician in an attempt to improve clinical outcomes and reduce morbidity and mortality. Until now the beneficial effect of orthogeriatric co-management has not been definitively proven. The primary objective of this study is to determine the effect of GFC on predefined major adverse events related to a hip fracture compared to usual care centres (UCC). The secondary objectives include assessments in quality of life, patient-reported outcomes and cost-effectiveness. Two hundred and sixty-six elderly patients diagnosedwith hip fracture and planned to be treated with osteosynthesis or endoprosthesis in either a GFC or UCC study site will be recruited, 133 per type of centre. All procedures and management will be done according to the site's standard of care. Study-related visits will be performed at the following time points: preoperative, intraoperative, discharge from the orthopaedic/trauma department, discharge to definite residential status, 12 weeks and 12 months postsurgery. Data collected include demographics, residential status, adverse events, patient-reported outcomes, fall history, costs and resources related to treatment. The risk of major adverse events at 12 months will be calculated for each centre type; patient-reported outcomes will be analysed by mixed effects regression models to estimate differences in mean scores between baseline and follow-ups whereas cost-effectiveness will be assessed using the incremental cost-effectiveness ratio. Ethics approval for this study was granted from the local Ethics Committees or Institutional Review Board from each of the participating sites prior to patient enrolment. The results of this study will be published in peer-reviewed journals and presented at different conferences. ClinicalTrials.gov: NCT02297581; pre-results.

  15. GUNSHOT FRACTURES OF TIBIA AND FEMUR - EXCELLENT ...

    African Journals Online (AJOL)

    2011-10-10

    Oct 10, 2011 ... GUNSHOT FRACTURES OF TIBIA AND FEMUR - EXCELLENT RESULTS WITH REAMED BONE MARROW GRAFT. AND INTERLOCKING .... between injury and surgery as well as associated injuries were documented. ..... injection in the treatment. of delayed and non-union in long bones. Singapore Med ...

  16. Automated Acquisition of Proximal Femur Morphological Characteristics

    Science.gov (United States)

    Tabakovic, Slobodan; Zeljkovic, Milan; Milojevic, Zoran

    2014-10-01

    The success of the hip arthroplasty surgery largely depends on the endoprosthesis adjustment to the patient's femur. This implies that the position of the femoral bone in relation to the pelvis is preserved and that the endoprosthesis position ensures its longevity. Dimensions and body shape of the hip joint endoprosthesis and its position after the surgery depend on a number of geometrical parameters of the patient's femur. One of the most suitable methods for determination of these parameters involves 3D reconstruction of femur, based on diagnostic images, and subsequent determination of the required geometric parameters. In this paper, software for automated determination of geometric parameters of the femur is presented. Detailed software development procedure for the purpose of faster and more efficient design of the hip endoprosthesis that ensures patients' specific requirements is also offered

  17. The best location for proximal locking screw for femur interlocking nailing: A biomechanical study

    Directory of Open Access Journals (Sweden)

    Ahmet A Karaarslan

    2016-01-01

    Conclusion: According to our findings, there is twice as much difference in locking screw bending resistance between these two application levels. To avoid proximal locking screw deformation, locking screws should be placed in the level of the lesser trochanter in nailing of 1/3 middle and distal femur fractures.

  18. Quantitative CT assessment of proximal femoral bone density. An experimental study concerning its correlation to breaking load for femoral neck fractures; Quantitative CT des proximalen Femurs. Experimentelle Untersuchungen zur Korrelation mit der Bruchlast bei Schenkelhalsfrakturen

    Energy Technology Data Exchange (ETDEWEB)

    Buitrago-Tellez, C.H.; Schulze, C.; Gufler, H.; Langer, M. [Abt. Roentgendiagnostik, Radiologische Universitaetsklinik, Albert-Ludwigs-Univ. Freiburg (Germany); Bonnaire, F.; Hoenninger, A.; Kuner, E. [Abt. Unfallchirurgie, Chirurgische Universitaetsklinik, Albert-Ludwigs-Univ. Freiburg (Germany)

    1997-12-01

    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{sup 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.) [Deutsch] Ziel: In einer experimentellen Versuchsserie wurde der Zusammenhang zwischen der Knochendichte an verschiedenen Lokalisationen des proximalen Femurs und der maximalen Last bei der Entstehung von Schenkelhalsfrakturen (Bruchlast) untersucht. Methode: An 41 frisch entnommenen proximalen Leichenfemora wurde die trabekulaere Knochendichte mit Hilfe der Ein-Energie Quantitativen Computertomographie (SE-QCT) bei einer Schichtdicke von 10 mm in der Mitte der Schenkelhalsachse bestimmt. Erfasst wurden die maximale extrakortikale, zylinderfoermige Messregion im Hueftkopf, Schenkelhals und der Intertrochantaerregion sowie das 1 cm{sup 3} umfassende Zentrum dieser Regionen. Die Praeparate wurden unter Zweibeinstandbedingungen

  19. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.

    2005-01-01

    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  20. A device for in vivo measurements of quantitative ultrasound variables at the human proximal femur.

    Science.gov (United States)

    Barkmann, Reinhard; Laugier, Pascal; Moser, Urs; Dencks, Stefanie; Klausner, Michael; Padilla, Frédéric; Haïat, Guilleaume; Glüer, Claus-C

    2008-01-01

    Quantitative ultrasound (QUS) at the calcaneus has similar power as a bone mineral density (BMD)- measurement using DXA for the prediction of osteoporotic fracture risk. Ultrasound equipment is less expensive than DXA and free of ionizing radiation. As a mechanical wave, QUS has the potential of measuring different bone properties than dual X-ray absorptiometry (DXA,) which depends on X-ray attenuation and might be developed into a tool of comprehensive assessment of bone strength. However, site-specific DXA at the proximal femur shows best performance in the prediction of hip fractures. To combine the potential of QUS with measurements directly at the femur, we developed a device for in vivo QUS measurements at this site. Methods comprise ultrasound transmission through the bone, reflection from the bone surface, and backscatter from the inner trabecular structure. The complete area of the proximal femur can be scanned except at the femoral head, which interferes with the ilium. To avoid edge artifacts, a subregion of the proximal femur in the trochanteric region was selected as measurement region. First, in vivo measurements demonstrate a good signal to noise ratio and proper depiction of the proximal femur on an attenuation image. Our results demonstrate the feasibility of in vivo measurements. Further improvements can be expected by refinement of the scanning technique and data evaluation method to enhance the potential of the new method for the estimation of bone strength.

  1. Transverse Stress Fracture of the Proximal Patella

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

  2. bilateral recon nailing of comminuted fracture femur in a severely ...

    African Journals Online (AJOL)

    2012-09-06

    Sep 6, 2012 ... Severely comminuted fractures of the femur can be challenging injuries to manage. The incidence of these ... (KNH). Injuries identified included almost identical bilateral fracture femur consisting of high subtrochanteric fracture with .... nailing for ipsilateral femoral neck and shaft fractures. Strategies Trauma ...

  3. Bisphosphonates and Atypical Fractures of Femur

    Directory of Open Access Journals (Sweden)

    Tero Yli-Kyyny

    2011-01-01

    Full Text Available Bisphosphonates are the most widely prescribed medicines for the treatment of osteoporosis and have generally been regarded as well-tolerated and safe drugs. Since 2005, there have been numerous case reports about atypical fractures of the femur linked to long-term treatment of osteoporosis with bisphosphonates. Some attempts to characterize pathophysiology and epidemiology of these fractures have been published as well. However, as the American Society for Bone and Mineral Research (ASBMR concluded in their task force report, the subject warrants further studies.

  4. Uncemented allograft-prosthetic composite reconstruction of the proximal femur

    Directory of Open Access Journals (Sweden)

    Li Min

    2014-01-01

    Full Text Available Background: Allograft-prosthetic composite can be divided into three groups names cemented, uncemented, and partially cemented. Previous studies have mainly reported outcomes in cemented and partially cemented allograft-prosthetic composites, but have rarely focused on the uncemented allograft-prosthetic composites. The objectives of our study were to describe a surgical technique for using proximal femoral uncemented allograft-prosthetic composite and to present the radiographic and clinical results. Materials and Methods: Twelve patients who underwent uncemented allograft-prosthetic composite reconstruction of the proximal femur after bone tumor resection were retrospectively evaluated at an average followup of 24.0 months. Clinical records and radiographs were evaluated. Results: In our series, union occurred in all the patients (100%; range 5-9 months. Until the most recent followup, there were no cases with infection, nonunion of the greater trochanter, junctional bone resorption, dislocation, allergic reaction, wear of acetabulum socket, recurrence, and metastasis. But there were three periprosthetic fractures which were fixed using cerclage wire during surgery. Five cases had bone resorption in and around the greater trochanter. The average Musculoskeletal Tumor Society (MSTS score and Harris hip score (HHS were 26.2 points (range 24-29 points and 80.6 points (range 66.2-92.7 points, respectively. Conclusions: These results showed that uncemented allograft-prosthetic composite could promote bone union through compression at the host-allograft junction and is a good choice for proximal femoral resection. Although this technology has its own merits, long term outcomes are yet not validated.

  5. The Analysis of Biomechanical Properties of Proximal Femur after Implant Removal

    Directory of Open Access Journals (Sweden)

    Jae Hyuk Yang

    2016-01-01

    Full Text Available Introduction. To compare the biomechanical stability of the femur following the removal of proximal femoral nail antirotation (PFNA-II and dynamic hip screw (DHS. Material and Methods. 56 paired cadaveric femurs were used as experimental and control groups. In the experimental group, PFNA-II and DHS were randomly inserted into femurs on both sides and then removed. Thereafter, compression load was applied until fracture occurred; biomechanical stability of the femurs and associated fracture patterns were studied. Results. The ultimate load and stiffness of the control group were 6227.8±1694.1 N and 990.5±99.8 N/mm, respectively. These were significantly higher than experimental group (p=0.014, <0.001 following the removal of PFNA-II (4085.6±1628.03 N and 656.3±155.3 N/mm and DHS (4001.9±1588.3 N and 656.3±155.3 N/mm. No statistical differences in these values were found between the 2 device groups (p=0.84, 0.71, regardless of age groups. However, fracture patterns were different between two devices, intertrochanteric and subtrochanteric fractures. Conclusions. Mechanical stability of the proximal femurs does not differ after the removal of 2 different of fixation devices regardless of the age. However, it was significantly lower compared to an intact femur. Different fracture patterns have been shown following the removal of different fixation devices as there are variations in the site of stress risers for individual implants.

  6. Population-based epidemiology and incidence of distal femur fractures

    DEFF Research Database (Denmark)

    Elsoe, Rasmus; Ceccotti, Adriano Axel; Larsen, Peter

    2017-01-01

    The literature lacks recent epidemiological studies on the incidence, trauma mechanism and fracture classification of distal femur fractures. The aim of the present study was to provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population...

  7. Pipkin Fractures: Fracture of the Head of Femur A Case Report ...

    African Journals Online (AJOL)

    Pipkin fracture is the fracture of the head of the femur. It can be associated with neck of femur fracture or / and posterior dislocation of the hip. This fracture is very rare fracture and has not been reported at our sub- region. We present this fracture in a 26 year old with a type I Pipkin fracture treated with closed reduction and ...

  8. Correlação entre tempo para o tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur Correlation between time until surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur

    Directory of Open Access Journals (Sweden)

    Gustavo Gonçalves Arliani

    2011-04-01

    Full Text Available OBJETIVO: O objetivo primário do estudo é analisar a possível associação entre o atraso para a realização do tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur. MÉTODOS: Foram estudados 269 pacientes com fraturas da extremidade proximal do fêmur (fraturas do colo do fêmur e fraturas intertrocanterianas, tratadas cirurgicamente no Hospital São Paulo - Unifesp-SP, no período de janeiro de 2003 a dezembro de 2007. Foram analisados e comparados com a literatura referente ao assunto os seguintes atributos: sexo, idade, tipo de fratura, classificação da mesma, lado acometido, síntese utilizada, mecanismo de trauma, tempo de internação, tempo para cirurgia, comorbidades associadas, hemograma de entrada, tipo de anestesia, necessidade de transfusão sanguínea, dia da semana e estação do ano da fratura. RESULTADOS: O estudo apresentou correlação entre maior número de comorbidades clínicas, maior tempo de internação e utilização de anestesia geral na cirurgia com maior mortalidade dos pacientes. CONCLUSÃO: Não houve associação entre tempo para realização da cirurgia e mortalidade.OBJECTIVE: The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. METHODS: 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. Sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, length of surgery, associated comorbidities, hemogram at admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture were analyzed and compared with the literature

  9. Comparison of morphological features in the femur between femoral neck fractures and femoral intertrochanteric fractures.

    Science.gov (United States)

    Yamauchi, Koun; Naofumi, Mitsuishi; Sumida, Hisashi; Fukuta, Shoji; Hori, Hirohiko

    2016-09-01

    The purpose of this study is to make proximal femur fracture types more predictable by considering morphological features of an acetabulum as well as of a proximal femur in the Japanese population. A retrospective review of radiographs of the proximal femoral fractures was conducted in patients registered from 2010 to 2012, dividing into patients with femoral neck fractures; Group Neck (n = 101), and patients with femoral intertrochanteric fractures; Group IT (n = 99). Intergroup comparison was conducted: age, sex, height, weight, the ratios of femoral intertrochanteric length (IT Length), femoral neck length (Neck Length), femoral neck width (Neck Width), lateral offset length (Offset) to femoral head diameter, neck-shaft angle (N-S angle), and center-edge angle of the acetabulum (C-E angle), adjusting for age. Multiple logistic regression analysis was conducted among these parameters. The Group IT showed significantly older age than the Group Neck. Greater C-E angle in Group IT was observed in the patients in their 80s and 90s years of age. The Group Neck showed greater N-S angle only in the patients in their 80s years of age. In multiple logistic regression analysis, the impact of the age and the C-E angle on the fracture types was similar (odds ratio 1.08, 1.09, respectively, p fracture types.

  10. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia; Eastell, Richard

    2009-01-01

    of bone turnover. Two national observational register-based studies were performed: (1) cross-sectional study (N = 11,944) comparing age distribution, exposure, and trauma mechanisms between different types of proximal femur fractures and (2) matched cohort study in patients with prior nonhip fractures (N......Alendronate (aln) is a potent bisphosphonate with a prolonged duration of action. Recent reports have found long-term aln use to be common in patients with subtrochanteric or proximal diaphyseal femur fracture, raising concerns that these fractures could be a consequence of excessive suppression...... = 5187 + 10,374), testing the hypothesis that the increase in the risk of subsequent atypical femur fractures exceeded the increase in typical hip fractures. We also sought evidence of a dose-response relationship, where high adherence to or long-term use of aln led to more atypical femur fractures. We...

  11. Distribution of bone density and cortical thickness in the proximal femur and their association with hip fracture in postmenopausal women: a quantitative computed tomography study.

    Science.gov (United States)

    Yang, L; Udall, W J M; McCloskey, E V; Eastell, R

    2014-01-01

    The quantitative computed tomography (QCT) scans in an individually matched case-control study of women with hip fracture were analysed. There were widespread deficits in the femoral volumetric bone mineral density (vBMD) and cortical thickness of cases, and cortical vBMD and thickness discriminated hip fracture independently of BMD by dual-energy X-ray absorptiometry (DXA). Acknowledging the limitations of QCT associated with partial volume effects, we used QCT in an individually matched case-control study of women with hip fracture to better understand its structural basis. Fifty postmenopausal women (55-89 years) who had sustained hip fractures due to low-energy trauma underwent QCT scans of the contralateral hip within 3 months of the fracture. For each case, postmenopausal women, matched by age (±5 years), weight (±5 kg) and height (±5 cm), were recruited as controls. We quantified cortical, trabecular and integral vBMD and apparent cortical thickness (AppCtTh) in four quadrants of cross-sections along the length of the femoral head (FH), femoral neck (FN), intertrochanter and trochanter and examined their association with hip fracture. Women with hip or intracapsular (IC) fracture had significantly (p fractures independent of hip areal BMD (aBMD). The combination of AppCtTh and trabecular or integral vBMD discriminated hip fracture, whereas the combination of FH and FN AppCtTh discriminated IC fracture significantly (p fracture independently of aBMD by DXA.

  12. Current concepts in pediatric femur fracture treatment.

    Science.gov (United States)

    Kanlic, Enes; Cruz, Miguel

    2007-12-01

    Femoral neck fractures require urgent evacuation of intracapsular hematoma, anatomic reduction, and secure fixation with screws and cast immobilization. Extracapsular trochanteric and subtrochanteric fractures are best treated by fixed angle devices (locked plates or dynamic screw and side plate). "Length stable" low energy shaft fractures with minimal displacement or nails. Bridge plating will provide better stability in complex fractures. Children > 12 years have less risk of vascular disturbance to the proximal physis, and should have lateral transtrochanateric entry locked rigid nails. Fractures with severe soft tissue injuries could be temporized with external fixation. Distal physis and epiphyseal injuries require anatomical reduction and smooth wires and/or screw fixation (placed in such a way as to minimize further damage to the physis) and need to be augmented with a brace. Leg-length discrepancy is not a significant clinical problem in operatively treated patients. We recommend hardware removal after complete fracture healing, usually in 6 to 12 months. Implants left in the growing child could become buried deep inside of the bone, or cause "periprosthetic" fractures and/or eventually impede adult reconstruction. Minimal risks are reported for hardware removal in healthy patients with healed fractures (4 cortices bridged).

  13. Treatment of femur shaft fractures using Perkins' traction at Addis ...

    African Journals Online (AJOL)

    Objectives: To evaluate the outcomes of Perkins' technique in the treatment of adult femur shaft fractures from October 2007 – May 2009. Faculty of Medicine, Black-Lion Hospital (BLH), Addis Ababa University, Ethiopia, The study also aimed at looking into the spectrum of femur shaft fractures referred to BLH. Design: This ...

  14. Avaliação do emprego da haste femoral curta na fratura trocantérica instável do fêmur Evaluating the use of a proximal femoral nail in unstable trochanteric fracture of the femur

    Directory of Open Access Journals (Sweden)

    João Antonio Matheus Guimarães

    2008-09-01

    , devido a uma redução inadequada em varo, ocorreu um cutout que necessitou de revisão cirúrgica. Outro caso de fratura do tipo 31A2, evoluiu para necrose avascular da cabeça femoral, após consolidação da fratura. Por fim, um caso de fratura do tipo 31A3, devido a redução inadequada no plano sagital, evoluiu para retarde de consolidação, com quebra da haste após 13 meses da cirurgia. CONCLUSÃO: A osteossíntese com haste proximal, como tratamento da fratura trocantérica instável do fêmur realizada em pacientes com idade superior a 60 anos, resultou na consolidação da maioria dos casos. As complicações foram distintas nos dois subgrupos estudados. A redução adequada da fratura antes da introdução da haste intramedular é fundamental para o sucesso do procedimento.OBJECTIVE: Identifying the rate of healing of unstable trochanteric fractures submitted to osteosynthesis with a proximal femoral nail (PFN® - AO/ASIF, in patients operated on between November 1999 and March 2004. METHODS: 45 patients were analyzed, ages ranging from 60 to 93, with unstable trochanteric fractures of the femur submitted to osteosynthesis with short PFN®, with indirect reduction in a traction device guided by radioscopy. The fractures were classified according to the AO/OTA classification. Bone quality was evaluated by the Singh index in the post-operative radiographic routine. The quality of the reduction achieved and the positioning of the implant were evaluated by post-operative anteroposterior and profile X-ray of the proximal femur, with analysis of the cervicodiaphyseal angle and the distance between the tip of the sliding nail and the center of the femoral head, the so-called "tip apex distance" (TAD. RESULTS: The mean age of patients studied was 80.8 years (60-93. Females prevailed, with 37 cases (82.2%. The right side was involved in 22 cases (48.89% and the left side, in 23 (51.1%. All fractures were unstable, 22 of them of the type 31A2 (48.8%, and 23, of the

  15. Metachronous bilateral subtrochanteric fracture of femur in an osteopetrotic bone: A case report with technical note☆

    Science.gov (United States)

    Kumar, Dharmendra; Jain, Vijay Kumar; lal, Hitesh; Arya, Rajinder Kumar; Sinha, Skand

    2012-01-01

    Osteopetrosis is a rare inherited skeletal disorder characterized by increased density. The increased fragility of such dense bone results in a greater incidence of fractures, especially around hip and proximal femur. The surgical treatment of such fractures is difficult due to hard but brittle structure of bone. Herein we report a case of bilateral subtrochanteric fracture in an osteopetrotic patient. It was fixed using a dynamic hip screw with plate. PMID:26403447

  16. Prediction of Pathologic Fracture Risk in Activities of Daily Living and Rehabilitation of Patients With Metastatic Breast Carcinoma of the Pelvis and Femur

    National Research Council Canada - National Science Library

    Inoue, Nozomu

    2002-01-01

    The purpose of the project was to develop a computer model of the pelvis and proximal femur which could be used to predict pathologic fracture risk and study the effects of pelvic and proximal femoral...

  17. Fibroblast Growth Factor-23, Sclerostin, and Bone Microarchitecture in Patients With Osteoporotic Fractures of the Proximal Femur: A Cross-sectional Study.

    Science.gov (United States)

    Herlyn, Philipp K E; Cornelius, Norina; Haffner, Dieter; Zaage, Franziska; Kasch, Cornelius; Schober, Hans-Christof; Mittlmeier, Thomas; Fischer, Dagmar-C

    2016-01-01

    This cross-sectional observational cohort study was designed to simultaneously investigate bone microarchitecture and serum markers of bone metabolism in elderly osteoporotic patients experiencing a trochanteric or femoral neck fracture. Special emphasis was put on renal function, sclerostin and fibroblast growth factor-23 (FGF-23). Eighty-two patients (median age: 84 years; 49 trochanteric fractures) scheduled for emergency surgery due to an osteoporotic fracture participated. Bone specimens for ex vivo microcomputed X-ray tomography were sampled during surgery. Blood samples for laboratory workup were collected before surgery (t0) and 1 day afterward (t1). Fifty-eight patients consented to dual-energy X-ray absorptiometry scanning of the lumbar spine and/or contralateral femoral neck after recovery during the in-patient stay. Samples were grouped according to the site of fracture. Regression coefficients were controlled for age and/or estimated glomerular filtration rate (eGFR), if appropriate. Patients experiencing a femoral neck fracture presented with better preserved renal function (eGFR) and lower C-terminal fragment of fibroblast growth factor-23 (cFGF-23) concentrations compared to those with trochanteric fractures. By contrast, serum sclerostin was similar at both time points and did not differ between groups. Age-adjusted correlation analysis revealed negative associations between eGFR and cFGF-23 determined at t1 (R=-0.34; pfemoral neck fractures, respectively. Our study provides evidence that not only an age-related decline of renal function but also the type of skeletal injury may contribute to the circulating concentrations of cFGF-23. Copyright © 2016 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  18. Fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig

    2013-01-01

    . The bandages were further supported by splints made of wood or coarse grass. Healing was expected in forty days. Different fracture patterns have been discussed and classified since Ancient Greece. Current classification of proximal humeral fractures mainly relies on the classifications proposed by Charles......, classification of proximal humeral fractures remains a challenge for the conduct, reporting, and interpretation of clinical trials. The evidence for the benefits of surgery in complex fractures of the proximal humerus is weak. In three systematic reviews I studied the outcome after locking plate osteosynthesis......Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate...

  19. Biological plating of comminuted fractures of femur and tibia

    Directory of Open Access Journals (Sweden)

    Mohammad Javdan

    2007-08-01

    Full Text Available

    BACKGROUND: The treatment of comminuted fractures in long bones has continued to be a problem in orthopedic surgery. Recently, fixation without exploration of the fracture site, known as "biologic fixation”, has been introduced. This study was performed to assess the results and complications of this method for the treatment of comminuted fractures of the tibia and femur.
    METHODS: The study included 41 patients with comminuted fractures of the tibia and femur treated with biologic plating from 2003 to 2006 (25 femur fractures and 16 tibial fractures. After biological fixation joint motion was started but weight bearing was avoided until radiographic evidence of union was shown.
    RESULTS: The mean time of union in the tibial fractures was 19 ± 2 weeks and 17 ± 2 weeks for the femur fractures. All patients had fracture union without any infection, non-union or implant failure. In one patient with a femur fracture there was a 10° internal rotation deformity. Two of the femoral fractures had shortening of 1 cm, and one patient had shortening of about 2 cm. Compared to similar studies, all results were statistically significant (P<0.05.
    CONCLUSIONS: The biologic plating method is a safe, simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications.
    KEY WORDS: Biological fixation, plate, comminuted fracture.

  20. Bone turnover markers are associated with higher cortical porosity, thinner cortices, and larger size of the proximal femur and non-vertebral fractures.

    Science.gov (United States)

    Shigdel, Rajesh; Osima, Marit; Ahmed, Luai A; Joakimsen, Ragnar M; Eriksen, Erik F; Zebaze, Roger; Bjørnerem, Åshild

    2015-12-01

    Bone turnover markers (BTM) predict bone loss and fragility fracture. Although cortical porosity and cortical thinning are important determinants of bone strength, the relationship between BTM and cortical porosity has, however, remained elusive. We therefore wanted to examine the relationship of BTM with cortical porosity and risk of non-vertebral fracture. In 211 postmenopausal women aged 54-94 years with non-vertebral fractures and 232 age-matched fracture-free controls from the Tromsø Study, Norway, we quantified femoral neck areal bone mineral density (FN aBMD), femoral subtrochanteric bone architecture, and assessed serum levels of procollagen type I N-terminal propeptide (PINP) and C-terminal cross-linking telopeptide of type I collagen (CTX). Fracture cases exhibited higher PINP and CTX levels, lower FN aBMD, larger total and medullary cross-sectional area (CSA), thinner cortices, and higher cortical porosity of the femoral subtrochanter than controls (p≤0.01). Each SD increment in PINP and CTX was associated with 0.21-0.26 SD lower total volumetric BMD, 0.10-0.14 SD larger total CSA, 0.14-0.18 SD larger medullary CSA, 0.13-0.18 SD thinner cortices, and 0.27-0.33 SD higher porosity of the total cortex, compact cortex, and transitional zone (all p≤0.01). Moreover, each SD of higher PINP and CTX was associated with increased odds for fracture after adjustment for age, height, and weight (ORs 1.49; 95% CI, 1.20-1.85 and OR 1.22; 95% CI, 1.00-1.49, both pfracture after accounting for FN aBMD, cortical porosity or cortical thickness (OR ranging from 1.31 to 1.39, p ranging from 0.005 to 0.028). In summary, increased BTM levels are associated with higher cortical porosity, thinner cortices, larger bone size and higher odds for fracture. We infer that this is produced by increased periosteal apposition, intracortical and endocortical remodeling; and that these changes in bone architecture are predisposing to fracture. Copyright © 2015 Elsevier Inc. All

  1. Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures

    Energy Technology Data Exchange (ETDEWEB)

    Link, Thomas M. [Department of Clinical Radiology, University of Muenster (Germany); Department of Diagnostic Radiology, Technical University Munich (Germany); Department of Radiology, University of California, San Francisco, CA (United States); Vieth, Volker; Matheis, Julia [Department of Clinical Radiology, University of Muenster (Germany); Newitt, David; Lu, Ying; Majumdar, Sharmila [Department of Radiology, University of California, San Francisco, CA (United States); Rummeny, Ernst J. [Department of Diagnostic Radiology, Technical University Munich (Germany)

    2002-02-01

    The aim of this study was to compare structure measures obtained from high-resolution MR images of the calcaneus and the distal radius with bone mineral density (BMD) of the spine and hip in the prediction of osteoporotic spine fracture status. High-resolution MR images of the calcaneus and radius were obtained in 24 post-menopausal women with spine fractures and 22 age-matched controls. Imaging was performed at 1.5 T using a T1-weighted spin-echo sequence (slice thickness 1 mm, in-plane spatial resolution 195 x 195 {mu}m{sup 2}). Structure analysis was performed using parameters analogous to standard histomorphometry. Bone mineral density of the spine was obtained using quantitative CT and of the hip with dual-energy X-ray absorptiometry. Significant differences between both patient groups were obtained with BMD and all structure parameters (p<0.05). Using receiver operating characteristic analysis to determine the diagnostic performance in differentiating both groups, the best results were found for BMD of the spine, one of the radial structure measures and a combination of the calcaneal structure measures. In this study BMD of the spine and structure measures of the distal radius were best suited to predict the osteoporotic fracture status of the spine. A combination of BMD and structure measures did not yield any additional information on fracture status. (orig.)

  2. [Arthroscopic fracture management in proximal humeral fractures].

    Science.gov (United States)

    Lill, H; Katthagen, C; Jensen, G; Voigt, C

    2013-04-01

    Arthroscopy has become increasingly more established in the treatment of proximal humeral fractures. In addition to the known advantages of minimally invasive surgery fracture and implant positioning can be optimized and controlled arthroscopically and relevant intra-articular concomitant pathologies (e.g. biceps tendon complex and rotator cuff) can be diagnosed and treated. Arthroscopic techniques have proven to be advantageous in the treatment of various entities of greater tuberosity fractures, lesser tuberosity fractures (suture bridging technique) and subcapital humeral fractures (arthroscopic nailing). This article presents an overview on innovative arthroscopic modalities for treating proximal humeral fractures, describes the surgical techniques and the advantages compared to open procedures as well as initial clinical results.

  3. A method for sex estimation using the proximal femur.

    Science.gov (United States)

    Curate, Francisco; Coelho, João; Gonçalves, David; Coelho, Catarina; Ferreira, Maria Teresa; Navega, David; Cunha, Eugénia

    2016-09-01

    The assessment of sex is crucial to the establishment of a biological profile of an unidentified skeletal individual. The best methods currently available for the sexual diagnosis of human skeletal remains generally rely on the presence of well-preserved pelvic bones, which is not always the case. Postcranial elements, including the femur, have been used to accurately estimate sex in skeletal remains from forensic and bioarcheological settings. In this study, we present an approach to estimate sex using two measurements (femoral neck width [FNW] and femoral neck axis length [FNAL]) of the proximal femur. FNW and FNAL were obtained in a training sample (114 females and 138 males) from the Luís Lopes Collection (National History Museum of Lisbon). Logistic regression and the C4.5 algorithm were used to develop models to predict sex in unknown individuals. Proposed cross-validated models correctly predicted sex in 82.5-85.7% of the cases. The models were also evaluated in a test sample (96 females and 96 males) from the Coimbra Identified Skeletal Collection (University of Coimbra), resulting in a sex allocation accuracy of 80.1-86.2%. This study supports the relative value of the proximal femur to estimate sex in skeletal remains, especially when other exceedingly dimorphic skeletal elements are not accessible for analysis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Retrograde intramedullary nailing for distal femur fracture with osteoporosis.

    Science.gov (United States)

    Kim, Jihyeung; Kang, Seung-Baik; Nam, Kyungpyo; Rhee, Seung Hwan; Won, Jong Won; Han, Hyuk-Soo

    2012-12-01

    The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and managed with retrograde intramedullary nailing were retrospectively reviewed. Cement augmentation was used in four patients, shape memory alloy was used in eight patients and both were used in one patient. All patients were followed up for more than 2 years. Radiologic alignments were scored and Tegner and the Lysholm activity score was used for a functional assessment. The average time to clinical union was 13 weeks (range, 10 to 15 weeks). In 12 of our cases, the total alignment scores were excellent. At the last follow-up, the mean range of motion was 116° (range, 110° to 125°). The average functional score at postoperative 1 year was 2.6 (range, 1 to 5). Retrograde intramedullary nailing is a good surgical option for distal femur fracture with osteoporosis. Cement augmentation and shape memory alloy can also be used for added mechanical stability. This surgical technique is very useful for distal femur fracture with osteoporosis as it promotes fracture healing and early rehabilitation.

  5. Operative treatment of a unilateral bicondylar fracture of the femur

    NARCIS (Netherlands)

    Zeebregts, CJAM; Zimmerman, KW; ten Duis, HJ

    A case of isolated tangential fracture of the dorsal part of both condyles of the femur (bicondylar Hoffa fracture) is described. After open reduction, four lag screws were introduced through the fractured condyles to fur the fragments. A plaster cast was applied for a period of four weeks. Full

  6. Three-Dimensional Bone Adaptation of the Proximal Femur

    DEFF Research Database (Denmark)

    Bagge, Mette

    1998-01-01

    The bone remodeling of a three-dimensional model of the proximal femur is considered. The bone adaptation is numerically described as an evolution in time formulated such that the structural change goes in an optimal direction within each time step for the optimal boundary conditions. In the bone...... remodeling scheme is included the memory of past loadings to account for the delay in the bone response to the load changes. In order to get a realistic bone adaptation process, the bone structure at the onset of the remodeling needs to be realistic too. A start design is obtained by structural optimization...

  7. 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

  8. Pilot study on proximal femur strains during locomotion and fall-down scenario

    Energy Technology Data Exchange (ETDEWEB)

    Klodowski, Adam, E-mail: adam.klodowski@lut.fi; Valkeapaeae, Antti, E-mail: antti.valkeapaa@lut.fi; Mikkola, Aki, E-mail: aki.mikkola@lut.fi [Lappeenranta University of Technology (Finland)

    2012-09-15

    The most common and severe type of fracture among the elderly is known as a proximal femur fracture. Aging-related bone loss is one of the major contributing factors to increased likelihood of bone fracture. Specific exercises can be used to strain bones and increase bone strength to counter the effects of bone loss. The flexible multibody simulation approach can be used as a non-invasive method for estimating bone strains caused by physical activity. This method was recently used to analyze the strain of locomotion in regard to human femur and tibia leg bones. The current study focuses on strain analysis of the femoral neck. The research test person was a clinically healthy 65-year old Caucasian male. The computed tomography was used to build a geometrically accurate finite element model of the femur with inhomogeneous material properties derived from the voxel data. The anthropometric data was used to model the musculoskeletal system of the test person. The multibody skeletal model was utilized to estimate loading on the femoral neck during walking, which represents a routine daily activity. The flexible multibody simulation results were compared to strains that occurred during a simulated fall onto the greater trochanter of the femur. The fall simulation was made entirely using finite element software. Results from the finite element analysis were compared with the previous study showing that the test person does not belong to the high-risk hip fracture group. Finally, the estimated strains gathered from the walking simulation were compared to the strain values from the simulated fall-down scenario.

  9. Análisis numérico comparativo de fijadores para el tratamiento de fracturas proximales del fémur // Comparative numerical analysis of fixers for the treatment of proximal fractures of the femur

    Directory of Open Access Journals (Sweden)

    Jorge Bosch-Cabrera

    2011-08-01

    Full Text Available ResumenMúltiples son los dispositivos utilizados para lograr la consolidación de las fracturas proximales delfémur, algunos sufren roturas antes de ser retirados del paciente, ocasionando nuevascomplicaciones al mismo. En esta investigación se presentan los resultados del análisis numéricorealizado a un fijador interno del tipo placa DHS (Dinámic Hip Screw y a un fijador externomonolateral con tornillo cefálico RALCA (Rodrigo Álvarez Cambras, con el propósito de determinarel comportamiento del estado tensional-deformacional de ambos dispositivos durante laconsolidación ósea de fracturas proximales de cadera, bajo la marcha monopodal del paciente. Parala modelación geométrica de los dispositivos en cuestión se empleó el paquete de diseño en 3DSolidWorks y la simulación numérica se realizó con el empleo del paquete de análisis por elementosfinitos Cosmos/Works. Los resultados muestran valores inferiores de las tensiones máximas en elfijador externo en comparación con las tensiones que surgen en la placa dinámica bajo la acción delas cargas actuantes en los modelos, por lo que se concluye que el primero posee mejorescaracterísticas resistivas, siendo recomendable su uso en pacientes de mayor peso corporal o quepodrían realizar actividades físicas más activas durante su recuperación postoperatoria.Palabras claves: elementos finitos, biomecánica, osteosíntesis, fractura de cadera.____________________________________________________________________________AbstractMultiple are devices used to achieve the consolidation of proximal femur fractures, some sufferingbreakage before being removed from the patient, causing new complications to them. This researchpresents the results of the numerical analysis made to an internal fixer type plate DHS (Dinámic HipScrew, and to a monolateral external fixer with RALCA (Rodrigo Alvarez Cambras head screw, withthe purpose of determining the behavior of the tensional

  10. The combination of structural parameters and areal bone mineral density improves relation to proximal femur strength

    DEFF Research Database (Denmark)

    Hansen, Stinus; Jensen, Jens-Erik Beck; Ahrberg, Fabian

    2011-01-01

    -one human proximal femur specimens (8 men and 23 women, median age 74 years, range 50-89) were examined with HR-pQCT at four regions of interest (femoral head, neck, major and minor trochanter) with 82 μm and in a subgroup (n = 17) with 41 μm resolution. Separate analyses of cortical and trabecular geometry...... fractures were confirmed. Geometry, vBMD, microarchitecture, and aBMD correlated significantly with MCS, with Spearman's correlation coefficients up to 0.77, 0.89, 0.90, and 0.85 (P ...

  11. Submuscular bridge plating for length-unstable, pediatric femur fractures.

    Science.gov (United States)

    Samora, Walter P; Guerriero, Michael; Willis, Leisel; Klingele, Kevin E

    2013-12-01

    Submuscular bridge plating has become an acceptable method of treatment for pediatric femur fractures. The purpose of our study was to describe a technique for submuscular bridge plating and review a series of consecutive, length-unstable, pediatric femur fractures treated at a single institution with this technique. We performed a query of hospital records from January 4, 2006, to May 10, 2011, to identify length-unstable femur fractures treated with submuscular bridge plating by 5 pediatric surgeons. Included were patients treated with submuscular bridge plating for a femur fracture. Excluded were patients with incomplete medical records, inadequate radiographs, or follow-up femur fractures. There were 15 left femurs and 18 right femurs, including 1 bilateral fracture patient. Fracture pattern was composed of 13 comminuted, 5 spiral, 9 long oblique, and 6 short oblique. Mechanisms of injury included: fall from height (8), recreation (23), and MVA (2). Mean time for full weightbearing was 8.1 weeks (range, 3 to 17.6 wk). All patients were radiographically healed by their 12-week assessment. There were no intraoperative complications. Implant removal occurred in 26 patients. There were 2 cases of a broken screw discovered upon implant removal. The remnant screw was not removed in either case. The mean follow-up time for those with implant removal was 43.6 weeks (range, 27 to 83 wk). The 11 patients without implant removal had a mean follow-up time of 38.6 weeks (range, 31.6 to 50 wk). There were no cases of varus or valgus malalignment >10 degrees. One patient experienced implant irritation. There were no cases of wound infections. Our technique of surgical intervention has simplified both implantation and removal, and produced comparable and excellent healing rates, low complication rates, and early return to full weightbearing. Level IV, case series.

  12. Treatment of femur shaft fractures using Perkins' traction at Addis ...

    African Journals Online (AJOL)

    60 (88.2%) were males and only 8 (11.8%) were females making the fracture over eight times frequent ... good results with their use of a single rope suspension .... of causes of all adult femur shaft fractures presented to BLH, radiology department. Cause. Frequency. (%). RTA. 202. 47.9. Fall. 126. 29.9. Machine. 28. 6.6.

  13. Gunshot fractures of tibia and femur - excellent results with reamed ...

    African Journals Online (AJOL)

    East African Medical Journal ... Objective: To document the outcome of treatment of femur and tibia diaphyseal fractures due to gunshot injury grafted with reamed bone marrow and immobilised with Surgical Implant ... Mean outcome measure: Clinical and radiological evidences of healing of the fracture at six weeks.

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

    African Journals Online (AJOL)

    This study aims to describe a rare and challenging case of a patient who presented ipsilateral subtrochanteric and distal femur fractures due to low‑energy trauma. The peculiarity of this case is the presence of femoral shaft fracture malunion and knee disarticulation in the same limb resulting from an accident suffered 30 ...

  15. Treatment outcomes of intertrochanteric femur fractures treated with DLT™ nail

    Directory of Open Access Journals (Sweden)

    Mehmet Arıcan

    2015-12-01

    Full Text Available Objective: Intramedullary nails frequently use in proximal femur fractures. In this study, 49 patients with intertrochanteric fractures were evaluated clinical and radiological results treated with dyna locking trochanteric (DLT™ nail retrospectively. Methods: Twenty-two (44.9% patients were male and 27 (55.1% patients were female. Mean age was 74.29±1.98 (28-99 years and Followed up for a mean of 14.35±3.43 (9-24 months. Thirty-seven (75.6% of the fractures resulted from simple falls while 6 (12.2% caused from traffic accidents and 6 (12.2% fall down from height. There were 24 (49.0% left and 25 (51.0% right lower extremities fractured. According to Orthopaedic Trauma Association classification system; 21 (42.9%, 21 (42.9% and 7 (14.2% fractures were classified as 31A1, 31A2, and 31A3 respectively. One (2.0% patient had claviculae fracture, 3 (6.1% patients had radius distal fracture and 1 (2.0% patient had total knee arthroplasty. After surgery, X-ray was used for radiological results and functional outcomes were evaluated according to the Harris hip scoring system. Results: The average waiting time for the surgery was 2.02±0.18 (1-7 days and hospitalization time was 6.23±0.29 (4-15 days. Mean fracture healing time was 11.74±1.82 (8-15 weeks. Three patients had screw cut-out in the follow-up time and performed hemiarthroplasty. The average Harris hip score was 88.02±1.21 (42-97 points and included 29 (59.2% excellent cases, 17 (34.7% good and 3 (6.1% poor. Conclusion: DLT ™ nail is a safe and successful method because of low complication rates, and capability of detection.

  16. The effectiveness of the implementation of new technologies in the prevention of purulent complications of repeated surgеries for complications of fractures of the proximal femur of patients

    Directory of Open Access Journals (Sweden)

    An. V. Kalashnikov

    2016-06-01

    Full Text Available Despite the latest achievements of modern traumatology, remains quite high percentage of unsatisfactory results of treatment of fractures of the proximal femur (fPf. According to the literature repeated surgery increases the risk of postoperative purulent complications in several times. The authors of the article developed the innovations introduced in practice based on the use of thrombocytopoiesis fibrin gel, which has a high antibacterial activity due to preservation of leukocytes (local antibiotic effect, together with bone shavings during the performing of the operations when performing reactioneze and TEP after performing osteosynthesis, and also at persons of senile and elderly, for prevention of postoperative purulent complications in fPf. A comprehensive clinical study of 120 patients with fPf complications (false joints, aseptic necrosis of the femoral head, axial deformation after osteomyelitis who underwent re-operative intervention was provided. Patients were divided into two groups, first (control group consisted of 60 patients with consequences fPf who underwent total endoprosthesis (TEP of the hip joint (30 patients and locked intramedullary nailing (LIN (30 patients by conventional methods. The second (experimental group consisted of 60 patients with consequences fPf who underwent TEP of the hip joint (30 patients and LIN (30 patients with use developed by authors of innovations. Effectiveness of prevention of septic complications in both groups of observation was evaluated. The observation period was 1 year. There was statistically significant (p≤0.01 decrease in the number of early (4 times and late (3 times postoperative complications in patients of the experimental group in comparison with patients of control group. The new technologies use allows to increase in 8.4% the efficiency of preventive maintenance of purulent complications of surgical treatment of patients with complications after performing osteosynthesis in the

  17. Determination of muscle effort at the proximal femur rotation osteotomy

    Science.gov (United States)

    Sachenkov, O.; Hasanov, R.; Andreev, P.; Konoplev, Yu

    2016-11-01

    The paper formulates the problem of biomechanics of a new method for treatment of Legg-Calve-Perthes disease. Numerical calculations of the rotational flexion osteotomy have been carried out for a constructed mathematical model of the hip joint, taking into account the main set of muscles. The work presents the results of the calculations and their analysis. The results have been compared with the clinical data. The calculations of the reactive forces arising in the acetabulum and the proximal part of the femur allowed us to reveal that this reactive force changes both in value and direction. These data may be useful for assessing the stiffness of an external fixation device used in orthopedic intervention and for evaluating the compression in the joint.

  18. Evaluation of vertebral hidden fractures in patients with proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    André Luís Sebben

    2014-12-01

    Full Text Available Objective: To evaluate the Spine Deformity Index (SDI and serum levels of vitamin D in patients surgically treated for proximal femur fracture and its relationship with osteoporosis. Methods: Between August and November 2013, patients older than 50 years-old with surgical fracture of the proximal femur by low-energy trauma underwent radiographic evaluation of the spine and the vitamin D levels, and enquired about diagnoses and previous treatment of osteoporosis. Results: Sixty-six patients met the inclusion criteria. The mean age was 78 years; the average level of vitamin D was 19 ng/mL. The SDI ranged between zero and 25, with a mean of 8.2. Eighty percent of these patients had never been treated for osteoporosis. Of the patients analyzed, 89.3% had insufficient levels of vitamin D. Of these, 68.1% had also SDI above 5, and only one fifth of them had any treatment for osteoporosis. Statistical significance was found between age and levels of vitamin D as well as age and SDI. Gender was not predictive of the vitamin D levels or the amount of hidden spine fractures. The season of the year had no direct influence on vitamin D levels. Conclusions: Hospitalized patients with surgical fractures of the proximal femur had a higher SDI associated with vitamin D insufficiency, with osteoporosis most often untreated, which results in delayed spinal fractures diagnosis of spinal fractures and increased risk of new fractures.

  19. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures.

    Science.gov (United States)

    Jain, Anuj; Aggarwal, Prakash; Pankaj, Amite

    2014-01-01

    The aim of this study was to report our experience on concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Nine patients (8 male, 1 female; mean age: 30.9; range: 19-49 years) presented to our emergency room with an ipsilateral proximal tibia and femoral Hoffa fracture, following road traffic accident. Six patients had open fracture. Two patients had ipsilateral femoral shaft fracture, two patients had fracture of intercondylar part of distal femur, one had fracture of patella and one had fracture of both bones of the leg. Out of nine Hoffa's fracture eight involved lateral and one involved medial femoral condyle. There were five type II, two type VI, one type I and one type IV proximal tibial fracture according to Schatzker classification. Mean duration of follow-up was 13 months (range: 9-21 months). At final follow-up, all fractures united. Mean knee society score was 163 (range: 127-182). Mean ROM at knee joint was 97.4 degrees (75°-115°). Our results suggest that in this combination of intraarticular fractures anatomic reduction and rigid fixation followed by early mobilization reveal satisfactory results.

  20. Complex femur fractures in children: treatment with external fixation.

    Science.gov (United States)

    Kirschenbaum, D; Albert, M C; Robertson, W W; Davidson, R S

    1990-01-01

    External fixation was used to treat complex femur fractures in 10 children. These injuries were associated with head trauma, cerebral palsy, epidermolysis bullosa, open wounds, and failed casting. The duration of external fixation averaged 8 weeks, and the mean follow-up was 5 years 8 months. At follow-up, one patient had 2.6 cm of residual shortening, and two had overgrowth. Complications included one refracture. Three children developed superficial pin site drainage. Although most femur fractures can be treated with traction or casting, external fixation may simplify overall care in children with multiple injuries and is effective in controlling unacceptable femoral shortening and angulation.

  1. Bone mineral loss at the proximal femur in acute spinal cord injury.

    Science.gov (United States)

    Edwards, W B; Schnitzer, T J; Troy, K L

    2013-09-01

    This study used quantitative computed tomography to assess changes in bone mineral at the proximal femur after acute spinal cord injury (SCI). Individuals with acute SCI experienced a marked loss of bone mineral from a combination of trabecular and endocortical resorption. Targeted therapeutic interventions are thus warranted in this population. SCI is associated with a rapid loss of bone mineral and an increased rate of fragility fracture. Some 10 to 20% of these fractures occur at the proximal femur. The purpose of this study was to quantify changes to bone mineral, geometry, and measures of strength at the proximal femur in acute SCI. Quantitative computed tomography analysis was performed on 13 subjects with acute SCI at serial time points separated by a mean of 3.5 months (range, 2.6-4.8 months). Changes in bone mineral content (BMC) and volumetric bone mineral density (vBMD) were quantified for integral, trabecular, and cortical bone at the femoral neck, trochanteric, and total proximal femur regions. Changes in bone volumes, cross-sectional areas, and surrogate measures of compressive and bending strength were also determined. During the acute period of SCI, subjects experienced a 2.7-3.3%/month reduction in integral BMC (p < 0.001) and a 2.5-3.1 %/month reduction in integral vBMD (p < 0.001). Trabecular BMC decreased by 3.1-4.7 %/month (p < 0.001) and trabecular vBMD by 2.8-4.4 %/month (p < 0.001). A 3.9-4.0 %/month reduction was observed for cortical BMC (p < 0.001), while the reduction in cortical vBMD was noticeably lower (0.8-1.0 %/month; p ≤ 0.01). Changes in bone volume and cross-sectional area suggested that cortical bone loss occurred primarily through endosteal resorption. Declines in bone mineral were associated with a 4.9-5.9 %/month reduction in surrogate measures of strength. These data highlight the need for therapeutic interventions in this population that target both trabecular and endocortical bone mineral

  2. Transverse Stress Fracture of the Proximal Patella: A Case Report.

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-02-01

    Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete.A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity.Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws.

  3. Spinal coronal profiles and proximal femur bone mineral density in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Chen, Rui-Qiang; Watanabe, Kota; Hosogane, Naobumi; Hikata, Tomohiro; Iwanami, Akio; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

    2013-11-01

    Although the occurrence and progression of AIS has been linked to low bone mineral density (BMD), the relationships between spinal curvature and bilateral differences in proximal femur BMD are controversial. Few correlation studies have stratified patients by curve type. The purpose of this study was to evaluate the relationships between spinal coronal profile and bilateral differences in proximal femur BMD in patients with adolescent idiopathic scoliosis (AIS). This study included 67 patients with AIS who underwent posterior correction and fusion surgery between January 2009 and October 2011. The mean age at the time of surgery was 17.4 ± 4.1 years. Bilateral proximal femur BMD was measured before surgery by dual-energy X-ray absorptiometry. We compared the proximal femur BMDs by determining the bilateral BMD ratio (left proximal femur BMD divided by that of the right). We evaluated correlations between coronal parameters, obtained from preoperative radiographs, and the BMD ratio using Pearson's correlation analysis. Patients with Lenke type 1 curve (48; all with a right convex curve) had a mean bilateral proximal femur BMD ratio of 1.00 ± 0.04. Patients with Lenke type 5 curve (19; all with a left convex curve) had a mean bilateral proximal femur BMD ratio of 0.94 ± 0.04, indicating that the BMD in the proximal femur on the right side (concave) was greater than that in the left (convex). Coronal balance was significantly correlated with the BMD ratio in both the Lenke type 1 and type 5 groups, with a correlation coefficient of 0.46 and 0.50, respectively. The bilateral proximal femur BMD ratio was significantly correlated with the coronal balance in AIS patients. When the C7 plumb line was shifted toward one side, the BMD was greater in the contralateral proximal femur.

  4. A muscular imprint on the anterolateral surface of the proximal femurs of the Krapina Neandertal collection.

    Science.gov (United States)

    Belcastro, Maria Giovanna; Mariotti, Valentina

    2017-03-01

    The purpose of this study is to report and interpret a feature on the anterolateral surface of the proximal femurs of the Krapina hominid collection that we briefly described in 2006 (Periodicum Biologorum, 108, 319-329). We recorded the presence or absence of the feature in all the proximal femurs of the Krapina collection (six specimens recordable) and in 622 modern human adult femurs. The feature consists in a series of crests delimitating three raised or depressed areas. This feature has been found in three out of four adult Neandertal femurs observable. The two observable subadult Neandertal femurs do not show this character. None of the modern femurs displayed the feature. We interpret this feature as a muscular imprint, probably representing the m. vastus intermedius origin and discuss a possible interpretation. We did not find any other references for such imprint in the existing literature regarding the Neandertal femurs. © 2017 Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    N.V. Grygorieva

    2016-05-01

    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.

  6. Prevalence of abuse among young children with femur fractures: a systematic review

    OpenAIRE

    Wood, Joanne N.; Fakeye, Oludolapo; Mondestin, Valerie; Rubin, David M.; Localio, Russell; Feudtner, Chris

    2014-01-01

    Background Clinical factors that affect the likelihood of abuse in children with femur fractures have not been well elucidated. Consequently, specifying which children with femur fractures warrant an abuse evaluation is difficult. Therefore the purpose of this study is to estimate the proportion of femur fractures in young children attributable to abuse and to identify demographic, injury and presentation characteristics that affect the probability that femur fractures are secondary to abuse....

  7. Bilateral recon nailing of comminuted fracture femur in a severely ...

    African Journals Online (AJOL)

    The patient was mobilized from bed to chair post-operatively. After 4 weeks from the last surgery he was gradually mobilized full weight bearing with a walker. At 4 months follow-up he was walking full weight bearing without support. Recon nails can be employed successfully to treat complex fractures of the femur shaft.

  8. management of bilateral fracture femur with implant failure

    African Journals Online (AJOL)

    . In summary, patients with bilateral fractures of the femur are difficult to treat. These are factures where one must consider strongly the use of operative method of fixation. Further, one needs to choose a means of definite fixation which will ...

  9. The effect of modular tapered fluted stems on proximal stress shielding in the human femur.

    Science.gov (United States)

    Hnat, William P; Conway, Justin S; Malkani, Arthur L; Yakkanti, Madhu R; Voor, Michael J

    2009-09-01

    The purpose of this study was to show a change in proximal femur surface strains following total hip arthroplasty and after the addition of BoneSource hydroxyapatite bone cement in the proximal region of an instrumented femur and to measure the surface strain on the proximal body. Seven third-generation composite femurs (Pacific Research Laboratories, Vashon, Wash) were instrumented with 12 uniaxial strain gages, 6 gages on the anterior face, and 6 gages on the posterior face of each femur. All femurs exhibited stress shielding since the strains in the proximal region were drastically reduced. There was a large decrease in strain in the mid-shaft region and small changes in strain in the distal region. The surface strains on the modular implant were relatively low.

  10. Proximal femoral bone geometry in osteoporotic hip fractures in Thailand.

    Science.gov (United States)

    2015-01-01

    A number of different bone geometries have been reported to be correlated with osteoporosis, bone mineral density and fractures. Those correlations are used for diagnosis, treatment and prediction of fracture risk in osteoporosis cases. However there have been no studies of significant bone parameters predicting osteoporosis and hip fracture in Thailand To evaluate the correlation between geometric parameters of the proximal femur and both the Singh index and bone mineral density as well as to investigate the relationship between those two metrics and osteoporotic hip fracture in the Thai population. Forty-four Thai patients with osteoporotic hip fractures andforty-five healthy Thai people matched for age and gender were included in the present study. Bone mineral density and bone geometry from plain hip radiographs of non-fracture sites in the fracture group and proximal femur radiographs of the same site in the healthy group were measured That data were analyzed to determine levels of correlation. Bone geometries were also analyzed to determine hip fracture predictive capacity. Correlation between the Singh index and bone mineral density was significant (p hip fracture (p = 0.014 and p = 0.035, respectively). Each 1 mm reduction in the width of the femoral medial neck cortex increased the osteoporotic hip fracture risk by a factor of 2.7 (OR = 0.37, 95% CI = 0.15-0.93). In the Thai population, bone geometry from plain radiographs can help predict the risk of osteoporotic hip fracture. Osteoporosis is correlated with a low Singh index value. The width of the femoral medial neck cortex is a reliable predictor of hip fracture risk.

  11. Generation of an Atlas of the Proximal Femur and Its Application to Trabecular Bone Analysis

    Science.gov (United States)

    Carballido-Gamio, Julio; Folkesson, Jenny; Karampinos, Dimitrios C.; Baum, Thomas; Link, Thomas M.; Majumdar, Sharmila; Krug, Roland

    2013-01-01

    Automatic placement of anatomically corresponding volumes of interest and comparison of parameters against a standard of reference are essential components in studies of trabecular bone. Only recently, in vivo MR images of the proximal femur, an important fracture site, could be acquired with high-spatial resolution. The purpose of this MRI trabecular bone study was two-fold: (1) to generate an atlas of the proximal femur to automatically place anatomically corresponding volumes of interest in a population study and (2) to demonstrate how mean models of geodesic topological analysis parameters can be generated to be used as potential standard of reference. Ten females were used to generate the atlas and geodesic topological analysis models, and 10 females were used to demonstrate the atlas-based trabecular bone analysis. All alignments were based on three-dimensional (3D) multiresolution affine transformations followed by 3D multiresolution free-form deformations. Mean distances less than 1 mm between aligned femora, and sharp edges in the atlas and in fused gray-level images of registered femora indicated that the anatomical variability was well accommodated and explained by the free-form deformations. PMID:21432904

  12. Predicting the biomechanical strength of proximal femur specimens with Minkowski functionals and support vector regression

    Science.gov (United States)

    Yang, Chien-Chun; Nagarajan, Mahesh B.; Huber, Markus B.; Carballido-Gamio, Julio; Bauer, Jan S.; Baum, Thomas; Eckstein, Felix; Lochmüller, Eva-Maria; Link, Thomas M.; Wismüller, Axel

    2014-03-01

    Regional trabecular bone quality estimation for purposes of femoral bone strength prediction is important for improving the clinical assessment of osteoporotic fracture risk. In this study, we explore the ability of 3D Minkowski Functionals derived from multi-detector computed tomography (MDCT) images of proximal femur specimens in predicting their corresponding biomechanical strength. MDCT scans were acquired for 50 proximal femur specimens harvested from human cadavers. An automated volume of interest (VOI)-fitting algorithm was used to define a consistent volume in the femoral head of each specimen. In these VOIs, the trabecular bone micro-architecture was characterized by statistical moments of its BMD distribution and by topological features derived from Minkowski Functionals. A linear multiregression analysis and a support vector regression (SVR) algorithm with a linear kernel were used to predict the failure load (FL) from the feature sets; the predicted FL was compared to the true FL determined through biomechanical testing. The prediction performance was measured by the root mean square error (RMSE) for each feature set. The best prediction result was obtained from the Minkowski Functional surface used in combination with SVR, which had the lowest prediction error (RMSE = 0.939 ± 0.345) and which was significantly lower than mean BMD (RMSE = 1.075 ± 0.279, pfemur specimens with Minkowski Functionals extracted from on MDCT images used in conjunction with support vector regression.

  13. Model-based estimation of quantitative ultrasound variables at the proximal femur.

    Science.gov (United States)

    Dencks, Stefanie; Barkmann, Reinhard; Padilla, Frédéric; Laugier, Pascal; Schmitz, Georg; Glüer, Claus-C

    2008-01-01

    To improve the prediction of the osteoporotic fracture risk at the proximal femur we are developing a scanner for quantitative ultrasound (QUS) measurements at this site. Due to multipath transmission in this complex shaped bone, conventional signal processing techniques developed for QUS measurements at peripheral sites frequently fail. Therefore, we propose a model-based estimation of the QUS variables and analyze the performance of the new algorithm. Applying the proposed method to QUS scans of excised proximal femurs increased the fraction of evaluable signals from approx. 60% (using conventional algorithms) to 97%. The correlation of the standard QUS variables broadband ultrasound attenuation (BUA) and speed of sound (SOS) with the established variable bone mineral density (BMD) reported in previous studies is maintained (BUA/BMD: r(2) = 0.69; SOS/BMD: r(2) = 0.71; SOS+BUA/BMD: r(2) = 0.88). Additionally, different wave types could be clearly detected and characterized in the trochanteric region. The ability to separate superimposed signals with this approach opens up further diagnostic potential for evaluating waves of different sound paths and wave types through bone tissue.

  14. Femur ultrasound (FemUS)--first clinical results on hip fracture discrimination and estimation of femoral BMD.

    Science.gov (United States)

    Barkmann, R; Dencks, S; Laugier, P; Padilla, F; Brixen, K; Ryg, J; Seekamp, A; Mahlke, L; Bremer, A; Heller, M; Glüer, C C

    2010-06-01

    A quantitative ultrasound (QUS) device for measurements at the proximal femur was developed and tested in vivo (Femur Ultrasound Scanner, FemUS). Hip fracture discrimination was as good as for DXA, and a high correlation with hip BMD was achieved. Our results show promise for enhanced QUS-based assessment of osteoporosis. Dual X-ray absorptiometry (DXA) at the femur is the best predictor of hip fractures, better than DXA measurements at other sites. Calcaneal quantitative ultrasound (QUS) can be used to estimate the general osteoporotic fracture risk, but no femoral QUS measurement has been introduced yet. We developed a QUS scanner for measurements at the femur (Femur Ultrasound Scanner, FemUS) and tested its in vivo performance. Using the FemUS device, we obtained femoral QUS and DXA on 32 women with recent hip fractures and 30 controls. Fracture discrimination and the correlation with femur bone mineral density (BMD) were assessed. Hip fracture discrimination using the FemUS device was at least as good as with hip DXA and calcaneal QUS. Significant correlations with total hip bone mineral density were found with a correlation coefficient R (2) up to 0.72 and a residual error of about one half of a T-score in BMD. QUS measurements at the proximal femur are feasible and show a good performance for hip fracture discrimination. Given the promising results, this laboratory prototype should be reengineered to a clinical applicable instrument. Our results show promise for further enhancement of QUS-based assessment of osteoporosis.

  15. Diaphyseal Femur Fractures in Osteogenesis Imperfecta: Characteristics and Relationship With Bisphosphonate Treatment.

    Science.gov (United States)

    Trejo, Pamela; Fassier, François; Glorieux, Francis H; Rauch, Frank

    2017-05-01

    Several recent case reports have suggested that bisphosphonate treatment in individuals with osteogenesis imperfecta (OI) is causally related to atypical femur fractures. However, it is not known whether atypical femur fractures are actually more frequent in patients who have received bisphosphonates. In the present study, we retrospectively analyzed 166 femur fractures in 119 children with a diagnosis of OI that had not undergone intramedullary rodding procedures. A total of 130 fractures in 90 patients occurred in femurs with preexisting deformities (age at fracture between 1 month and 19.9 years; 43 girls). Because deformities are a typical cause of fracture in OI, deformed femurs were excluded from the analysis of atypical fractures. However, it was noted that in deformed femurs a transverse fracture pattern (one of the criteria of atypical fractures) was associated with a moderate to severe OI phenotype and not related to bisphosphonate treatment. Of the 36 fractures that occurred in nondeformed femurs (30 individuals; age at fracture between 1 month and 17.4 years; 13 girls), 11 (in nine children) occurred during bisphosphonate treatment. Three of these fractures (27%) resembled atypical femur fractures. Among the 25 femur fractures (23 patients) that occurred in the absence of prior bisphosphonate treatment, 8 (22%) resembled atypical femur fractures. Logistic regression analysis showed that bisphosphonate treatment history was not associated with the occurrence of atypical fractures. In contrast, the presence of moderate to severe OI (defined as any OI type other than OI type I) was strongly associated with atypical femur fractures. Thus, we observed an atypical appearance in about a quarter of nondeformed femur fractures that occurred in children with OI. Such atypical femur fractures seemed to be related to the severity of OI rather than to bisphosphonate treatment history. © 2016 American Society for Bone and Mineral Research. © 2016 American Society

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

    Directory of Open Access Journals (Sweden)

    Mantu Jain

    2013-10-01

    Full Text Available Introduction: Neglected hip dislocation is rare in today’s world and after prosthesis replacement even rarer finding. However such patients may not report to surgeons until they develop secondary complications. Management of such patient’s is a challenge to the treating surgeon and need to be tailored suiting to patient’s demands, expectations and constraints of financial resources. We did not find a similar case in the electronic and print media and therefore report this case which was innovatively managed. Case Report: A 60 year farmer presented with fracture shaft femur and ipsilateral dislocation prosthesis of right hip. He had a hemiarthroplasty done for fracture neck of femur in the past but used to walk with a lurch since he started to ambulate after discharge. However he was satisfied despite “some problems” which had caused shortening of his limb. The patient was informed of the various treatment options and their possible complications. He expressed his inability to afford a Total Hip Arthroplasty (THA at any stage and consented for other options discussed with him. The patient was positioned supine and adductor tenotomy done. Next he was positioned laterally and the fracture was fixed with heavy duty broad dynamic compression plate and screws. The wound was temporarily closed. Now through the previous scar via posterior approach the hip was exposed. The prosthesis was found to be firmly fixed to the proximal femur. The acetabulum was cleared with fibrous tissue. All attempts the prosthesis to relocate the prosthesis failed after several attempts and it was best decided to leave alone. Post operatively period was uneventful. At follow up he refused for any further manoeuvre in future inform of heavy traction and attempts to reduce the same. At one year when he was walking unaided and his X-rays showed that fracture had well united his SF-36 score was PCS – 49.6 and MCS – 51.9. Conclusion: Ipsilateral shaft femur fracture

  17. Intraoperative Periprosthetic Femur Fracture: A Biomechanical Analysis of Cerclage Fixation.

    Science.gov (United States)

    Frisch, Nicholas B; Charters, Michael A; Sikora-Klak, Jakub; Banglmaier, Richard F; Oravec, Daniel J; Silverton, Craig D

    2015-08-01

    Intraoperative periprosthetic femur fracture is a known complication of total hip arthroplasty (THA) and a variety of cerclage systems are available to manage these fractures. The purpose of this study was to examine the in situ biomechanical response of cerclage systems for fixation of periprosthetic femur fractures that occur during cementless THA. We compared cobalt chrome (CoCr) cables, synthetic cables, monofilament wires and hose clamps under axial compressive and torsional loading. Metallic constructs with a positive locking system performed the best, supporting the highest loads with minimal implant subsidence (both axial and angular) after loading. Overall, the CoCr cable and hose clamp had the highest construct stiffness and least reduction in stiffness with increased loading. They were not demonstrably different from each other. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. A process evaluation of the WHiTE Two trial comparing total hip artroplasty with and without dual mobility component in the treatment of displaced intracapsular fractures of the proximal femur: Can a trial investigating total hip arthroplasty for hip fracture be delivered in the NHS?

    Science.gov (United States)

    Huxley, C; Achten, J; Costa, M L; Griffiths, F; Griffin, X L

    2016-10-01

    The annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS? We performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two - a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients. We have shown that patients are willing to participate in this type of research and that surgeons value being part of a team that has a strong research ethos. However, surgical practice does not currently reflect NICE guidance. Current models of service delivery for hip fractures are unlikely to be able to provide timely total hip arthroplasty for suitable patients. Further observational research should be conducted to define the population of interest before future interventional studies are performed.Cite this article: C. Huxley, J. Achten, M. L. Costa, F. Griffiths, X. L. Griffin. A process evaluation of the WHiTE Two trial comparing total hip artroplasty with and without dual mobility component in the treatment of displaced intracapsular fractures of the proximal femur: Can a trial investigating total hip arthroplasty for hip fracture be delivered in the NHS? Bone Joint Res 2016;5:444-452. DOI: 10

  19. ANATOMIC STUDY OF THE PROXIMAL THIRD OF THE FEMUR: FEMOROACETABULAR IMPACT AND THE CAM EFFECT

    OpenAIRE

    Labronici, Pedro José; Alves, Sergio Delmonte; da Silva, Anselmo Fernandes; Giuberti, Gilberto Ribeiro; Azevedo Neto, Justino Nóbrega de; Mezzalira Penedo, Jorge Luiz

    2015-01-01

    To analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact. Methods: 199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5...

  20. Femur fracture classification in women with a history of breast cancer

    OpenAIRE

    Chau, Stephanie; Chandra, Malini; Grimsrud, Christopher D.; Gonzalez, Joel R.; Hui, Rita L; Lo, Joan C.

    2014-01-01

    Purpose: Women with breast cancer are at increased risk for femur fracture. Contributing factors include estrogen deficiency, cancer-related therapies, or direct bone involvement. This study examines fracture subtypes in women with prior breast cancer experiencing a femur fracture. Methods: Women age ≥50 years old with a history of invasive breast cancer who experienced a femur fracture were identified during 2005–2012. Fracture site was classified by hospital diagnosis (for hip) and/or ra...

  1. Extensively coated revision stems in proximally deficient femur: Early results in 15 patients

    Directory of Open Access Journals (Sweden)

    Marya SKS

    2008-01-01

    intraoperative severe comminuted fracture extending into the supracondylar region while hammering in the stem. Post cerclage wiring, she was put on a long knee brace and her mobilization was delayed to 12 weeks. Conclusions: The extensively coated cementless ( ′Solution™′ femoral stem provides a reasonable ′solution′ to the deficient femur in hip revision. The proximal femoral deficiences can be relatively easily bypassed and distal fixation can be achieved with this stem. Extreme care needs to be taken to avoid fractures and penetration of the femoral shaft, which can, however, be managed by cerclage wiring. Principles of a successful outcome include preservation of the functional continuity of the abduction apparatus, care to recognize and prevent distal extension of fracture while inserting the stem (preemptive cerclage wiring and supervised rehabilitation.

  2. Predictors of Functional Recovery Following Periprosthetic Distal Femur Fractures.

    Science.gov (United States)

    Ruder, John A; Hart, Gavin P; Kneisl, Jeffrey S; Springer, Bryan D; Karunakar, Madhav A

    2017-05-01

    Treatment options for periprosthetic distal femur fractures include open reduction internal fixation (ORIF) and distal femoral replacement (DFR). The purpose of this study was to evaluate the complications, and functional recovery (ambulatory status, living situation, mortality) in patients undergoing operative treatment (DFR and ORIF) of periprosthetic distal femur fractures. A retrospective review of 58 patients with distal femoral periprosthetic fractures treated with either ORIF or DFR was conducted. Surgical complications, discharge disposition, ambulatory status, living situation at 1 year, and mortality at 1 year were compared between patients treated with ORIF and DFR. Outcomes at 1 year were also compared between patients older and younger than 85 years of age. Fifty-eight patients with a mean age of 80 years (range, 61-95 years) met inclusion criteria. The mean follow-up was 29.5 months (range, 5-81 months). Patients undergoing DFR were significantly older than those who underwent ORIF (83 vs 78, P femur fractures. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The shape of the early hominin proximal femur.

    Science.gov (United States)

    Harmon, Elizabeth H

    2009-06-01

    Postcranial skeletal variation among Plio-Pleistocene hominins has implications for taxonomy and locomotor adaptation. Although sample size constraints make interspecific comparisons difficult, postcranial differences between Australopithecus afarensis and Australopithecus africanus have been reported (McHenry and Berger: J Hum Evol 35 1998 1-22; Richmond et al.: J Hum Evol 43 [2002] 529-548; Green et al.: J Hum Evol 52 2007 187-200). Additional evidence indicates that the early members of the genus Homo show morphology like recent humans (e.g., Walker and Leakey: The Nariokotome Homo erectus skeleton. Cambridge: Harvard, 1993). Using a larger fossil sample than previous studies and novel methods, the early hominin proximal femur is newly examined to determine whether new data alter the current view of femoral evolution and inform the issue of interspecific morphological variation among australopiths. Two- and three-dimensional data are collected from large samples of recent humans, Pan, Gorilla, and Pongo and original fossil femora of Australopithecus, Paranthropus, and femora of African fossil Homo. The size-adjusted shape data are analyzed using principal components, thin plate spline analysis, and canonical variate analysis to assess shape variation. The results indicate that femora of fossil Homo are most similar to modern humans but share a low neck-shaft angle (NSA) with australopiths. Australopiths as a group have ape-like greater trochanter morphology. A. afarensis differs from P. robustus and A. africanus in attributes of the neck and NSA. However, interspecific femoral variation is low and australopiths are generally morphologically similar. Although the differences are not dramatic, when considered in combination with other postcranial evidence, the adaptive differences among australopiths in craniodental morphology may have parallels in the postcranium. Copyright 2009 Wiley-Liss, Inc.

  4. Femur fracture classification in women with a history of breast cancer

    Directory of Open Access Journals (Sweden)

    Stephanie Chau

    2014-05-01

    Conclusion: Most femur fractures in women with prior breast cancer occurred in the hip. Among younger women and those experiencing diaphyseal fractures, a larger proportion were pathologic and some were found to be atypical. Further studies should examine risk factors for femur fracture in women with breast cancer with specific attention to fracture subtype and pharmacologic exposures.

  5. Temporary antibiotic cement-covered gamma nail spacer for an infected nonunion of the proximal femur.

    Science.gov (United States)

    Rodriguez, Hugo; Ziran, Bruce H

    2007-01-01

    We report the case of an infected nonunion of the proximal femoral in an elderly patient. There was extensive involvement of the entire proximal femur precluding salvage. An impromptu use of a cephalomedullary nail coated with antibiotic-laden bone cement is described, followed by reimplantation with a revision-type proximal femoral prosthesis. The patient had resection of the proximal femur, placement of a temporary functional spacer, and reimplantation after a course of antibiotics, with good success. The method we describe is a reasonable alternative when standard off-the-shelf systems or other methods of temporary spacer creation are not available.

  6. Radiographic study on the anatomical characteristics of the proximal femur in Brazilian adults

    Directory of Open Access Journals (Sweden)

    Tércio Henrique Soares de Farias

    2015-02-01

    Full Text Available OBJECTIVE: To ascertain the geometry of the femur in the Brazilian population by means of a radiographic study and to correlate the values with regard to sex and right/left side.METHODS: Five hundred anteroposterior radiographs of the pelvis of skeletally mature patients (250 of each sex who did not present any osteoarthrosis, fractures or tumoral or infectious lesions were analyzed. The length and width of the femoral neck, length of the femoral axis, neck-shaft angle and femoral offset were measured.RESULTS: The following means were observed: 36.54 mm for the length of the femoral neck; 37.48 mm for the width of the femoral neck; 108.42 mm for the length of the femoral axis; 130.47° for the neck-shaft angle; and 44.4 mm for the femoral offset.CONCLUSION: The mean values for the main measurements on the proximal femur in Brazilians differed from those of previous studies. It could also be shown that there was a statistically significant mean difference between men and women for all the variables, both on the left and on the right side, and that the men had greater means than the women.

  7. Complications in proximal humeral fractures.

    Science.gov (United States)

    Calori, Giorgio Maria; Colombo, Massimiliano; Bucci, Miguel Simon; Fadigati, Piero; Colombo, Alessandra Ines Maria; Mazzola, Simone; Cefalo, Vittorio; Mazza, Emilio

    2016-10-01

    Necrosis of the humeral head, infections and non-unions are among the most dangerous and difficult-to-treat complications of proximal humeral fractures. The aim of this work was to analyse in detail non-unions and post-traumatic bone defects and to suggest an algorithm of care. Treatment options are based not only on the radiological frame, but also according to a detailed analysis of the patient, who is classified using a risk factor analysis. This method enables the surgeon to choose the most suitable treatment for the patient, thereby facilitating return of function in the shortest possible time. The treatment of such serious complications requires the surgeon to be knowledgeable about the following possible solutions: increased mechanical stability; biological stimulation; and reconstructive techniques in two steps, with application of biotechnologies and prosthetic substitution. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Estimation of femoral bone density from trabecular direct wave and cortical guided wave ultrasound velocities measured at the proximal femur in vivo

    DEFF Research Database (Denmark)

    Barkmann, Reinhard; Dencks, Stefanie; Bremer, Alexander

    2008-01-01

    Bone mineral density (BMD) of the proximal femur is a predictor of hip fracture risk. We developed a Quantitative Ultrasound (QUS) scanner for measurements at this site with similar performance (FemUS). In this study we tested if ultrasound velocities of direct waves through trabecular bone and o...

  9. Comparative morphometric analysis of the proximal femur of African hominids and felids

    Directory of Open Access Journals (Sweden)

    Andrew Gallagher

    2015-09-01

    Full Text Available Size and shape of the mammalian proximal femur and taxon-specific distinctions in the relative proportions of the proximal articulation, the femoral neck and the proximal femoral diaphysis, are critical determinants in its adaptation to differential biomechanical stresses and observed locomotor habitus in different taxa. The morphometrics of the proximal femur are considered equally critical in the assessment of locomotor habitus of extinct fossil mammals, particularly extinct Miocene anthropoids and Plio-Pleistocene hominins. Analyses of size and shape of k=10 dimensions of the proximal femur were undertaken for a large sample series of two extant mammal families the Felidae and Hominidae using conventional multivariate statistical procedures, commonly used size-correction methods, and post-hoc tests of significance. While significant differences in form do exist, there are equally striking convergences in the functional morphology of extant hominid and felid taxa. Multivariate and bivariate allometric analyses confirm that the proximal femur of these two mammalian families share a common underlying structure manifest in a shared first common principal component. Nevertheless, while considerable convergences in general form of the proximal femur of African hominids and large-bodied felids are apparent, there exist equally discreet distinctions which are consistent with the differential structural demands imposed by their distinct locomotor and behavioural habitus.

  10. Intramedullary compression device for proximal ulna fracture.

    Science.gov (United States)

    Hong, Choon Chiet; Han, Fucai; Decruz, Joshua; Pannirselvam, Vinodhkumar; Murphy, Diarmuid

    2015-02-01

    Proximal ulna fractures account for 20% of all proximal forearm fractures. Many treatment options are available for such fractures, such as cast immobilisation, plate and screw fixation, tension band wiring and intramedullary screw fixation, depending on the fracture pattern. Due to the subcutaneous nature of the proximal forearm, it is vulnerable to open injuries over the dorsal aspect of the proximal ulna. This may in turn prove challenging, as it is critical to obtain adequate soft tissue coverage to reduce the risk of implant exposure and bony infections. We herein describe a patient with a Gustillo III-B open fracture of the proximal ulna, treated with minimally invasive intramedullary screw fixation using a 6.0-mm cannulated headless titanium compression screw (FusiFIX, Péronnas, France).

  11. The shape of the hominoid proximal femur: a geometric morphometric analysis

    Science.gov (United States)

    Harmon, Elizabeth H

    2007-01-01

    As part of the hip joint, the proximal femur is an integral locomotor component. Although a link between locomotion and the morphology of some aspects of the proximal femur has been identified, inclusive shapes of this element have not been compared among behaviourally heterogeneous hominoids. Previous analyses have partitioned complex proximal femoral morphology into discrete features (e.g. head, neck, greater trochanter) to facilitate conventional linear measurements. In this study, three-dimensional geometric morphometrics are used to examine the shape of the proximal femur in hominoids to determine whether femoral shape co-varies with locomotor category. Fourteen landmarks are recorded on adult femora of Homo, Pan, Gorilla, Pongo and Hylobates. Generalized Procrustes analysis (GPA) is used to adjust for position, orientation and scale among landmark configurations. Principal components analysis is used to collapse and compare variation in residuals from GPA, and thin-plate spline analysis is used to visualize shape change among taxa. The results indicate that knucklewalking African apes are similar to one another in femoral shape, whereas the more suspensory Asian apes diverge from the African ape pattern. The shape of the human and orangutan proximal femur converge, a result that is best explained in terms of the distinct requirements for locomotion in each group. These findings suggest that the shape of the proximal femur is brought about primarily by locomotor behaviour. PMID:17310545

  12. 'Pathological' fracture of the femur -a complication of failed total hip ...

    African Journals Online (AJOL)

    Ten patients with a major femur fracture complicating total hip arthroplasty were seen at the Princess Alice Orthopaedic Hospital between June 1986 and May 1988. Four cases were intra-operative fractures sustained at revision surgery and 6 were late postoperative fractures of the femur associated with minimal trauma, ...

  13. Retrograde nailing for distal femur fractures in the elderly

    Directory of Open Access Journals (Sweden)

    Giddie Jasdeep

    2015-01-01

    Full Text Available Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years, 52/54 (96% were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3% and the one year mortality was 17/54 (31.5%. Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients.

  14. Simultaneous Periprosthetic Fractures of the Femur and the Acetabulum After Bipolar Hip Arthroplasty

    OpenAIRE

    Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia-Paraskevi; Drosos, Georgios; Vogiatzaki, Theodosia; Tilkeridis, Konstantinos; Kazakos, Konstantinos

    2016-01-01

    Patient: Female, 68 Final Diagnosis: Periprosthetic fractures of the acetabulum and femur after bipolar hip arthroplasty Symptoms: Inability to walk Medication: ? Clinical Procedure: Revision cup and internal fixation femur Specialty: Orhopedics and Traumatology Objective: Rare co-existance of disease or pathology Background: Although periprosthetic fractures of the femur are a recognized complication of total hip arthroplasty, periprosthetic fractures of the acetabulum are rare. Simultaneous...

  15. Maturational timing does not predict HSA estimated adult bone geometry at the proximal femur.

    Science.gov (United States)

    Jackowski, Stefan A; Kontulainen, Saija A; Cooper, David M L; Lanovaz, Joel L; Baxter-Jones, Adam D G

    2011-12-01

    Late maturational timing is documented to be detrimental to bone strength primarily at the distal radius. Studies at the proximal femur have focused on bone mass and the results remain controversial. The purpose of this study was to examine the long term relationship between the onset of maturation and the development of estimated cross sectional area (CSA) and section modulus (Z) at the proximal femur. Two hundred and twenty six individuals (108 males and 118 females) from the Saskatchewan Pediatric Bone Mineral Accrual Study (PBMAS) were classified into maturity groups based on age of attainment of peak height velocity. CSA and Z were serially assessed at the narrow neck (NN), intertrochanter (IT) and proximal shaft (S) sites using hip structural analysis (HSA). Multilevel models were constructed to examine the development of CSA and Z by maturity group. Cross sectional observations indicated that during adolescence, early maturing males had significantly greater CSA and Z than late maturing males at all sites of the proximal femur, while early maturing females had greater Z at the NN and S, and greater CSA at the NN, IT and S sites compared to late maturing females. When age, body size, body composition, physical activity and dietary intake were controlled no significant effects of maturational timing were found at the NN, IT or S regions (p>0.05) in either males or females. In this population of healthy individuals there appears to be no effect of the onset of maturation on estimated CSA and Z development at the proximal femur in both males and females. This may be a result of the proximal femur's loading environment. Future research is required to determine the role of loading on the relationship between maturational timing and bone structure and strength development at the proximal femur. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Development and testing of texture discriminators for the analysis of trabecular bone in proximal femur radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Huber, M. B.; Carballido-Gamio, J.; Fritscher, K.; Schubert, R.; Haenni, M.; Hengg, C.; Majumdar, S.; Link, T. M. [Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, San Francisco, California 94143 (United States); University of Health Sciences, Medical Informatics and Technology, 6060 Hall (Austria); AO Development Institute, 7270 Davos Platz (Switzerland); Medical University Innsbruck, 6020 Innsbruck (Austria); Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, San Francisco, California 94143 (United States)

    2009-11-15

    Purpose: Texture analysis of femur radiographs may serve as a potential low cost technique to predict osteoporotic fracture risk and has received considerable attention in the past years. A further application of this technique may be the measurement of the quality of specific bone compartments to provide useful information for treatment of bone fractures. Two challenges of texture analysis are the selection of the best suitable texture measure and reproducible placement of regions of interest (ROIs). The goal of this in vitro study was to automatically place ROIs in radiographs of proximal femur specimens and to calculate correlations between various different texture analysis methods and the femurs' anchorage strength. Methods: Radiographs were obtained from 14 femoral specimens and bone mineral density (BMD) was measured in the femoral neck. Biomechanical testing was performed to assess the anchorage strength in terms of failure load, breakaway torque, and number of cycles. Images were segmented using a framework that is based on the usage of level sets and statistical in-shape models. Five ROIs were automatically placed in the head, upper and lower neck, trochanteric, and shaft compartment in an atlas subject. All other subjects were registered rigidly, affinely, and nonlinearly, and the resulting transformation was used to map the five ROIs onto the individual femora. Results: In each ROI, texture features were extracted using gray level co-occurence matrices (GLCM), third-order GLCM, morphological gradients (MGs), Minkowski dimensions (MDs), Minkowski functionals (MFs), Gaussian Markov random fields, and scaling index method (SIM). Coefficients of determination for each texture feature with parameters of anchorage strength were computed. In a stepwise multiregression analysis, the most predictive parameters were identified in different models. Texture features were highly correlated with anchorage strength estimated by the failure load of up to R{sup 2

  17. Simultaneous Periprosthetic Fractures of the Femur and the Acetabulum After Bipolar Hip Arthroplasty.

    Science.gov (United States)

    Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia-Paraskevi; Drosos, Georgios; Vogiatzaki, Theodosia; Tilkeridis, Konstantinos; Kazakos, Konstantinos

    2016-12-22

    BACKGROUND Although periprosthetic fractures of the femur are a recognized complication of total hip arthroplasty, periprosthetic fractures of the acetabulum are rare. Simultaneous periprosthetic fractures of both the acetabulum and the femur have not been reported, to our knowledge. CASE REPORT We report a simultaneous fracture of the acetabulum and the femur in a 68-year-old female patient who had previously sustained a subcapital fracture of the femur, treated with a bipolar uncemented prosthesis. We discuss the possible mechanism of this combination of fractures. CONCLUSIONS Simultaneous periprosthetic fractures of the femur and the acetabulum can occur if, in the presence of osteoporotic bone, the metallic femoral head has migrated medially in the acetabulum while the femoral stem is not loose.

  18. [Bone Remodelling in the Proximal Femur after Uncemented Total Hip Arthroplasty in Patients with Osteoporosis].

    Science.gov (United States)

    Lacko, M; Schreierová, D; Čellár, R; Vaško, G

    2015-01-01

    -ray examination revealed stable fibrous ingrowth in one patient with untreated osteoporosis and in one with normal bone density. All remaining patients had stable bone ingrowth fixation. In THA the majority of compressive loads are transferred through the stem to the femoral bone below the apex of the stem. This results in reduction of bone density in the calcar and greater trochanter regions. Osteoporosis is the most important factor related to changes in periprosthetic bone mass. Therefore, it can be anticipated that an excess loss of bone mass in the proximal femur may, in a long term, interfere with THA stability and may increase the risk of periprosthetic fractures and aseptic loosening. The results of our study showed that the patients with untreated osteoporosis, who underwent uncemented THA, experienced a considerable decrease in the periprosthetic bone density of the proximal femur and were in worse clinical health. A bisphospohonate therapy was effective in eliminating this negative outcome. Both the clinical and densitometric findings in patients with treated osteoporosis were similar to those in patients with no osteoporosis.

  19. Magnetic resonance imaging findings of osteoid osteoma of the proximal femur

    Energy Technology Data Exchange (ETDEWEB)

    Gaeta, Michele; Minutoli, Fabio; Pandolfo, Ignazio; Vinci, Sergio; Blandino, Alfredo [Department of Radiological Sciences, University of Messina, Policlinico ' ' G. Martino' ' , Via Consolare Valeria, 98100, Messina (Italy); D' Andrea, Letterio [Department of Orthopedics, University of Messina, Policlinico ' ' G. Martino' ' , Via Consolare Valeria, 98100, Messina (Italy)

    2004-09-01

    Osteoid osteoma (OO) is a benign bone tumor whose main radiological finding is nidus. OO of the proximal femur can also result in non-specific findings such as hip joint effusion, perinidal bone marrow edema and soft tissue mass. Since the nidus may be difficult to identify with MR, these non-specific findings can lead to erroneous diagnosis. Therefore, MR imaging technique should be optimized in order to identify nidus. Since MR imaging has assumed increasing importance in the evaluation of disorders of the hip, radiologists must be aware of the spectrum of findings of OO of the proximal femur. The aim of this pictorial review is to show the MR imaging findings of intra-articular and extra-articular OO of the proximal femur. (orig.)

  20. Systemic treatment with telmisartan improves femur fracture healing in mice.

    Science.gov (United States)

    Zhao, Xiong; Wang, Jia-xing; Feng, Ya-fei; Wu, Zi-xiang; Zhang, Yang; Shi, Lei; Tan, Quan-chang; Yan, Ya-bo; Lei, Wei

    2014-01-01

    Recent clinical studies indicated that angiotensin receptor blockers (ARBs) would decrease the risk of bone fractures in the elderly populations. There is little known about the role of the ARBs in the process of fracture healing. The purpose of the present study was to verify the hypothesis that systemic treatment with telmisartan has the ability to promote fracture healing. In this study, femur fractures were produced in 96 mature male BALB/c mice. Animals were treated with the ARBs telmisartan or vehicle. Fracture healing was analysed after 2, 5 and 10 weeks postoperatively using X-ray, biomechanical testing, histomorphometry, immunohistochemistry and micro-computed tomography (micro-CT). Radiological analysis showed the diameter of the callus in the telmisartan treated animals was significantly increased when compared with that of vehicle treated controls after two weeks of fracture healing. The radiologically observed promotion of callus formation was confirmed by histomorphometric analyses, which revealed a significantly increased amount of bone formation when compared with vehicle-treated controls. Biomechanical testing further showed a significantly greater peak torque at failure, and a higher torsional stiffness in telmisartan-treated animals compared with controls. There was an increased fraction of PCNA-positive cells and VEGF-positive cells in telmisartan-treated group compared with vehicle-treated controls. From the three-dimensional reconstruction of the bony callus, telmisartan-treated group significantly increased the values of BV/TV by 21.7% and CsAr by 26.0% compared to the vehicle-treated controls at 5 weeks post-fracture. In summary, we demonstrate in the current study that telmisartan could promote fracture healing in a mice model via increasing mechanical strength and improving microstructure. The most mechanism is probably by an increase of cell proliferation and neovascularization associated with a decreased VEGF expression in hypertrophic

  1. Systemic Treatment with Telmisartan Improves Femur Fracture Healing in Mice

    Science.gov (United States)

    Wu, Zi-xiang; Zhang, Yang; Shi, Lei; Tan, Quan-chang; Yan, Ya-bo; Lei, Wei

    2014-01-01

    Recent clinical studies indicated that angiotensin receptor blockers (ARBs) would decrease the risk of bone fractures in the elderly populations. There is little known about the role of the ARBs in the process of fracture healing. The purpose of the present study was to verify the hypothesis that systemic treatment with telmisartan has the ability to promote fracture healing. In this study, femur fractures were produced in 96 mature male BALB/c mice. Animals were treated with the ARBs telmisartan or vehicle. Fracture healing was analysed after 2, 5 and 10 weeks postoperatively using X-ray, biomechanical testing, histomorphometry, immunohistochemistry and micro-computed tomography (micro-CT). Radiological analysis showed the diameter of the callus in the telmisartan treated animals was significantly increased when compared with that of vehicle treated controls after two weeks of fracture healing. The radiologically observed promotion of callus formation was confirmed by histomorphometric analyses, which revealed a significantly increased amount of bone formation when compared with vehicle-treated controls. Biomechanical testing further showed a significantly greater peak torque at failure, and a higher torsional stiffness in telmisartan-treated animals compared with controls. There was an increased fraction of PCNA-positive cells and VEGF-positive cells in telmisartan-treated group compared with vehicle-treated controls. From the three-dimensional reconstruction of the bony callus, telmisartan-treated group significantly increased the values of BV/TV by 21.7% and CsAr by 26.0% compared to the vehicle-treated controls at 5 weeks post-fracture. In summary, we demonstrate in the current study that telmisartan could promote fracture healing in a mice model via increasing mechanical strength and improving microstructure. The most mechanism is probably by an increase of cell proliferation and neovascularization associated with a decreased VEGF expression in hypertrophic

  2. Rare stress fracture: longitudinal fracture of the femur.

    Science.gov (United States)

    Pérez González, M; Velázquez Fragua, P; López Miralles, E; Abad Moretón, M M

    2017-09-21

    42-year-old man with pain in the posterolateral region of the right knee that began while he was running. Initially, it was diagnosed by magnetic resonance (MR) as a possible aggressive process (osteosarcoma or Ewing's sarcoma) but with computed tomography it was noted a cortical hypodense linear longitudinal image with a continuous, homogeneous and solid periosteal reaction without clear soft tissue mass that in this patient suggest a longitudinal distal femoral fatigue stress fracture. This type of fracture at this location is very rare. Stress fractures are entities that can be confused with an agressive process. MR iscurrently the most sensitive and specific imaging method for its diagnosis. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Compartment syndrome of the thigh complicating surgical treatment of ipsilateral femur and ankle fractures

    Science.gov (United States)

    Moore, M. R.; Garfin, S. R.; Hargens, A. R.

    1987-01-01

    A 26-year-old man presented with ipsilateral femur and ankle fractures. The patient was treated with interlocking nail of his femur fracture, followed by open reduction and internal fixation of his ankle fracture under tourniquet control. Postoperatively, the patient developed compartment syndrome of his thigh with elevated pressures, requiring decompressive fasciotomies. This case illustrates the possible complication of treating a femur fracture with intramedullary nailing and then immediately applying a tourniquet to treat an ipsilateral extremity fracture. Because of the complication with this patient, we feel the procedure should be staged, or a tourniquet should be avoided if possible.

  4. Management of Acute Proximal Humeral Fractures.

    Science.gov (United States)

    Kancherla, Vamsi Krishna; Singh, Anshuman; Anakwenze, Oke A

    2017-01-01

    Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. A myriad of nonsurgical and surgical treatment options exist for these injuries, including short-term immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. The choice of treatment depends on the fracture type and severity, surgeon expertise, patient age, and patient health status.

  5. Adolescent physical activity and bone strength at the proximal femur in adulthood.

    Science.gov (United States)

    Jackowski, Stefan A; Kontulainen, Saija A; Cooper, David M L; Lanovaz, Joel L; Beck, Thomas J; Baxter-Jones, Adam D G

    2014-04-01

    Physical activity (PA) enhances bone structural strength at the proximal femur in adolescence, but whether these benefits are maintained into early adulthood remains unknown. The purpose of this study was to investigate whether males and females, described as active, average, and inactive during adolescence, display differences in structural strength at the proximal femur in early adulthood (20-30 yr). One hundred four participants (55 males and 49 females) from the Pediatric Bone Mineral Accrual Study (PBMAS) were categorized into adolescent PA groupings (inactive, average, and active) using the Physical Activity Questionnaire for Adolescents. Cross-sectional area and section modulus (Z) at the narrow neck, intertrochanter, and femoral shaft (S) sites of the proximal femur were assessed using hip structural analysis in young adulthood from femoral neck dual-energy x-ray absorptiometry scans. Group differences were assessed using ANCOVA, controlling for adult height (Ht), adult weight (Wt), adolescent bone geometry, sex, percentage adult total body lean tissue (LTM%), and adult PA levels. Active adolescents had significantly greater adjusted bone geometric measures at all sites than their inactive classified peers during adolescence (P femur than adult participants who were classified as inactive during adolescence (P femur in young adulthood.

  6. Prevalence of abuse among young children with femur fractures: a systematic review.

    Science.gov (United States)

    Wood, Joanne N; Fakeye, Oludolapo; Mondestin, Valerie; Rubin, David M; Localio, Russell; Feudtner, Chris

    2014-07-02

    Clinical factors that affect the likelihood of abuse in children with femur fractures have not been well elucidated. Consequently, specifying which children with femur fractures warrant an abuse evaluation is difficult. Therefore the purpose of this study is to estimate the proportion of femur fractures in young children attributable to abuse and to identify demographic, injury and presentation characteristics that affect the probability that femur fractures are secondary to abuse. We conducted a systematic review of published articles written in English between January 1990 and July 2013 on femur fracture etiology in children less than or equal to 5 years old based on searches in PubMed/MEDLINE and CINAHL databases. Data extraction was based on pre-defined data elements and included study quality indicators. A meta-analysis was not performed due to study population heterogeneity. Across the 24 studies reviewed, there were a total of 10,717 children less than or equal to 60 months old with femur fractures. Among children less than 12 months old with all types of femur fractures, investigators found abuse rates ranging from 16.7% to 35.2%. Among children 12 months old or greater with femur fractures, abuse rates were lower: from 1.5% - 6.0%. In multiple studies, age less than 12 months, non-ambulatory status, a suspicious history, and the presence of additional injuries were associated with findings of abuse. Diaphyseal fractures were associated with a lower abuse incidence in multiple studies. Fracture side and spiral fracture type, however, were not associated with abuse. Studies commonly find a high proportion of abuse among children less than 12 months old with femur fractures. The reported trauma history, physical examination findings and radiologic results must be examined for characteristics that increase or decrease the likelihood of abuse determination.

  7. Prevalence of abuse among young children with femur fractures: a systematic review

    Science.gov (United States)

    2014-01-01

    Background Clinical factors that affect the likelihood of abuse in children with femur fractures have not been well elucidated. Consequently, specifying which children with femur fractures warrant an abuse evaluation is difficult. Therefore the purpose of this study is to estimate the proportion of femur fractures in young children attributable to abuse and to identify demographic, injury and presentation characteristics that affect the probability that femur fractures are secondary to abuse. Methods We conducted a systematic review of published articles written in English between January 1990 and July 2013 on femur fracture etiology in children less than or equal to 5 years old based on searches in PubMed/MEDLINE and CINAHL databases. Data extraction was based on pre-defined data elements and included study quality indicators. A meta-analysis was not performed due to study population heterogeneity. Results Across the 24 studies reviewed, there were a total of 10,717 children less than or equal to 60 months old with femur fractures. Among children less than 12 months old with all types of femur fractures, investigators found abuse rates ranging from 16.7% to 35.2%. Among children 12 months old or greater with femur fractures, abuse rates were lower: from 1.5% - 6.0%. In multiple studies, age less than 12 months, non-ambulatory status, a suspicious history, and the presence of additional injuries were associated with findings of abuse. Diaphyseal fractures were associated with a lower abuse incidence in multiple studies. Fracture side and spiral fracture type, however, were not associated with abuse. Conclusions Studies commonly find a high proportion of abuse among children less than 12 months old with femur fractures. The reported trauma history, physical examination findings and radiologic results must be examined for characteristics that increase or decrease the likelihood of abuse determination. PMID:24989500

  8. Impacted valgus fractures of the proximal humerus

    Directory of Open Access Journals (Sweden)

    Fabiano Rebouças Ribeiro

    2016-04-01

    Full Text Available Impacted valgus fractures of the proximal humerus are considered to be a special type fracture, since impaction of the humeral head on the metaphysis with maintenance of the posteromedial periosteum improves the prognosis regarding occurrences of avascular necrosis. This characteristic can also facilitate the reduction maneuver and increase the consolidation rate of these fractures, even in more complex cases. The studies included were obtained by searching the Bireme, Medline, PubMed, Cochrane Library and Google Scholar databases for those published between 1991 and 2013. The objective of this study was to identify the most common definitions, classifications and treatment methods used for these fractures in the orthopedic medical literature.

  9. Biomechanical comparison of 2 different locking plate fixation methods in vancouver b1 periprosthetic femur fractures.

    Science.gov (United States)

    Pletka, Joshua D; Marsland, Daniel; Belkoff, Stephen M; Mears, Simon C; Kates, Stephen L

    2011-03-01

    Locking plates are commonly used to treat fractures around a well-fixed femoral component. The optimal construct should provide sufficient fixation while minimizing soft-tissue dissection. The purpose of the current study was to determine whether plate length, working length, or bone mineral density affects survival of locking plate fixation for Vancouver type B1 periprosthetic hip fractures. A transverse osteotomy was created just distal to cemented femoral prostheses in 9 pairs of cadaveric femurs. Fractures were stabilized with long (20-hole) or short (12-hole) locking plates that were secured proximally with cables and screws and distally with screws only. Specimens were then cycled 10 000 times at 2500 N of axial force and 15 Nm of torque to simulate full weightbearing. A motion capture system was used to record fracture displacement during cycling. Failure occurred in 5 long and 3 short plates, with no significant differences found in the number of cycles to failure. For the specimens that survived, there were no significant differences found between long and short plates for displacement or rotation observed at the fracture site. A shorter working length was not associated with increased failure rate. Lower bone mineral density was significantly associated with failure (P = .02). We concluded that long locked plates do not appear to offer a biomechanical advantage over short locking plates in terms of fixation survival, and that bone mineral density was a better predictor of failure than was the fixation construct type.

  10. Limb-sparing surgery in a dog with osteosarcoma of the proximal femur.

    Science.gov (United States)

    Liptak, Julius M; Pluhar, G Elizabeth; Dernell, William S; Withrow, Stephen J

    2005-01-01

    To report successful limb-sparing surgery in a dog with a proximal femoral osteosarcoma (OSA) using a composite allograft-prosthetic technique. Case report. Client-owned dog. A stage IIB OSA of the proximal aspect of the femur was resected in accordance with oncologic and limb-sparing principles. The osseous defect was reconstructed with a proximal femoral allograft and cemented, long-stemmed femoral prosthesis. Soft tissue reconstruction was achieved by suturing host tendons to their respective allogeneic tendons on the allograft. Coxofemoral joint function was preserved using standard total hip arthroplasty techniques. Limb-sparing surgery of the proximal aspect of the femur using a composite allograft-prosthetic technique resulted in excellent limb function. Postoperative complications included aseptic loosening of the femoral composite graft and allograft nonunion, which required revision, traumatic implant luxation, and local tumor recurrence. Limb function was excellent after surgical stabilization of the allograft nonunion but deteriorated after implant luxation 270 days postlimb-sparing surgery. Pulmonary and skeletal metastases were diagnosed and local tumor recurrence suspected 596 and 650 days postoperatively, respectively. The dog was euthanatized 688 days after limb-sparing surgery as a result of progressive local and metastatic disease. Limb-sparing surgery for dogs with primary bone tumors of the proximal aspect of the femur is feasible with good functional results.

  11. [Gait analysis after rotationplasty hip surgery for malignant tumor of the proximal femur].

    Science.gov (United States)

    Donati, D; Benedetti, M G; Catani, F; Berti, L; Capanna, R

    2004-10-01

    Rotationplasty of the hip joint is a special surgical technique used for the treatment of malignant tumors of the proximal part of the femur. We report a clinical case and gait analysis results before and after rehabilitation training. Evaluation of joint motion, kinetic moments, and the electromyographic findings enabled us to document progressive adaptation of muscle and joint function to their new role in the motor pattern, demonstrating the exceptional strength of rotationplasty. Active control of two fulcrums in the lower limb, the pseudo hip proximally and the pseudo knee intermedially, makes this type of operation extremely advantageous compared to the alternative of hip disarticulation or hemipelvectomy. Total absence of pain together with the preservation of articular and cutaneous proprioception are important advantages. Rotationplasty is an attractive alternative for treatment of malignant tumors of the proximal part of the femur.

  12. Femur Fractures in Parkinsonism: Analysis of a National Sample Cohort in South Korea

    Science.gov (United States)

    An, Soo Jeong; Lee, Seo-Young; Kwon, Jae-Woo; Lee, Seung-Joon; Kim, Young-Ju

    2017-01-01

    Background and Purpose Falling with a femur fracture is a serious event that negatively affects the quality of life of elderly individuals as well as patients with parkinsonism. This study investigated the association between parkinsonism and femur fracture and compared the risk of femur fracture between subjects with and without parkinsonism. Methods This study examined a population-based matched cohort constructed using the National Sample Cohort data set, which comprises approximately one million subscribers to medical insurance and aid in South Korea. Subjects with parkinsonism during 2003–2013 were identified as the exposed group, and up to five individuals matched for age, sex, and index years were identified as the controls for each parkinsonism subject. The risk of femur fracture for parkinsonism was evaluated using Cox regression. Results The incidence of femur fracture according to age, sex, and body mass index varied significantly between subjects with parkinsonism and controls (pfemur fractures for males [hazard ratio (HR)=2.85, 95% confidence interval [CI]=1.87–4.34], subjects younger than 65 years (HR=2.89, 95% CI=1.64–5.11), and underweight subjects (HR=3.90, 95% CI=1.82–8.35). The adjusted HR for femur fracture with parkinsonism was highest within 2 years of the disease diagnosis (HR=3.10, 95% CI=2.12–4.53). Conclusions Our study found that the presence of parkinsonism is more strongly related to femur fracture in males, and increases the influence of traditional risk factors on femur fracture. It is necessary to consider how factors associated with the amount of ambulatory activity–even in an early diagnosed state–can play an important role in femur fracture in subjects with parkinsonism. PMID:29057630

  13. Locking plate fixation for proximal humerus fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.

  14. Surgically Relevant Bony and Soft Tissue Anatomy of the Proximal Femur

    Science.gov (United States)

    Philippon, Marc J.; Michalski, Max P.; Campbell, Kevin J.; Goldsmith, Mary T.; Devitt, Brian M.; Wijdicks, Coen A.; LaPrade, Robert F.

    2014-01-01

    Background: Hip endoscopy facilitates the treatment of extra-articular disorders of the proximal femur. Unfortunately, current knowledge of proximal femur anatomy is limited to qualitative descriptions and lacks surgically relevant landmarks. Purpose: To provide a quantitative and qualitative analysis of proximal femur anatomy in reference to surgically relevant bony landmarks. Study Design: Descriptive laboratory study. Methods: Fourteen cadaveric hemipelvises were dissected. A coordinate measuring device measured dimensions and interrelationships of the gluteal muscles, hip external rotators, pectineus, iliopsoas, and joint capsule in reference to osseous landmarks. Results: The vastus tubercle, superomedial border of the greater trochanter, and femoral head-neck junction were distinct and reliable osseous landmarks. The anteroinferior tip of the vastus tubercle was 17.1 mm (95% CI: 14.5, 19.8 mm) anteroinferior to the center of the gluteus medius lateral insertional footprint and was 22.9 mm (95% CI: 20.1, 25.7 mm) inferolateral to the center of the gluteus minimus insertional footprint. The insertions of the piriformis, conjoint tendon of the hip (superior gemellus, obturator internus, and inferior gemellus), and obturator externus were identified relative to the superomedial border of the greater trochanter. The relationship of the aforementioned footprints were 49% (95% CI: 43%, 54%), 42% (95% CI: 33%, 50%), and 64% (95% CI: 59%, 69%) from the anterior (0%) to posterior (100%) margins of the superomedial border of the greater trochanter, respectively. The hip joint capsule attached distally on the proximal femur 18.2 mm (95% CI: 14.2, 22.2 mm) from the head-neck junction medially on average. Conclusion: The vastus tubercle, superomedial border of the greater trochanter, and the femoral head-neck junction were reliable osseous landmarks for the identification of the tendinous and hip capsular insertions on the proximal femur. Knowledge of the

  15. [Total hip replacement in elderly and senile patients with initial femur neck fractures].

    Science.gov (United States)

    Ternovoĭ, N K; Samokhin, A V; Grebennikov, K A

    2003-12-01

    We carried out researches with the purpose of comparison of operative treatment results of femur neck fractures in elderly and senile patients with those in other countries. Total hip replacement technique was used over the period of 1991-2002 yy. for 123 patients with femur neck fractures. We have used "Smith & Nephews" or "Zimmer" prostheses with "Polacos" or "Osteobond" acrylcements. Surgical approach tactics is very important for prophylaxis of early and late postoperative complications. Active and of sound mind patients with femur neck fractures should undergo total hip replacement procedure. Rehabilitation is also an important factor in preventive early and late postoperative complications.

  16. Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures

    Energy Technology Data Exchange (ETDEWEB)

    Favinger, Jennifer L. [University of Washington, Department of Radiology, 1959 N.E. Pacific Street, Box 357115, Seattle, WA (United States); Hippe, Daniel [University of Washington, Department of Radiology, Seattle, WA (United States); Ha, Alice S. [University of Washington, Department of Radiology, 4245 Roosevelt Way NE, Box 354755, Seattle, WA (United States)

    2016-05-15

    To evaluate the appearance of bisphosphonate-related femur insufficiency fractures on long-term follow-up radiographic studies and to describe the rate of fracture line obscuration and cortical beak healing over time. In this retrospective study, bisphosphonate-related femur fracture radiographs were reviewed by two radiologists for the presence of a fracture line, callus, and the characteristic cortical beak. Kaplan-Meier curves were used to analyze the time to first indication of healing. Femurs were also subdivided into those who underwent early versus late surgical fixation and those who underwent early versus late discontinuation of bisphosphonate. Clinical data including pain level and medication history were collected. Forty-seven femurs with a bisphosphonate-related femur fracture were identified in 28 women. Eighty-five percent took a bisphosphonate for greater than 5 years and 59 % for greater than 10 years. The median time to beak healing was 265 weeks and the median time to fracture line healing was 56 weeks in the 31 femurs with a baseline fracture. No statistically significant difference was identified between surgical fixation and conservative management. Bisphosphonate-related fractures demonstrate notably prolonged healing time on long-term follow-up. (orig.)

  17. Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

    2009-07-01

    The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

  18. The association of distal femur and proximal tibia shape with sex: The Osteoarthritis Initiative.

    Science.gov (United States)

    Wise, Barton L; Liu, Felix; Kritikos, Lisa; Lynch, John A; Parimi, Neeta; Zhang, Yuqing; Lane, Nancy E

    2016-08-01

    Risk of knee osteoarthritis (OA) is much higher in women than in men. Previous studies have shown that bone shape is a risk factor for knee OA. However, few studies have examined whether knee bone shape differs between men and women. The purpose of the present study was to determine whether there are differences between men and women in knee bone shape. We used information from the NIH-funded Osteoarthritis Initiative (OAI), a cohort of persons aged 45-79 at baseline who either had symptomatic knee OA or were at high risk of it. Among participants aged between 45 and 60 years, we randomly sampled 340 knees without radiographic OA (i.e., Kellgren/Lawrence grade of 0 in central readings on baseline radiograph). We characterized distal femur and proximal tibia shape of these selected radiographs using statistical shape modeling (SSM). We performed linear regression analysis to examine the association between sex and each knee shape mode (proximal tibia and distal femur), adjusting for age, race, body mass index (BMI), and clinic site. The mean age was 52.7 years (±4.3 SD) for both men and women. There were 192 female and 147 male knees for the distal femur analysis. Thirteen modes were derived for femoral shape, accounting for 95.5% of the total variance. Distal femur mode 1 had the greatest difference in standardized score of knee shape between females and males (1.04, p femur and proximal tibia that form the knee joint differ by sex. Additional analyses are warranted to assess whether the difference in risk of OA between the sexes arises from bone shape differences. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Efficiency of the Lausanne clinical pathway for proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    Nicole eFleury

    2015-02-01

    Full Text Available Purpose/Introduction: The number of hip fractures is rising, due to increases in life expectancy. In such cases patients are at risk from post-operative complications and subsequently the average length of hospitalisation may be extended. In 2011, we established a clinical pathway (CP, a specific model of care for patient-care management, to improve the clinical and economic outcomes of proximal femoral fracture management in elderly patients. The goal was to evaluate the CP using clinical, process and financial indicators.Methods: We included all surgical patients aged 65 and over, admitted to the emergency department with a fracture of the proximal femur following a fall. Assessment parameters included three performance indicators: clinical, process and financial. The clinical indicators were the presence or absence of acute delirium on the third post-operative day, diagnosis of nosocomial pneumonia, and the number of patients fulfilling at least 75% of their nutritional requirements at the end of the hospitalisation period. The process indicator was the time interval between arrival at the emergency department and surgery. The financial indicator was based on the number of days spent in hospital.Results: From 2011 to 2013, 669 patients were included in the CP. We observed that the average length of stay in hospital decreased as soon as the CP was implemented and stabilised afterwards. The goal of 90% of patients undergoing surgery within 48 hours of arrival in the emergency department was surpassed in 2013 (93.1%. Furthermore, we observed an improvement in the clinical indicators. Conclusions: The application of a CP allowed an improvement in the qualitative and quantitative efficiency of proximal femoral fracture management in elderly patients, in terms of clinical, process and financial factors.

  20. Assessment of femur geometrical parameters using EOS™ imaging technology in patients with atypical femur fractures; preliminary results.

    Science.gov (United States)

    Morin, Suzanne N; Wall, Michelle; Belzile, Etienne L; Godbout, Benoit; Moser, Thomas P; Michou, Laëtitia; Ste-Marie, Louis-Georges; de Guise, Jacques A; Rahme, Elham; Brown, Jacques P

    2016-02-01

    Atypical femur fractures (AFF) arise in the subtrochanteric and diaphyseal regions. Because of this unique distribution, we hypothesized that patients with AFF demonstrate specific geometrical variations of their lower limb whereby baseline tensile forces applied to the lateral cortex are higher and might favor the appearance of these rare stress fractures, when exposed to bisphosphonates. Using the low irradiation 2D-3D X-ray scanner EOS™ imaging technology we aimed to characterize and compare femur geometric parameters between women who sustained bisphosphonate-associated AFF and those who had experienced similar duration of exposure to bisphosphonates but did not sustain fractures. Conditional logistic regression models were constructed to estimate the association between selected geometric parameters and the occurrence of AFF. We identified 16 Caucasian women with AFF and recruited 16 ethnicity-, sex-, age-, height- and cumulative bisphosphonate exposure-matched controls from local osteoporosis clinics. Compared to controls, those with AFF had more lateral femur bowing (-3.2° SD [3.4] versus -0.8° SD [1.9] p=0.02). In regression analysis, lateral femur bowing was associated with the risk of AFF (aOR 1.54; 95% CI 1.04-2.28, p=0.03). Women who sustained a subtrochanteric AFF demonstrated a lesser femoral neck shaft angle (varus geometry) than those with a fracture at a diaphyseal site (121.9 [3.6]° versus 127.6 [7.2]°, p=0.07), whereas femur bowing was more prominent in those with a diaphyseal fracture compared to those with a subtrochanteric fracture (-4.3 [3.2]° versus -0.9 [2.7]°, p=0.07). Our analyses support that subjects with AFF exhibit femoral geometry parameters that result in higher tensile mechanical load on the lateral femur. This may play a critical role in the pathogenesis of AFF and requires further evaluation in a larger size population. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Implant failure caused by non-union of bisphosphonate-associated subtrochanteric femur fracture.

    LENUS (Irish Health Repository)

    O'Neill, Barry James

    2014-04-03

    Bisphosphonate use has been identified as a contributory factor in atypical subtrochanteric fracture of the femur. These fractures are commonly treated with an intramedullary device. We present a case of implant failure of an intrameduallary device caused by non-union of an atypical subtrochanteric fracture.

  2. Validation of subject-specific automated p-FE analysis of the proximal femur.

    Science.gov (United States)

    Trabelsi, Nir; Yosibash, Zohar; Milgrom, Charles

    2009-02-09

    The use of subject-specific finite element (FE) models in clinical practice requires a high level of automation and validation. In Yosibash et al. [2007a. Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations. J. Biomechanics 40, 3688-3699] a novel method for generating high-order finite element (p-FE) models from CT scans was presented and validated by experimental observations on two fresh frozen femurs (harvested from a 30 year old male and 21 year old female). Herein, we substantiate the validation process by enlarging the experimental database (54 year old female femur), improving the method and examine its robustness under different CT scan conditions. A fresh frozen femur of a 54 year old female was scanned under two different environments: in air and immersed in water (dry and wet CT). Thereafter, the proximal femur was quasi-statically loaded in vitro by a 1000N load. The two QCT scans were manipulated to generate p-FE models that mimic the experimental conditions. We compared p-FE displacements and strains of the wet CT model to the dry CT model and to the experimental results. In addition, the material assignment strategy was reinvestigated. The inhomogeneous Young's modulus was represented in the FE model using two different methods, directly extracted from the CT data and using continuous spatial functions as in Yosibash et al. [2007a. Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations. J. Biomechanics 40, 3688-3699]. Excellent agreement between dry and wet FE models was found for both displacements and strains, i.e. the method is insensitive to CT conditions and may be used in vivo. Good agreement was also found between FE results and experimental observations. The spatial functions representing Young's modulus are local and do not influence strains and displacements prediction. Finally, the p-FE results of

  3. SHORTAND MIDDLE-TERM RESULTS OF HIP ARTHROPLASTY FOR TUMORS OF THE PROXIMAL FEMUR

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2014-01-01

    Full Text Available A purpose of the study was to evaluate the immediate and medium-term outcomes of the treatment of patients with primary tumor lesions of proximal femur after the lesion resection together with total hip arthroplastyby total revision systems. Material and methods. 34 patients with primary tumors of proximal femur [chondrosarcoma - 9 (26.5%,giant cell tumor - II (32.4%,osteosarcoma - 2 (5.8%, other malignancies - 5 (14.7%,benign neoplasms - 7 (20.6%] underwent the conserving surgery at R.R. Vreden Russian Research Institute of Traumatology and Orthopedics since 2003 through 2013. The follow-up was from one to five years. The age of patients ranged from 16 to 70 years, patients younger than 40 years accounted for 61.8%. Acetabulum was replaced by standard components. To replace post-resection defects of proximal femur, in 21 (61.8% patents revision legs of cementless fixation Wagner Revision (Zimmer were used, in 10 (29.4% - “Fenix”, and in 3 (8.8% - Solution (DePuy, J&J. Results. A technique of total hip arthroplasty with the use of revision systems demonstrated excellent and positive results in 32 (94.2% cases. Complications leading to revision surgery occurred in 3 (8.8% patients. Conclusion. The method allows achievement of favorable functional outcomes and early patients’ activation without worsening the oncologic component of treatment and being not inferior to expensive modular systems.

  4. Proximal Femoral Fracture in Hip Arthrodesis Treated with Double Reconstruction Plates

    Directory of Open Access Journals (Sweden)

    Shunsuke Asakawa

    2017-01-01

    Full Text Available We present a rare clinical case of a 90-year-old female who sustained a proximal femoral neck fracture following long-standing hip arthrodesis. Since the fracture occurred relatively proximally and involved the pelvis, double-plate fixation was chosen to achieve rigid fixation. The reconstruction plate was placed at the posterior and anterior columns individually through single vertical incision. She was treated successfully, and she attained preinjury activity level. Proximal femoral fractures in arthrodesed hips need to be recognized as a fracture between the pelvis and femur. Rotational stress from the trunk and lower extremity requires rigid fixation to minimize the increase of displacement and the risk for nonunion.

  5. Asymmetry and structural system analysis of the proximal femur meta-epiphysis: osteoarticular anatomical pathology

    Directory of Open Access Journals (Sweden)

    Baydoun Safaa

    2008-02-01

    Full Text Available Abstract Background The human femur is commonly considered as a subsystem of the locomotor apparatus with four conspicuous levels of organization. This phenomenon is the result of the evolution of the locomotor apparatus, which encompasses both constitutional and individual variability. The work therein reported, therefore, underlies the significance of observing anatomical system analysis of the proximal femur meta-epiphysis in normal conditions, according to the anatomic positioning with respect to the right or left side of the body, and the presence of system asymmetry in the meta-epiphysis structure, thus indicating structural and functional asymmetry. Methods A total of 160 femur bones of both sexes were compiled and a morphological study of 15 linear and angulated parameters of proximal femur epiphysis was produced, thus defining the linear/angulated size of tubular bones. The parameters were divided into linear and angulated groups, while maintaining the motion of the hip joint and transmission of stress to the unwanted parts of the limb. Furthermore, the straight and vertical diameters of the femoral head and the length of the femoral neck were also studied. The angle between the neck and diaphysis, the neck antiversion and angle of rotation of the femoral neck were subsequently measured. Finally, the condylo-diaphyseal angle with respect to the axis of extremity was determined. To visualize the force of intersystem ties, we have used the method of correlation galaxy construction. Results The absolute numeral values of each linear parameter were transformed to relative values. The values of superfluity coefficient for each parameter in the right and left femoral bone groups were estimated and Pearson's correlation coefficient has been calculated (> 0.60. Retrospectively, the observed results have confirmed the presence of functional asymmetry in the proximal femur meta-epiphysis. On the basis of compliance or insignificant difference in

  6. Asymmetry and structural system analysis of the proximal femur meta-epiphysis: osteoarticular anatomical pathology.

    Science.gov (United States)

    Samaha, Ali A; Ivanov, Alexander V; Haddad, John J; Kolesnik, Alexander I; Baydoun, Safaa; Arabi, Maher R; Yashina, Irena N; Samaha, Rana A; Ivanov, Dimetry A

    2008-02-27

    The human femur is commonly considered as a subsystem of the locomotor apparatus with four conspicuous levels of organization. This phenomenon is the result of the evolution of the locomotor apparatus, which encompasses both constitutional and individual variability. The work therein reported, therefore, underlies the significance of observing anatomical system analysis of the proximal femur meta-epiphysis in normal conditions, according to the anatomic positioning with respect to the right or left side of the body, and the presence of system asymmetry in the meta-epiphysis structure, thus indicating structural and functional asymmetry. A total of 160 femur bones of both sexes were compiled and a morphological study of 15 linear and angulated parameters of proximal femur epiphysis was produced, thus defining the linear/angulated size of tubular bones. The parameters were divided into linear and angulated groups, while maintaining the motion of the hip joint and transmission of stress to the unwanted parts of the limb. Furthermore, the straight and vertical diameters of the femoral head and the length of the femoral neck were also studied. The angle between the neck and diaphysis, the neck antiversion and angle of rotation of the femoral neck were subsequently measured. Finally, the condylo-diaphyseal angle with respect to the axis of extremity was determined. To visualize the force of intersystem ties, we have used the method of correlation galaxy construction. The absolute numeral values of each linear parameter were transformed to relative values. The values of superfluidity coefficient for each parameter in the right and left femoral bone groups were estimated and Pearson's correlation coefficient has been calculated (> 0.60). Retrospectively, the observed results have confirmed the presence of functional asymmetry in the proximal femur meta-epiphysis. On the basis of compliance or insignificant difference in the confidence interval of the linear parameters, we

  7. Proximal femur of Australopithecus africanus from Member 4, Makapansgat, South Africa.

    Science.gov (United States)

    Reed, K E; Kitching, J W; Grine, F E; Jungers, W L; Sokoloff, L

    1993-09-01

    A left proximal femur (MLD 46) from Member 4, Makapansgat, South Africa is described and analyzed. It consists of the head, neck, and a small segment of the shaft that extends to just below the lesser trochanter. The femur exhibits degenerative joint disease in the form of marginal osteophyte formation and thus its taxonomic identity has been somewhat obscured. Consideration of all like-sized mammalian femora from Makapansgat suggests that the femur is that of either a felid or hominid. Comparison of MLD 46 to femora of extent and extinct felids reveals that MLD 46 does not possess two morphological features that are characteristic of felids, namely a deep, prolonged trochanteric fossa and a high neck-shaft angle. Simple shape variables (ratios) and multivariate analyses consistently place MLD 46 with modern and fossil hominids, and most closely align it with the australopithecines. We conclude that the femur is most reasonably attributable to Australopithecus africanus, which is the only hominid yet identified from Makapansgat. Despite its pathological condition, MLD 46 is the most complete proximal femur known for A. africanus, thereby permitting further morphological comparisons with homologues of A. afarensis and Paranthropus. Marginal osteophytes of mammalian femoral heads characteristically occur in individuals of advanced age, suggesting that MLD 46 may have lived some time with the disease. Finally, MLD 46 is considerably larger than the previously described specimen, Sts 14, from Sterkfontein Member 4. There may be as great a contrast in body size in A. africanus as there is between the large and small specimens of A. afarensis.

  8. Bone mineral and stiffness loss at the distal femur and proximal tibia in acute spinal cord injury.

    Science.gov (United States)

    Edwards, W B; Schnitzer, T J; Troy, K L

    2014-03-01

    Computed tomography and finite element modeling were used to assess bone mineral and stiffness loss at the knee following acute spinal cord injury (SCI). Marked bone mineral loss was observed from a combination of trabecular and endocortical resorption. Reductions in stiffness were 2-fold greater than reductions in integral bone mineral. SCI is associated with a rapid loss of bone mineral and an increased rate of fragility fracture. The large majority of these fractures occur around regions of the knee. Our purpose was to quantify changes to bone mineral, geometry, strength indices, and stiffness at the distal femur and proximal tibia in acute SCI. Quantitative computed tomography (QCT) and patient-specific finite element analysis were performed on 13 subjects with acute SCI at serial time points separated by a mean of 3.5 months (range 2.6-4.8 months). Changes in bone mineral content (BMC) and volumetric bone mineral density (vBMD) were quantified for integral, trabecular, and cortical bone at epiphyseal, metaphyseal, and diaphyseal regions of the distal femur and proximal tibia. Changes in bone volumes, cross-sectional areas, strength indices and stiffness were also determined. Bone mineral loss was similar in magnitude at the distal femur and proximal tibia. Reductions were most pronounced at epiphyseal regions, ranging from 3.0 % to 3.6 % per month for integral BMC (p < 0.001) and from 2.8 % to 3.4 % per month (p < 0.001) for integral vBMC. Trabecular BMC decreased by 3.1-4.4 %/month (p < 0.001) and trabecular vBMD by 2.7-4.7 %/month (p < 0.001). A 3.8-5.4 %/month reduction was observed for cortical BMC (p < 0.001); the reduction in cortical vBMD was noticeably lower (0.6-0.8 %/month; p ≤ 0.01). The cortical bone loss occurred primarily through endosteal resorption, and reductions in strength indices and stiffness were some 2-fold greater than reductions in integral bone mineral. These findings highlight the need for therapeutic

  9. Cast index in predicting outcome of proximal pediatric forearm fractures

    Directory of Open Access Journals (Sweden)

    Hassaan Qaiser Sheikh

    2015-01-01

    Conclusion: Cast index is useful in predicting redisplacement of manipulated distal forearm fractures. We found that in proximal half forearm fractures it is difficult to achieve a CI of <0.8, but increased CI does not predict loss of position in these fractures. We therefore discourage the use of CI in proximal half forearm fractures.

  10. ANATOMIC STUDY OF THE PROXIMAL THIRD OF THE FEMUR: FEMOROACETABULAR IMPACT AND THE CAM EFFECT.

    Science.gov (United States)

    Labronici, Pedro José; Alves, Sergio Delmonte; da Silva, Anselmo Fernandes; Giuberti, Gilberto Ribeiro; de Azevedo Neto, Justino Nóbrega; Mezzalira Penedo, Jorge Luiz

    2009-01-01

    To analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact. 199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5mm of the head and neck junction and anteroposterior distance of the neck base. we found that the impact subgroup presented a significantly larger junction diameter of 5mm (p = 0.0001) and cam-head (%) (p= 0.0001), while base-cam (%) (p = 0.0001) showed a significantly smaller diameter than the subgroup without impact. It was identified that cam-head (%) ≤ 80 e base-cam (%) ≤ 73 were identified as the optimal impact points. our study showed that the effect cam, caused by anatomical variations of the proximal femoral end focused the head-neck junction and base of the neck-junction head-neck. These rates can be predictive factors of the impact.

  11. Transverse Stress Fracture of the Proximal Patella: A Case Report

    National Research Council Canada - National Science Library

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    .... Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella...

  12. [Surgical outcome in pertrochanteric femur fracture: the impact of osteoporosis. Comparison between DHS and percutaneous compression plate].

    Science.gov (United States)

    Knobe, M; Münker, R; Schmidt-Rohlfing, B; Sellei, R M; Schubert, H; Erli, H J

    2008-01-01

    The dynamic hip screw (DHS) often shows an impared outcome and a high incidence of therapeutic failure in patients with osteoporotic pertrochanteric femur fractures. This is caused predominantly by a fracture collapse and appears often in unstable fractures (31A2, 31A3). In a prospectively documented clinical study, we examined whether or not the percutaneous compression plate (PCCP, Gotfried) offers advantages following osteoporotic fractures. From August 2003 to December 2005, 103 patients underwent internal fixation with the DHS (n = 40, age 76.1, ASA 2.9) or with the PCCP (n = 63, age 76.9, ASA 2.8). Proximal femurs were classified with the Singh grading system, which uses six grades of trabecular patterns to describe the degree of osteoporosis. Reexamination of the patients (27 DHS, 43 PCCP) was performed on average 18 months later. The PCCP was implanted into very osteoporotic femurs (Singh 2) in less time than the DHS (47 vs. 79 min). These patients treated with PCCP showed no difference in blood loss, but tended to have better outcomes (Merle d'Aubigné, Harris hip score) than those treated with DHS. Life quality, subjectively measured with the visual analogue score, was significantly better in the PCCP group with high-grade osteoporosis (Singh 2). The outcome after implantation of the PCCP was not correlated to the Singh index in stable or in unstable fractures. Mechanical complications occurred especially in unstable fractures (re-operation rate: DHS 4/18 [22 %], PCCP 3/29 [10 %], p = 0.266), without correlation to the Singh index. Excluding the avoidable complication of loosening of the screw-barrel portion, the re-operation rate for the PCCP was 3 % (cut-out: 1/29, p = 0.042) in unstable fractures. Use of the minimally invasive PCCP technique in osteoporotic pertrochanteric femur fractures provides an alternative to the dynamic hip screw, especially with regard to surgical time and outcome. Advantages occurred also in the re-operation rate following

  13. Neck of femur fracture fixation in a bilateral amputee: an uncommon condition requiring an improvised fracture table positioning technique

    Science.gov (United States)

    Berg, Andrew James; Bhatia, Chandra

    2014-01-01

    While neck of femur fractures are common it is rare to see this injury in a bilateral leg amputee. Special consideration needs to be given to the management of these patients. We report the case of a 58-year-old man with bilateral leg amputation who presented to the emergency department with left hip pain following a fall. A fracture of the left neck of femur with extension into the femoral shaft was diagnosed. Internal fixation was planned with a dynamic hip screw. Standard fracture table setup, which allows for traction of the fractured limb and positioning of the contralateral limb such that anteroposterior and lateral X-rays can be obtained, was not possible in this case due to the amputations. We highlight considerations that need to be made in positioning a bilateral amputee for neck of femur fracture fixation and also highlight an improvised technique that can be utilised by other surgeons. PMID:24563044

  14. Orthopaedic approaches to proximal humeral fractures following trauma.

    OpenAIRE

    Mafi, R.; Khan, W.; Mafi, P; Hindocha, S.

    2014-01-01

    Proximal humeral fractures have been a topic of discussion in medical literature dating back as far as 3rd century BC. Today, these fractures are the most common type of humeral fractures and account for about 5-6% of all fractures in adults with the incidence rising rapidly with age. In broad terms the management of proximal humeral fractures can be divided into two categories: conservative versus surgical intervention. The aim of treatment is to stabilize the fracture, aid better union and ...

  15. A PTH-responsive circadian clock operates in ex vivo mouse femur fracture healing site.

    Science.gov (United States)

    Kunimoto, Tatsuya; Okubo, Naoki; Minami, Yoichi; Fujiwara, Hiroyoshi; Hosokawa, Toshihiro; Asada, Maki; Oda, Ryo; Kubo, Toshikazu; Yagita, Kazuhiro

    2016-02-29

    The circadian clock contains clock genes including Bmal1 and Period2, and it maintains an interval rhythm of approximately 24 hours (the circadian rhythm) in various organs including growth plate and articular cartilage. As endochondral ossification is involved not only in growth plate but also in fracture healing, we investigated the circadian clock functions in fracture sites undergoing healing. Our fracture models using external fixation involved femurs of Period2::Luciferase knock-in mice which enables the monitoring of endogenous circadian clock state via bioluminescence. Organ culture was performed by collecting femurs, and fracture sites were observed using bioluminescence imaging systems. Clear bioluminescence rhythms of 24-hour intervals were revealed in fracture healing sites. When parathyroid hormone (PTH) was administered to fractured femurs in organ culture, peak time of Period2::Luciferase activity in fracture sites and growth plates changed, indicating that PTH-responsive circadian clock functions in the mouse femur fracture healing site. While PTH is widely used in treating osteoporosis, many studies have reported that it contributes to improvement of fracture healing. Future studies of the role of this local clock in wound healing may reveal a novel function of the circadian timing mechanism in skeletal cells.

  16. Reducing returns to theatre for neck of femur fracture patients.

    Science.gov (United States)

    Graham, Selina; Dahill, Mark; Robinson, Derek

    2017-01-01

    The Royal United Hospital, Bath, admits approximately 550 patients with neck of femur fractures per year. The risks from returning to theatre for this patient group are often life-threatening. Post-operative wound ooze was noted to cause a significant rate of return to theatre, with increased lengths of stay and patient morbidity. A wound closure protocol was agreed by the consultant body. This information was disseminated by email and teaching sessions to all members of the multidisciplinary team, including surgeons, theatre staff and ortho-geriatricians. The plan-do-study-act model for improvement was used to reduce rates of returns to theatre for wound ooze. Interventions included cyclical teaching during each trainee rotation, updated inductions, posters, email reminders and scrub team involvement to open the protocol sutures unprompted. The primary outcome measure was returns to theatre for wound complications. Baseline data showed 4 returns to theatre over a two month period (4.40% of patients). Length of stay for each patient affected by wound ooze was also compared to the departmental mean. In the 6 month intervention period there was one return to theatre (0.36% of patients). The observed reduction saved the department an estimated £13,831 in length of stay alone. The standardisation of wound closure protocol, with continued reinforcement to all members of the multidisciplinary team, improves patient outcome in this group. Mobilising a group of clinicians across a variety of specialities, with one common goal, is highly effective for patients, improves multidisciplinary working and reduces cost.

  17. Evaluating accuracy of structural geometry by DXA methods with an anthropometric proximal femur phantom.

    Science.gov (United States)

    Khoo, B C C; Beck, T J; Brown, K; Price, R I

    2013-09-01

    DXA-derived bone structural geometry has been reported extensively but lacks an accuracy standard. In this study, we describe a novel anthropometric structural geometry phantom that simulates the proximal femur for use in assessing accuracy of geometry measurements by DXA or other X-ray methods. The phantom consists of seven different interchangeable neck modules with geometries that span the range of dimensions in an adult human proximal femur, including those representing osteoporosis. Ten repeated hip scans of each neck module using two current DXA scanner models were performed without repositioning. After scanner specific calibration, hip structure analysis was used to derive structural geometry. Scanner performance was similar for the two manufacturers. DXA-derived HSA geometric measurements were highly correlated with values derived directly from phantom geometry and position; R² between DXA and phantom measures were greater than 94% for all parameters, while precision error ranged between 0.3 and 3.9%. Despite high R² there were some systematic geometry errors for both scanners that were small for outer diameter, but increasing with complexity of geometrical parameter; e.g. buckling ratio. In summary, the anthropometric phantom and its fabrication concept were shown to be appropriate for evaluating proximal femoral structural geometry in two different DXA systems.

  18. Extreme femoral valgus and patella dislocation following lateral plate fixation of a pediatric femur fracture.

    Science.gov (United States)

    Ezzat, Ahmed; Iobst, Christopher

    2016-07-01

    A 15-year-old boy presented with a 35° femoral valgus deformity, leg-length discrepancy, painful retained hardware, and a lateral dislocation of the patella 4 years after undergoing lateral plate fixation of a distal femur fracture. Femoral valgus is a possible complication of lateral plate fixation in up to 30% of pediatric distal femur fractures. With this patient's unusual combination of deformities as an example, we suggest early hardware removal after fracture union to prevent the development of deformity. If plate removal is not chosen, then continued close monitoring of the patient is necessary until skeletal maturity.

  19. A proximal femur aneurysmal bone cyst resulting in amputation: a rare case report.

    Directory of Open Access Journals (Sweden)

    Khodamorad Jamshidi

    2015-02-01

    Full Text Available Aneurysmal bone cyst (ABC is blood filled expansile cystic lesion that most commonly occurs in patients during the second decade of their lives. Traditionally it has been described as a benign lesion but can be locally aggressive and result in the destruction of the involved bone. Treatment methods include surgical excision and curettage with or without bone grafting. We report a proximal femur aneurysmal bone cyst, which resulted in the amputation of the lower extremity, even though all available classic methods of treatment were applied for it.

  20. Paediatric femur fractures at the emergency department: accidental or not?

    NARCIS (Netherlands)

    Hoytema van Konijnenburg, Eva M. M.; Vrolijk-Bosschaart, Thekla F.; Bakx, Roel; van Rijn, Rick R.

    2016-01-01

    Only a small proportion of all paediatric fractures is caused by child abuse or neglect, especially in highly prevalent long bone fractures. It can be difficult to differentiate abusive fractures from non-abusive fractures. This article focuses on femoral fractures in young children. Based on three

  1. [Effect of intramedullary reaming and nailing on the production of growth factors in the femur fracture callus in rats].

    Science.gov (United States)

    Mingo-Robinet, J; Valle-Cruz, J A; Ortega-Medina, L; Fuentes-Ferrer, M; López-Durán Stern, L

    2013-01-01

    Many studies have been conducted to determine the different effects that reaming or intramedullary nailing have on fracture healing, but there is no evidence in the literature of the effect of intramedullary reaming on osteogenesis. We performed a prospective study to analyse the effect of intramedullary reaming and nailing on the production of growth factors during the process of fracture healing in the femur of rats. A transverse mid-shaft non-comminuted femur fracture was produced in 64 rats; 34 rats did not receive any treatment, and a standardized surgical procedure was performed on 30 rats, by exposing the left knee, reaming the medullary canal from distal to proximal, and then fixing the fracture with a steel pin. The rats were sacrificed at the 24th hour, 4th, 7th and 15th days after the fracture. The amount of growth factors that appeared in the callus fracture was measured using histopathology studies. The primary categorical variables analysed were PDGFA, TGF2 and TGFβ-R2. These variables were analysed in each group at the different sacrifice times. The results of the primary variables of the study, stratified by the time until sacrifice, showed no statistically significant differences. Even if the presence of an intramedullary wire facilitates the fracture repair and the stabilising the bridge of bone between both edges of the fracture site, no evidence was found that reaming changes the expression of the growth factors studied (PDGFA, TGFβ-R2 and TGFβ2) during the callus formation in rats. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  2. J-splint use for temporizing management of pediatric femur fractures: a review of 18 cases.

    Science.gov (United States)

    Ritterman, Scott A; Daniels, Alan H; Kane, Patrick M; Eberson, Craig P; Born, Christopher T

    2014-08-01

    Pediatric femoral fractures are common injuries encountered in the field and in emergency departments. Currently described temporizing management strategies include skeletal traction, skin traction, traction splinting, and posterior splinting, all of which are suboptimal in some instances. J-splinting femur fractures may be advantageous in temporizing management of pediatric femur fractures. The objective of this study was to evaluate the safety and effectiveness of J-splint use for temporizing management of pediatric femur fractures. This study used a retrospective review of 18 pediatric patients with femur fractures treated with J-splinting in the emergency department. Patient age, weight, and presplinting and postsplinting pain scale ratings were recorded, as well as presplint and postsplint anteroposterior and lateral radiographic fracture angulation. Pain before and after J-splinting was compared using a paired t test. The mean age of this cohort was 5.4 years (range, 6 months-13 y), with a mean weight of 21.1 kg (range, 7.7-57 kg). In this cohort, there was a significant reduction in pain after reduction and splinting from a mean of 6 to a mean of 1 (P < 0.001). No significant difference in fracture alignment was noted after J-splinting. No complications were noted. The J-splint is a reliable, simple, and rapidly applied splint that prevents many of the complications and downfalls of other described temporizing measures and helps to provide excellent pain management in the acute setting.

  3. Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry.

    Science.gov (United States)

    Gruber, M; Bauer, J S; Dobritz, M; Beer, A J; Wolf, P; Woertler, K; Rummeny, E J; Baum, T

    2013-02-01

    To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD(MDCT) values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 × BMD(MDCT) - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 × BMD(MDCT) - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures.

  4. Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Gruber, M. [Medical University of Vienna, Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Vienna (Austria); Bauer, J.S.; Dobritz, M.; Woertler, K.; Rummeny, E.J.; Baum, T. [Technische Universitaet Muenchen, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); Beer, A.J. [Technische Universitaet Muenchen, Department of Nuclear Medicine, Munich (Germany); Wolf, P. [Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Munich (Germany)

    2013-02-15

    To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD{sub MDCT} values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 x BMD{sub MDCT} - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 x BMD{sub MDCT} - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures. (orig.)

  5. Computational study of Wolff's law with trabecular architecture in the human proximal femur using topology optimization.

    Science.gov (United States)

    Jang, In Gwun; Kim, Il Yong

    2008-08-07

    In the field of bone adaptation, it is believed that the morphology of bone is affected by its mechanical loads, and bone has self-optimizing capability; this phenomenon is well known as Wolff's law of the transformation of bone. In this paper, we simulated trabecular bone adaptation in the human proximal femur using topology optimization and quantitatively investigated the validity of Wolff's law. Topology optimization iteratively distributes material in a design domain producing optimal layout or configuration, and it has been widely and successfully used in many engineering fields. We used a two-dimensional micro-FE model with 50 microm pixel resolution to represent the full trabecular architecture in the proximal femur, and performed topology optimization to study the trabecular morphological changes under three loading cases in daily activities. The simulation results were compared to the actual trabecular architecture in previous experimental studies. We discovered that there are strong similarities in trabecular patterns between the computational results and observed data in the literature. The results showed that the strain energy distribution of the trabecular architecture became more uniform during the optimization; from the viewpoint of structural topology optimization, this bone morphology may be considered as an optimal structure. We also showed that the non-orthogonal intersections were constructed to support daily activity loadings in the sense of optimization, as opposed to Wolff's drawing.

  6. Guided Growth of the Proximal Femur for Hip Displacement in Children With Cerebral Palsy.

    Science.gov (United States)

    Lee, Wei-Chun; Kao, Hsuan-Kai; Yang, Wen-E; Ho, Pei-Chi; Chang, Chia-Hsieh

    2016-01-01

    Guided growth by 1 eccentric transphyseal screw has been used to correct lower limb deformities. Pilot animal studies showed encouraging results in producing varus deformity in the proximal femur. The purpose of this study was to report the preliminary results of guided growth surgery to treat spastic hip displacement. This case series study included consecutive patients who received soft-tissue release and guided growth at the proximal femur from January 2004 to May 2012 with minimal 2-year follow-up. Surgical indications were children with spastic cerebral palsy aged 4 to 10 years, a gross motor function classification system level IV or V, and hip displacement on 1 or both sides. Study outcomes were Reimer's migration percentage (MP) and the head-shaft angle (HSA). Nine children with 13 spastic displaced hips received surgery at the age of 6.2 years and were followed up for a mean of 45.6 months. The mean MP improved significantly from 52.2% preoperatively to 45.8% at 3 months, 40.3% at 1 year, and 37.1% at 2 years after operation. HSA was unchanged in the first 3 months, and deceased from 173.3 to 166.4 degrees at 1 year (Pcoxa valga in spastic hip displacement in nonambulant cerebral palsy children. Level IV-therapeutic, case series.

  7. Individual-specific multi-scale finite element simulation of cortical bone of human proximal femur

    Science.gov (United States)

    Ascenzi, Maria-Grazia; Kawas, Neal P.; Lutz, Andre; Kardas, Dieter; Nackenhorst, Udo; Keyak, Joyce H.

    2013-07-01

    We present an innovative method to perform multi-scale finite element analyses of the cortical component of the femur using the individual's (1) computed tomography scan; and (2) a bone specimen obtained in conjunction with orthopedic surgery. The method enables study of micro-structural characteristics regulating strains and stresses under physiological loading conditions. The analysis of the micro-structural scenarios that cause variation of strain and stress is the first step in understanding the elevated strains and stresses in bone tissue, which are indicative of higher likelihood of micro-crack formation in bone, implicated in consequent remodeling or macroscopic bone fracture. Evidence that micro-structure varies with clinical history and contributes in significant, but poorly understood, ways to bone function, motivates the method's development, as does need for software tools to investigate relationships between macroscopic loading and micro-structure. Three applications - varying region of interest, bone mineral density, and orientation of collagen type I, illustrate the method. We show, in comparison between physiological loading and simple compression of a patient's femur, that strains computed at the multi-scale model's micro-level: (i) differ; and (ii) depend on local collagen-apatite orientation and degree of calcification. Our findings confirm the strain concentration role of osteocyte lacunae, important for mechano-transduction. We hypothesize occurrence of micro-crack formation, leading either to remodeling or macroscopic fracture, when the computed strains exceed the elastic range observed in micro-structural testing.

  8. 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.

  9. Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion.

    Science.gov (United States)

    Rupani, Neal; Riley, Nicholas; McNab, Ian

    2018-02-01

    Background  Scaphoid fractures in the pediatric population are rare. The majority of nondisplaced fractures tend to unite; however, there is an increased risk of nonunion in proximal pole fractures. Limited evidence exists in their outcomes, owing to the scarcity of the fracture pattern. Case Description  A 13-year-old boy who presented late after developing a traumatic proximal pole scaphoid fracture developed nonunion. He was treated conservatively owing to it being asymptomatic and developed union at 18 months. Literature Review  No previous case of proximal pole pediatric scaphoid fractures with established nonunion that has developed union with conservative management has been described. Clinical Relevance  The authors highlight a unique case of an established proximal pole scaphoid nonunion in a child progressing to union with nonoperative intervention. Owing to its rarity and difficulty in obtaining research, we recommend consideration of nonoperative management of asymptomatic nondisplaced proximal pole fractures in children.

  10. Midshaft humeral fracture following a proximal humeral fracture: a case report

    National Research Council Canada - National Science Library

    Jayaseelan, Dhinu J; Post, Andrew A; Ruggirello, Leah D; Sault, Josiah D

    2014-01-01

    ... of rehabilitation of a proximal humerus fracture. A 63-year-old female recreational tennis player presented to physical therapy, progressing well following a proximal humeral fracture, sustained 18 weeks prior...

  11. Bilateral Neck Femur Fracture Following a Generalized Seizure- A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Harshad Shah

    2014-10-01

    Full Text Available Hip fractures are one of the most common injuries which present to an orthopaedic surgeon. Most of these cases are unilateral .Bilateral simultaneous femur neck fracture is a rare occurrence. We report a case of a bilateral neck femur fracture in a 30 year male following a generalized tonic clonic seizure in view of its rarity and also to increase the awareness of such rare injuries. The patient was operated within 3 hours. At 5 months, the patient had good radiological and functional outcome. During a convulsion, there is a powerful and forceful contraction of muscles which may lead to fracture or dislocation. The incidence of fractures following a convulsion is 1.1%. A delay in diagnosis can lead to complications like avascular necrosis, osteoarthritis, non union, functional disability and legal consequences. All orthopaedic surgeons and emergency physicians should be aware of such uncommon injuries to ensure early diagnosis and treatment.

  12. Bilateral Neck Femur Fracture Following a Generalized Seizure- A Rare Case Report

    Science.gov (United States)

    M Shah, Harshad; Grover, Amit; Gadi, Daksh; Sudarshan, K

    2014-01-01

    Hip fractures are one of the most common injuries which present to an orthopaedic surgeon. Most of these cases are unilateral .Bilateral simultaneous femur neck fracture is a rare occurrence. We report a case of a bilateral neck femur fracture in a 30 year male following a generalized tonic clonic seizure in view of its rarity and also to increase the awareness of such rare injuries. The patient was operated within 3 hours. At 5 months, the patient had good radiological and functional outcome. During a convulsion, there is a powerful and forceful contraction of muscles which may lead to fracture or dislocation. The incidence of fractures following a convulsion is 1.1%. A delay in diagnosis can lead to complications like avascular necrosis, osteoarthritis, non union, functional disability and legal consequences. All orthopaedic surgeons and emergency physicians should be aware of such uncommon injuries to ensure early diagnosis and treatment. PMID:25692154

  13. The Relationship Between Fractures and DXA Measures of BMD in the Distal Femur of Children and Adolescents With Cerebral Palsy or Muscular Dystrophy

    Science.gov (United States)

    Henderson, Richard C; Berglund, Lisa M; May, Ryan; Zemel, Babette S; Grossberg, Richard I; Johnson, Julie; Plotkin, Horacio; Stevenson, Richard D; Szalay, Elizabeth; Wong, Brenda; Kecskemethy, Heidi H; Harcke, H Theodore

    2010-01-01

    Children with limited or no ability to ambulate frequently sustain fragility fractures. Joint contractures, scoliosis, hip dysplasia, and metallic implants often prevent reliable measures of bone mineral density (BMD) in the proximal femur and lumbar spine, where BMD is commonly measured. Further, the relevance of lumbar spine BMD to fracture risk in this population is questionable. In an effort to obtain bone density measures that are both technically feasible and clinically relevant, a technique was developed involving dual-energy X-ray absorptiometry (DXA) measures of the distal femur projected in the lateral plane. The purpose of this study is to test the hypothesis that these new measures of BMD correlate with fractures in children with limited or no ability to ambulate. The relationship between distal femur BMD Z-scores and fracture history was assessed in a cross-sectional study of 619 children aged 6 to 18 years with muscular dystrophy or moderate to severe cerebral palsy compiled from eight centers. There was a strong correlation between fracture history and BMD Z-scores in the distal femur; 35% to 42% of those with BMD Z-scores less than −5 had fractured compared with 13% to 15% of those with BMD Z-scores greater than −1. Risk ratios were 1.06 to 1.15 (95% confidence interval 1.04–1.22), meaning a 6% to 15% increased risk of fracture with each 1.0 decrease in BMD Z-score. In clinical practice, DXA measure of BMD in the distal femur is the technique of choice for the assessment of children with impaired mobility. © 2010 American Society for Bone and Mineral Research PMID:19821773

  14. Bilateral simultaneous neck femur fracture following domestic fall in an elderly patient: a rare case report

    Directory of Open Access Journals (Sweden)

    Mayank Vijayvargiya

    Full Text Available ABSTRACT Simultaneous bilateral neck femur fracture is a rare entity that has been associated with underlying bone disease, various metabolic diseases, high-energy trauma, and seizure disorders. Its occurrence following minimal trauma is very rare. This article presents the case of a 66-year-old female who sustained bilateral intracapsular fracture neck femur following a slip and fall at home. Single-stage bilateral cemented total hip replacement was done using a direct lateral approach with alternate right and left lateral positions. The authors report a satisfactory outcome, with Harris hip score of 98 at one year, which persisted until her last follow-up at 30 months.

  15. ASYMMETRICAL BILATERAL HIP DISLOCATION WITH SEGMENTAL FRACTURE FEMUR: AN UNUSUAL CASE REPORT AND LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-01-01

    Full Text Available Bilateral traumatic hip dislocation is rarely seen. A unique case is presented, consisting of asymmetric bilateral hip dislocation with associated segmental fracture femur, resulting from fall from bus. This case represents an unusual, severe combination of injuries resulting from the fall from bus under influence of alcohol. Traumatic hip dislocation represents a true orthopaedic emergency . Given the severity of associated complications, every effort should be made to ensure pr ompt diagnosis and immediate therapy. We report our experience in the management of this complex injury pattern and review the pertinent literature on this subject. Keywords: Bilateral hip dislocation , Asymmetric hip dislocation , Segmental femur fracture , Closed reduction , Fall from bus .

  16. Prediction on fracture risk of femur with Osteogenesis Imperfecta using finite element models: Preliminary study

    Science.gov (United States)

    Wanna, S. B. C.; Basaruddin, K. S.; Mat Som, M. H.; Mohamad Hashim, M. S.; Daud, R.; Majid, M. S. Abdul; Sulaiman, A. R.

    2017-10-01

    Osteogenesis imperfecta (OI) is a genetic disease which affecting the bone geometry. In a severe case, this disease can cause death to patients. The main issue of this disease is the prediction on bone fracture by the orthopaedic surgeons. The resistance of the bone to withstand the force before the bones fracture often become the main concern. Therefore, the objective of the present preliminary study was to investigate the fracture risk associated with OI bone, particularly in femur, when subjected to the self-weight. Finite element (FEA) was employed to reconstruct the OI bone model and analyse the mechanical stress response of femur before it fractures. Ten deformed models with different severity of OI bones were developed and the force that represents patient self-weight was applied to the reconstructed models in static analysis. Stress and fracture risk were observed and analysed throughout the simulation. None of the deformed model were observed experienced fracture. The fracture risk increased with increased severity of the deformed bone. The results showed that all deformed femur models were able to bear the force without experienced fracture when subjected to only the self-weight.

  17. Decreased complications of pediatric femur fractures with a change in management.

    Science.gov (United States)

    Sink, Ernest L; Faro, Francis; Polousky, John; Flynn, Katherine; Gralla, Jane

    2010-01-01

    Elastic intramedullary nails are commonly the preferred treatment option for operative stabilization of pediatric diaphyseal femur fractures. Increased complication rates have been reported in unstable fractures and older patients treated with TENs (titanium elastic nails). The reported complications have led to a change in management at our institution: limiting the use of TENs and using submuscular plating and trochanteric entry nails as alternatives. The purpose of this study is to analyze whether this change in management has improved outcomes defined by a decrease in complications between 2 time periods. This retrospective study compared 2 cohorts of femur fractures: those treated from January 2001 to January 2003 versus those treated from January 2003 to December 2006. Patient's age, weight, fracture type (stable or unstable), operative fixation technique, and complications were compared. Outcomes were measured by major or minor complications that occurred after operative treatment. Period I consisted of 46 patients and Period II of 95 patients. There was a significant decrease in TEN use in unstable fractures in Period II versus Period I. Submuscular plating increased from 9% in Period I to 28% in Period II. All complications decreased from 52% in Period I to 23% in Period II. Major complications decreased from 22% to 5%, and minor complications decreased from 30% to 18%. Complications in unstable fractures decreased from 57% to 26% and in stable fractures from 48% to 22%. Outcomes of pediatric femur fractures are improved with limiting the use of TENs to stable fractures. Complications resulting from unstable femur fracture management have decreased with other methods of stabilization such as submuscular plating or trochanteric entry nails.

  18. Size and shape variation in the proximal femur of Australopithecus africanus.

    Science.gov (United States)

    Harmon, Elizabeth

    2009-06-01

    Aside from use as estimates of body mass dimorphism and fore to hind limb joint size comparisons, postcranial elements have not often contributed to assessments of variation in Australopithecus africanus. Meanwhile, cranial, facial, and dental size variation is interpreted to be high or moderately high. Further, the cranial base and face express patterns of structural (shape) variation, which are interpreted by some as evidence for the presence of multiple species. Here, the proximal femur is used to consider postcranial size and shape variation in A. africanus. Original fossils from Makapansgat and Sterkfontein, and samples from Homo, Pan, Gorilla, and Pongo were measured. Size variation was assessed by comparing the A. africanus coefficient of variation to bootstrapped distributions of coefficient of variation samples for each taxon. Shape variation was assessed from isometrically adjusted shape variables. First, the A. africanus standard deviation of log transformed shape variables was compared to bootstrapped distributions of logged standard deviations in each taxon. Second, shape variable based Euclidean distances between fossil pairs were compared to pairwise Euclidean distance distributions in each reference taxon. The degree of size variation in the A. africanus proximal femur is consistent with that of a single species, and is most comparable to Homo and Pan, lower than A. afarensis, and lower than some estimates of cranial and dental variation. Some, but not all, shape variables show more variation in A. africanus than in extant taxa. The degree of shape difference between some fossils exceeds the majority of pairwise differences in the reference taxa. Proximal femoral shape, but not size, variation is consistent with high estimates of A. africanus cranial variation.

  19. Conservative Treatment for Bilateral Displaced Proximal Humerus Head Fracture

    OpenAIRE

    Rodriguez-Corlay, Ruy E; Velutini-Becker, Ricardo; Aguilar-Alcal?, Luis D

    2016-01-01

    Proximal humerus fracture represents five to eight percent of all fractures and is twice as common in women than in men. Most cases of displaced fracture of the proximal humerus are treated surgically; it is probable that more cases are preferred to be treated surgically greater than required. The optimal treatment for these fractures remains controversial, but physicians have a tendency to treat via open reduction and fixation with angular locking plates or glenohumeral arthroplasty.? We pre...

  20. What is the role of bosentan in healing of femur fractures in a rat model?

    Science.gov (United States)

    Aydin, Ali; Halici, Zekai; Akpinar, Erol; Aksakal, A Murat; Saritemur, Murat; Yayla, Muhammed; Kunak, C Semih; Cadirci, Elif; Atmaca, H Tarik; Karcioglu, S Sena

    2015-09-01

    The purpose of this study was to examine the effects bosentan (which is a strong vasoconstrictor) on bone fracture pathophysiology, and investigate the roles of the nonselective endothelin 1 receptor blocker bosentan on the bone fractures formed in rats through radiographic, histopathologic, and immunohistochemical methods. The rats were divided into three groups (six rats in each group): a femoral fracture control group, a femoral fracture plus bosentan at 50 mg/kg group, and a femoral fracture plus bosentan at 100 mg/kg group. The femoral fracture model was established by transversely cutting the femur at the midsection. After manual reduction, the fractured femur was fixed with intramedullary Kirschner wires. The radiographic healing scores of the bosentan 100 and 50 mg/kg groups were significantly better that those of the fracture control group. The fracture callus percent of new bone in the bosentan 100 mg/kg group was significantly greater than that in the control group. Also, semiquantitative analysis showed higher positive vascular endothelial growth factor and osteocalcin staining and lower positive endothelin receptor type A staining in the treatment groups than in the control group. Bosentan treatment also decreased tissue endothelin 1 expression relative to that in the fracture control group. As a result of our study, the protective effect of bosentan was shown in experimental femoral fracture healing in rats by radiographic, histopathologic, and molecular analyses.

  1. INTRACAPSULAR FRACTURE OF NECK OF FEMUR (IC#NF - OSTEOSYNTHESIS BY CANNULATED CANCELLOUS SCREW FIXATION

    Directory of Open Access Journals (Sweden)

    L. Lokanadha Rao

    2016-09-01

    Full Text Available Fractures of neck of femur have always presented great challenges to the orthopaedic surgeons. This remains, even today, an unsolved fracture as far as treatment and results are concerned. Results depend upon the extent of injury, timing of surgery and adequacy of reduction and fixation. Fixation with cannulated cancellous screws is usually adequate for femoral neck fractures. Lateral cortex plays a very important role in screw fixation. AIMS AND OBJECTIVES To study the effectiveness of cannulated cancellous screw fixation for treatment of fracture of neck of femur in adults. MATERIALS AND METHODS This study was conducted at Andhra Medical College, King George Hospital, Visakhapatnam, AP from Nov 2013 to Oct 2015. The patients with intracapsular fracture of neck of femur are evaluated with pre-operative X-rays of pelvis with both hips and X-ray of the concerned hip joint both in anteroposterior and lateral views and their outcome was evaluated postoperatively after fixation with cancellous screws. The outcome is evaluated in terms of pain relief, extent of ambulation achieved after surgery. The classifications we followed are Pauwel’s and Garden’s classification of fracture of neck of femur. The patients were followed up to one year to assess the functional outcome. OBSERVATION AND RESULTS A good result was obtained in 66.1% of the patients, excellent in 23.2%, fair in 3.8% and poor result in 6.9% of the patients. Complications such as Non-union & avascular necrosis in one case, Non-union and Extrusion of screws in one case, Cut through of screws into articular surface leading to painful joint in one case. Most of the cases of intracapsular neck of femur were in the age group of 31-40 years. There was male preponderance as shown in this study (69%. CONCLUSION By the usage of multiple cannulated cancellous lag screws, compression effect at the fracture site is achieved, it also avoids re-displacement and rotations. The implant occupies less

  2. Foal Fractures: Osteochondral Fragmentation, Proximal Sesamoid Bone Fractures/Sesamoiditis, and Distal Phalanx Fractures.

    Science.gov (United States)

    Reesink, Heidi L

    2017-08-01

    Foals are susceptible to many of the same types of fractures as adult horses, often secondary to external sources of trauma. In addition, some types of fractures are specific to foals and occur routinely in horses under 1 year of age. These foal-specific fractures may be due to the unique musculoskeletal properties of the developing animal and may present with distinct clinical signs. Treatment plans and prognoses are tailored specifically to young animals. Common fractures not affecting the long bones in foals are discussed in this article, including osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. TREATMENT OF INTRACAPSULAR FRACTURE NECK FEMUR BY CANCELLOUS HIP SCREW FIXATION IN ADULTS

    Directory of Open Access Journals (Sweden)

    Kumar Shantanu Anand

    2017-04-01

    Full Text Available BACKGROUND Neck of femur fracture is one of the commonest fracture seen at all ages. It comprises 20% of all the fractures and 50% of all intracapsular fractures, only 15% of all the neck of femur (NOF fracture is undisplaced, remaining 85% is displaced. Even in undisplaced neck of femur fractures, surgery is treatment of choice. Mechanism of injury in this is simple. Fall with force being transmitted to femoral neck via greater trochanter. There are other mechanism also. MATERIALS AND METHODS This is a prospective and retrospective study conducted at MGM Medical College, Kishanganj, in which 15 patients who is suffering from NOF fracture were selected randomly. All these patients were treated by closed reduction by Flynn method and internal fixation by three divergent cannulated screws with 10 mm distance from each other. Fixation was done under spinal or epidural anaesthesia. Preoperatively, optimal 3 kg surface traction was given in affected limb. RESULTS Out of 15 operated patients, 2 patients had implant failure due to fall and 3 patients did not turned up for surgery, hence these 5 patients were excluded from the study. Rest 10 patients were followed up at 4, 12, 24, 48 and 96 weeks. In 2 cases, there was nonunion. In 2 cases, fracture united after follow up of 14 months. A 2 years follow up was done for 6 patients in which there was no evidence of an avascular necrosis and all these cases had good healing. CONCLUSION In neck of femur fracture, our first intention injury of treatment is by internal fixation in young individuals as well as elderly population. We should never directly go for partial/full replacement in young individuals. We felt the most important thing, which should be kept in mind while operating is to do accurate reduction and rigid fixation with 3 parallel short headed cannulated screw.

  4. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures

    OpenAIRE

    Thyagarajan David; Haridas Samarth; Jones Denise; Dent Colin; Evans Richard; Williams Rhys

    2009-01-01

    Aim: To assess the functional outcome following internal fixation with the PHILOS (proximal humeral interlocking system) for displaced proximal humeral fractures. Patients and Methods: We reviewed 30 consecutive patients treated surgically with the proximal humeral locking plate for a displaced proximal humeral fracture. Functional outcome was determined using the American Shoulder and Elbow Society (ASES) score and Constant Murley score. Results: Average age of the patients was 58 years...

  5. The chondrogenic response to exercise in the proximal femur of normal and mdx mice

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    Nye David J

    2010-09-01

    Full Text Available Abstract Background Submaximal exercise is used in the management of muscular dystrophy. The effects of mechanical stimulation on skeletal development are well understood, although its effects on cartilage growth have yet to be investigated in the dystrophic condition. The objective of this study was to investigate the chondrogenic response to voluntary exercise in dystrophin-deficient mice. Methods Control and dystrophin-deficient (mdx mice were divided into sedentary and exercise-treated groups and tested for chondral histomorphometric differences at the proximal femur. Results Control mice ran 7 km/week further than mdx mice on average, but this difference was not statistically significant (P > 0.05. However, exercised control mice exhibited significantly enlarged femur head diameter, articular cartilage thickness, articular cartilage tissue area, and area of calcified cartilage relative to sedentary controls and exercised mdx mice (P Conclusions Mdx mice exhibit a reduced chondrogenic response to increased mechanical stimulation relative to controls. However, no significant reduction in articular dimensions was found, indicating loss of chondral tissue may not be a clinical concern with dystrophinopathy.

  6. Use of oral anticoagulants after intramedullary nailing of femur and tibial fractures in trauma department

    Directory of Open Access Journals (Sweden)

    A. K. Dulaev

    2014-01-01

    Full Text Available The authors evaluated of the effectiveness of new oral anticoagulants in patients with diaphyseal fractures of the femur and tibia.We analyzed the effectiveness of thromboprophylaxis in 85 patients with diaphyseal fractures of the femur and tibia in the early postoperative period. Patients were divided into 3 groups: group 1 - patients, who was taking enoxaparin, group 2 - dabigatran etexilate, group 3 - rivaroxaban. We evaluated the frequency of thromboembolic complications and bleeding for 4 weeks after intramedullary nailing of femur and tibia.The lowest frequency of postoperative bleeding was observed in patients treated with dabigatran etexilate. In addition, the minimum frequency of complications was observed among patients of the second group of the study (9.7% in the group receiving dabigatran etexilati compared with 27.8% for the combined group I and III.Statistically significant differences between groups of patients taking oral or parenteral anticoagulants was not obtained.

  7. A CLINICAL STUDY OF SURGICAL MANAGEMENT OF FRACTURE SHAFT FEMUR IN ADULTS WITH INTRAMEDULLARY INTERLOCKING NAIL

    Directory of Open Access Journals (Sweden)

    A. M. Ilias Basha

    2017-07-01

    Full Text Available BACKGROUND Orthopaedic surgeons often encounter diaphyseal femur fractures, because these fracture most often result from high-energy trauma, one must have high index of suspicion for complications. Currently surgery is indicated for most femur fractures because of high rate of union, low rate of complications and advantage of early stabilization which decreases the morbidity and mortality rate in patients. The main stay of the treatment has been reamed interlocking intramedullary nailing, one of the frequently performed procedure for diaphyseal fracture of femur. MATERIALS AND METHODS We studied a total of 40 patients of fracture shaft of femur admitted in the Orthopaedic Department of Government General Hospital, Kurnool, treated with reamed femur intramedullary interlocking nailing. The common age group was ranging from 20 to 71 yrs. with average age group of 36 yrs. 32 patients were males, 8 were females. 26 patients had closed fracture, 10 had Gustillo Anderson Grade I compound and 4 had Grade II compound fracture. In 22 patients fracture was at M/3rd, in 10 patients it was at L/3rd level and in 8 patients it was at U/3rd level. 4 patients were operated by open interlocking nail and other 36 by closed technique using C-arm. RESULTS Injury surgery interval was 6.20 days on an average. Mean time for union was more in patients treated by open procedure (20 weeks as compared to closed technique (18.35 weeks. We found 2 patients developed superficial infection, which healed completely and 2 had deep infection with nonunion. In our series of 40 patients, 24 patients had excellent results, 12 patients had good results, 2 fair results and 2 poor results, and functional evaluation was done using Thoresen et al classification system. CONCLUSION Interlocking intramedullary nailing is a very effective and successful method of definitive treatment in most types of fractures of the shaft of the femur. It is effective in controlling rotational and

  8. Incidence rates and trends of hip/femur fractures in five European countries

    DEFF Research Database (Denmark)

    Requena, G; Abbing-Karahagopian, V; Huerta, C

    2014-01-01

    Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seven...... electronic health-care records databases (DBs) from Denmark, The Netherlands, Germany, Spain, and the United Kingdom, based on the same protocol. Yearly IRs of hip/femur fractures were calculated for the general population and for those aged ≥50 years. Trends over time were evaluated using linear regression......, P fractures varied greatly across European countries. With the exception of Denmark, no decreasing trend was observed over the study period....

  9. Persistent wound drainage after tumor resection and endoprosthetic reconstruction of the proximal femur

    DEFF Research Database (Denmark)

    Hettwer, Werner H; Horstmann, Peter F; Grum-Schwensen, Tomas A

    2014-01-01

    PURPOSE: To examine the prevalence of prolonged wound drainage (PWD) after tumor resection and endoprosthetic reconstruction of the hip. METHODS: Retrospective review of 86 consecutive patients with metastatic bone disease, malignant hematologic bone disease or bone sarcoma, treated with tumor...... resection and subsequent endoprosthetic reconstruction of the proximal femur, between 2010 and 2012, in a single center. RESULTS: PWD for 7 days or more was observed in 41 cases (48%). The wounds only ceased oozing after a mean of 8.4 days, leading to prolonged administration of prophylactic antibiotics...... to be significantly more prevalent in patients undergoing tumor arthroplasty procedures of the hip. Given the potentially increased risk for periprosthetic joint infection (PJI), increased awareness, identification and implementation of adequate strategies for prevention and treatment of this avoidable complication...

  10. Transient Receptor Potential Vanilloid 1-Immunoreactive Innervation Increases in Fractured Rat Femur

    OpenAIRE

    Kawarai, Yuya; Suzuki, Miyako; Yoshino, Kensuke; Inoue, Gen; Orita, Sumihisa; Yamauchi, Kazuyo; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Kubota, Go; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi

    2013-01-01

    Purpose Pain from vertebral or femoral neck fractures is a particularly important problem in clinical orthopaedics. Transient receptor potential vanilloid 1 (TRPV1) is a ligand-gated nonselective cation channel, and there are recent reports on an association between bone pain and TRPV1. However, an increase in TRPV1 activity has not been reported following femoral fracture. Materials and Methods We applied a neurotracer [Fluoro-gold (FG)] onto femur to detect dorsal root ganglia (DRGs) innerv...

  11. Management and prognostic significance of pathological fractures through chondrosarcoma of the femur.

    Science.gov (United States)

    Albergo, Jose I; Gaston, Czar L; Jeys, Lee M; Khajuria, Arun; Carter, Simon R; Tillman, Roger M; Abudu, Adesegun T; Grimer, Robert J

    2015-05-01

    The aim of the study was to report overall survival, local recurrence and development of metastasis in a group of patients with femur chondrosarcoma that presented with or without a pathological fracture. A retrospective review was performed, and 182 patients (39 pathological fractures) that had been treated by oncologic surgery for femoral chondrosarcoma were included. The mean age of the series was 50 years (range, eight to 90) and 114 patients were male (63%). Mean follow-up was 113 months (range, three to 216). Cancer-specific overall survival, development of metastasis and local recurrence were analysed, grouping patients by grade (grade I / grade 2-3 / dedifferentiated). Disease-specific survival in the entire group of chondrosarcoma of the femur was 69% (CI95% 63-76) at 5 years. Five-year disease-specific survival in the fracture group was 49% lower than in the control group 75% (p = 0.0001). Survival of patients with grade 1 chondrosarcoma with fracture was significantly less than those without fracture (p = 0.02) but there was no difference in those with grade 2-3 (p = 0.49) and dedifferentiated tumours (p = 0.09). The local recurrence rate of the entire series was 27%. Only dedifferentiated chondrosarcomas with an associated pathological fracture had a significantly higher rate of local recurrence. There was no relationship between development of metastases and fracture. A pathological fracture of the femur has a negative prognostic influence in grade 1 chondrosarcoma and increases the risk of local recurrence in dedifferentiated femur chondrosarcomas.

  12. Case-only designs for studying the association of antidepressants and hip or femur fracture.

    NARCIS (Netherlands)

    Groot, M.C.H. de; Candore, G.; Uddin, M.J.; Souverein, P.C.; Ali, M.S.; Belitser, S.V.; Huerta, C.; Groenwold, R.H.H.; Alvarez, Y.; Slattery, J.; Korevaar, J.; Hoes, A.W.; Roes, K.C.B.; Boer, A. de; Douglas, I.J.; Schlienger, R.G.; Reynolds, R.; Klungel, O.H.; Gardarsdottir, H.

    2016-01-01

    Purpose: The purpose of this study is to evaluate the performance and validity of the case-crossover (CCO) and self-controlled case-series (SCCS) designs when studying the association between hip/femur fracture (HF) and antidepressant (AD) use in general practitioner databases. In addition,

  13. Case-only designs for studying the association of antidepressants and hip or femur fracture

    NARCIS (Netherlands)

    De Groot, Mark C H; Candore, Gianmario; Uddin, Md Jamal; Souverein, Patrick C.; Ali, M. Sanni; Belitser, Svetlana V.; Huerta, Consuelo; Groenwold, Rolf H H; Alvarez, Yolanda; Slattery, Jim; Korevaar, Joke; Hoes, Arno W.; Roes, Kit C B; de Boer, Anthonius; Douglas, Ian J.; Schlienger, Raymond G.; Reynolds, Robert; Klungel, Olaf H.; Gardarsdottir, Helga

    2016-01-01

    PURPOSE: The purpose of this study is to evaluate the performance and validity of the case-crossover (CCO) and self-controlled case-series (SCCS) designs when studying the association between hip/femur fracture (HF) and antidepressant (AD) use in general practitioner databases. In addition,

  14. Case-only designs for studying the association of antidepressants and hip or femur fracture

    NARCIS (Netherlands)

    De Groot, Mark C. H.; Candore, Gianmario; Uddin, Jamal; Souverein, Patrick; Ali, M. Sanni; Belitser, S.; Huerta, Consuelo; Groenwold, Rolf H. H.; Alvarez, Yolanda; Slattery, Jim; Korevaar, Joke; Hoes, Arno W.; Roes, Kit C. B.; de Boer, Anthonius; Douglas, Ian J.; Schlienger, Raymond G.; Reynolds, Robert; Klungel, Olaf H.; Gardarsdottir, Helga

    2016-01-01

    Purpose: The purpose of this study is to evaluate the performance and validity of the case-crossover (CCO) and self-controlled case-series (SCCS) designs when studying the association between hip/femur fracture (HF) and antidepressant (AD) use in general practitioner databases. In addition,

  15. Is endoprosthesis safer than internal fixation for metastatic disease of the proximal femur? A systematic review.

    Science.gov (United States)

    Di Martino, Alberto; Martinelli, Nicolò; Loppini, Mattia; Piccioli, Andrea; Denaro, Vincenzo

    2017-10-01

    Metastases to the proximal femur are usually managed surgically by tumor resection and reconstruction with an endoprosthesis, or by fixation with osteosynthesis. Still controversy remains regarding the most appropriate surgical treatment. We posed the following questions: (1) Is the frequency of surgical revision greater in patients treated with internal fixation than endoprosthetic reconstruction, and (2) Do complications that do not require surgery occur more frequently in patients treated with internal fixation rather than in those with endoprosthetic reconstruction? A systematic review was performed of those studies reporting on surgical revision and complication rates comparing the two surgical methods. Ten studies including 1107 patients met the inclusion criteria, three with high methodological quality, three intermediate, and four with lowquality, according to the STROBE guidelines. At present, prosthetic dislocation is the most common complication observed in patients managed by prosthesis replacement of the proximal femur, while loosening was the main cause of reoperation in the fixation group. Time to reintervention ranged from 3 to 11.6 months for the prosthetic replacement and from 7.8 to 22.3 months for the fixation group. Non surgical complications, (mainly dislocations and infections) were more commonly observed in patients operated on by prosthetic replacement. Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery. © 2017 Elsevier Ltd. All rights reserved.

  16. The Effect of GSM Mobile Phone Electromagnetic Field on Femur Fracture Healing in a Rat Model

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    Ali Kalender

    2012-10-01

    Full Text Available Aim: Biological effects of electromagnetic field (EMF and their consequences on human health have been the subject of much interest and research in recent years. The aim of this study was to investigate the effects of 900 MHz EMF on femur fracture healing in a rat model. Material and Method: After sixty male Sprague-Dawley rats were exposed to a closed right femur fracture under anesthesia, the reduction and fixation were done with a 21 g needle. Then, 900 MHz radiation (2 W peak output power and 1.04 mW/cm2 power density was applied to EM group for one hour/day for seven days. The healing was assessed using radiological (Lane and Sandhu classification, histological (Huo scale for callus evaluation, and biomechanical (3-point bending measures at 2nd, 4th and 6th weeks after fracture. Results: Fracture healing, as assessed radiologically and histopathologically, in Group EM and control animals was similar at 2nd, 4th and 6th weeks. Fracture healing, as assessed biomechanically, was significantly better in Group EM compared to controls in those sacrificed at 2nd week post-procedure (p<0.05. Biomechanical strength was not different between the groups at 4th and 6th weeks. Discussion: 900 MHz EMF from a mobile phone in this rat femur fracture model resulted in no significant difference in healing from controls not exposed to EM radiation.

  17. Individual-specific multi-scale finite element simulation of cortical bone of human proximal femur

    Energy Technology Data Exchange (ETDEWEB)

    Ascenzi, Maria-Grazia, E-mail: mgascenzi@mednet.ucla.edu [UCLA/Orthopaedic Hospital, Department of Orthopaedic Surgery, Rehabilitation Bldg, Room 22-69, 1000 Veteran Avenue, University of California, Los Angeles, CA 90095 (United States); Kawas, Neal P., E-mail: nealkawas@ucla.edu [UCLA/Orthopaedic Hospital, Department of Orthopaedic Surgery, Rehabilitation Bldg, Room 22-69, 1000 Veteran Avenue, University of California, Los Angeles, CA 90095 (United States); Lutz, Andre, E-mail: andre.lutz@hotmail.de [Institute of Biomechanics and Numerical Mechanics, Leibniz University Hannover, 30167 Hannover (Germany); Kardas, Dieter, E-mail: kardas@ibnm.uni-hannover.de [ContiTech Vibration Control, Jaedekamp 30 None, 30419 Hannover (Germany); Nackenhorst, Udo, E-mail: nackenhorst@ibnm.uni-hannover.de [Institute of Biomechanics and Numerical Mechanics, Leibniz University Hannover, 30167 Hannover (Germany); Keyak, Joyce H., E-mail: jhkeyak@uci.edu [Department of Radiological Sciences, Medical Sciences I, Bldg 811, Room B140, University of California, Irvine, CA 92697-5000 (United States)

    2013-07-01

    We present an innovative method to perform multi-scale finite element analyses of the cortical component of the femur using the individual’s (1) computed tomography scan; and (2) a bone specimen obtained in conjunction with orthopedic surgery. The method enables study of micro-structural characteristics regulating strains and stresses under physiological loading conditions. The analysis of the micro-structural scenarios that cause variation of strain and stress is the first step in understanding the elevated strains and stresses in bone tissue, which are indicative of higher likelihood of micro-crack formation in bone, implicated in consequent remodeling or macroscopic bone fracture. Evidence that micro-structure varies with clinical history and contributes in significant, but poorly understood, ways to bone function, motivates the method’s development, as does need for software tools to investigate relationships between macroscopic loading and micro-structure. Three applications – varying region of interest, bone mineral density, and orientation of collagen type I, illustrate the method. We show, in comparison between physiological loading and simple compression of a patient’s femur, that strains computed at the multi-scale model’s micro-level: (i) differ; and (ii) depend on local collagen-apatite orientation and degree of calcification. Our findings confirm the strain concentration role of osteocyte lacunae, important for mechano-transduction. We hypothesize occurrence of micro-crack formation, leading either to remodeling or macroscopic fracture, when the computed strains exceed the elastic range observed in micro-structural testing.

  18. Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur? Data from the National Hip Fracture Database.

    Science.gov (United States)

    Costa, M L; Griffin, X L; Pendleton, N; Pearson, M; Parsons, N

    2011-10-01

    Concerns have been reported to the United Kingdom National Patient Safety Agency, warning that cementing the femoral component during hip replacement surgery for fracture of the proximal femur may increase peri-operative mortality. The National Hip Fracture Database collects demographic and outcome data about patients with a fracture of the proximal femur from over 100 participating hospitals in the United Kingdom. We conducted a mixed effects logistic regression analysis of this dataset to determine whether peri-operative mortality was increased in patients who had undergone either hemiarthroplasty or total hip replacement using a cemented femoral component. A total of 16,496 patients from 129 hospitals were included in the analysis, which showed a small but significant adjusted survival benefit associated with cementing (odds ratio 0.83, 95% confidence interval 0.72 to 0.96). Other statistically significant variables in predicting death at discharge, listed in order of magnitude of effect, were gender, American Society of Anesthesiologists grade, age, walking accompanied outdoors and arthroplasty. Interaction terms between cementing and these other variables were sequentially added to, but did not improve, the model. This study has not shown an increase in peri-operative mortality as a result of cementing the femoral component in patients requiring hip replacement following fracture of the proximal femur.

  19. Unicondylar fracture of the femur associated with intra-articular ...

    African Journals Online (AJOL)

    Distal femoral fracture associated with knee extensor apparatus injury is a rare event. The authors report the case of a 19-year-old boy featuring an unicondylar femoral fracture with an intra-articular dislocation of the ipsilateral patella. Both injuries were treated surgically. Emphasis is placed on the mechanism of the lesions ...

  20. The epidemiology and treatment of femur fractures at a northern ...

    African Journals Online (AJOL)

    Introduction: Femoral fractures are the most common presenting injury at the orthopaedic department in a large Tanzanian hospital. To date, there has been no current examination of the epidemiology of femoral fractures and the disease burden has not been quantified. Methods: A retrospective descriptive study of patient ...

  1. Traitement des fractures diaphysaires du femur au Chu De Lome ...

    African Journals Online (AJOL)

    We have made a retrospective study from January 2002 to December 2005 in order to detect the possible imperfections and to propose the corrections needed in the treatment of the fractures of the femoral shaft in the Tokoin teaching Hospital. One hundred and eighty two cases of femoral shaft fractures were treated.

  2. Management of bilateral fracture femur with implant failure: a case ...

    African Journals Online (AJOL)

    Successful treatment of a fracture by use of implants is a race between rate of fracture healing and metal fatigue of implant used. Implant failure is thus one of the most feared but often encountered complications in the practice of an orthopaedic surgeon. It becomes even more difficult for the surgeon when a patient has ...

  3. A STUDY OF CLINICAL AND SURGICAL OUTCOME OF FRACTURE NECK OF FEMUR

    Directory of Open Access Journals (Sweden)

    Anish G. Cherian

    2016-09-01

    Full Text Available BACKGROUND Fracture neck of femur has high incidence of complications even with treatment, hence it is also termed as unsolved fracture. Factors making treatment difficult are the blood supply to head, which gets cut off and difficulty in achieving reduction. Impacted fractures can be treated conservatively. If the fracture is undisplaced, a conservative approach may be done or multiple cancellous screws can be used. If the patient’s age is less than 60 years, a closed reduction under C-arm control can be tried. If the reduction is possible, then multiple screw fixations can be done. If reduction is not achieved, then open screw reduction and screw fixation can be done. If the patient is above 60 years of age, then it is preferable to excise the head off and replace it with prosthesis. If the hip is normal, then hemiarthroplasty with a unipolar or bipolar prosthesis can be done. If the hip has pre-existing arthritis, then total hip replacement surgery is advisable. A sincere effort has been put to understand the clinical and surgical outcome of fracture neck of femur in elderly. This paper is intended to help the practicing orthopaedicians to understand the various treatment modalities which is commonly used in practice and also the complications which are associated with the pathology. METHODS  The study was done in the Department of Orthopaedics, Travancore Medical College at Kollam.  The study was done from August 2014 to June 2016.  Eighty cases who attended in the Department of Orthopaedics were taken for the study.  Detailed History and Clinical Examination was conducted. INCLUSION CRITERIA  Both traumatic and pathological fractures were taken up for the study.  Individuals who were aged more than 55 years were taken up for the study. EXCLUSION CRITERIA  Aged less than 55 years were not considered.  All the statistical analysis was done using the latest SPSS software 2015 (California. RESULT Fracture neck of femur

  4. Bilateral trampoline fracture of the proximal tibia in a child

    Directory of Open Access Journals (Sweden)

    Enrico B Arkink, MD

    2017-12-01

    Full Text Available Trampoline fractures are transversely oriented impaction fractures of the proximal tibia sustained by young children jumping on a trampoline. Unaware of the mechanism of this specific nontraumatic fracture, physicians may fail to detect these fractures on plain radiographs, as radiological findings may be very subtle. In this case report, we present a rare case of bilateral trampoline fractures with an explanation of the trauma mechanism.

  5. Open supracondylar femur fractures with bone loss in the polytraumatized patient - Timing is everything!

    Science.gov (United States)

    Dugan, Tiffany R; Hubert, Mark G; Siska, Peter A; Pape, Hans-Christoph; Tarkin, Ivan S

    2013-12-01

    Open supracondylar femur fractures are rare, complex injuries which occur in polytrauma patients and are complicated by bone loss, contamination, compromised soft tissues, and poor host condition. The purpose of this study is to demonstrate a successful treatment protocol for these challenging injuries. A consecutive series of 15 open supracondylar femur fractures in 14 polytrauma patients (ages 16-75, mean 41) were treated at one Level I trauma centre by a single surgeon. Fracture patterns included seven AO/OTA Type C2 and eight Type C3 fractures. All fractures were open and classified by Gustillo/Anderson as type IIIA (10 fractures) and type IIIB (five fractures). Stage I was performed within 24h and included thorough open fracture care and early definitive fixation with a laterally based locking device and antibiotic bead placement. Stage II was performed several months later (average 3.6 months) when the soft tissue envelope had revascularized and the polytrauma patient had recovered from their other injuries. Stage II consisted of either an anterior incision or subvastus approach to the distal femur, bone grafting, BMP application, and addition of medial column support to create rigid fixation. All fractures (15/15) healed uneventfully. Union was determined by absence of pain and radiographic union in 3/4 cortices. Mean time to union was 4 months. There were no deep infections and alignment was maintained (average tibiofemoral angel of 5° of valgus) although several limbs were complicated by knee stiffness. Healing of open supracondylar femur fractures with critical sized bone defects requires diligent surgical timing in order to optimise the host and wound bed. Thorough initial debridement and early definitive fixation halt ongoing soft tissue injury, restores length and alignment, and allow for sterilisation of the wound. After patients have recovered from their other injuries and the soft tissue sleeve has revascularized, bone grafting with BMP

  6. Using anisotropic 3D Minkowski functionals for trabecular bone characterization and biomechanical strength prediction in proximal femur specimens

    Science.gov (United States)

    Nagarajan, Mahesh B.; De, Titas; Lochmüller, Eva-Maria; Eckstein, Felix; Wismüller, Axel

    2014-04-01

    The ability of Anisotropic Minkowski Functionals (AMFs) to capture local anisotropy while evaluating topological properties of the underlying gray-level structures has been previously demonstrated. We evaluate the ability of this approach to characterize local structure properties of trabecular bone micro-architecture in ex vivo proximal femur specimens, as visualized on multi-detector CT, for purposes of biomechanical bone strength prediction. To this end, volumetric AMFs were computed locally for each voxel of volumes of interest (VOI) extracted from the femoral head of 146 specimens. The local anisotropy captured by such AMFs was quantified using a fractional anisotropy measure; the magnitude and direction of anisotropy at every pixel was stored in histograms that served as a feature vectors that characterized the VOIs. A linear multi-regression analysis algorithm was used to predict the failure load (FL) from the feature sets; the predicted FL was compared to the true FL determined through biomechanical testing. The prediction performance was measured by the root mean square error (RMSE) for each feature set. The best prediction performance was obtained from the fractional anisotropy histogram of AMF Euler Characteristic (RMSE = 1.01 ± 0.13), which was significantly better than MDCT-derived mean BMD (RMSE = 1.12 ± 0.16, p<0.05). We conclude that such anisotropic Minkowski Functionals can capture valuable information regarding regional trabecular bone quality and contribute to improved bone strength prediction, which is important for improving the clinical assessment of osteoporotic fracture risk.

  7. Preliminary testing of a novel bilateral plating technique for treating periprosthetic fractures of the distal femur.

    Science.gov (United States)

    Muizelaar, Aaron; Winemaker, Mitchell J; Quenneville, Cheryl E; Wohl, Gregory R

    2015-11-01

    Current stabilization methods for periprosthetic fractures of the distal femur are inadequate in achieving fracture fixation, with complication rates as high as 29%. A major contributor to poor outcomes is that these methods rely only on screw purchase in the bone to maintain fracture reduction. We designed, manufactured and evaluated a novel plating method that utilizes the femoral prosthesis to enhance stability for treatment of distal femoral periprosthetic fractures. Medial and lateral plates were designed and manufactured based on geometry of a synthetic femur and femoral prosthesis. The two plates were linked via a compression screw and a small tab on each plate that inserted into pre-existing slots on the prosthesis. Mechanical tests (500N compression or 250N anterior directed cantilever bending), were performed on synthetic femurs with simple transverse fractures (3mm gap) just superior to the distal femoral prosthesis that were stabilized using either the prototype plates or a single lateral plate. Translational movements of the fracture site during loading were measured using 3D motion tracking. With the single lateral plate, the distal fragment experienced a resultant displacement of 0.40mm under cantilever bending and 0.61mm under compression (13% and 20% respectively of fracture gap width). With the bilateral plates, fracture gap motion was significantly reduced to 0.13mm under bending and compression (4.3% of the fracture gap). Our results indicate that a bilateral plating method is capable of improving stabilization of periprosthetic fractures compared to the traditional lateral plating technique. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Morphological analysis of the proximal femur by computed tomography in Japanese subjects

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    Hagiwara, Masashi [Chiba Univ. (Japan). School of Medicine

    1995-11-01

    In order to evaluate the morphological features of the proximal femur in the Japanese, 100 femora of normal Japanese subjects (normal group) and 60 femora of 43 Japanese patients with secondary osteoarthrosis of the hip (OA group) were analyzed using CT images. The scans for the dried bones (normal group) were done at a setting of 80 kV and 20 mA, for 2 sec duration. The scans were reconstructed using the soft tissue algorithm built into the GE-9800 scanner. The patient scans (OA group) were done at 120 kV and 170 mA also for 2 sec duration, and reconstructed using the same bone algorithm. The results were as follows: Thinning of the femoral cortex occurred in normal females over 60 years of age. The canal flare index at the proximal part of the femoral diaphysis was negatively correlated with the canal diameter at the isthmus. The index at the upper part was greater than that at the lower part. The two groups showed no statistical difference in this index. In the metaphysis, the canal flare index at the anterior portion was twice that at the posterior portion. In absolute terms, the OA group had a reduced flare or curve along the medial portion. In cross-section, the canal shape of the diaphysis was more elliptical in the OA group than in the normal group. The longitudinal axis of the canal was directed more sagittally in the OA group than in the normal group. (author).

  9. The Tribology of Explanted Hip Resurfacings Following Early Fracture of the Femur.

    Science.gov (United States)

    Lord, James K; Langton, David J; Nargol, Antoni V F; Meek, R M Dominic; Joyce, Thomas J

    2015-10-15

    A recognized issue related to metal-on-metal hip resurfacings is early fracture of the femur. Most theories regarding the cause of fracture relate to clinical factors but an engineering analysis of failed hip resurfacings has not previously been reported. The objective of this work was to determine the wear volumes and surface roughness values of a cohort of retrieved hip resurfacings which were removed due to early femoral fracture, infection and avascular necrosis (AVN). Nine resurfacing femoral heads were obtained following early fracture of the femur, a further five were retrieved due to infection and AVN. All fourteen were measured for volumetric wear using a co-ordinate measuring machine. Wear rates were then calculated and regions of the articulating surface were divided into "worn" and "unworn". Roughness values in these regions were measured using a non-contacting profilometer. The mean time to fracture was 3.7 months compared with 44.4 months for retrieval due to infection and AVN. Average wear rates in the early fracture heads were 64 times greater than those in the infection and AVN retrievals. Given the high wear rates of the early fracture components, such wear may be linked to an increased risk of femoral neck fracture.

  10. BISPHOSPHONATE INDUCED STRESS FRACTURE OF BILATERAL FEMUR: A CASE REPORT

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    Saidapur

    2015-08-01

    Full Text Available Osteoporosis is a common problem affecting people after 4 - 5 decade of life. There are various treatment options available for Osteoporosis and Bisphosphonates are widely used. Bisphosphonates work by blocking osteoclast mediated bone resorption and can be given in oral and injectable forms. R ecent studies have brought to light the risk of sub trochanteric stress fracture secondary to bisphosphonate therapy. Here we are presenting a case with bilateral sub trochanteric fracture following prolonged bisphosphonate therapy

  11. Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial.

    Science.gov (United States)

    Hanschen, Marc; Aschenbrenner, Ina M; Fehske, Kai; Kirchhoff, Sonja; Keil, Leonhard; Holzapfel, Boris M; Winkler, Sebastian; Fuechtmeier, Bernd; Neugebauer, Rainer; Luehrs, Sven; Liener, Ulrich; Biberthaler, Peter

    2014-04-01

    Treatment of complex fractures of the distal femur utilizing monoaxial locking plates (e.g. Less Invasive Stabilisation System, LISS®, Synthes) is considered to be superior to conventional plating systems. Due to the limitation that the thread forces the screw into pre-determined positions, modifications have been made to allow screw positioning within a range of 30° (Non Contact Bridging, NCB®-DF, Zimmer). For the first time, this multicenter prospective randomized clinical trial (RCT) investigates the outcome of LISS® vs. NCB®-DF treatment following complex fractures of the distal femur. Since June 2008, 27 patients with a fracture of the distal femur (AO ASIF 33-A-C and periprosthetic fractures) were enrolled in this study by four university trauma centres in southern Germany. Clinical (e.g. range of motion, Oxford knee score, Tegner score) and radiological (e.g. axis deviation, secondary loss of realignment) follow-ups were conducted one and six weeks, as well as three, six, and 12 months after the operation. This study comprises data of 27 patients (8 male, 19 female; 15 NCB®-DF, 12 LISS®). Polyaxial osteosynthesis using the NCB® system tended to result in better functional knee scores and a higher range of motion. Interestingly, fracture union tended to be more rapid using the polyaxial plating system. We present the analysis of a multicenter prospective RCT to compare the monoaxial LISS® vs. the polyaxial NCB®-DF treatment following complex fractures of the distal femur. NCB®-DF treatment tended to result in better functional and radiological outcomes than LISS® treatment. Level I.

  12. Cesarean Section and Right Femur Fracture: A Rare but Possible Complication for Breech Presentation

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    Giampiero Capobianco

    2013-01-01

    Full Text Available Background. The breech extraction of the fetus through the vagina has a greater risk of hip fracture compared with the extraction by abdominal route. Case. A 2390 g female infant was delivered at 39 weeks by elective cesarean section for breech presentation. The newborn sustained a fracture of the right femur. A simple immobilization of the limb in extension led to a complete healing of the fracture without sequelae. Conclusion. Caesarean delivery reduces the risk of causing a traumatic injury of the newborn compared to vaginal delivery, especially with breech presentation but does not eliminate this possible accidental complication.

  13. Subtrochanteric Femur Fracture after Slipped Capital Femoral Epiphysis Pinning: A Novel Treatment

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    Michael Paloski

    2011-01-01

    Full Text Available Slipped capital femoral epiphysis is a common injury suffered by adolescents worldwide. Treatment of most slips can be accomplished by percutaneous screw fixation, as this is an accepted and proven method associated with minimal morbidity. Complications, although limited, can be problematic for both the patient and treating physician. These include avascular necrosis, chondrolysis, infection, and fracture. We report a case of an individual who sustained a subtrochanteric femure fracture three weeks after in situ pinning of his left hip treated with a reconstruction intramedullary nail. This option allowed both the subtrochanteric fracture and SCFE to be treated concomitantly with minimized morbidity.

  14. Internal fixation of proximal humerus fractures using the T2-proximal humeral nail.

    Science.gov (United States)

    Popescu, Dragos; Fernandez-Valencia, Jenaro A; Rios, Moisés; Cuñé, Jordi; Domingo, Anna; Prat, Salvi

    2009-09-01

    Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. Created to improve previous designs, the T2-proximal humeral nail (PHN) (Stryker) has been recently released, and the English literature lacks a series evaluating its results. We present a clinical prospective study evaluating this implant for proximal humeral fractures. We evaluated the functional and radiological results and possible complications. Twenty-nine patients with displaced fractures of the proximal humerus were treated with this nail. One patient was lost right after surgery and excluded from the assessment. Eighteen patients were older than 70 years. There were 21 fractures of the proximal part of the humerus and 7 fractures that also involved the shaft; 15 of the fractures were two-part fractures (surgical neck), 5 were three-part fractures, and 1 was a four-part fracture. All fractures healed in a mean period of 2.7 months. There was one delayed union that healed in 4 months. One case of avascular necrosis of the humeral head was observed (a four-part fracture), but remained asymptomatic and did not require further treatment. In one case a back-out of one proximal screw was observed. A final evaluation with a minimum 1 year follow-up was performed by an independent observer; in 18 patients, the mean Constant score was 65.7 or 76.1% with the adjustment of age and gender; in 19 patients, the mean Oxford Shoulder Score was 21.7. The results obtained with the T2-PHN nail indicate that it represents a safe and reliable method in the treatment of two- and three-part fractures of the proximal humerus. The proximal fixation mechanism diminishes the rate of back-out of the screws, a frequent complication described in the literature. Better functional results were obtained from the patients younger than 70 years, but these were not statistically significant.

  15. [Minimally invasive treatment of geriatric and osteoporotic femur fractures with polyaxial locking implants (NCB-DF®)].

    Science.gov (United States)

    El-Zayat, B F; Zettl, R; Efe, T; Krüger, A; Eisenberg, F; Ruchholtz, S

    2012-02-01

    Periprosthetic femur fractures in elderly patients are a challenging surgical procedure. The aim of this study was a prospective evaluation of minimally invasive implantation of non-contact bridging (NCB-DF®) plates. A total of 30 osteosynthesis procedures in 29 patients (average age 76 years and mean ASA 2.9) with complex femur fractures were registered, 19 fractures were periprosthetic and osteoporosis was present in 17 bones. In 25 patients a minimally invasive percutaneous procedure was performed using a standardized technique. An x-ray examination and clinical follow-up were performed after 6, 12 and 24 weeks. The early complications (14% in total) included 1 plate breakage after 16 weeks as well as 3 minor revisions for screw length correction. The x-ray follow-up after 24 weeks showed a secondary extension deficit of 10° and 15° in the knee joint in 2 patients, respectively. The NCB-DF® implantation using a standardized minimally invasive technique in periprosthetic femur fractures is a safe alternative in elderly patients. In this very sensitive population the early revision rate within the first 24 weeks is noticeable lower compared to similar procedures.

  16. A study of management of fracture shaft femur in children in a rural population

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    Soumya Ghosh

    2013-01-01

    Full Text Available Background: Femoral shaft fractures account for 1.6% of all bony injuries in children, and the mode of treatment for children between 6 and 16 years of age is still debatable. Objectives: To compare the merits and demerits of operative and conservative managements of fracture shaft femur in children in a rural population in a developing country. Materials and Methods: Forty patients in the age group of 6-14 years with transverse fractures of shaft of the femur and two different treatment protocols were selected. The patients treated in skeletal traction or fixed traction in Thomas′ splint were included in one group and patients who were treated operatively with titanium elastic nails comprised the other group. Data was analyzed using Chi-square test. Results: The commonest cause of injury was motor vehicle accident, accounting for 70% of the cases, with left femur (60% more commonly injured. All fractures in the operative group united clinically by 8 weeks and radiologically by 10 weeks, and, in the conservative group, by 9 weeks clinically and 12 weeks radiologically. The difference was statistically significant. Shortening and angular mal alignments were found more commonly in the conservative group, and the difference was significant. The follow-up for 1 year of all cases were uneventful. Conclusion: Internal fixation with titanium elastic nails provides better results than conservative treatment in traction.

  17. Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate.

    Science.gov (United States)

    Sun, Jing-Cheng; Li, Yu-Lin; Ning, Guang-Zhi; Wu, Qiang; Feng, Shi-Qing

    2013-08-01

    The purpose of this study was to evaluate the effectiveness and complications of the locking proximal humerus plate to treat proximal humerus fractures. A retrospective clinical trial. Department of Orthopaedics, Tianjin Medical University General Hospital. Sixty-eight consecutive patients with three- or four-part fractures of the proximal humerus were treated with locking proximal humerus plates. The deltopectoral anterolateral acromial approach was used to the proximal humerus; open reduction and locking proximal humerus plate were applied. Constant Score was used to measure the shoulder functional recovery, and Visual Analog Scale (VAS) was used to measure subjective evaluation of pain. The radiology was observed. After average 26.7 months, the average Constant Score was 72.6 ± 13.2 points and the average VAS was 1.2 ± 0.8 points. All the complications such as screw perforation into the glenohumeral joint, screws loosening, soft tissue infections, avascular necrosis and delayed union occurred in eight cases (11.8 %). The effectiveness of the locking proximal humerus plate was similar to other published literatures on treating fractures of the proximal humerus; however, a lower complications rate in short follow-up time was observed in this study. It may potentially provide a favorable option for treating three- or four-part fractures of the proximal humerus. Dealing with each particular fracture pattern, surgeons should have a decision of appropriate way to internal fixation.

  18. Fascia iliaca block, for fractured femur, in Emergency Departments

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    M.A. Majeed*

    2013-12-01

    Discussion: We have traditionally been using opiates for severe pain but they don’t come without side effects, especially the elderly group takes most of the blow. As discussed above, NOF fracture makes a significant number of patients presenting to ED. Therefore having a non-opiates based pain relief like FIB, makes it very useful. The above papers suggest a beneficial role of ultrasound guided FIB in femoral fractures either as an alternative or adjunct to the routinely used analgesia. Evidence suggests that the placement of local anaesthetic in the wrong plane will reduce the success of any regional anaesthetic technique. The use of ultrasound guidance will permit the identification of the fascia iliaca and neurovascular bundle. It will also provide help in the needle guidance and direct observation of local anaesthetic spread in real time. Therefore the chances of effective block are extremely high when done under ultrasound guidance.

  19. GROWTH CHANGES OF THE FEMUR AND TIBIA AFTER FRACTURES IN CHILDREN

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    Valery V. Timofeev

    2017-03-01

    Full Text Available Introduction. In contrast to adults, the reparative process in children with fractures has one essential feature: the consolidation of bones tissue runs parallel to further growth and bone formation. The aim of the study. To determine the frequency of growth changes of different segments of the lower extremities in children, to determine the association of these types of fractures with age and/or method of treatment; to clarify the indications for orthopedic correction or surgical treatment of these deformities in long-term perspective. Material and methods. Between 2001 and 2014, 306 children with multiple fractures of the lower limbs were treated in the Regional Clinical Emergency Hospital, Barnaul. Fifty six with femoral and tibial fractures of 306 children were re-evaluated in 3-10 years for the long-term results of treatment. Results and discussion. In the long-term follow-up period, the measuring of the contralateral lower limb segments (tibia and femur showed that 27 (44.3% children had marked differences in their length. Three of them had shortening of limb segment and 24 children had lengthening shortening of limb segment. Changes in the growth rate were observed in fractures of the femur in 22 cases and in fractures of the tibia in 5 cases. Conclusion. The frequency of limb segment elongation after surgical and conservative treatment was approximately the same.

  20. Anterior dislocation of the hip associated with intertrochanteric fracture of the femur - Case presentation.

    Science.gov (United States)

    Radulescu, R; Badila, A; Japie, I; Papuc, A; Manolescu, R

    2013-09-15

    Dislocations of the hip usually occur following high energy trauma, the coxo-femoral joint being inherently stable, and can be associated with acetabular fractures or fractures of the head, neck or shaft of femur. However, the combination between the anterior hip dislocation and the ipsilateral intertrochanteric fracture is extremely rare, the literature offering only scarce information. We present the case of a patient, aged 44, victim of a trauma by precipitation from height (12m), diagnosed with left hip anterior dislocation and intertrochanteric fracture of the ipsilateral femur. An emergency surgical treatment was applied in less than 3 hours after trauma. The hip dislocation was reduced under general anesthesia and the intertrochanteric fracture was also reduced and internally fixed with a dynamic hip screw. Radiological and functional evaluation at 6 months after surgery, using the modified Merle D'Aubigne hip score was good. The clinical outcome of such a case depends on the quick evaluation and treatment. Providing a stable reduction of the dislocation and a stable internal fixation of the fracture as soon as possible (within the first 6 hours) will allow an early physical rehabilitation and decrease the risk of complications.

  1. 3D bone mineral density distribution and shape reconstruction of the proximal femur from a single simulated DXA image: an in vitro study

    Science.gov (United States)

    Whitmarsh, Tristan; Humbert, Ludovic; De Craene, Mathieu; del Río Barquero, Luis M.; Fritscher, Karl; Schubert, Rainer; Eckstein, Felix; Link, Thomas; Frangi, Alejandro F.

    2010-03-01

    Area Bone Mineral Density (aBMD) measured by Dual-energy X-ray Absorptiometry (DXA) is an established criterion in the evaluation of hip fracture risk. The evaluation from these planar images, however, is limited to 2D while it has been shown that proper 3D assessment of both the shape and the Bone Mineral Density (BMD) distribution improves the fracture risk estimation. In this work we present a method to reconstruct both the 3D bone shape and 3D BMD distribution of the proximal femur from a single DXA image. A statistical model of shape and a separate statistical model of the BMD distribution were automatically constructed from a set of Quantitative Computed Tomography (QCT) scans. The reconstruction method incorporates a fully automatic intensity based 3D-2D registration process, maximizing the similarity between the DXA and a digitally reconstructed radiograph of the combined model. For the construction of the models, an in vitro dataset of QCT scans of 60 anatomical specimens was used. To evaluate the reconstruction accuracy, experiments were performed on simulated DXA images from the QCT scans of 30 anatomical specimens. Comparisons between the reconstructions and the same subject QCT scans showed a mean shape accuracy of 1.2mm, and a mean density error of 81mg/cm3. The results show that this method is capable of accurately reconstructing both the 3D shape and 3D BMD distribution of the proximal femur from DXA images used in clinical routine, potentially improving the diagnosis of osteoporosis and fracture risk assessments at a low radiation dose and low cost.

  2. Associations of Age, BMI, and Years of Menstruation with Proximal Femur Strength in Chinese Postmenopausal Women: A Cross-Sectional Study.

    Science.gov (United States)

    Kang, Huili; Chen, Yu-Ming; Han, Guiyuan; Huang, Hua; Chen, Wei-Qing; Wang, Xidan; Zhu, Ying-Ying; Xiao, Su-Mei

    2016-01-23

    This study aimed to elucidate the associations of age, BMI, and years of menstruation with proximal femur strength in Chinese postmenopausal women, which may improve the prediction of hip fracture risk. A cross-sectional study was conducted in 1322 Chinese postmenopausal women recruited from communities. DXA images were used to generate bone mineral density (BMD) and geometric parameters, including cross-sectional area (CSA), outer diameter (OD), cortical thickness (CT), section modulus (SM), buckling ratio (BR) at the narrow neck (NN), intertrochanter (IT), and femoral shaft (FS). Relationships of age, BMI, and years of menstruation with bone phenotypes were analyzed with the adjustment of height, age at menarche, total daily physical activity, education, smoking status, calcium tablet intake, etc. Age was associated with lower BMD, CSA, CT, SM, and higher BR (p menstruation had the positive relationships with proximal femur strength (p menstruation were 0.14%-1.34%, 0.20%-2.70%, and 0.16%-0.98%, respectively. These results supported that bone strength deteriorated with aging and enhanced with higher BMI and longer time of years of menstruation in Chinese postmenopausal women.

  3. Aneurysmal Bone Cyst of the Proximal Femur and Its Management - A Case Report.

    Science.gov (United States)

    Kapoor, Chirag; Shah, Malkesh; Soni, Rishit; Patwa, Jagdish; Merh, Aditya; Golwala, Paresh

    2017-01-23

    Aneurysmal bone cyst (ABC) is a benign, expansile, non-neoplastic lesion of the bone, characterized by channels of blood and spaces that are separated by fibrous septae. Giant ABC is an uncommon condition and can be difficult to handle because of the destructive effect of the cyst on the bones and the compressive effect on the nearby structures, especially in weight-bearing bones of the body. We report a case of a giant aneurysmal bone cyst in the proximal femur of a six-year-old child, which was treated with a sclerosing agent and ender's nail fixation first. There was recurrence after 13 months. It was then curetted out extensively, the cavity was filled with bone graft, and fixation with a dynamic hip screw (DHS) was done. At 19 months follow-up, the lesion had subsided and patient was walking pain-free without any deformity. We suggest this method of treatment to be worthwhile for ABC at this site and at this age.

  4. FUNCTIONAL OUTCOME EVALUATION AFTER DISTAL FEMORAL LOCKING PLATE FIXATION OF SUPRACONDYLAR FRACTURES OF FEMUR

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    Kishore Babu S

    2017-10-01

    Full Text Available BACKGROUND Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures. Nearly, 50% of distal femur intraarticular fractures are open fractures. Despite many changes and refinements in the surgical treatment of the supracondylar and intercondylar fractures of femur their surgical management remains challenging. Since the introduction of the condylar blade plate to the present retrograde supracondylar nailing and locking condylar plates, these fractures particularly if open and associated with severe fragmentation of the articular cartilage and in the elderly with severe osteoporosis continue to be a major unsolved surgical challenge. Improved imaging facilities rendered surgical results far better than those treated with long periods of traction on bed with accompanying complications. LCP along with isolated 6.5 mm cannulated cancellous screw systems are best suited for with unicondylar fractures of distal femur in young patient with good bone stock. The functional outcome is largely determined by the degree of accompanying soft tissue injury. Presence of a compound fracture leads to a higher incidence of infection. With good preoperative antibiotics and sterile surgical techniques along with stable fixation, infection can be brought under control and a good outcome can be achieved. MATERIALS AND METHODS Thirty supracondylar and intercondylar fractures of femur (Muller’s type ‘A’, type ‘B’ and type ‘C’ fractures, which were treated with open reduction and internal fixation by locking compression plate were included in the study. The study was conducted at the Department of Orthopaedics, King George Hospital, Visakhapatnam, from August 2014 to November 2016. Among 30 patients, 5 patients were lost for follow up due to various reasons leaving 25 fractures from 25 patients for the study. RESULTS There were 16 males and 9 females. Age range was 19 years to 80 years with an average of 44

  5. Spontaneous bilateral fracture neck of femur secondary to vitamin D deficiency: a case report

    Science.gov (United States)

    Desai, Mihir; Nadkarni, Sambprasad

    2015-01-01

    Summary We report a case of a patient who presented with inability to walk for 2 days which was acute in onset, with no history or preceeding trauma. On examination it was found to have stable vitals. Both lower limbs were in the flexed, abducted & externally rotated attitude, with no sensory motor deficit. Radiological investigations revealing osteoporosis and bilateral fracture neck of femur and blood investigations indicated severe vitamin D deficiency. PMID:26811714

  6. Femur Pathological Fracture Caused by Metastatic Bone Disease Derived from Foot Squamous Cell Carcinoma

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    Ferdiansyah .

    2017-07-01

    Full Text Available Background : Bone is an organ and the most common site that prone to metastatic cancer and cause serious morbidity. Besides, metastatic cancer to bone will limit skeletal function so that decrease quality of life and even death that most of them caused by its complication. Objective : Reporting a rare case about Squamous Cell Carcinoma that cause femur pathological fracture caused by Metastatic Bone Disease. Material and Method : Case report in women patients 55 years old with femur close fracture one-third middle caused by Metastatic Bone Disease in RSUD Soetomo Surabaya, period May 2015-March 2016.Data is taken retrospectively from medical record through interview, physical examination, radiological examination, and laboratory. Result and Discussion : Patients are treated in hospital because of femur close fracture one-third middle caused by Metastatic Bone Disease.  Based on physical and radiological examination, it is decided being done by skin traction first. The next plan is surgery. Patients are treated with interlocking nail left femur. Evaluation after surgery is done with medical rehabilitation, that is ROM exercise. Until now, 9 months after surgery, patients still control routinely to be done chemotherapy and there is improvement in patient’s condition. Conclusion : Metastatic process in bone often cause pathological fracture. Bone Metastatic is common from Breast, Lung, Prostate and Kideney Cancer. There was no publication before about Bone Metastatic Disease come from Squamous Cell Cancer. Mirel’s score is used as guiding in fixation prior to the next treatment. Decision of surgery is considered through patient’s objective and subjective appraisal that can be calculated in Abdurrahman score system.

  7. Open fractures of the femur in children: analysis of various treatment methods.

    Science.gov (United States)

    Allison, Patrick; Dahan-Oliel, Noémi; Jando, Victor T; Yang, Stephen Su; Hamdy, Reggie C

    2011-04-01

    To describe the demographic and clinical characteristics of children who presented with open femur fractures. A retrospective chart review of all children treated for open femur fractures at the McGill University Health Center between 1980 and 2009 was conducted. Thirty-seven patients (28 males and 9 females) were identified. Union was determined clinically by the absence of pain, tenderness to palpation and crepitus with motion. Complications were reported. The mean age of the patients was 11.5 years (range 2.8-18.1 years). The mechanism of injury involved motor vehicle-related injuries in 70% of cases. There were 13 Grade I, 15 Grade II and 9 Grade III fractures. The treatment involved traction and hip spica in 11 patients, external fixator in nine patients, intramedullary nailing in seven patients, open reduction and internal fixation in six patients, and traction and an ischial weight bearing brace in four patients. Average time to union was 5.1 months (range 1.5-14.4 months). Infections occurred in ten patients, nine had delayed unions, two developed malunions, four had a refracture and four patients developed a limb length discrepancy >2 cm. Open fractures of the femur are often accompanied by associated injuries, indicating the importance of early and comprehensive treatment. Treatment may include hip spica application in school-age children and solid intramedullary nails in adolescents. In children with multiple injuries, specifically those with higher fracture grades, treatment with an external fixator provides immediate stability of the fracture and allows early mobilization and ease of management of associated injuries.

  8. STUDY OF SURGICAL MANAGEMENT OF FRACTURE NECK OF FEMUR IN ADULTS WITH BIPOLAR HEMI ARTHROPLASTY

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    K. B. Vijayamohan Reddy

    2017-07-01

    Full Text Available BACKGROUND Fracture neck of femur are one of the most common fractures in elderly population following a trivial trauma. The goal of treatment of these fractures is restoration of pre fracture function without associated morbidity, in earliest possible time Earlier hemiarthroplasty by using Vitallium or stainless steel was popular, practiced by Austin Moore's method which produced fairly good results. But it had its limitations in loosening and reactions at acetabulum among others. Many of the shortcomings of this procedure was overcome by a new type of prosthesis, which had the great advantage of second joint, below the acetabulum. It was named as bipolar prosthesis, since it had an outer head of metal which is stationary and this articulates with acetabulum and a second inner small metallic head articulates with the high density polyethylene (HDPE lining the inner surface of the outer head. This prosthesis proved very useful and results are encouraging. The aim of the study is to assess the functional outcome of Bipolar prosthesis in Intracapsular fracture neck of femur. MATERIALS AND METHODS This study was done in 20 patients with fracture neck of femur in government general hospital Kurnool over a period of 2 years, All of them were managed by bipolar hemiarthroplasty through posterior approach. All patients were followed up for 6 months, results were evaluated with Harris Hip Score. RESULTS 85% of the patients had an excellent to good Harris Hip Score while 10% of the patients had a fair result and 5% had a poor result. CONCLUSION Bipolar hemiarthroplasty provides early mobilization, good relief of pain and good level of activities with minimal complications.

  9. Shoulder arthroplasty in complex acute and chronic proximal humeral fractures

    DEFF Research Database (Denmark)

    Frich, Lars Henrik; Søjbjerg, J.O.; Sneppen, O.

    1991-01-01

    From 1983 to 1988, 42 shoulder arthroplasties were performed on comminuted acute or chronic proximal humeral fractures. Patients were categorized according to the post-fracture operative delay; there were 15 four-part fractures, with median post-fracture delay of 13 days (range: 7 to 21), and 27...... chronic fractures, including 11 four-part fractures, 9 three-part fractures, and 7 two-part fractures, with median post-fracture delay of 14 months (range: 4 to 72). Follow up was approximately 2 years in both groups (range: 1 to 5). All patients were evaluated according to a modified Neer score......-system and classified into four groups. Pain relief was satisfactory in the acute group, but was unpredictable in the chronic group. The results in the acute group were significantly superior (P less than .05). In the acute group, 3 (20%) patients had an excellent result and 6 patients (40%) had a good result, compared...

  10. Is dislocation rate higher in total hip arthroplasty done for acute displaced fracture neck of femur?

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    Ganesan Ram Ganesan

    2015-01-01

    Full Text Available Background Hip replacement has transformed the lives of hundreds of thousands of people regardless of the underlying aetiology. Debate about the role of arthroplasty for an acute displaced femoral neck fracture has been ongoing for decades. In this article we are going to evaluate whether dislocation rate is higher in total hip replacement done for acute displaced fracture neck of femur. Materials and Methods: Retrospective study of sixty two patients who underwent total hip replacement in Sri Ramachandra medical center. The minimum follow-up was taken as 5 years. Patients were divided into two group; traumatic and non traumatic group. We had 38 patient who underwent hip replacement for non traumatic indications. Traumatic group had 24 patients. The inclusion criteria for the traumatic group were acute displaced fracture neck of femur above 50 years and fracture neck with fracture head with dislocation above 50 years. We used the Harris hip score (Modified for clinical and functional evaluation. Results: We had 89% excellent/good results in non traumatic group 75% excellent/good result in traumatic group. We had one dislocation in non-traumatic group and four dislocations in traumatic group. Conclusions: There is an increase rate of dislocation in patient who underwent total hip replacement for a traumatic condition when compared to their non traumatic counterpart.

  11. Deformity of the proximal end of the femur following open reduction for developmental dislocation of the hip

    OpenAIRE

    Ikegami, Koichi; Nakatsuka, Yoichi; Akazawa, Hirofumi; Mitani, Shigeru; Inoue, Hajime

    1997-01-01

    We studied deformity of the proximal end of the femur following open reduction using the wide exposure method for developmental dislocation of the hip. We reviewed radiographs of 22 children with unilateral dislocation of the hip who had undergone open reduction between one and three years of age. Ages at final examination ranged from 14 to 21 years. None of the patients in this study had undergone any additional surgery. Avascular necrosis of the femoral head was not observed in any patients...

  12. The Influence of High-Impact Exercise on Cortical and Trabecular Bone Mineral Content and 3D Distribution Across the Proximal Femur in Older Men: A Randomized Controlled Unilateral Intervention.

    Science.gov (United States)

    Allison, Sarah J; Poole, Kenneth E S; Treece, Graham M; Gee, Andrew H; Tonkin, Carol; Rennie, Winston J; Folland, Jonathan P; Summers, Gregory D; Brooke-Wavell, Katherine

    2015-09-01

    Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were

  13. Fractures of the proximal humerus in children and adolescents

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    Ruban Raj Joshi, Dr

    2013-12-01

    Full Text Available Background: In most children proximal humeral fractures are treated non-operatively with generally good results. The aim of the study was to evaluate the clinical outcome of closed/open reduction in children with severely displaced proximal humeral fractures. Materials and Methods: The charts of 15 patients (8 girls and 7 boys; mean age: 9.4 years with proximal humeral fractures who were managed at our institution were reviewed from October 2011 to December 2013. Results: There were 7 metaphyseal fractures and 8 physeal injuries which were angulated according to Neer-Horowitz score as grade II (n=2, grade III(n=4 and grade IV(n=9. Associated lesions comprised open fracture with head trauma in a 2 year old female child which was operated on primarily and the 14 others by secondary intention. All patients were treated surgically with either closed (n = 5 or open (n=10 reduction and internal fixation with Kirschner wire or titanium elastic nails (TENs. They were assessed for clinical and radiological healing at a mean follow up of 1.25 years ranging from 0.5 to 2.0 years. Conclusion: Surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. In addition to the periosteum , long head of the biceps, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Key words: Proximal humerus fracture, Children, Open reduction, Operative.

  14. Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study

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    Anttila Esa

    2011-05-01

    Full Text Available Abstract Background Hip resurfacing arthroplasty (HRA is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up. Methods Thirty three patients (9 females and 24 males with a mean (SD age of 55 (9 years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI were used. Stem-neck angle was analyzed from anteroposterior radiographs. Results Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI on the side operated on and in one ROI on the control side (p Conclusions After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors.

  15. Immediate weight bearing of comminuted supracondylar femur fractures using locked plate fixation.

    Science.gov (United States)

    Granata, Jaymes D; Litsky, Alan S; Lustenberger, David P; Probe, Robert A; Ellis, Thomas J

    2012-08-01

    Comminuted supracondylar femur fractures (AO-OTA 33A3) are commonly treated with locked plates. Weight bearing is generally restricted for 6 to 12 weeks until radiologic evidence exists of sufficient callous to support weight bearing. Recent clinical studies have reported high nonunion rates with distal femur locked plates. In an attempt to induce beneficial motion across the fracture site, some studies have recommended earlier weight bearing. The purpose of the current study was to determine the biomechanical feasibility of an immediate weight-bearing rehabilitation protocol to encourage healing of distal femur fractures treated with lateral locked plate fixation.Sixteen fresh-frozen cadaveric femora were used for this study. A 2.5-cm supracondylar gap osteotomy was made. Ten-hole, 4.5-mm distal femur locking plates were used with a standardized screw configuration that maximized the working length. The specimens were placed in a servohydraulic testing machine and axially loaded (unidirectional) at 1 Hz for up to 200,000 cycles. Failure was defined as 1 cm of deformation of the construct. The staircase method was used to determine the fatigue limit of the construct. The fatigue limit was calculated to be 1329±106 N. No specimen failed through the non-locking diaphyseal screws. Plastic deformation, when present, occurred at the metaphyseal flare of the plate. The fatigue limit of the locked plate constructs equaled 1.9 times body weight for an average 70-kg patient over a simulated 10-week postoperative course. Given that distal femoral loads during gait have been estimated to be more than 2 times body weight, the data from this study do not support immediate full weight bearing. Copyright 2012, SLACK Incorporated.

  16. A Review of Management Options for Proximal Humeral Fractures

    OpenAIRE

    Jordan, Robert W; Modi, Chetan S

    2014-01-01

    Proximal humeral fractures are common and although the majority can be managed non-operatively, the optimal treatment of displaced or complex fractures remains controversial. Non-operative treatment is typically selected for minimally displaced fractures where union rates are high and good or excellent outcomes can be expected in approximately 80% of cases. The aims of surgical fixation are to restore articular surface congruency, alignment and the relationship between the tuberosities and th...

  17. Evolution of treatment of of the proximal humerus fractures (review

    Directory of Open Access Journals (Sweden)

    P. G. Kogan

    2013-01-01

    Full Text Available The article in generalized form acquaints with the publications devoted to the bases of proximal humeral fractures treatment. A brief digression on anatomy and biomechanics of the humeral joint allows to consider the main morphological features of it. The most commonly used classification of proximal humeral fractures concisely classify many types of damage. According to the clinical and anatomical characteristics of fractures tracked the historical aspect, the development and the current state of the most common methods of treatment. In his review collected works authors share their experience in the application of methods. It allows to further the perspective directions.

  18. OUTCOMES IN CLOSED REAMED INTERLOCKING NAIL IN FRACTURES OF SHAFT OF FEMUR.

    Science.gov (United States)

    Mohammad, Taj; Khan, Alamzeb; Sawati, Alamzeb; Ahmed, Ashfaq; Awan, Abdus Saboor; Saboor, Abdus; Siddique

    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. 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. 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. 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.

  19. The Applications of Finite Element Analysis in Proximal Humeral Fractures

    Science.gov (United States)

    Ye, Yongyu; You, Wei; Zhu, Weimin; Cui, Jiaming; Chen, Kang

    2017-01-01

    Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases. PMID:29081829

  20. The Applications of Finite Element Analysis in Proximal Humeral Fractures

    Directory of Open Access Journals (Sweden)

    Yongyu Ye

    2017-01-01

    Full Text Available Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases.

  1. FUNCTIONAL OUTCOME OF PHILOS PLATE FIXATION FOR PROXIMAL HUMERUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Ch. Venkateswarlu

    2016-01-01

    Full Text Available INTRODUCTION Treating a proximal humerus fracture remained a challenging problem until proximal humeral internal locking system has been developed. Our study aims at evaluating the functional outcome of 30 consecutive patients with proximal humeral fracture treated by Philos plate fixation; 30 patients with proximal humeral fractures who attended our hospital between December 2013 and December 2015 were included in the study; 18 women and 12 men with a mean age of 47.5years (30-60 years are included. Data was collected prospectively and outcomes were assessed using constant shoulder score. The mean follow-up period was 12 months (6-18 months. Mean union time of all the fractures was 11.4 weeks (8-20 weeks. The mean constant shoulder score at final review was 70.5 (52-92. Philos plate provides stable fracture fixation for proximal humerus fracture in both young and elderly patients, which enables for early mobilisation and achieves acceptable functional results.

  2. Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

    Directory of Open Access Journals (Sweden)

    Hannah R. Lancer

    2016-01-01

    Full Text Available According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses.

  3. [Early result of femur neck fracture treated with modular hemiarthroplasty fenix].

    Science.gov (United States)

    Deszczyński, Jarosław; Mikusek, Rafał; Pisarski, Artur; Stolarczyk, Artur; Nowak, Piotr

    2009-01-01

    The aim of the study is clinical assessment of modular arthroplasty Fenix and early assessment of 77 patient with femoral neck fracture treated with Fenix hemiarthroplasty. The mean age of the group was 77 years. There were 51 woman and 16 men in the group. Size of the used steam and head, the way of steam implantation, time of the operation and early complication was assessed. Operated patients were evaluated with Harris Hip Score, Larson I and Larson II score. The most common used steams were number 3 and 4, and the most common used head was number 44 with -4 mm offset. Mean operation time was 68.9 minute. The following early complication occurs: superficial wound infection treated with antibiotics--8 cases, pneumonia--8 cases, urinary tract infection--6 cases, intra operative femur shaft fracture during steam implantation, treated with plate osetosynthesis--1 cases. There were 14 cases of death in the group. 22 patients were evaluated with HHS and Larson. Mean score in HHS was 71 point, in Larson I--76 point, in Larson II--72 point. There was found that operating technique is similar like in the others hemiarthroplasty system and system is easy to use. Most of the stems were cemented. There was found that there are a high percent of death in femur neck fracture patient group during the first year after the operation and this kind of fractures handicap patient locomotion in spite of good hip joint function.

  4. Timing of diaphyseal femur fracture nailing: is the difference night and day?

    Science.gov (United States)

    Patel, Neeraj M; Yoon, Richard S; Koerner, John D; Donegan, Derek J; Liporace, Frank A

    2014-03-01

    Most hospitals are faced with reduced personnel, resources, and provider fatigue or shift changes when day turns to night. For these reasons, some have suggested that diaphyseal femur fractures should be fixed during the daytime. The purpose of this study is to determine whether the time of surgery affects the post-operative difference in femoral version (DFV) and femoral length (DFL) between the fixed and uninjured sides following intramedullary nailing (IMN). Over a 10-year period, 340 patients underwent IMN of a diaphyseal femur fracture (AO types 32-A to C) with a post-operative computed tomography scanogram for version measurement. Demographic and surgical data, including time operated was collected. "Daytime" was defined as 7:00 AM to 6:59 PM, while the remainder of the clock was "nighttime". Additionally, the night hours were split into 3 consecutive 4-h categories for further analysis. Stepwise, multivariate regressions were used to evaluate any effect of time of surgery on post-operative DFV or DFL. Other variables included in these statistical models were age, sex, mechanism of injury, open vs. closed fracture, trauma vs. non-trauma surgeon, and AO and Winquist classifications. Overall, 22.4% (76/340) of all fractures were fixed at night. The mean post-operative DFV and DFL from the uninjured side in these patients was 8.9° and 4.1 mm, respectively, compared to 9.0° and 4.8 mm in those treated during the daytime. This difference was not statistically significant when accounting for other factors (p>0.05). There was no statistically significant difference in patients with >10 mm limb length discrepancy or >15 degrees DFV (p=1.0 for both). The time of day at which diaphyseal femur fractures are treated does not have an impact on post-operative femoral version or length. While certain other injuries may be better handled during daytime hours, acceptable IMN of mid-shaft femur fractures may be achieved during all hours at a level 1 trauma centre. Copyright

  5. Catastrophic cement reaction following cementation for megaprosthesis for proximal femoral fracture.

    Science.gov (United States)

    Baig, Muhammad Nouman; Curtin, William; Callaghan, Michael Andrew; Murphy, Colin G

    2017-09-23

    Bone cement implantation syndrome (BCIS) is a well-described and potentially fatal complication of orthopaedic surgery involving pressurised bone cement. Although also described for certain spinal procedures, it is most commonly associated with cemented hip and knee arthroplasty and with cemented hemiarthroplasty following neck of femur fracture in particular.Donaldson et alproposed the definition of BCIS as a syndrome "characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery". Other features include increased vascular resistance, cardiac arrhythmias and cardiac arrest post cement use.We describe a case of a patient who suffered a catastrophic reaction to cement during surgery for a comminuted proximal femoral fracture. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Intraoperative Femur Fracture Risk During Primary Direct Anterior Approach Cementless Total Hip Arthroplasty With and Without a Fracture Table.

    Science.gov (United States)

    Cohen, Eric M; Vaughn, Joshua J; Ritterman, Scott A; Eisenson, Daniel L; Rubin, Lee E

    2017-09-01

    There is no study to date comparing intraoperative femur fractures (IFFs) in the direct anterior approach (DAA) with and without a fracture table. We hypothesize that there is no significant difference in the IFF with and without a fracture table when performed by experienced DAA hip surgeons. This study is a 1-year retrospective review of patients who underwent DAA total hip arthroplasty by 2 surgeons: one surgeon uses a flat table and manually elevates the femur with a large bone hook, while the other surgeon uses a fracture table and a mechanical femoral elevator. Exclusion criteria included cemented femoral implants, femoral neck fractures, and lack of 6-month follow-up. We identified 487 patients for analysis (220 male and 267 female, average age 66.55 years). There were 12 total IFFs (2.46%): 8 female and 4 male patients. The average age of IFF patients was 70.67 years and in nonfracture patients was 66.00 years. There was no difference in gender (P = .2981) or age (P = .2099) between IFF and nonfracture patients. In the fracture table group, there were 6 IFFs (2.22%) in 271 patients; in the nonfracture table group, there were 6 IFFs (2.76%) in 216 patients. There was no statistical difference in IFF between the 2 groups (P = .6973). We observed just 2 patients (0.4%) in this series where the IFFs changed management requiring a revision femoral stem. There was no statistical difference in IFF with or without the use of fracture table. Both DAA surgical technique variations are felt to be equivalent regarding the risk for IFF during DAA cementless total hip arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Multiple intramedullary nailing of proximal phalangeal fractures of hand

    Directory of Open Access Journals (Sweden)

    Patankar Hemant

    2008-01-01

    Full Text Available Background: Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique. Materials and Methods: Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength. Results: All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient. Conclusion: Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.

  8. Treatment of Gustilo grade III B supracondylar fractures of the femur with Ilizarov external fixation.

    Science.gov (United States)

    Kumar, Pankaj; Singh, Girish K; Singh, Mahipal; Bajraacharya, Suraj

    2006-06-01

    Twenty patients who had been treated with Ilizarov external fixation for a Gustilo grade IIIB supracondylar fracture of the femur were functionally assessed 12 to 52 months after treatment. Fourteen fractures were type C3 and 6 were type C2 according to the AO classification. Fractures were united at an average of 39 +/- 9 weeks. There was a final knee extension deficit of 5 degrees to 10 degrees (12.2 degrees +/- 3.5 degrees) and flexion reached 110 degrees +/- 10 degrees in type C2 and 73 degrees +/- 36 degrees in C3 supracondylar fractures. Forty percent of the supracondylar fractures had 4cm shortening and 40% had 1.5 cm. Pin-track infection occurred in 21%. Half of the C3 fracture cases had problems with pain on walking, needed support and had pain at rest, whereas no patients had difficulty getting out of a chair, going up and down stairs. However, all C2 type fractures had problems with all types of function.

  9. Functional Outcome of Conservatively Treated Bilateral Neck of Femur Fracture in an Elderly: A Case Report

    Science.gov (United States)

    2016-01-01

    Bilateral Neck of Femur (NOF) fractures is relatively rare. Surgery, either osteosynthesis or hemireplacement arthroplasty, is the mainstay of treatment. Significant complications are known to occur in such cases. In this case report, we present the functional outcome of a conservatively treated bilateral NOF fracture at one year, in a 93-year-old man. Our patient, a 93-year-old gentleman, sustained right side NOF fracture in May 2014 and left side NOF fracture in May 2015, both after trivial fall. He did not give consent for surgery considering high operative risk. Now, at one year follow-up he has no true or apparent limb length discrepancy. He is ambulant with walker, self reliant for toilet care and other personal needs. Harris hip score is 75.80 and 69.65 after 1 year from right and left NOF fracture respectively. In view of high mortality after surgery for NOF fracture in high risk patients or unavailability of resources, conservative treatment for bilateral NOF fracture can achieve satisfactory functional outcome in selected patients. PMID:28208960

  10. [Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)].

    Science.gov (United States)

    Blum, Jochen; Hansen, Matthias; Rommens, Pol Maria

    2009-09-01

    Stable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities. Unstabile two- and three-part fractures of the proximal humerus (AO classification: 11-A2, 11-A3, 11-B1, 11-B2, 11-B3). Subcapital nonunion of the humerus. Pathologic fractures. Pediatric fractures of the proximal humerus. Fractures of the proximal humerus types 11-C2 und 11-C3 according to the AO classification. Active local infection, e.g., after former operation. Closed reduction. Anterior acromial incision, splitting of the deltoid muscle and the rotator cuff. Opening of the medullary canal with the awl. Nail introduction. Spiral blade introduction in cannulated technique through stab incision. Distal interlocking through aiming device, angle-stable blocking of nail and blade through end cap. Postoperative fixation in Gilchrist sling until 2nd postoperative day; then physiotherapy respecting fracture type and stability, local swelling, patient's age and compliance, and concomitant injuries. 151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.

  11. Reverse shoulder arthroplasty in acute fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Rasmussen, Jeppe V; Olsen, Bo S

    2013-01-01

    The indications for surgical intervention in complex fractures of the proximal humerus are disputed. In elderly patients with poor bone stock it may be impossible to obtain satisfactory fixation of the tuberosities to a hemiarthroplasty (HA). In such cases primary insertion of a reverse shoulder...... control group of HA. The median constant score was 58 (range 44-68) which is comparable to previous reviews of HA in 4-part fractures. Complications included dislocation, infection, hematoma, instability, neurological injury, reflex sympathetic dystrophy, intraoperative fractures, periprosthetic fractures...

  12. Femur ultrasound (FemUS)-first clinical results on hip fracture discrimination and estimation of femoral BMD

    DEFF Research Database (Denmark)

    Barkmann, R; Dencks, S; Laugier, P

    2010-01-01

    -based assessment of osteoporosis. INTRODUCTION: Dual X-ray absorptiometry (DXA) at the femur is the best predictor of hip fractures, better than DXA measurements at other sites. Calcaneal quantitative ultrasound (QUS) can be used to estimate the general osteoporotic fracture risk, but no femoral QUS measurement...

  13. Low-energy diaphyseal femoral fractures associated with bisphosphonate use and severe curved femur: a case series.

    Science.gov (United States)

    Sasaki, Satoshi; Miyakoshi, Naohisa; Hongo, Michio; Kasukawa, Yuji; Shimada, Yoichi

    2012-09-01

    Recent reports have raised concerns about low-energy subtrochanteric and diaphyseal femoral fractures after long-term bisphosphonate treatment, which may be associated with severely suppressed bone turnover (SSBT). However, diaphyseal femoral fractures without bisphosphonate treatment have also been reported in patients with severely curved femur, which are commonplace in the elderly. The purpose of this study was therefore to investigate associations between occurrence of such fractures, bisphosphonate use, and curvature of the femur. Nine consecutive elderly patients treated for low-energy diaphyseal femoral fractures between 2005 and 2010 were retrospectively reviewed. Three patients sustained bilateral fractures. Eight patients were administered bisphosphonates and one patient was administered raloxifene. Duration of osteoporosis treatment, type of fractures, surgical procedure, cortical thickness and curvature of opposite femur were evaluated. The cortical thickness and femoral curvature were further compared with those of 24 control subjects without fractures. The mean duration of drug administration was 3.6 years. All fractures showed similar X-ray patterns of simple transverse fracture with medial spike. Only one femur showed thickening of the femoral cortex. One case was treated with locking plate fixation, while the other cases were operated with intramedullary nails (9 antegrade nails, 2 retrograde nails). One femur treated with retrograde nail showed delayed bone union. The femoral curvature was significantly higher in the low-energy fracture group than the control group (P < 0.01); however, cortical thickness did not show a significant difference between the groups. In addition to SSBT, increased femoral curvature might be a causative factor for low-energy diaphyseal femoral fracture in the elderly.

  14. Evaluating Atypical Features of Femur Fractures: How Change in Radiological Criteria Influenced Incidence and Demography of Atypical Femur Fractures in a Community Setting.

    Science.gov (United States)

    LeBlanc, Erin S; Rosales, A Gabriela; Black, Dennis M; Genant, Harry K; Dell, Richard M; Friess, Darin M; Boardman, David L; Bauer, Douglas C; de Papp, Anne; Santora, Arthur C; Orwoll, Eric S

    2017-11-01

    Identification of atypical femoral fractures (AFFs) can be challenging. To assist in the radiological assessment, an American Society for Bone and Mineral Research (ASBMR) Task Force developed a case definition for AFFs in 2010, revising it in 2013. How the revised definition performs in a community setting compared with the 2010 definition is unknown. We applied the 2013 criteria to 372 femoral fractures that occurred between January 1, 1996, and June 30, 2009, employing two independent expert physician reviewers. We used radiographs that had been categorized in a previous study on the incidence of atypical fractures using 2010 ASMBR criteria (BEAK1). In this follow-up study (BEAK2), the same reviewers reviewed all previously identified femoral shaft fractures (FSFs) (n = 197) and distal femur fractures (n = 131) plus a 15% random sample of intertrochanteric fractures (n = 49). After initial review, agreement between the two reviewers ranged from 63% to 100% for specific features, and 84% of radiographs received the same overall classification. Fewer fractures met the 2013 compared with 2010 ASMBR case definition of AFFs (37 per 2013 criteria versus 74 per 2010 criteria). Forty-three radiographs (58%) categorized as AFFs according to 2010 criteria were no longer AFFs when 2013 criteria were applied, and an additional 12 non-atypical FSFs according to 2010 criteria were reclassified as AFFs according to 2013 criteria. The major cause of AFF reclassification was the change in the definition of transverse configuration. The modification of the comminution, non-traumatic, and periosteal/endosteal thickness criteria resulted in the reclassification of non-atypical FSFs to AFFs. Incidence rate of AFFs according to 2013 ASBMR criteria was lower overall during the 13 years of observation than when the 2010 ASBMR criteria were applied, although we saw a slight increase starting in 2000. As in BEAK1, we found that those with AFFs were younger, more often female

  15. DHS osteosynthesis with internal bone grafting in unstable delayed presented intracapsular neck femur fractures.

    Science.gov (United States)

    Gadegone, Wasudeo M; Chandak, R M; Lokhande, Vijayanand R

    2017-08-01

    The aim of this study was to assess fracture union and complications following use of dynamic hip screw (DHS) with internal bone grafting in treatment of unstable delayed presented intracapsular neck femur fractures in patients younger than 65 years of age. Thirty two patients with displaced intracapsular neck femur fractures(Garden III and IV, Pauwels III, with comminution) with delayed presentation (15-60 days) in the 45-65 year age group (mean 54.4±10.2 years) were included in this study. All patients were treated with dynamic sliding hip screw with closed cancellous bone grafting through a tunnel of a triple reamer. The average time to union was 3.8 months (3-5 months). Satisfactory union was achieved in all patients except two. One case developed avascular necrosis of the femoral head. Other complications were coxa vara in two, shortening of less than 10mm in three cases but there were no cases of infection or implant failure. Excellent results were achieved in 27, good/fair in 4 and poor in 1 patient. Osteosynthesis with DHS and primary cancellous bone grafting in indicated cases is a simple, providing biological stimulation for early union. Failure in a particular case can be treated with any appropriate second procedure. © 2017 Elsevier Ltd. All rights reserved.

  16. Femoral head diameter in subcapital fracture of the femur in Ibadan, Nigeria.

    Science.gov (United States)

    Ogunlade, S O; Omololu, A B; Alonge, T O; Obajimi, M O

    2004-09-01

    Subcapital fracture of the femur is common in the elderly patients though the incidence is less in our environment than in the western world. Primary prosthetic replacement is the method of treatment in the majority of the patients. To facilitate this, a foreknowledge of the femoral head diameter is necessary. To determine the diameter of the femoral head and its magnification on radiograph among patients with hip fractures seen in South-West Nigeria, all patients with subcapital fracture of the neck of femur seen between March 1997 and February 2002 were included in the study. The femoral heads were measured on the radiographic film using a transparent ruler and after extraction of the femoral head during surgery using callipers. There were 25 patients in all, the mean age of patients was 73.2 years. Fall at home accounted for 70% of the cases. The femoral head diameter was between 42 mm and 50 mm in 92% of patients while magnification of femoral head diameter on radiograph was 10-14% in 92% of cases. The usaof 10-14% magnification of femoral head on radiograph would help the surgeon determine the size of prosthetic head before commencement of surgery.

  17. Subtrochanteric femur fracture after removal of screws for femoral neck fracture in a child.

    Science.gov (United States)

    Song, Kwang Soon; Lee, Si Wook

    2015-01-01

    Displaced femoral neck fractures are rare in children and are associated with a high rate of complications. Subtrochanteric fractures after cannulated screw fixation of femoral neck fractures in adults are well recognized, and there are several reports on the topic. However, there are no reports on complications related to hardware or subtrochanteric fractures after removal of the screws in the treatment of femoral neck fractures in children. Here we report the case of a 10-year-old boy who sustained a subtrochanteric fracture after the screw removal and healing that followed a femoral neck fracture.

  18. New classification of proximal humeral fractures

    Energy Technology Data Exchange (ETDEWEB)

    Seemann, W.R.; Rupp, H.G.; Siebler, G.

    1986-08-01

    Neer's classification of humeral fractures was proved on 657 patients. This classification enables the radiologist to estimate the risk of avascular necrosis of the head of the humerus. The problematic group is that of four part lesions, which has a 19% incidence of humeral head necrosis. Since in this group minimal osteosynthesis produces better functional results than extensive osteosynthesis, a detailed pre-operative radiological description of the fracture type is necessary in order to spare the patient from extensive surgery which could have unsatisfactory results.

  19. Diagnosing displaced four-part fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Bagger, Jens; Sylvest, Annette

    2009-01-01

    Displaced four-part fractures comprise 2-10 % of all proximal humeral fractures. The optimal treatment is unclear and randomised trials are needed. The conduct and interpretation of such trials is facilitated by a reproducible fracture classification. We aimed at quantifying observer agreement...... on the classification of displaced four-part fractures according to the Neer system. Published and unpublished data from five observer studies were reviewed. Observers agreed less on displaced four-part fractures than on the overall Neer classification. Mean kappa values for interobserver agreement ranged from 0.......16 to 0.48. Specialists agreed slightly more than fellows and residents. Advanced imaging modalities (CT and 3D CT) seemed to contribute more to classification of displaced four-part patterns than in less complex fracture patterns. Low observer agreement may challenge the clinical approach to displaced...

  20. Interventions for treating proximal humeral fractures in adults

    DEFF Research Database (Denmark)

    Handoll, Helen H G; Brorson, Stig

    2015-01-01

    that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and fracture displacement...... supervised exercise in a swimming pool plus home exercise.Eight trials, involving 567 older participants, evaluated surgical intervention for displaced fractures. There was high quality evidence of no clinically important difference in patient-reported shoulder and upper-limb function at one- or two......BACKGROUND: Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. OBJECTIVES: To assess the effects (benefits...

  1. Surgical treatment of proximal humerus fractures using PHILOS plate

    Directory of Open Access Journals (Sweden)

    Vijay Sharma

    2014-10-01

    Full Text Available 【Abstract】Objective: To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS plate for proximal humerus fractures. Methods: We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012. There were 35 men and 16 women with a mean age of 38 years (range 24-68. There were 41 patients in the age group of <60 years and 10 patients in the age group of >60 years. According to Neer classification system, 8, 15 and 23 patients had 2-part, 3-part, and 4-part fractures, respectively and 5 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma centre. Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score. Results: The mean follow-up period was 30 months (range 12-44 months. Two patients were lost to followup. Of the remaining 49 patients, all fractures were united clinically and radiologically. The mean time for radiological union was 12 weeks (range 8-20 weeks. At the final follow-up the mean Constant-Murley score was 79 (range 50-100. The results were excellent in 25 patients, good in 13 patients, fair in 6 atients and poor in 5 patients. During the follow-up, four cases of varus malunion, one case of subacromial impingement, one case of deep infection, one case of intraarticular screw penetration and one case of failure of fi xation were noted. No cases of avascular necrosis, hardware failure, locking screw loosening or nonunion were noted. Conclusion: PHILOS provides stable fixation in proximal humerus fractures. To prevent potential complications like avascular necrosis, meticulous surgical dissection to preserve vascularity of humeral head is necessary. Key words: Proximal humerus fracture; Fracture fixation, internal; Proximal humeral internal locking system

  2. Indications for computed tomography (CT-) diagnostics in proximal humeral fractures

    DEFF Research Database (Denmark)

    Bahrs, Christian; Rolauffs, Bernd; Südkamp, Norbert P

    2009-01-01

    diagnostics depending on the fractured parts. METHODS: In a prospective diagnostic study in two level 1 trauma centers, 44 patients with proximal humeral fractures were diagnosed with conventional X-rays (22 AP + axillary views, 22 AP + scapular Y-views) and CT (multi-planar reconstruction (MPR) and maximum...... a significantly better assessment of the relevant structures than conventional diagnostics (p X-rays with AP view and a high-quality axillary view are useful for primary diagnostics of the fracture......--independently of the number of fractured parts--when the proximal humerus and the shoulder joint are not presented with sufficient X-ray-quality to establish a treatment plan....

  3. Improving outcomes for patients with proximal femoral fractures.

    Science.gov (United States)

    Shah, Dipal; Dhillon, Amritpaul; Mulvaney, Emily; Robinson, Margaret; Weerasuriya, Namal

    2014-09-25

    A peri-operative bay was created to treat all patients with proximal femoral fractures admitted to one trauma ward at the Queen's Medical Centre, Nottingham. All patients had urinary catheterisation and their fluid intake and output was recorded; patients had daily blood tests and were cared for on pressure-relieving mattresses. In addition, a study day was provided for all nursing staff on the management of patients with proximal femoral fractures. These measures resulted in a significant decrease in the incidence of acute kidney injury, reduced the length of hospital stay for patients on this ward and reduced the numbers of falls and pressure-related injuries for these patients.

  4. The Applications of Finite Element Analysis in Proximal Humeral Fractures

    OpenAIRE

    Yongyu Ye; Wei You; Weimin Zhu; Jiaming Cui; Kang Chen; Daping Wang

    2017-01-01

    Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze...

  5. Shape of growth plate of proximal femur in children and its significance in the aetiology of slipped capital femoral epiphysis.

    Science.gov (United States)

    Kandzierski, Grzegorz; Matuszewski, Lukasz; Wójcik, Anna

    2012-12-01

    The main objective of the study was to present the influence of the morphological shape of the proximal femoral growth plate in children as one of the risk factors for the incidence of slipped capital femoral epiphysis (SCFE) in adolescents. This research is based on the X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) data obtained for 100 children three to 13 years old, all treated at the Children's Orthopaedic Clinic and Rehabilitation Department and Department of Radiology Medical University of Lublin between 2005 and 2009. We took into account 83 children with healthy hip joints and 17 children with SCFE. We also performed morphological analysis of the shape of the proximal femoral growth plate together with X-ray, CT and MRI examinations of the proximal ends of cadaver femurs for two children aged six and 13. In the final findings we present an analysis of the shape of the proximal femoral growth plate in children between the third and 13th years of life and consider a correlation between the shape of the proximal femoral growth plate and its influence on the incidence of SCFE in adolescents. The change of shape of the proximal femoral growth plate from pleated to more spherical is one of the risk factors for the incidence of SCFE in children ten years old and older.

  6. Hemiarthroplasties in young patients with osteonecrosis or a tumour of the proximal femur; an observational cohort study.

    Science.gov (United States)

    van Egmond, Pim W; Taminiau, Antonie H M; van der Heide, Huub J L

    2013-01-17

    The failure scenario in total hip arthroplasty (THA), in younger patients, is dependent on the fixation and wear of the acetabular component. In selected cases, where endoprosthetic replacement of the femoral head is unavoidable for limb salvage or functional recovery, hemiarthroplasty can be chosen as an alternative. The purpose of this study is to evaluate hemiarthroplasty as treatment strategy for young patients with osteonecrosis or a tumour of the proximal femur. Between 1985 and 2008, 42 hemiarthroplasties (unipolar and bipolar) were performed in patients younger than 65 years with osteonecrosis (n=13) or a tumour of the proximal femur (n=29). All patients were seen at yearly follow-up examination and evaluated. Revision or conversion to a THA was regarded as a failure of the implant. A Kaplan Meier analysis was performed. To determine significant differences between categorical groups, the Pearson chi-square test was used. In numerical groups the independent T-test and One-way ANOVA were used. After a mean follow-up of 7.1 years, failure of the hemiarthroplasty occurred 6 times. The Kaplan Meier survival analysis with conversion to THA or revision as endpoint of the bipolar hemiarthroplasties (n=38) shows a 96% survival at 15, and 60% at 20 years. In the unipolar type (n=4) we found a conversion rate of 50% within 3 years. Bipolar hemiarthroplasty is a reasonable alternative in a young patient with osteonecrosis or a tumour of the proximal femur as indication. Because of the high conversion rate after unipolar hemiarthroplasties, we would not recommend this type of prosthesis in the young patient.

  7. [Morbidity and mortality of surgically treated proximal humerus fractures].

    Science.gov (United States)

    Isart, A; Sánchez, J F; Santana, F; Puig, L; Cáceres, E; Torrens, C

    2014-01-01

    The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis. A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  8. The advantages of tomosynthesis for evaluating bisphosphonate-related atypical femur fractures compared to radiography.

    Science.gov (United States)

    Petraszko, Andrew; Siegal, Daniel; Flynn, Michael; Rao, Sudhaker D; Peterson, Ed; van Holsbeeck, Marnix

    2016-05-01

    To investigate the advantages of using tomosynthesis (TS) compared to radiographs in the detection, characterization, and follow-up of bisphosphonate-related atypical femur fractures (BP-AFF). Eight patients were identified retrospectively who underwent TS for radiographic findings suspicious for BP-AFF. Two radiologists independently interpreted 15 radiographs and 16 TS examinations, indicating the presence or absence of the following: (1) cortical "beaking" on radiographs, (2) radiolucent fracture line on radiographs, and (3) fracture lucency on TS corresponding to the site of radiographic abnormality. Radiation dose data were calculated for radiographs and TS using Monte Carlo analysis. There was agreement on 100 % of radiographs regarding the presence or absence of a cortical beak. Regarding the presence or absence of a fracture lucency, there was agreement on 100 % of TS examinations (Kappa = 1.0) and 73 % of radiographs (Kappa = 0.40 ± 0.24). For the 46 % of radiographs in which one or both radiologists did not visualize a fracture line, there was 100 % agreement for the presence of a fracture line on the corresponding TS. The interobserver agreement for fracture line detection was significantly higher for TS than for radiographs (p = 0.012). The effective radiation dose using TS was approximately 96 % lower compared to radiography. TS outperformed radiographs in the detection and characterization of BP-AFF. TS may also have advantages over radiography for BP-AFF follow-up through its unique ability to visualize fracture healing with lower effective radiation doses to the patient.

  9. Sex specific association of physical activity on proximal femur BMD in 9 to 10 year-old children.

    Directory of Open Access Journals (Sweden)

    Graça Cardadeiro

    Full Text Available The results of physical activity (PA intervention studies suggest that adaptation to mechanical loading at the femoral neck (FN is weaker in girls than in boys. Less is known about gender differences associated with non-targeted PA levels at the FN or other clinically relevant regions of the proximal femur. Understanding sex-specific relationships between proximal femur sensitivity and mechanical loading during non-targeted PA is critical to planning appropriate public health interventions. We examined sex-specific associations between non-target PA and bone mineral density (BMD of three sub-regions of the proximal femur in pre- and early-pubertal boys and girls. BMD at the FN, trochanter (TR and intertrochanter (IT regions, and lean mass of the whole body were assessed using dual-energy x-ray absorptiometry in 161 girls (age: 9.7±0.3 yrs and 164 boys (age: 9.7±0.3 yrs. PA was measured using accelerometry. Multiple linear regression analyses (adjusted for body height, total lean mass and pubertal status revealed that vigorous PA explained 3-5% of the variability in BMD at all three sub-regions in boys. In girls, vigorous PA explained 4% of the variability in IT BMD and 6% in TR BMD. PA did not contribute to the variance in FN BMD in girls. An additional 10 minutes per day of vigorous PA would be expected to result in a ∼1% higher FN, TR, and IT BMD in boys (p<0.05 and a ∼2% higher IT and TR BMD in girls. In conclusion, vigorous PA can be expected to contribute positively to bone health outcomes for boys and girls. However, the association of vigorous PA to sub-regions of the proximal femur varies by sex, such that girlś associations are heterogeneous and the lowest at the FN, but stronger at the TR and the IT, when compared to boys.

  10. The effect of fixation technique on the stiffness of comminuted Vancouver B1 periprosthetic femur fractures.

    Science.gov (United States)

    Choi, Jung Keun; Gardner, Thomas R; Yoon, Ed; Morrison, Todd A; Macaulay, William B; Geller, Jeffrey A

    2010-09-01

    The purpose of this study was to evaluate the stiffness of 3 different constructs for the fixation of comminuted Vancouver B1 periprosthetic femoral shaft fractures: a single lateral locking plate, a single lateral locking plate plus an anterior strut allograft, and a lateral locking plate plus an anterior locking plate. The axial stiffness, lateral bending stiffness, and torsional stiffness of 10 synthetic periprosthetic femur fracture models were tested. Differences in stiffness between constructs were determined with a 1-way repeated-measures analysis of variance. Fixation technique was found to have a significant effect for all loading modalities (P < .0001). A lateral locked plate plus an anterior locked plate was significantly stiffer than the allograft that in turn was significantly stiffer than the single plate (P < .0001). Copyright 2010. Published by Elsevier Inc.

  11. Management of proximal humeral fractures by the Ilizarov external fixator.

    Science.gov (United States)

    Meselhy, Mohammed Anter; Singer, Mohamed Salah

    2017-09-01

    External fixation can be performed in poor bone and soft tissue conditions, and can be used in patients with poor general conditions or multiple injuries as a rapid, mini-invasive procedure. The purpose of the current study was to evaluate the effectiveness and safety of the Ilizarov external fixator in the management of proximal humeral fractures. Between May 2011 and December 2013, 14 patients with displaced proximal humeral fractures were enrolled in the current study. Nine patients were males and five were females, with mean age 42.9 years (range 21-55). All fractures were acute. The mode of injury was road traffic accident in eight patients and fall in six patients. There were six patients with two-part fracture, one of them with fracture dislocation, and eight patients presented with three-part fracture, two of them with fracture dislocation. All fractures were fixed using the Ilizarov external fixation. The average operative time was about 67 min (range 50-90). The mean follow-up period was (18) months (range 12-28). Healing was obtained in all 14 patients in a mean of 10.4 weeks (range 8-14). At the final follow-up, the mean constant score was 73.1 points (range 60-97 points), the mean visual analog score (VAS) for pain 3.2 (range 1-5), the mean DASH score 31.8 points (range 10-55 points), and the mean satisfaction VAS 7.6 (range 4-10). The Ilizarov external fixation is an effective technique in managing proximal humeral fractures with good outcome and low complication rates. Level IV, case series.

  12. A STUDY ON PROXIMAL HUMERAL FRACTURES STABILISED WITH PHILOS PLATE

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    Praveen Sivakumar K

    2017-02-01

    Full Text Available BACKGROUND Techniques for treating complex proximal humeral fractures vary and include fixations using tension bands, percutaneous pins, bone suture, T-plates, intramedullary nails, double tubular plates, hemiarthroplasty, plant tan humerus fixator plates, Polaris nails and blade plates. Complications of these techniques include cutout or back out of the screws and plates, avascular necrosis, nonunion, malunion, nail migration, rotator cuff impairment and impingement syndromes. Insufficient anchorage from conventional implants may lead to early loosening and failure, especially in osteoporotic bones. In general, nonoperative treatment of displaced three and four-part fractures of the proximal humerus leads to poor outcome due to intraarticular nature of injury and inherent instability of the fragments. Comminuted fractures of the proximal humerus are at risk of fixation failure, screw loosening and fracture displacement. Open reduction and internal fixation with conventional plate and screws has been associated with unacceptably high incidence of screw pull out. PHILOS (the proximal humeral internal locking system plate is an internal fixation system that enables angled stabilisation with multiple interlocking screws for fractures of the proximal humerus. MATERIALS AND METHODS 30 patients with proximal humerus fractures who were admitted in the Department of Orthopaedics, Government General Hospital, Kakinada, during the period November 2014 - November 2016 were taken up for study according to inclusion criteria. All patients were treated with PHILOS plate. These proximal humerus fractures were classified according to Neer’s classification. Patients were followed up at 6 weeks, 12 weeks and 6 months’ interval. Functional outcomes for pain, range of motion and muscle power and function were assessed using the Constant-Murley scoring system. Collected data analysed with independent t-test and ANNOVA test. RESULTS The outcome of the study was 1

  13. Correlation of measurable serum markers of inflammation with lung levels following bilateral femur fracture in a rat model

    Science.gov (United States)

    Sears, Benjamin W; Volkmer, Dustin; Yong, Sherri; Himes, Ryan D; Lauing, Kristen; Morgan, Michele; Stover, Michael D; Callaci, John J

    2010-01-01

    Introduction Evaluation of the systemic inflammatory status following major orthopedic trauma has become an important adjunct in basing post-injury clinical decisions. In the present study, we examined the correlation of serum and lung inflammatory marker levels following bilateral femur fracture. Materials and methods 45 Sprague Dawley rats underwent sham operation or bilateral femoral intramedullary pinning and mid-diaphyseal closed fracture via blunt guillotine. Animals were euthanized at specific time points after injury. Serum and lung tissue were collected, and 24 inflammatory markers were analyzed by immunoassay. Lung histology was evaluated by a blinded pathologist. Results Bilateral femur fracture significantly increased serum markers of inflammation including interleukin (IL)-2, IL-6, IL-10, GM-CSF, KC/GRO, MCP-1, and WBC. Femur fracture significantly increased serum and lung levels of IL-1a and KC/GRO at 6 hours. Lung levels of IL-6 demonstrated a trend towards significance. Histologic changes in pulmonary tissue after fracture included pulmonary edema and bone elements including cellular hematopoietic cells, bone fragments and marrow emboli. Discussion and conclusion Our results indicate that bilateral femur fracture with fixation in rats results in increases in serum markers of inflammation. Among the inflammatory markers measured, rise in the serum KC/GRO (CINC-1), a homolog to human IL-8, correlated with elevated levels of lung KC/GRO. Ultimately, analysis of serum levels of KC/GRO (CINC-1), or human IL-8, may be a useful adjunct to guide clinical decisions regarding surgical timing. PMID:21442011

  14. Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation

    Science.gov (United States)

    Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

    2015-01-01

    Background: Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. Objectives: This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. Materials and Methods: This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Results: Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Conclusions: Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group. PMID:26756019

  15. Enhancing fixation strength in periprosthetic femur fractures by orthogonal plating-A biomechanical study.

    Science.gov (United States)

    Lenz, Mark; Stoffel, Karl; Gueorguiev, Boyko; Klos, Kajetan; Kielstein, Heike; Hofmann, Gunther O

    2016-04-01

    Orthogonal plate osteosynthesis enhances fixation stability in periprosthetic femur fractures. Another option are locking attachment plates (LAP) allowing bicortical locking screw placement lateral to the prosthesis stem. Stability of lateral plate osteosynthesis with two LAP (2LAP) was compared to anterolateral orthogonal plate osteosynthesis (OP) with one LAP in a periprosthetic femur fracture model. In six pairs of fresh frozen human femora with cemented Charnley hip prosthesis, a transverse osteotomy was set distal to the tip of the prosthesis simulating a Vancouver type B1 fracture. Each pair was instrumented using a plate tensioner with either one lateral plate and two LAP, or two orthogonal anterolateral plates and one LAP. Stiffness was determined in a four-point-bending test prior to cyclic testing (2Hz) with physiologic profile and progressively increasing load up to catastrophic construct failure. Paired t-test and Wilcoxon-signed-rank test were used for statistical evaluation at a level of significance p = 0.05. The OP construct exhibited a significantly higher number of cycles and load to failure (39,627 cycles ± 4,056; 4,463 N ± 906) compared to the 2LAP construct (32,927 cycles ± 3,487; 3,793 N ± 849), p < 0.01. Mediolateral bending and torsional stiffness of the OP (1610 N/mm ± 249; 16.9 Nm/mm ± 6.3) were significantly higher compared to 2 LAP (1077 N/mm ± 189; 12.1 Nm/mm ± 3.9), p = 0.03 for both comparisons. Orthogonal plate osteosynthesis is a valuable option in periprosthetic fracture surgery, offering increased stability compared to a single lateral plate fixed with two LAP. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  16. Malignant peripheral nerve sheath tumor presenting as pathological fracture of femur in neurofibromatosis patient

    Directory of Open Access Journals (Sweden)

    Roobina Khan

    2017-01-01

    Full Text Available Malignant peripheral nerve sheath tumors (MPNSTs are rare soft tissue sarcomas that arise from a peripheral nerve or cells associated with the nerve sheath, such as Schwann cells, perineural cells, or fibroblasts. MPNSTs account for 5%–10% of all soft tissue sarcomas. Neurofibromas in Neurofibromatosis-1 (NF-1 may undergo malignant transformation in 2%–5% of patients. We are reporting a very rare case in NF-1 patient who, presented with pathological intertrochanteric fracture of femur and liver metastasis. X-ray from left hip joint shows lytic lesion which on histopathology turned out to be MPNST. S-100 was positive confirming its neural origin. Elbow lesion which was excised later, also showed similar features with S-100 positivity. Ultrasonography abdomen showed target lesions in liver. Fine-needle aspiration cytology from liver showed scattered malignant spindle cells. A final diagnosis of metastatic MPNST was made. Although malignant transformation in neurofibromas is extremely rare when it occurs, it is associated with NF-1 in 75% of patients. This case highlights the possibility of fracture femur as the presenting complains, in patients of NF with malignant transformation. The case is unique with regard to its presentation and rarity of metastatic sites.

  17. Effect of extracorporeal shock wave therapy on fracture healing in rat femural fractures with intact and excised periosteum.

    Science.gov (United States)

    Oktaş, Birhan; Orhan, Zafer; Erbil, Barış; Değirmenci, Erdem; Ustündağ, Nil

    2014-01-01

    The aim of this study is to compare the effect of extracorporeal shock wave therapy (ESWT) on fractures with intact periosteum and excised periosteum. Thirty-seven Wistar albino rats were randomized into four groups. Osteotomy and intramedullary Kirschner wire fixation were performed on all right femurs under ketamin anesthesia. The first group (n=10) was identified as control group. In the second group (n=10), periosteum located at the osteotomy site was excised circumferentially during surgery. In the third group (n=9), periosteum was left intact and ESWT was applied. In the forth group (n=8), periosteums of all rats were excised and ESWT was applied. All fracture lines were evaluated radiographically each two weeks and histologically at the sixth week. Results were evaluated statistically. In periosteum excised group which represents a model of open fractures with soft tissue defect, ESWT application had a significantly positive histologic effect on bone healing. However, radiological evaluation did not reveal any statistically significant difference between groups with intact and excised periosteums. According to our findings, ESWT can be used to improve fracture healing and prevent pseudoarthrosis in the treatment of open fractures with accompanying soft tissue and periosteum damage. However, further clinical studies are required to include ESWT in routine practice.

  18. Autologous grafts of double-strut fibular cortical bone plate to treat the fractures and defects of distal femur: a case report and review of literature

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    CHEN Xu

    2012-02-01

    Full Text Available 【Abstract】We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction and internal fixation with cloverleaf plate. And one hundred days after the surgery, the proximal screws were pulled-out, but the bone union was not achieved. Treatment consisted of exchanging the cloverleaf plate with a locking compression plate and using an auto-iliac bone graft to fill the nonunion gap. In July 2009, the patient had a sharp pain in the right lower limb. The X-ray revealed that the plate implanted last year was broken, causing a nonunion at the fracture site. Immediately the plate and screws were removed and an intramedullary nail was inserted reversely from the distal femur as well as a 7 cm long bone from the right fibula was extracted and longitudinally split into two pieces to construct cortical bone plates. Then we placed them laterally and medially to fracture site, drilled two holes respectively, and fastened them with suture. We carried on auto-iliac bone grafting with the nonunion bone grafts. The follow-up at 15 months after operation showed that the treatment was successful, X-ray confirmed that there was no rotation and no angular or short deformity. We briefly reviewed the literature regarding such an unusual presentation and discussed in details the possible etiology and the advantages of autologous double-strut fibular grafts to cope with such an intractable situation. Key words: Femur; Transplantation, autologous; Bone screws

  19. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

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    Jaiswal Atin

    2013-12-01

    Full Text Available 【Abstract】Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic dis- placed proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, internal

  20. Long endomedullary nail in proximal third humeral shaft fractures.

    Science.gov (United States)

    Caforio, Marco; Maniscalco, Pietro; Colombo, Massimiliano; Calori, Giorgio Maria

    2016-10-01

    Proximal humeral fractures with a spiral line of fracture extending from the humeral head to the diaphyseal region are increasing. Treatment for these fractures is comparable to that for shaft fractures. The purpose of this study was to evaluate the use of a new "Long" humeral nail for this type of lesion and identify the best distal locking. Forty-three patients treated with a Long Diphos Nail® were selected for this study: main exclusion criteria were poor cognitive and responsive ability to physical therapy, four-part fracture requiring humeral head replacement, an isolated greater or lesser tubercle fracture and a head-splitting fracture. All patients were divided into two groups according to the distal locking (single or double) and clinically evaluated at 1, 3, 6 and 12 months after surgery. The following parameters were evaluated: fracture healing on radiographic images every month; level of pain with Visual Analogue Scale (VAS); recovery of shoulder function or ability to resume normal daily activities according to the Constant Scoring System (CSS); patient satisfaction; and complications, like fracture consolidation defect or delay. A statistical analysis was performed. Improvements in pain, satisfaction and shoulder functional recovery were recorded. Patients reached fracture healing in two to six months. The mean healing time was better for double distal locking (p=0.04).There was a clinically greater difference (p=0.006) between the groups for the mean Constant score at 3 months follow-up, with better results for the double distal locking group. Complications were: one patient with a consolidation delay with a single distal locking screw breakage; it was necessary to remove the nail and perform a second treatment. The results of the study indicate the efficacy of Long Diphos Nail® in the treatment of fractures with a line of fracture extending to the proximal diaphyseal region. The features of a multiplane stabilisation above the fracture and a distal

  1. Proximal femoral periprosthetic fracture fixation with a hooked ...

    African Journals Online (AJOL)

    Proximal femoral periprosthetic fracture fixation with a hooked locking plate: a Kenyan experience. ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more information about how to print, save, and ...

  2. Proximal third humeral shaft fractures -- a fracture entity not fully characterized by conventional AO classification.

    Science.gov (United States)

    Stedtfeld, H W; Biber, R

    2014-01-01

    The retrospective study was made to evaluate the fracture patterns at the proximal humeral shaft for which the long version of a standard proximal humeral nail (PHNLV) has been used. The indication has been decided by the individual surgeons. Over a five year period 72 consecutive PHNLV cases of an acute fracture were identified and were included in the study. Mean patient age was 68.9 years. Gender ratio was m/f=22/50. 86.1% of the patients fractured their humerus by a fall, the rest by a high velocity accident. We analysed patient comorbidity, ASA score, osteoporosis, social status before accident, additional injuries affecting local soft tissues or other anatomic regions. We analysed the expansion of the fractures, dividing the humerus into five zones. Fracture morphology was categorized according to the standard AO/ASIF classification (if applicable). Comorbidities were found in 76.4% of the patients. Almost all patients (93.1%) had been living independently at home before the accident. 47.2% of patients had osteoporosis in their medical history. Five patients (6.9%) had a primary palsy of the radial nerve. Six fractures chosen for PHNLV fixation were clearly restricted to the humeral head. The remaining 66 fractures were located in the humeral shaft (AO region 12). There were 5 segmental fractures. Of the remaining 67 fractures affecting the proximal third of the humeral shaft 49.3 percent extended into the humeral head. 98 percent of these fractures displayed spiral morphology. Proximal humeral shaft fractures are amazingly similar to subtrochanteric and distal tibial shaft fractures: Spiral fracture types with different grades of comminution are absolutely dominant; a great proportion of the fractures extend into the humeral head with growing tendency of displacement if located closer to the humeral head. Diverging traction of deltoid and pectoralis muscle causes typical displacement if the fracture line runs in between their attachments substantiating the

  3. Fixation of periprosthetic femur fractures: a biomechanical analysis comparing cortical strut allograft plates and conventional metal plates.

    Science.gov (United States)

    Peters, Christopher L; Bachus, Kent N; Davitt, James S

    2003-07-01

    This study compared the stability of periprosthetic femur fractures fixed using cortical allograft struts with a metal plate. Cadaveric specimens were loaded in single-leg stance and stair climbiing to 2250 N. Optimum stability in single-leg stance was achieved with two long struts medially and laterally. No clear advantage was noted in using a second strut in stair climbing. Cables rather than wires were useful in single-leg stance, but not in stair climbing. Allograft cortical struts are a biomechanically sound alternative to metal plates fixed with screws and cables for femur fracture fixation below a well-fixed femoral component.

  4. The influence of local bone quality on fracture pattern in proximal humerus fractures.

    Science.gov (United States)

    Mazzucchelli, Ruben A; Jenny, Katharina; Zdravkovic, Vilijam; Erhardt, Johannes B; Jost, Bernhard; Spross, Christian

    2017-12-26

    Bone mineral density and fracture morphology are widely discussed and relevant factors when considering the different treatment options for proximal humerus fractures. It was the aim of this study to investigate the influence of local bone quality on fracture patterns of the Neer classification as well as on fracture impaction angle in these injuries. All acute, isolated and non-pathological proximal humerus fractures admitted to our emergency department were included. The fractures were classified according to Neer and the humeral head impaction angle was measured. Local bone quality was assessed using the Deltoid Tuberosity Index (DTI). The distribution between DTI and fracture pattern was analysed. 191 proximal humerus fractures were included (61 men, mean age 59 years; 130 women, mean age 69.5). 77 fractures (40%) were classified as one-part, 72 (38%) were two-part, 24 (13%) were three- and four-part and 18 (9%) were fracture dislocations. 30 fractures (16%) were varus impacted, whereas 45 fractures (24%) were classified as valgus impacted. The mean DTI was 1.48. Valgus impaction significantly correlated with good bone quality (DTI ≥ 1.4; p = 0.047) whereas no such statistical significance was found for the Neer fracture types. We found that valgus impaction significantly depended on good bone quality. However, neither varus impaction nor any of the Neer fracture types correlated with bone quality. We conclude that the better bone quality of valgus impacted fractures may be a reason for their historically benign amenability to ORIF. On the other hand, good local bone quality does not prevent fracture comminution. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Minimally invasive plate osteosynthesis for proximal humeral fractures.

    Science.gov (United States)

    Koljonen, Paul Aarne; Fang, Christian; Lau, Tak Wing; Leung, Frankie; Cheung, Nigel W K

    2015-08-01

    To report the outcome after minimally invasive plate osteosynthesis (MIPO) through the deltoid-splitting approach for proximal humeral fractures. 10 men and 30 women aged 37 to 88 years underwent MIPO through the deltoid-splitting approach using the Proximal Humerus Internal Locking System or the Locking Proximal Humerus Plate for 2-part (n=18), 3-part (n=20), and 4-part (n=2) proximal humeral fractures. The rehabilitation protocol was standardised. All 40 patients were followed up at 3 months, 34 (85%) at 6 months, 30 (75%) at one year, and 13 (33%) at 2 years. Two patients had malunion. No patient had avascular necrosis, infection, nerve palsy, or nonunion. The mean Constant score at one year and 2 years was 75 and 87.5, respectively. The Constant score at 6 months correlated to that at one year (r=0.926, pfracture grade, or hand dominance. MIPO for fixation of proximal humeral fractures using a locking plate is safe and effective in enabling an early return of shoulder function.

  6. Intramedullary Nailing for Pathological Fractures of the Proximal Humerus.

    Science.gov (United States)

    Choi, Eun-Seok; Han, Ilkyu; Cho, Hwan Seong; Park, In Woong; Park, Jong Woong; Kim, Han-Soo

    2016-12-01

    Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes. We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes. The mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up. Proximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction.

  7. A COMPAR A TIVE STUDY OF FIXATION OF DISTAL END FRACTURES OF FEMUR BY SUPRACONDYLAR NAIL AND DYNAMIC CONDYLAR SCREW

    Directory of Open Access Journals (Sweden)

    Penugonda Ravi Shankar

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES : To study the functional outcome of fractures of distal end of femur in adults surgically treated with supracondyl ar nail and Dynamic condylar screw. To study the complications of Dynamic Condylar screw and supracondylar nail in fractures of distal end of femur in Adults . RESULTS : In this study 20 cases of distal femoral fractures were treated with DCS and Supracondyl ar Nail. Our aim was to treat these fractures by rigid internal fixation, early mobilization and to know the outcome of DCS and SC Nail in these fractures.The mean age group of patients was 41.8 years in DCS and 38.4 in Nail group. Males were predominating in our study. Radiological union was seen at an average of 14.6 weeks in DCS and 13 weeks in supracondylar Nail. Average Range of Knee motion was 97 0 in DCS and 101 0 in Nail. Overall results were excellent in 10 cases (4 in DCS, 6 in Nail Good in 4 cases (2 in DCS, 2 in Nail Poor in 6 cases (4 in DCS 2 in Nail. CONCLUSION : From the study, We concluded DCS and Supracondylar Nail can be used for treating fractures of distal femur and supracondylar Nail is a better implant than DCS as it provides stable fr acture fixation with minimal disruption of soft tissues allowing early joint mobilization. The simplicity of the procedure (SC Nail also facilitates fracture fixation in patients with multiple trauma, including those with multiple fractures

  8. Comparative Study of Surgical Management of Fracture Neck of Femur with Cemented Versus Uncemented Bipolar Hemiarthroplasty.

    Science.gov (United States)

    Prashanth, Y S; Niranjan, M

    2017-02-01

    There is evidence for use of cemented hemiarthroplasty resulting in greater anchoring and lesser peri prosthetic fracture. However, this procedure results in more haemodynamic instability and cardiopulmonary complications termed as 'cement reaction' or bone cement implantation syndrome. There has been a heightened interest among surgeons to compare cemented and uncemented hemiarthroplasty for fracture neck of femur. To compare cemented and uncemented hemiarthroplasty in terms of blood loss during the procedure, post-operative complications, mortality, functional recovery and long term clinical outcome. In a prospective study spanning 8 years from January 2006 to January 2014 in a tertiary care hospital, 52 cases of fracture of neck were selected. Twenty four patients underwent cemented and 28 patients underwent uncemented hemiarthroplasty. Mean follow up duration was 59.3 months. Harris Hip Score evaluation was done at each follow up. Radiological evaluation was done at each follow up for calcar length and periprosthetic fractures. Mean age of patients was 70 years. Harris Hip scores at 3, 6 and 12 months did not show statistically significant differences. Periprosthetic osteolysis or loosening was not seen in the present study. No complications noted in uncemented hemiarthroplasty. Four patients who had cemented hemiarthroplasty had infections. No mortality occurred during admission and within 12 months after surgery. No significant difference was noted between the cemented and uncemented hemiarthroplasty procedures on long term follow up in terms of functionality. No re-operations and no mortality reported. Cemented hemiarthroplasty had more blood loss and minimal post-operative complications.

  9. The timing of bone SPECT to predict osteonecrosis after internal fixation of femur neck fractures.

    Science.gov (United States)

    Kim, Ji Wan; Ryu, Jin-Sook; Baek, Sora; Byun, Seong-Eun; Chang, Jae Suk

    2017-05-01

    Bone SPECT can be used after a femur neck fracture to assess the circulation of the femoral head in the immediate postoperative period because the blood supply is one of the major factors affecting bone uptake of radiotracer on bone scintigraphy. The purpose of our present study was to investigate whether osteonecrosis of the femoral head (OFH) after internal fixation of femoral neck fracture could be predicted by early and late bone SPECT. This retrospective cohort study enrolled 44 patients (33 women; mean age, 66.9 years) who underwent surgical fixation for femoral neck fractures. Early and late bone SPECT images were obtained within 2 weeks postoperatively and at 3 months postoperatively. Patients were followed up for a minimum of 24 months (average, 34 months). OFH developed in 9 out of 44 patients but no patient showed nonunion. Seventeen patients with normal femoral head uptake on early bone SPECT were healed. Of 27 patients with decreased femoral head uptake on early bone SPECT, 2 patients developed OFH on radiography before 3 months postoperatively, 18 patients recovered to normal uptake on the late SPECT, and the remaining 7 patients still showed decreased uptake on the late SPECT at 3 months postoperatively. All of these 7 cases finally developed OFH on radiography. Bone SPECT can reliably predict the possibility of OFH with after femoral neck fracture at least 3 months after surgery, while early bone SPECT showed low specificity. Clinical. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  10. Changes of the bone mineral density in proximal femur following total hip resurfacing arthroplasty in osteonecrosis of femoral head.

    Science.gov (United States)

    Lian, Yong-yun; Pei, Fu-xing; Yoo, Myung-chul; Cheng, Jing-qiu; Fatou, Camara-yagouba

    2008-04-01

    Total hip resurfacing arthroplasty (THRA) is being performed with increasing frequency for osteonecrosis of femoral head (ONFH). To evaluate femoral bone remodeling in ONFH after THRA and determine the impact of stem-neck angle (SNA) of inserted femoral component on bone remodeling, we monitored the changes in BMD in proximal femur in 23 patients with ONFH after surgery. Patients were divided into group A (SNA >or= 5 degrees ) and group B (SNA < 5 degrees ). The BMD was measured in seven Gruen zones and two neck zones using dual-energy X-ray absorptiometry preoperatively, then at 3, 6, 12, and 24 months after surgery. At all ROIs, the BMD decreased significantly by 3 months postoperatively. The BMD ceased to decrease and reversed by 6 months. The BMD in neck increased significantly in group A, compared with group B at 24 months. The BMD increased 2% at ROI1 at 24 months in both groups, and at ROI7, the BMD in group A reversed to baseline value by 6 months and increased 5.81% at 24 months. These findings implied that the bone stock of proximal femur in ONFH can be well reserved after total hip resurfacing arthroplasty with valgus positioning of the femoral component.

  11. Minimally Invasive Fixation for Proximal Humeral Fracture: A Review on the use of T2 Proximal Humeral Nail

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    Sze-Ling Iris Ngai

    2013-12-01

    Discussion and conclusion: With the proper surgical technique high union rate, good functional recovery, and low complication rate can be achieved by using T2 Proximal Humeral Nail in managing traumatic proximal humeral fracture.

  12. Displaced proximal humeral fractures: when is surgery necessary?

    Science.gov (United States)

    Tamimi, Iskandar; Montesa, Guillermo; Collado, Francisco; González, David; Carnero, Pablo; Rojas, Facundo; Nagib, Mohamed; Pérez, Verónica; Álvarez, Miguel; Tamimi, Faleh

    2015-10-01

    Several therapeutic methods have been traditionally used in the treatment of displaced proximal humeral fractures; however, the indication of these treatments is still controversial. The purpose of this study was to compare the medium-term functional results of four methods commonly used in the treatment of proximal humeral fractures [conservative treatment, proximal humeral nails (PHN), percutaneous K-wiring (PKW), and locking-plates (LP)] taking into consideration the type of fracture and the age of the patients. We conducted a retrospective cohort study on patients with proximal humeral fractures treated with one of the following methods: conservative treatment, PHN, PKW, or LP. Functional results were assessed using the absolute Constant score and the disabilities of the arm shoulder and hand score (DASH). The functional outcome was analysed according to age (≥65 years and fracture type (displaced 2-fragment and 3-4-fragment fractures). A total of 113 patients were included in the study, with a mean age of 65.3 SD 15.2 years and average follow-up time of 26.2 SD 12.6 months. Patients under 65 years had higher Constant scores when treated with PHN and PKW than those treated conservatively (77.2 vs. 54.7, p=0.01 and 74.0 vs. 54.7, p=0.03, respectively). Patients above 65 years had higher Constant scores when treated with PKW compared to PHN and conservative treatment (68.7 vs. 51.9, p=0.02 and 68.7 vs. 55.9, p=0.029, respectively). In 2-fragment fractures, PKW resulted in higher Constant scores than conservative treatment (70.4 vs. 53.9, p=0.048). No differences were found in the final outcome between patients treated with LP and those treated conservatively regardless of age, and fracture type. There were also no differences between any of the evaluated methods in the treatment of 3-4-fragment fractures. The use of PKW was associated with better functional results than conservative treatment in individuals of all ages, especially in patients with 2-fragment

  13. Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the women's health initiative-observational study.

    Science.gov (United States)

    Beck, Thomas J; Petit, Moira A; Wu, Guanglin; LeBoff, Meryl S; Cauley, Jane A; Chen, Zhao

    2009-08-01

    Heavier individuals have higher hip BMD and more robust femur geometry, but it is unclear whether values vary in proportion with body weight in obesity. We studied the variation of hip BMD and geometry across categories of body mass index (BMI) in a subset of postmenopausal non-Hispanic whites (NHWs) from the Women's Health Initiative Observational Cohort (WHI-OS). The implications on fracture incidence were studied among NHWs in the entire WHI-OS. Baseline DXA scans of hip and total body from 4642 NHW women were divided into BMI (kg/m(2)) categories: underweight (obesity (>40). Femur BMD and indices of bone axial (cross-sectional area [CSA]) and bending strength (section modulus [SM]) were extracted from DXA scans using the hip structure analysis (HSA) method and compared among BMI categories after adjustment for height, age, hormone use, diabetes, activity level, femur neck-shaft angle, and neck length. The association between BMI and incident fracture was studied in 78,013 NHWs from the entire WHI-OS over 8.5 +/- 2.6 (SD) yr of follow-up. Fracture incidence (cases/1000 person-years) was compared among BMI categories for hip alone, central body (hip, pelvis, spine, ribs, and shoulder girdle), upper extremity (humerus and distal), and lower extremity (femur shaft and distal but not hip). Femur BMD, CSA, and SM were larger in women with higher BMI, but values scaled in proportion to lean and not to fat or total body mass. Women with highest BMI reported more falls in the 12 mo before enrollment, more prevalent fractures, and had lower measures of physical activity and function. Incidence of hip fractures and all central body fractures declined with BMI. Lower extremity fractures distal to the hip trended upward, and upper extremity incidence was independent of BMI. BMD, CSA, and SM vary in proportion to total body lean mass, supporting the view that bones adapt to prevalent muscle loads. Because lean mass is a progressively smaller fraction of total mass in obesity

  14. Orthogonal plating of Vancouver B1 and C-type periprosthetic femur fracture nonunions.

    Science.gov (United States)

    Birch, Christopher E; Blankstein, Michael; Chlebeck, Jesse D; Bartlett Rd, Craig S

    2017-11-21

    Periprosthetic femoral shaft fractures are a significant complication after total hip arthroplasty (THA). Plate osteosynthesis has been the mainstay of treatment around well-fixed stems. Nonunions are a rare and challenging complication of this fixation method. We report the outcomes of a novel orthogonal plating surgical technique for Vancouver B1 and C-type periprosthetic fractures that previously failed open reduction internal fixation (ORIF). A retrospective review identified all patients with Vancouver B1/C THA periprosthetic femoral nonunions from 2010 to 2015. Exclusion criteria included open fractures and periprosthetic infections. The technique utilised a mechanobiologic strategy of atraumatic exposure, resection of necrotic tissue, bone grafting with adjuvant bone morphogenetic protein (BMP) and revision open reduction internal fixation with orthogonal plate osteosynthesis. 6 Vancouver B1/C periprosthetic femoral nonunions were treated. 5 patients were female with an average age of 80.3 years (range 72-91 years). The fractures occurred at a mean of 5.8 years (range 1-10 years) from their initial arthroplasty procedure. No patients underwent further revision surgery; there were no perioperative complications. All patients had a minimum of 11 months follow-up (mean 18.6, range 11-36 months). All fractures achieved osseous union, defined as solid bridging callus over at least 2 cortices and pain free, independent ambulation, at an average of 24.4 weeks (range 6.1-39.7 weeks). This is the 1st series describing orthogonal locked compression plating using modern implants for periprosthetic femoral nonunions. This technique should be considered in periprosthetic femur fracture nonunions around a well-fixed stem.

  15. Interval hypoxic training in complex treatment of fractures of trochanteric area of the femur

    Directory of Open Access Journals (Sweden)

    Василь Михайлович Шимон

    2015-05-01

    Full Text Available The method of interval hypoxic training (IHT is used to increase physical endurance of athletes and for treatment of certain systemic diseases, due to the ability of IHT affect metabolism, homeostasis and the immune system. The aims of the article are improving the results of treatment and rehabilitation of patients with fractures of the trochanteric area of the femur by the method of interval hypoxic training and study its influence on bone metabolism.Materials and methods. 17 patients who were hospitalized in the clinic of general surgery UzhNU with fractures of the trochanteric area of the femur are examined in the period from 2012 to 2015.The first group consisted of 6 patients who from day-patient treatment is conducted IHT by gas mixture of 12 % oxygen. The second group consisted of 4 patients with thyrotoxicosis who are also receiving IHT by gas mixture of 12% oxygen.The control group consisted of 7 patients with fractures of the trochanteric area of the femur who refused from IHT.Results and its discussion. The best physical activity is observed in the first group. Starting physical activity is the lowest in the second group, but its development is faster. Slowly increase the duration of physical activity compared with the first two groups is observed in the control group.In the control study after 1 month it is noted that calcium level increased in all three groups. Increase in the second group is biggest. The level of phosphorus decreased in the first and the control group and increased in the second group.The levels of osteocalcin and alkaline phosphatase increased. Rates were higher and increase was substantial in the first two groups in comparison with the control group.Conclusions.• Intensive growth of length of one-time physical activity most notably in patients with thyrotoxicosis is observed in patients who are receiving IHT.• Improvement of the activity of bone metabolism is observed in patients after IHT

  16. Minimally invasive plate osteosynthesis for proximal humeral fractures: clinical and radiologic outcomes according to fracture type.

    Science.gov (United States)

    Sohn, Hoon-Sang; Shin, Sang-Jin

    2014-09-01

    This study evaluated the clinical and radiologic outcomes, according to fracture type, of proximal humeral fractures treated by the minimally invasive plate osteosynthesis (MIPO) technique. Of 85 patients with proximal humeral fractures who were treated by the MIPO technique, 62 were evaluated: 27 with 2-part fractures, 24 with 3-part fractures, and 11 with 4-part fractures. An additional inferomedial screw or fibular allograft was used when severe medial cortical comminution was found in the proximal humerus. Clinical and radiographic outcomes were evaluated during the follow-up of 37 months. There was a significant difference in the Constant scores of patients with 4-part fractures compared with those with 3-part fractures (P = .039). The neck-shaft angle in 4-part fractures (121° ± 3°) at final follow-up was significantly lower compared with other fracture types (2-part: 129° ± 9°, P = .036; 3-part: 129° ± 2°, P = .031). Complication rates (72.7%) of 4-part fractures were significantly higher than with other fracture types (2-part, 7.4%; 3-part, 20.8%; P = .001). Sixteen fractures were fixed with an additional inferomedial screw, and 3 patients had insertion of a fibular allograft. Satisfactory clinical and radiologic outcomes were obtained by the MIPO technique in proximal humeral fractures. In addition, medial cortical support can be performed with an inferomedial screw or fibular allograft in the MIPO technique. However, the MIPO technique for 4-part fractures showed relatively inferior outcomes compared with 2- and 3-part fractures. Conversion to open plating is also considered if adequate reduction, that is, a neck-shaft angle >120°, is not able to be obtained in the MIPO technique for 4-part fractures of the proximal humerus. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  17. Treatment of proximal fifth metatarsal bone fractures in athletes.

    Science.gov (United States)

    Japjec, M; Starešinić, M; Starjački, M; Žgaljardić, I; Štivičić, J; Šebečić, B

    2015-11-01

    Proximal fifth metatarsal (V MT) bone fractures are common injuries that are a major diagnostic and therapeutic challenge. Lawrence and Botte considered different treatment options and the possibility of recovery and divided these fractures into three different regions: tuberosity avulsion fractures (zone I), acute fractures of the metaphysis at the level of the intermetatarsal junction (zone II) and proximal diaphysis stress fracture (zone III). A total of 42 athletes with fracture of the V MT bone in zone II and III were treated in our institution during a 6-year period. All patients were offered surgical treatment, but nine patients refused surgery. Thus, the patients were divided into two groups: group 1 comprised 33 patients who underwent an intramedullary screw fixation operation under regional anaesthesia immediately after the fracture was diagnosed; group 2 contained the remaining nine patients who had refused surgery and received conservative therapy with non-weight-bearing short-leg casts or orthosis. Follow-up ranged from 6 to 24 months. All fractures healed in group 1: healing occurred within 8 weeks in 26 patients and was prolonged to 16 to 18 weeks in four patients. In group 2, fractures healed in four patients but did not heal in five patients even after 6 months. Four of the five patients in whom the fracture did not heal required subsequent osteosynthesis because they had constant problems that caused absence from sport. After the operation, their fractures healed in an average of 10 weeks. One patient decided not to undergo the operation due to the absence of subjective symptoms. Three patients in group 1 who started intensive training sustained a refracture and underwent re-operation in which osteosynthesis was performed with a stronger screw. The fractures then healed again. Treatment results were evaluated radiologically and clinically using the Modified Foot Score. Results in group 1 were significantly better than those in group 2 and there

  18. Postpartum osteoporosis associated with proximal tibial stress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Clemetson, I.A.; Anderson, S.E. [Department of Radiology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Popp, A.; Lippuner, K. [Department of Osteology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Ballmer, F. [Knee and Sports Medicine Unit, Lindenhofspital Bern, 3012, Bern (Switzerland)

    2004-02-01

    A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fracture. (orig.)

  19. Pinning technique for shoulder fractures in adolescents: computer modelling of percutaneous pinning of proximal humeral fractures

    Science.gov (United States)

    Mehin, Ramin; Mehin, Afshin; Wickham, David; Letts, Merv

    2009-01-01

    Background In the technique of percuatenous pinning of proximal humerus fractures, the appropriate entry site and trajectory of pins is unknown, especially in the adolescent population. We sought to determine the ideal entry site and trajectory of pins. Methods We used magnetic resonance images of nonfractured shoulders in conjunction with radiographs of shoulder fractures that were treated with closed reduction and pinning to construct 3-dimensional computer-generated models. We used engineering software to determine the ideal location of pins. We also conducted a literature review. Results The nonfractured adolescent shoulder has an articular surface diameter of 41.3 mm, articular surface thickness of 17.4 mm and neck shaft angle of 36°. Although adolescents and adults have relatively similar shoulder skeletal anatomy, they suffer different types of fractures. In our study, 14 of 16 adolescents suffered Salter–Harris type II fractures. The ideal location for the lateral 2 pins in an anatomically reduced shoulder fracture is 4.4 cm and 8.0 cm from the proximal part of the humeral head directed at 21.2° in the coronal plane relative to the humeral shaft. Conclusion Operative management of proximal humerus fractures in adolescents requires knowledge distinct from that required for adult patients. This is the first study to examine the anatomy of the nonfractured proximal humerus in adolescents. This is also the first study to attempt to model the positioning of percutaneous proximal humerus pins. PMID:20011155

  20. Studying the effect of photodynamic therapy (PDT) to enhance healing of femur fractures using polarimetric second-harmonic generation microscopy

    Science.gov (United States)

    Golaraei, Ahmad; Raja, Vaishnavi; Akens, Margarete K.; Wilson, Brian C.; Barzda, Virginijus

    2017-07-01

    Linear polarization-in, polarization-out second-harmonic generation microscopy was used to study the effect of Photodynamic therapy treatment on enhancing the healing of femur fracture by investigating the ultrastructure of collagen as a major component of bone matrix.

  1. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: a cross-sectional study from a Korean population in women.

    Science.gov (United States)

    Im, Gun-Il; Kwon, Oh-Jin; Kim, Chang Hee

    2014-12-01

    The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship. There was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade. The radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward's triangle).

  2. Management of Simultaneous Bilateral Neck of Femur Fractures in an Elderly Patient

    Science.gov (United States)

    McGoldrick, Niall P.; Dodds, Michael K.; Green, Connor; Synnott, Keith

    2013-01-01

    Simultaneous bilateral neck of femur fracture is rare. There have been few reports of such a condition in the literature. This uncommon pattern of injury has been associated with high-energy trauma, underlying bone disease, and seizure disorders. We describe our experience of such a condition involving an elderly patient with significant cardiovascular comorbidity. The operative approach involved single-stage repair of both the involved joints. Bilateral uncemented hemi-arthroplasty was performed using a single tray of sterile surgical instruments and 2 sterile drapes. We report a satisfactory outcome. Uncemented arthroplasty should be considered in such a case so as to minimize the risk of a possible bone cement implantation syndrome. PMID:24319617

  3. Techniques for intramedullary nailing of proximal tibia fractures.

    Science.gov (United States)

    Stinner, Daniel J; Mir, Hassan

    2014-01-01

    Despite poor early results with intramedullary nailing of extra-articular proximal tibia fractures, improvements in surgical technique and implant design modifications have resulted in more acceptable outcomes. However, prevention of the commonly encountered apex anterior and/or valgus deformities remains a challenge when treating these injuries. It is necessary for the surgeon to recognize this and know how to neutralize these forces. Surgeons should be comfortable using a variety of the reduction techniques presented to minimize fracture malalignment. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Plate fixation in periprosthetic femur fractures Vancouver type B1-Trochanteric hook plate or subtrochanterical bicortical locking?

    Science.gov (United States)

    Lenz, Mark; Stoffel, Karl; Kielstein, Heike; Mayo, Keith; Hofmann, Gunther O; Gueorguiev, Boyko

    2016-12-01

    Proximal plate fixation in periprosthetic femur fractures can be improved by plate anchorage in the greater trochanter (lateral tension band principle) or bicortical locking screw placement beside the prosthesis stem in an embracement configuration. Both concepts were compared in a biomechanical test using a femoral hook plate (hook) or a locking attachment plate (LAP). After bone mineral density (BMD) measurement in the greater trochanter, six pairs of fresh frozen human femora were assigned to two groups and instrumented with cemented hip endoprostheses. A transverse osteotomy was set distal to the tip of the prosthesis, simulating a Vancouver B1 fracture. Each pair was instrumented using a plate tensioner with either hook or LAP construct. Cyclic testing (2Hz) with physiologic profile and monotonically increasing load was performed until catastrophic failure. Plate stiffness was compared in a four-point-bending-test. Paired student's-t-test was used for statistical evaluation (p<0.05). Mean BMD was 250mgHA/ccm±47. The hook construct exhibited a significantly (p=0.015) lower number of cycles and load to failure (26'177cycles±2777; 3'118N±778) correlating significantly with BMD (R2=0.83; p=0.04) compared to the LAP construct (37'423cycles±5'299; 4'242N±1'030) (R2=0.71;p=0.11). BMD was a significant covariate (p=0.01). Plate stiffness was in a comparable range (hook Plate 468N/mm±7; LCP 445N/mm±6). Subtrochanterically placed LAP provides an increased fixation strength under repetitive loading compared to hook plate fixation in the greater trochanter. Trochanteric fixation is highly BMD dependent and may be restricted to major greater trochanteric involvement requiring stabilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. [DHS osteosynthesis for proximal femoral fractures: infectious complications].

    Science.gov (United States)

    Hrubina, M; Skoták, M; Běhounek St, J

    2013-01-01

    Evaluation of infectious complications in patients with proximal femoral fractures treated by osteosynthesis using dynamic hip screws (DHS). The group included 501 patients with 532 DHS procedures performed in the years 1996-2010. In 31 patients osteosynthesis was carried out bilaterally. Osteosynthesis was indicated for femoral neck fracture in 18 hips and for pertrochanteric fracture in 514 hips. Prophylactic antibiotic therapy was administered within 48 hours of surgery. The occurrence of infectious complications (surface and deep wound infection), presence of infectious agents, risk factors, and the course of treatment and its outcome were investigated. Of 532 fractures treated by DHS osteosynthesis, seven were infected (1.3%) as follows: one fracture of the femoral neck with methicillin-resistant Staphylococcus aureus, and, of six pertrochanteric fractures, four with Staphylococcus aureus, one with Escherichia coli and one with Staphylococcus epidermidis. Surface wound infection was diagnosed in one case (0.2%) and deep infection in six cases (1.1%). Five revision DHS procedures were carried out in five patients. One or more risk factors were found in each patient with infected DHS. The treatment of infection included wound dressing and abscess drainage without reoperation in two cases, implant removal in three, and implant removal with femoral head resection and spacer insertion in two cases. Second-stage total hip arthroplasty (THA) was performed in one case. Of the seven infected fractures, five (71%) healed successfully. DISCUSSION DHS osteosynthesis is a reliable method for treating proximal femoral fractures. The 1.3% infection rate in our group is comparable with other relevant studies. This complication is serious and requires prolonged treatment but is not as devastating as an infected THA. For the treatment of infected DHS osteosynthesis, standard methods from screw removal to second-stage THA were employed. Infectious complications following

  6. Frequency of Osteoporosis and Osteopenia According To Bone Mineral Density of Proximal Femur Subregions in Normal and Osteopenic Postmenopausal Women With Respect to Total Hip Bone

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    Murat Ersöz

    2002-09-01

    Full Text Available In this study 29 normal (mean age: 65.6 ± 5.1 years and 33 osteopenic (mean age: 67.6 ± 4.9 years postmenopausal women according to total bone mineral density (BMD of the hip were evaluated for BMD values of subregions of proximal femur. The percentages for osteoporosis and osteopenia with respect to subregions were 13.8% and 58.6% for femoral neck and 20.7% and 41.4% for Ward’s triangle in normal group. In trochanteric and intertrochanteric measurements there were no T scores below –2.5 but 17.2% of the subjects were osteopenic with regard to trochanteric and 6.9% were osteopenic due to intertrochanteric BMD values. The percentages for osteoporosis and osteopenia with respect to subregion measurements were 57.6% and 42.4% for femoral neck, 60.6% and 36.4% for Ward’s triangle, 3% and 78.8% for trochanteric, 9.1% and 87.9% for intertrochanteric regions in osteopenic group according to total hip values. Knowing that hip fracture risk is increasing 2-3 fold for 1 standart deviation decrease from the young adult mean value for all subregions and knowing the relation between cervical hip fractures and BMD values of Ward’s triangle and femoral neck and the relation between intertrochanteric fractures and trochanteric BMD values, it is recommended to evaluate the BMD values of subregions of the hip besides the total hip values in daily practice.

  7. Pseudoarthrosis following proximal humeral fractures: A possible mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Rooney, P.J.; Cockshott, W.P.

    1986-01-01

    A small series of four patients with pseudarthrosis of the proximal humeral shaft is reported. These patients all had restricted movement of the shoulder joint prior to the trauma, three as a result of rheumatoid arthritis and one due a surgical fusion of the glenohumeral joint. It is suggested that pseudarthrosis is more likely under these circumstances and that pursuit of union of the fracture in such patients may not always be necessary.

  8. Comparative Study of Surgical Management of Fracture Neck of Femur with Cemented Versus Uncemented Bipolar Hemiarthroplasty

    Science.gov (United States)

    Niranjan, M

    2017-01-01

    Introduction There is evidence for use of cemented hemiarthroplasty resulting in greater anchoring and lesser peri prosthetic fracture. However, this procedure results in more haemodynamic instability and cardiopulmonary complications termed as ‘cement reaction’ or bone cement implantation syndrome. There has been a heightened interest among surgeons to compare cemented and uncemented hemiarthroplasty for fracture neck of femur. Aim To compare cemented and uncemented hemiarthroplasty in terms of blood loss during the procedure, post-operative complications, mortality, functional recovery and long term clinical outcome. Materials and Methods In a prospective study spanning 8 years from January 2006 to January 2014 in a tertiary care hospital, 52 cases of fracture of neck were selected. Twenty four patients underwent cemented and 28 patients underwent uncemented hemiarthroplasty. Mean follow up duration was 59.3 months. Harris Hip Score evaluation was done at each follow up. Radiological evaluation was done at each follow up for calcar length and periprosthetic fractures. Results Mean age of patients was 70 years. Harris Hip scores at 3, 6 and 12 months did not show statistically significant differences. Periprosthetic osteolysis or loosening was not seen in the present study. No complications noted in uncemented hemiarthroplasty. Four patients who had cemented hemiarthroplasty had infections. No mortality occurred during admission and within 12 months after surgery. Conclusion No significant difference was noted between the cemented and uncemented hemiarthroplasty procedures on long term follow up in terms of functionality. No re-operations and no mortality reported. Cemented hemiarthroplasty had more blood loss and minimal post-operative complications. PMID:28384949

  9. A Review of Management Options for Proximal Humeral Fractures

    Science.gov (United States)

    Jordan, Robert W; Modi, Chetan S

    2014-01-01

    Proximal humeral fractures are common and although the majority can be managed non-operatively, the optimal treatment of displaced or complex fractures remains controversial. Non-operative treatment is typically selected for minimally displaced fractures where union rates are high and good or excellent outcomes can be expected in approximately 80% of cases. The aims of surgical fixation are to restore articular surface congruency, alignment and the relationship between the tuberosities and the humeral head. Hemiarthroplasty provides patients with reliable pain relief and its indications include fracture dislocations, humeral head splitting fractures and some three- and four- part fractures. The key areas of surgical technique that influence functional outcome include correctly restoring the humeral height, humeral version and tuberosity position. Function, however, is poor if the tuberosities either fail to unite or mal-unite. The interest in reverse shoulder arthroplasty as an alternative option has therefore recently increased, particularly in older patients with poor bone quality and tuberosity comminution. The evidence supporting this, however, is currently limited to multiple case series with higher level studies currently underway. PMID:25067968

  10. Study of the interactions between proximal femur 3d bone shape, cartilage health, and biomechanics in patients with hip Osteoarthritis.

    Science.gov (United States)

    Pedoia, Valentina; Samaan, Michael A; Inamdar, Gaurav; Gallo, Matthew C; Souza, Richard B; Majumdar, Sharmila

    2017-07-08

    In this study quantitative MRI and gait analysis were used to investigate the relationships between proximal femur 3D bone shape, cartilage morphology, cartilage biochemical composition, and joint biomechanics in subject with hip Osteoarthritis (OA). Eighty subjects underwent unilateral hip MR-imaging: T1ρ and T2 relaxation times were extracted through voxel based relaxometry and bone shape was assessed with 3D MRI-based statistical shape modeling. In addition, 3D gait analysis was performed in seventy-six of the studied subjects. Associations between shape, cartilage lesion presence, severity, and cartilage T1ρ and T2 were analyzed with linear regression and statistical parametric mapping. An ad hoc analysis was performed to investigate biomechanics and shape associations. Our results showed that subjects with a higher neck shaft angle in the coronal plane (higher mode 1, coxa valga), thicker femoral neck and a less spherical femoral head (higher mode 5, pistol grip) exhibited more severe acetabular and femoral cartilage abnormalities, showing different interactions with demographics factors. Subjects with coxa valga also demonstrated a prolongation of T1ρ and T2. Subjects with pistol grip deformity exhibited reduced hip internal rotation angles and subjects with coxa valga exhibited higher peak hip adduction moment and moment impulse. The results of this study establish a clear relationship between 3D proximal femur shape variations and markers of hip joint degeneration-morphological, compositional, well as insight on the possible interactions with demographics and biomechanics, suggesting that 3D MRI-based bone shape maybe a promising biomarker of early hip joint degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  11. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study.

    Science.gov (United States)

    Konya, Mehmet Nuri; Verim, Özgür

    2017-09-29

    Proximal femoral fracture rates are increasing due to osteoporosis and traffic accidents. Proximal femoral nails are routinely used in the treatment of these fractures in the proximal femur. To compare various combinations and to determine the ideal proximal lag screw position in pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31-A1) of the femur by using optimized finite element analysis. Biomechanical study. Computed tomography images of patients' right femurs were processed with Mimics. Afterwards a solid femur model was created with SolidWorks 2015 and transferred to ANSYS Workbench 16.0 for response surface optimization analysis which was carried out according to anterior-posterior (-10°0) and posterior-anterior directions of the femur neck significantly increased these stresses. The most suitable position of the proximal lag screw was confirmed as the middle of the femoral neck by using optimized finite element analysis.

  12. [Hip arthroplasty for the severe comminuted proximal femoral fracture with psilateral acetabulum fracture].

    Science.gov (United States)

    Lü, Bo; Wang, Yue; Zhu, Jian-Xin; Huang, Chong-Xin; Liao, Tian-Cheng; Wang, An

    2014-09-01

    To investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture. From June 2007 to September 2013, 8 patients (8 hips) with severe comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain, function, range of motion to evaluate clinical effects. There was no untoward reaction in 8 patients. And bed rest at 3 months after operation, waiting for acetabulum fracture healed to out-of-bed activity. There was no complications such as pneumonia, bedsore and so on in the patients. Follow-up time was from 9 to 72 months with an average of 35.8 months, the wound healed, there was no the subsidence and loosening of prosthesis, no dislocation and infection. The mean of Harris score was 87.5 points after operation. The effect of the hip replacement in treating severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic complication, may serve as a substitute for internal fixation of difficult operation. The long-term efficacy is necessary to further observe.

  13. Displaced proximal humeral fractures: an Indian experience with locking plates

    Directory of Open Access Journals (Sweden)

    Aggarwal Sameer

    2010-08-01

    Full Text Available Abstract Background The treatment of displaced proximal humerus fractures, especially in elderly, remains controversial. The objective of this study was to evaluate functional outcome of locking plate used for fixation of these fractures after open reduction. We also attempted to evaluate the complications and predictors of loss of fixation for such an implant. Methods Over two and a half years, 56 patients with an acute proximal humerus fracture were managed with locking plate osteosynthesis. 47 of these patients who completed a minimum follow up of 1 year were evaluated using Constant score calculation. Statistical analysis was done using SPSS 16 and a p value of less than 0.05 was taken as statistically significant. Results The average follow up period was around 21.5 months. Outcomes were excellent in 17%, good in 38.5%, moderate in 34% while poor in 10.5%. The Constant score was poorer for AO-OTA type 3 fractures as compared to other types. The scores were also inferior for older patients (> 65 years old. Complications included screw perforation of head, AVN, subacromial impingement, loss of fixation, axillary nerve palsy and infection. A varus malalignment was found to be a strong predictor of loss of fixation. Conclusion Locking plate osteosynthesis leads to satisfactory functional outcomes in all the patients. Results are better than non locking plates in osteoporotic fractures of the elderly. However the surgery has steep learning curve and various complications could be associated with its use. Nevertheless we believe that a strict adherence to the principles of locking plate use can ensure good result in such challenging fractures.

  14. Correlation of measurable serum markers of inflammation with lung levels following bilateral femur fracture in a rat model

    Directory of Open Access Journals (Sweden)

    Benjamin W Sears

    2010-08-01

    Full Text Available Benjamin W Sears1, Dustin Volkmer1, Sherri Yong2, Ryan D Himes1, Kristen Lauing1, Michele Morgan1, Michael D Stover1, John J Callaci11Department of Orthopaedics, 2Department of Pathology, Loyola University Medical Center, Maywood, IL, USAIntroduction: Evaluation of the systemic inflammatory status following major orthopedic trauma has become an important adjunct in basing post-injury clinical decisions. In the present study, we examined the correlation of serum and lung inflammatory marker levels following bilateral femur fracture.Materials and methods: 45 Sprague Dawley rats underwent sham operation or bilateral femoral intramedullary pinning and mid-diaphyseal closed fracture via blunt guillotine. Animals were euthanized at specific time points after injury. Serum and lung tissue were collected, and 24 inflammatory markers were analyzed by immunoassay. Lung histology was evaluated by a blinded pathologist.Results: Bilateral femur fracture significantly increased serum markers of inflammation including interleukin (IL-2, IL-6, IL-10, GM-CSF, KC/GRO, MCP-1, and WBC. Femur fracture ­significantly increased serum and lung levels of IL-1a and KC/GRO at 6 hours. Lung levels of IL-6 ­demonstrated a trend towards significance. Histologic changes in pulmonary tissue after fracture included pulmonary edema and bone elements including cellular hematopoietic cells, bone fragments and marrow emboli.Discussion and conclusion: Our results indicate that bilateral femur fracture with fixation in rats results in increases in serum markers of inflammation. Among the inflammatory markers measured, rise in the serum KC/GRO (CINC-1, a homolog to human IL-8, correlated with elevated levels of lung KC/GRO. Ultimately, analysis of serum levels of KC/GRO (CINC-1, or human IL-8, may be a useful adjunct to guide clinical decisions regarding surgical timing.Keywords: blunt trauma, injury, cytokine, IL-8, bone marrow emboli

  15. A comparison between the effects of simple and traction splints on pain intensity in patients with femur fractures.

    Science.gov (United States)

    Irajpour, Alireza; Kaji, Nariman Sadeghi; Nazari, Fatemeh; Azizkhani, Reza; Zadeh, Akbar Hassan

    2012-11-01

    Fractures of femur are among the most important causes of mortality in musculoskeletal injuries. Owning to lack of adequate research to compare various techniques of fracture stabilization, there has not yet been an agreement over a protocol to utilize a specific type of splint for femoral fracture immobilization. This study was thus conducted to compare the effects of simple and traction splints on pain intensityimmediately after and at the 1(st), 6(th), and 12(th)h after splinting among patients with femur fracture in the centers affiliated to Isfahan University of Medical Sciences (Isfahan, Iran). This quasi-experimental study was performed on 32 patients with femur fractures. Prehospital emergency ambulances were divided into two groups of simple and traction splints using a table of random numbers. Continuous convenient sampling was employed in each group to use either a simple or a traction splint for the patients with femur fractures. Pain intensity of the patients was then measured by a visual analogue scale (VAS) immediately, 1 h, 6 h, and 12 h after splinting. The effects of the two techniques were finally compared. After splinting, pain intensity decreased significantly in both groups (P = 0.0001 in both groups). The reductions were significantly more in the traction splint group at the 1(st), 6(th)(P = 0.0001), and 12(th)h after splinting (P = 0.02) compared with the simple splint group. There was no significant difference in pain intensity immediately after splintingbetween the two groups (P = 0.441). The significant difference in pain reduction between the simple and traction splint groups at the 1(st), 6(th), and 12(th)h after splinting emphasizes the superiority of traction splints.

  16. Complex AO type C3 distal femur fractures: Results after fixation with a lateral locked plate using modified swashbuckler approach

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    Anuj Agrawal

    2017-01-01

    Full Text Available Background: Complex AO type C3 fractures of the distal femur are challenging injuries, fraught with complications such as malunion and stiffness. We prospectively evaluated a consecutive series of patients with complex AO type C3 distal femur fractures to determine the clinicoradiological outcome after fixation with a single locked plate using modified swashbuckler approach. Materials and Methods: 12 patients with C3 type distal femur fractures treated with a lateral locked plate, using a modified swashbuckler approach, were included in the study. The extraarticular component was managed either by compression plating or bridge plating (transarticular approach and retrograde plate osteosynthesis depending on the fracture pattern. Primary bone grafting was not done in any case. The clinical outcome at 1 year was determined using the Knee Society Score (KSS. The presence of any secondary osteoarthritis in the knee joint was noted at final followup. Results: All fractures united at a mean of 14.3 ± 4.7 weeks (range 6-26 weeks. There were no significant complications such as nonunion, deep infection, and implant failure. One of the patients underwent secondary bone grafting at 3 months. The mean range of motion of the knee was 120° ± 14.8° (range 105°-150°. Seven patients had excellent, three patients had good and two patients had a fair outcome according to the KSS at 1 year. At a mean followup of 17.6 months, three patients showed radiological evidence of secondary osteoarthritis of the knee joint. However, only one of these patients was symptomatic. Conclusion: The results of complex C3 type distal femur fractures, fixed with a single lateral locked plate using a modified swashbuckler approach, are encouraging, with a majority of patients achieving good to excellent outcome at 1 year.

  17. 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.

  18. Extensive hydatidosis of the femur and pelvis with pathological fracture: a case report.

    Science.gov (United States)

    Siwach, Ramchander; Singh, Roop; Kadian, Virender Kumar; Singh, Zile; Jain, Mantu; Madan, Harnam; Singh, Sunita

    2009-11-01

    Hydatid cysts caused by Echinococcus sp can produce tissue cysts anywhere in the body. Skeletal cystic lesions are rare, yet because of their unusual presentation diagnosis can be missed. We report a case of extensive hydatidosis of the femur with pathological fracture and involvement of the pelvis bone, without involvement of abdominal viscera, in a 51-year-old woman. The patient presented with swelling and deformity of the upper and middle third of the left thigh. The diagnosis was confirmed clinico-radiologically and the patient was treated with hindquarter amputation and chemotherapy. The patient died of sepsis and extensive bedsores one month after surgery. Orthopedic surgeons should be alert to this morbid condition and this disease should be suspected in cystic lesions affecting any organ of the body in pathological fractures with non-union, especially in endemic areas of the world. Early diagnosis helps in eradication and salvage of the bone; misdiagnosis and delayed diagnosis are always fraught with the danger of amputation, recurrence, and sepsis.

  19. Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement.

    Science.gov (United States)

    Siegel, H J; Lopez-Ben, R; Mann, J P; Ponce, B A

    2010-05-01

    Bone loss secondary to primary or metastatic lesions of the proximal humerus remains a challenging surgical problem. Options include preservation of the joint with stabilisation using internal fixation or resection of the tumour with prosthetic replacement. Resection of the proximal humerus often includes the greater tuberosity and adjacent diaphysis, which may result in poor function secondary to loss of the rotator cuff and/or deltoid function. Preservation of the joint with internal fixation may reduce the time in hospital and peri-operative morbidity compared with joint replacement, and result in a better functional outcome. We included 32 patients with pathological fractures of the proximal humerus in this study. Functional and radiological assessments were performed. At a mean follow-up of 17.6 months (8 to 61) there was no radiological evidence of failure of fixation. The mean revised musculoskeletal Tumour Society functional score was 94.6% (86% to 99%). There was recurrent tumour requiring further surgery in four patients (12.5%). Of the 22 patients who were employed prior to presentation all returned to work without restrictions. The use of a locking plate combined with augmentation with cement extends the indications for salvage of the proximal humerus with good function in patients with pathological and impending pathological fractures.

  20. Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint.

    Science.gov (United States)

    Liodaki, E; Xing, S G; Mailaender, P; Stang, F

    2015-01-01

    Intra-articular fractures or fracture dislocations of the proximal interphalangeal joint are difficult clinically because the bone and soft tissue structures are small and intricate. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. This article reviews the current methods of treatment, together with the senior author's experience in treating difficult proximal interphalangeal joint fractures and dislocations. Besides conservative treatments, surgical treatments include open or closed reduction with traditional Osteosynthesis, such as K-wires, screws or plates. Among recent developments are the percutaneous application of thin cannulated compression screws and novel dynamic external fixators. After a preferred minimally invasive treatment with stable reconstruction of the articular surface, sufficient aftercare is necessary to improve surgical outcomes. © The Author(s) 2014.

  1. Trends in the surgical treatment of proximal humeral fractures ? a nationwide 23-year study in Finland

    OpenAIRE

    Huttunen Tuomas T; Launonen Antti P; Pihlajamäki Harri; Kannus Pekka; Mattila Ville M

    2012-01-01

    Abstract Background Proximal humeral fractures are common osteoporotic fractures. Most proximal humeral fractures are treated non-surgically, although surgical treatment has gained popularity. The purpose of this study was to determine changes in the surgical treatment of proximal humeral fractures in Finland between 1987 and 2009. Methods The study covered the entire adult (>19 y) population in Finland over the 23-year period from 1st of January 1987 to 31st of December 2009. We assessed the...

  2. A reliable method for measuring proximal tibia and distal femur bone mineral density using dual-energy X-ray absorptiometry

    NARCIS (Netherlands)

    Bakkum, Arjan J. T.; Janssen, Thomas W. J.; Rolf, Marijn P.; Roos, Jan C.; Burcksen, Jos; Knol, Dirk L.; de Groot, Sonja

    Purpose: To assess the intra- and inter-rater reliability of a standardized protocol for measuring proximal tibia and distal femur bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA). Methods: Ten able-bodied individuals (7 males) participated in this study. During one

  3. Treatment of proximal humerus fractures in the elderly

    Science.gov (United States)

    Launonen, Antti P; Lepola, Vesa; Flinkkilä, Tapio; Laitinen, Minna; Paavola, Mika; Malmivaara, Antti

    2015-01-01

    Background and purpose There is no consensus on the treatment of proximal humerus fractures in the elderly. Patients and methods We conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score. Results After 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health-related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10–29%). Interpretation Nonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment. PMID:25574643

  4. Influence of the timing of internal fixation of femur fractures during shock resuscitation on remote organ damage.

    Science.gov (United States)

    Hardy, Benjamin M; Yoshino, Osamu; Quail, Anthony W; Balogh, Zsolt J

    2015-12-01

    Reamed intramedullary nailing is the gold standard for management of femur fractures. Nailing within 24 h is proven to reduce complications from ongoing bleeding, soft-tissue damage and pain. However, when combined with haemorrhagic shock, femur fracture and intramedullary nailing are associated with immune-mediated damage to remote organs. We studied whether delaying fracture fixation until resuscitation was succeeding would lead to a significant reduction in remote organ damage. Twenty male rabbits underwent closed femur fracture, haemorrhagic shock, resuscitation and either immediate nailing (group: ImmFix, n = 9), delayed nailing (group: DelFix, n = 8) or just splinting (group: NoFix, n = 3). Haemorrhagic shock was maintained for 60 min. Resuscitation was with shed blood and Hartmann's solution. Animals were euthanized 8 h after fixation; the lungs and small bowel were scored histologically by two pathologists. Groups did not differ in weight, haemorrhage volume or magnitude of shock. At 8 h, there was no difference in end-organ damage between ImmFix and DelFix groups (11.3 ± 1.6 and 13.2 ± 1.6 versus 8.1 ± 1.3 and 12.9 ± 1.1, P = 0.26 between groups). However, the NoFix group had significantly greater end-organ damage when compared with the fixation at any time groups (17.3 ± 2.7 and 17.0 ± 3.3 versus 9.8 ± 1.1 and 13.1 ± 1, P = 0.01 between groups). In this laboratory model, we have demonstrated that timely femur fracture fixation outweighs the potential harmful effects of surgery performed during haemorrhagic shock with simultaneous resuscitation. We have failed to demonstrate a difference between immediate and delayed fixation during resuscitation. © 2015 Royal Australasian College of Surgeons.

  5. Arterial Injury to the Profunda Femoris Artery following Internal Fixation of a Neck of Femur Fracture with a Compression Hip Screw

    Directory of Open Access Journals (Sweden)

    Simon Craxford

    2013-01-01

    Full Text Available We report the case of an 82-year-old woman who developed extensive proximal thigh swelling and persistent anaemia following internal fixation of an extracapsular neck of femur fracture with a dynamic hip screw (DHS. This was revealed to be a pseudoaneurysm of a branch of profunda femoris artery on angiography. Her case was further complicated by a concurrent pulmonary embolism (PE. She underwent endovascular coil embolisation of the pseudoaneurysm. An IVC filter was inserted and the patient was fully anticoagulated once it had been ensured that there was no active bleeding. In this case, we review the potential for anatomical variations in the blood supply to this region and discuss treatment options for a complicated patient. We recommend that a pseudoaneurysm should be part of a differential diagnosis for postoperative patients with anaemia refractory to blood transfusion so as not to miss this rare but potentially serious complication.

  6. Coffee consumption and CYP1A2 genotype in relation to bone mineral density of the proximal femur in elderly men and women: a cohort study

    Directory of Open Access Journals (Sweden)

    Lind Lars

    2010-02-01

    Full Text Available Abstract Background Drinking coffee has been linked to reduced calcium conservation, but it is less clear whether it leads to sustained bone mineral loss and if individual predisposition for caffeine metabolism might be important in this context. Therefore, the relation between consumption of coffee and bone mineral density (BMD at the proximal femur in men and women was studied, taking into account, for the first time, genotypes for cytochrome P450 1A2 (CYP1A2 associated with metabolism of caffeine. Methods Dietary intakes of 359 men and 358 women (aged 72 years, participants of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, were assessed by a 7-day food diary. Two years later, BMD for total proximal femur, femoral neck and trochanteric regions of the proximal femur were measured by Dual-energy X-ray absorptiometry (DXA. Genotypes of CYP1A2 were determined. Adjusted means of BMD for each category of coffee consumption were calculated. Results Men consuming 4 cups of coffee or more per day had 4% lower BMD at the proximal femur (p = 0.04 compared with low or non-consumers of coffee. This difference was not observed in women. In high consumers of coffee, those with rapid metabolism of caffeine (C/C genotype had lower BMD at the femoral neck (p = 0.01 and at the trochanter (p = 0.03 than slow metabolizers (T/T and C/T genotypes. Calcium intake did not modify the relation between coffee and BMD. Conclusion High consumption of coffee seems to contribute to a reduction in BMD of the proximal femur in elderly men, but not in women. BMD was lower in high consumers of coffee with rapid metabolism of caffeine, suggesting that rapid metabolizers of caffeine may constitute a risk group for bone loss induced by coffee.

  7. Biomechanical analysis of distal femur fracture fixation: fixed-angle screw-plate construct versus condylar blade plate.

    Science.gov (United States)

    Higgins, Thomas F; Pittman, Gavin; Hines, Jerod; Bachus, Kent N

    2007-01-01

    The objective of this study is to establish the relative strength of fixation of a locking distal femoral plate compared with the condylar blade plate. Eight matched pairs of fresh-frozen cadaveric femurs were selected and evaluated for bone density. A gap osteotomy model was used to simulate an OTA/AO A3 comminuted distal femur fracture. One femur of each pair was fixed with the blade plate; the other, with a locking plate. After 100 N preload and 10,000 cycles between 100 N and 1000 N, total displacement of each specimen was assessed. After completion of cyclic loading, maximum load to failure was tested. Significantly greater subsidence (total axial displacement) occurred with the blade plate (1.70 +/- 0.45 mm; range, 1.21-2.48 mm) than with the locking plate fixation (1.04 +/- 0.33 mm; range, 0.67-1.60 mm) after cyclic loading (P = 0.03). In load-to-failure testing, force absorbed by the locking plate before failure (9085 +/- 1585 N; range, 7269-11,850 N) was significantly greater than the load tolerated by the blade plate construct (5591 +/- 945 N; range, 3546-6684 N; P = 0.001). Variability in bone mineral density did not affect the findings (fixed angle distal femoral plate r = 0.1563; condylar blade plate r = 0.0796). The locking screw-plate construct proved stronger than the blade plate in both cyclic loading and ultimate strength in biomechanical testing of a simulated A3 distal femur fracture. Although differences were small, the biomechanical performance of the locking plate construct over the blade plate may lend credence to use of the locking plate versus the blade plate in the fixation of comminuted distal femur fractures.

  8. Atypical femur fracture in an adolescent boy treated with bisphosphonates for X-linked osteoporosis based on PLS3 mutation.

    Science.gov (United States)

    van de Laarschot, Denise M; Zillikens, M Carola

    2016-10-01

    Long-term use of bisphosphonates has raised concerns about the association with Atypical Femur Fractures (AFFs) that have been reported mainly in postmenopausal women. We report a case of an 18-year-old patient with juvenile osteoporosis based on X-linked osteoporosis due to a PLS3 mutation who developed a low trauma femoral fracture after seven years of intravenous and two years of oral bisphosphonate use, fulfilling the revised ASBMR diagnostic criteria of an AFF. The occurrence of AFFs has not been described previously in children or adolescents. The underlying monogenetic bone disease in our case strengthens the possibility of a genetic predisposition at least in some cases of AFF. We cannot exclude that a transverse fracture of the tibia that also occurred after a minor trauma at age 16 might be part of the same spectrum of atypical fractures related to the use of bisphosphonates. In retrospect our patient experienced prodromal pain prior to both the tibia and the femur fracture. Case reports of atypical fractures in children with a monogenetic bone disease such as Osteogenesis Imperfecta (OI) or juvenile osteoporosis are important to consider in the discussion about optimal duration of bisphosphonate therapy in growing children. In conclusion, this case report 1) highlights that AFFs also occur in adolescents treated with bisphosphonates during childhood and pain in weight-bearing bones can point towards this diagnosis 2) supports other reports suggesting that low trauma fractures of other long bones besides the femur may be related to long-term use of bisphosphonates 3) strengthens the concept of an underlying genetic predisposition in some cases of AFF, now for the first time reported in X-linked osteoporosis due to a mutation in PLS3 and 4) should be considered in decisions about the duration of bisphosphonate therapy in children with congenital bone disorders. Copyright © 2016. Published by Elsevier Inc.

  9. Disproportional geometry of the proximal femur in patients with Turner syndrome: a cross-sectional study

    DEFF Research Database (Denmark)

    Nissen, Nis; Gravholt, Claus H; Abrahamsen, Bo

    2007-01-01

    OBJECTIVE: Patients with Turner syndrome (TS) have altered growth and increased risk of osteoporosis due to oestrogen deficiency and possibly a host of other factors. Thus, TS patients have a 4.9-fold increased risk of femoral neck fractures. Most patients are treated with oestrogen during puberty...... with healthy controls. PATIENTS: The study population comprised 58 patients with TS (aged 22-67 years) and 60 age-matched healthy women (aged 21-65 years). MEASUREMENTS: Hip axis length (HAL), neck width (NW), neck shaft angle (NSA), and femoral head-radius (HR) on dual-energy X-ray absorptiometry (DXA) screen...... and adolescence to facilitate pubertal development and prevent secondary osteoporosis. The geometry of the hip is a predictor for hip fractures independent of bone mineral density (BMD). The purpose of the present study was to investigate the variation of the geometry of the hip in patients with TS in comparison...

  10. Sequential Proximal Tibial Stress Fractures associated with Prolonged usage of Methotrexate and Corticosteroids: A Case Report

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    Tan TJL

    2015-11-01

    Full Text Available Stress fractures of the proximal tibia metaphysis are rare in the elderly. We present a case of a 65-year old male who developed sequential proximal tibia stress fractures associated with prolonged usage of methotrexate and prednisolone within a span of 18 months. Magnetic Resonance Imaging revealed an incomplete stress fracture involving the medial proximal tibial region. The patient was treated with stemmed total knee arthroplasty (TKA bilaterally. Stress fractures should be considered in patients with atypical knee pain who have a history of methotrexate and prednisolone usage. TKA is an effective treatment in stress fractures of the proximal tibia.

  11. Influence of Early Bisphosphonate Administration for Fracture Healing in Patients with Osteoporotic Proximal Humerus Fractures.

    Science.gov (United States)

    Seo, Joong-Bae; Yoo, Jae-Sung; Ryu, Jee-Won; Yu, Kun-Woong

    2016-12-01

    Bisphosphonates are generally known to adversely affect fracture healing because they inhibit osteoclastic bone resorption. However, some authors argue that bisphosphonates have no adverse effect on the restoration of the mechanical integrity of long bones after fractures. It is unclear whether bisphosphonates can be initiated safely in patients with acute proximal humerus fractures. The aim of this study was to determine whether the early use of a bisphosphonate affects healing and outcomes of osteoporotic proximal humerus fractures treated with a locking compression plate. Between August 2004 and June 2013, a total of 82 osteoporotic patients who underwent locking plate fixation of proximal humerus fractures were enrolled retrospectively. The patients were divided into two groups according to the timing of the commencement of treatment with alendronate after surgery: group A (n = 34, initiation of the bisphosphonate treatment within two weeks after surgery) and group B (n = 48, control group, initiation of the treatment three months after surgery). Patients were assessed for radiographic union at 2, 6, 10, and 16 weeks, 6 months, and 1 year after surgery. Clinical assessments were performed using the Constant score and American Shoulder and Elbow Surgeons (ASES) score at 1 year after surgery. No significant differences were observed between the two groups with respect to radiographic and clinical outcomes after locking plate fixation. All patients obtained fracture union, and the mean time to radiographic union was similar in group A and group B (6.3 and 6.6 weeks, respectively; p = 0.67). This study shows that the early initiation of bisphosphonate treatment does not affect bone union or clinical outcomes in patients with an osteoporotic proximal humerus fracture treated by locking compression plate fixation.

  12. Radiographic and Computed Tomographic Configuration of Incomplete Proximal Fractures of the Proximal Phalanx in Horses Not Used for Racing.

    Science.gov (United States)

    Brünisholz, Hervé P; Hagen, Regine; Fürst, Anton E; Kuemmerle, Jan M

    2015-10-01

    To characterize the configuration of incomplete proximal fractures of the proximal phalanx (P1) in horses not used for racing and compare radiographic with computed tomography (CT) findings. Historical cohort. Twenty-four horses with incomplete fractures of P1. Medical records of horses not used for racing diagnosed with an incomplete proximal fracture of P1 based on clinical and radiographic examination and confirmed by CT between 2008 and 2013 were retrieved. Radiographs and CT studies of these horses were analyzed using a subjective grading system and by measuring variables that characterized fracture configuration. Twenty-four horses were included (20 Warmbloods) with a mean age of 9.5 years and mean body weight of 574 kg. Fourteen forelimbs and 10 hind limbs were affected. Mean duration of lameness was 8.7 weeks. Computed tomography was superior to radiography in both identifying the fracture and determining fracture size and location. On CT, 92% of fractures were located in the mid-sagittal plane. Mean proximodistal length of the fracture was 13 mm. Fractures were frequently not bicortical. Fractures in forelimbs were located significantly more dorsally than fractures in hind limbs. A distinct fracture pattern with 2 subchondral lines running parallel in close proximity to each other was identified in 54% of cases. Incomplete proximal fractures of P1 have significant variation in their configurations, especially their dorsopalmar/-plantar location. Computed tomography examination allowed clear identification of the fracture configurations and was superior to radiography. © Copyright 2015 by The American College of Veterinary Surgeons.

  13. Does lean tissue mass accrual during adolescence influence bone structural strength at the proximal femur in young adulthood?

    Science.gov (United States)

    Jackowski, S A; Lanovaz, J L; Van Oort, C; Baxter-Jones, A D G

    2014-04-01

    The purpose of this study was to identify whether young adult bone structural strength at the hip is associated with adolescent lean tissue mass (LTM) accrual. It was observed that those individuals who accrued more LTM from adolescence to adulthood had significantly greater adult bone structural strength at the hip. The purpose of this study was to identify whether young adult bone cross-sectional area (CSA), section modulus (Z), and outer diameter (OD) at the hip were associated with adolescent LTM accrual. One hundred three young adult participants (55 males, 48 females) were tertiled into adolescent LTM accrual groupings. LTM accrual was assessed by serial measures using dual energy X-ray absorptiometry (DXA) from adolescence to young adulthood (21.3 ± 1.3 years). CSA, Z, and OD at the narrow neck (NN) and femoral shaft (S) sites of the proximal femur were assessed in young adulthood (21.3 ± 4.5 years), using hip structural analysis. Group differences were assessed using an analysis of covariance, controlling for adult height, weight, sex, and physical activity levels. It was found that individuals with higher adjusted adolescent LTM accrual had significantly greater adult adjusted values of NNCSA (2.49 ± 0.06 vs 2.77 ± 0.07 cm(2)), NN Z (1.18 ± 0.04 vs 1.37 ± 0.04 cm(3)), NN OD (3.07 ± 0.04 vs 3.21 ± 0.04 cm), SCSA (3.45 ± 0.08 vs 3.88 ± 0.09 cm(3)), and SZ (1.77 ± 0.05 vs 2.00 ± 0.05 cm(3)) than individuals with lower LTM accrual (p femur.

  14. Ipsilateral obturator type of hip dislocation with fracture shaft femur in a child: a case report and literature review.

    Science.gov (United States)

    Arjun, R H H; Kumar, Vishal; Saibaba, Balaji; John, Rakesh; Guled, Uday; Aggarwal, Sameer

    2016-09-01

    The incidence of traumatic hip dislocations in children is rising in this fast developing world along with increasing numbers of high-velocity road traffic accidents. Anterior dislocation of the hip has a lower incidence compared with posterior dislocation of the hip. We encountered a rare case of the obturator type of anteriorly dislocated hip associated with ipsilateral fracture of the shaft femur in an 11-year-old child. This is a highly unusual injury combination and the mechanism of injury is obscure. Only two similar cases have been reported in the English literature to date. Closed reduction of the hip using a hitherto undescribed technique and an intramedullary interlocking nail was performed in this case. At 6 months of follow-up, the fracture shaft femur has united and the child is bearing full weight on the limb.

  15. Chip Fracture of the Proximal Phalanx in Hard Working Donkeys

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    M.A. Semieka

    2012-10-01

    Full Text Available The present study was carried out in six mature hard working donkeys of both sexes. They were selected from the clinical cases admitted to the Veterinary Medicine Teaching Hospital, Assiut University during the period of 2007-2010. These animals suffering from chip fracture of the proximal phalanx. Diagnoses of the cases were depending on history, clinical examination and radiographic description. Surgical removal of the bone fragment was performed in all cases. Follow up of the cases revealed satisfactory results without any postoperative complications.

  16. Immediate weight-bearing after osteosynthesis of proximal tibial fractures may be allowed

    DEFF Research Database (Denmark)

    Haak, Karl Tobias; Palm, Henrik; Holck, Kim

    2012-01-01

    Immediate weight-bearing following osteosynthesis of proximal tibial fractures is traditionally not allowed due to fear of articular fracture collapse. Anatomically shaped locking plates with sub-articular screws could improve stability and allow greater loading forces. The purpose of this study...... was to investigate if immediate weight-bearing can be allowed following locking plate osteosynthesis of proximal tibial fractures....

  17. Comparison of Primary Hip Spica with Crossed Retrograde Intramedullary Rush Pins for the Management of Diaphyseal Femur Fractures in Children: A Prospective, Randomized Study

    Directory of Open Access Journals (Sweden)

    Mohammad Ruhullah

    2013-12-01

    Conclusions: Intra-medullary crossed Rush pinning is an effective method of paediatric diaphyseal femur fracture fixation as compared to primary hip spica in terms of early weight bearing and restoration of normal anatomy.

  18. Utility of the simplified Wells and revised Geneva scores to exclude pulmonary embolism in femur fracture patients.

    Science.gov (United States)

    Kim, Youn-Jung; Choi, Dae-Hee; Lee, Eu Sun; Ryoo, Seung Mok; Ahn, Shin; Sohn, Chang Hwan; Seo, Dong-Woo; Lim, Kyoung Soo; Kim, Won Young

    2017-08-01

    The diagnosis of acute pulmonary embolism (PE) in trauma patients is challenging. This study evaluated the diagnostic value of simplified Wells and simplified revised Geneva scores to predict PE in femur fracture patients in emergency department (ED). All consecutive adult patients with femur fractures and elevated D-dimer levels (>0.5μg/mL) who underwent CTPA within 72h of injury from January 2010 to December 2014 were included. The simplified Wells and simplified revised Geneva scores were applied to evaluate the clinical probability of PE. Among 519 femur fracture patients, 446 patients were finally included, and 23 patients (5.2%) were diagnosed with acute PE. The median values of simplified Wells and simplified revised Geneva scores [0 (IQR: 0-1) vs. 0 (IQR: 0-0), P=0.23; 3 (IQR: 2-4) vs. 3 (IQR: 2-3), P=0.48] showed no differences between the PE (n=23) and non-PE (n=423) groups. Using the simplified Wells score, 98% of the patients were categorized into the "PE unlikely" group. The sensitivity, specificity, positive predictive value, and negative predictive value of the simplified revised Geneva score (≥3 points) for the diagnosis of PE were 74%, 35%, 6%, and 96%, respectively. In femur fracture patients with elevated D-dimer levels, the simplified Wells and simplified revised Geneva scores have limited predictive value. However, the simplified revised Geneva score of <3 points may be possibly used as a diagnostic tool. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects

    Science.gov (United States)

    Pathrot, Devendra; Ul Haq, Rehan; Aggarwal, Aditya N; Nagar, Mahindra; Bhatt, Shuchi

    2016-01-01

    Background: Intramedullary devices have increasingly become popular and are widely used for fixation of unstable intertrochanteric and subtrochanteric fractures. These implants have been designed taking into consideration of the anthropometry of the western population which varies from those of other ethnic groups. This study was carried out to assess the geometry of proximal femur for the placement of short cephalomedullary nails in our subset of patients and suggest suitable design modifications based on these parameters. Materials and Methods: The study was conducted in the following three groups: (1) Anthropometric study of 101 adult human dry femora, (2) radiographs of the same femora, and (3) radiographs of the contralateral uninjured limb of 102 patients with intertrochanteric or subtrochanteric fractures. In Group 1, standard anthropometric techniques were used to measure neck shaft angle (NSA), minimal neck width (NW), trochanteric offset, and distance from the tip of greater trochanter (GT) to the lower border of lesser trochanter on the femoral shaft axis (distance X). In Group 2 and 3, the NSA, minimal NW, NW at 130° and 135°, trochanteric shaft angle (TSA), trochanteric offset, distance X, distance between the tip of GT and the point where the neck axis crosses the line joining the tip of the GT to the lower border of the lesser trochanter on the femoral shaft axis (distance Y), and canal width at 10, 15, and 20 cm from tip of GT were measured on standard radiographs. The values obtained in these three groups were pooled to obtain mean values. Various parameters of commonly used short cephalomedullary nails available for fixation of pertrochanteric fractures were obtained. These were compared to the results obtained to suggest suitable modifications in the nail designs for our subset of patients. Results: The mean parameters observed were as follows: NSA 128.07° ± 4.97 (range 107°–141°), minimum NW 29.0 ± 2.8 mm (range 22–42 mm), NW at 130

  20. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects

    Directory of Open Access Journals (Sweden)

    Devendra Pathrot

    2016-01-01

    Full Text Available Background: Intramedullary devices have increasingly become popular and are widely used for fixation of unstable intertrochanteric and subtrochanteric fractures as well. These implants have been designed taking into consideration the anthropometry of the western population whose anthropometry varies from those of other ethnic groups. This study was carried out to assess the geometry of proximal femur for the placement of short cephalomedullary nails in our subset of patients and suggest suitable design modifications based on these parameters. Materials and Methods: The study was conducted in the following three groups: (1 Anthropometric study of 101 adult human dry femora, (2 radiographs of the same femora, and (3 radiographs of the contralateral uninjured limb of 102 patients with intertrochanteric or subtrochanteric fractures. In Group 1, standard anthropometric techniques were used to measure neck shaft angle (NSA, minimal neck width (NW, trochanteric offset, and distance from the tip of greater trochanter (GT to the lower border of lesser trochanter on the femoral shaft axis (distance X. In Group 2 and 3, the NSA, minimal NW, NW at 130° and 135°, trochanteric shaft angle (TSA, trochanteric offset, distance X, distance between the tip of GT and the point where the neck axis crosses the line joining the tip of the GT to the lower border of the lesser trochanter on the femoral shaft axis (distance Y, and canal width at 10, 15, and 20 cm from tip of GT were measured on standard radiographs. The values obtained in these three groups were pooled to obtain mean values. Various parameters of commonly used short cephalomedullary nails available for fixation of pertrochanteric fractures were obtained. These were compared to the results obtained to suggest suitable modifications in the nail designs for our subset of patients. Results: The mean parameters observed were as follows: NSA 128.07° ± 4.97 (range 107°–141°, minimum NW 29.0 ± 2.8 mm

  1. Site-specific advantages in skeletal geometry and strength at the proximal femur and forearm in young female gymnasts.

    Science.gov (United States)

    Dowthwaite, Jodi N; Rosenbaum, Paula F; Scerpella, Tamara A

    2012-05-01

    We evaluated site-specific skeletal adaptation to loading during growth, comparing radius (RAD) and femoral neck (FN) DXA scans in young female gymnasts (GYM) and non-gymnasts (NON). Subjects from an ongoing longitudinal study (8-26yr old) underwent annual DXA scans (proximal femur, forearm, total body) and anthropometry, completing maturity and physical activity questionnaires. This cross-sectional analysis used the most recent data meeting the following criteria: gynecological age ≤2.5yr post-menarche; and GYM annual mean gymnastic exposure ≥5.0h/wk in the prior year. Bone geometric and strength indices were derived from scans for 173 subjects (8-17yr old) via hip structural analysis (femoral narrow neck, NN) and similar radius formulae (1/3 and Ultradistal (UD)). Maturity was coded as M1 (Tanner I breast), M2 (pre-menarche, ≥Tanner II breast) or M3 (post-menarche). ANOVA and chi square compared descriptive data. Two factor ANCOVA adjusted for age, height, total body non-bone lean mass and percent body fat; significance was tested for main effects and interactions between gymnastic exposure and maturity. At the distal radius, GYM means were significantly greater than NON means for all variables (padvantages only in M1 and M3; for BMC and buckling ratio, M1 advantages were greatest); 2) 1/3 radius BMC, width, endosteal diameter, cortical cross-sectional area, and section modulus (GYM advantages primarily post-menarche); and 3) UD radius BMC and axial compressive strength (GYM advantages were larger with greater maturity, greatest post-menarche). Maturity-specific comparisons suggested site-specific skeletal adaptation to loading during growth, with greater advantages at the radius versus the proximal femur. At the radius, GYM advantages included greater bone width, cortical cross-sectional area and cortical thickness; in contrast, at the femoral neck, GYM bone tissue cross-sectional area and cortical thickness were greater, but bone width was narrower than

  2. Interventions for treating proximal humeral fractures in adults.

    Science.gov (United States)

    Handoll, Helen H G; Brorson, Stig

    2015-11-11

    Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference proceedings and bibliographies of trial reports. The full search ended in November 2014. We considered all randomised controlled trials (RCTs) and quasi-randomised controlled trials pertinent to the management of proximal humeral fractures in adults. Both review authors performed independent study selection, risk of bias assessment and data extraction. Only limited meta-analysis was performed. We included 31 heterogeneous RCTs (1941 participants). Most of the 18 separate treatment comparisons were tested by small single-centre trials. The main exception was the surgical versus non-surgical treatment comparison tested by eight trials. Except for a large multicentre trial, bias in these trials could not be ruled out. The quality of the evidence was either low or very low for all comparisons except the largest comparison.Nine trials evaluated non-surgical treatment in mainly minimally displaced fractures. Four trials compared early (usually one week) versus delayed (three or four weeks) mobilisation after fracture but only limited pooling was possible and most of the data were from one trial (86 participants). This found some evidence that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and

  3. Anatomic study of the proximal third of the femur: femoroacetabular impact and the cam effect

    OpenAIRE

    Pedro José Labronici; Sergio Delmonte Alves; Anselmo Fernandes da Silva; Gilberto Ribeiro Giuberti; Rolix Hoffmann; Justino Nóbrega de Azevedo Neto; Jorge Luiz Mezzalira Penedo

    2009-01-01

    OBJETIVO: Analisar as varia��ões anatômicas da extremidade proximal do fêmur que pudessem desenvolver o impacto femoroacetabular. MÉTODOS: Foram utilizados 199 espécimes anatômicos de fêmures esqueleticamente maduros. Os fêmures foram medidos para determinar o ângulo da anteversão do colo femoral, ângulo cervicodiafisário, esfericidade da cabeça femoral em ântero-posterior e súpero-inferior, ângulo entre a epífise e o colo femoral anterior, ângulo entre a epífise e o colo em perfil, distância...

  4. Biomechanical comparison of a 3.5-mm conical coupling plating system and a 3.5-mm locking compression plate applied as plate-rod constructs to an experimentally created fracture gap in femurs of canine cadavers.

    Science.gov (United States)

    Tremolada, Giovanni; Lewis, Daniel D; Paragnani, Ken Luka; Conrad, Bryan P; Kim, Stanley E; Pozzi, Antonio

    2017-06-01

    OBJECTIVE To compare stiffness and resistance to cyclic fatigue of two 3.5-mm locking system plate-rod constructs applied to an experimentally created fracture gap in femurs of canine cadavers. SAMPLE 20 femurs from cadavers of 10 mixed-breed adult dogs. PROCEDURES 1 femur from each cadaver was stabilized with a conical coupling plating system-rod construct, and the contralateral femur was stabilized with a locking compression plate (LCP)-rod construct. An intramedullary Steinmann pin was inserted in each femur. A 40-mm gap then was created; the gap was centered beneath the central portion of each plate. Cyclic axial loading with increasing loads was performed. Specimens that did not fail during cyclic loading were subjected to an acute load to failure. RESULTS During cyclic loading, significantly more LCP constructs failed (6/10), compared with the number of conical coupling plating system constructs that failed (1/10). Mode of failure of the constructs included fracture of the medial or caudal aspect of the cortex of the proximal segment with bending of the plate and pin, bending of the plate and pin without fracture, and screw pullout. Mean stiffness, yield load, and load to failure were not significantly different between the 2 methods of stabilization. CONCLUSIONS AND CLINICAL RELEVANCE Both constructs had similar biomechanical properties, but the conical coupling plating system was less likely to fail than was the LCP system when subjected to cyclic loading. These results should be interpreted with caution because testing was limited to a single loading mode.

  5. [Unstable pertrochanteric femur fractures. Failure rate, lag screw sliding and outcome with extra- and intramedullary devices (PCCP, DHS and PFN)].

    Science.gov (United States)

    Knobe, M; Münker, R; Sellei, R M; Schmidt-Rohlfing, B; Erli, H J; Strobl, C S; Niethard, F U

    2009-01-01

    The dynamic hip screw (DHS) often shows a high incidence of therapeutic failure and an impared outcome in the treatment of the unstable pertrochanteric femur fracture (31A2). Therefore often an intramedullary device is recommended. In a retrospective clinical study we examined whether the percutaneous compression plate (PCCP, Gotfried) provides advantages following unstable fractures in comparison to DHS and PFN. From January 2002 to April 2007 135 patients with unstable pertrochanteric femur fractures underwent internal fixation with the PCCP (n = 46, age 78.3, ASA 2.8), DHS (n = 36, age 75.9, ASA 3.0) or PFN (n = 53, age 77.2, ASA 2.8). Radiological and clinical re-examination of the patients (33 PCCP, 24 DHS, 34 PFN) was performed 17 months later. The PCCP was implanted in less time than the DHS and PFN (59 vs. 80 vs. 79 min, p = 0.004). Radiographic screening time was low (PCCP 143 vs. DHS 146 vs. PFN 280 s, p = 0.001). Re-operations for wound infections and haematomas occurred in 2 % after PCCP, 14 % after DHS and 4 % after PFN (p = 0.058). There was a low re-operation rate for fracture fixation complications in PCCP (9 %), in contrast to DHS (25 %) and PFN (13 %, p = 0.109). Cut-out was seen more in DHS (19 %, PCCP 2 %, PFN 4 %, p = 0.005). Lag screw sliding was high with DHS (PCCP 4 mm vs. DHS 9 mm vs. PFN 6 mm, p = 0.032). There was no correlation between lag screw sliding and outcome. PCCP, DHS and PFN had the same functional results in Merle d'Aubigné and Harris hip scores. Using the minimally invasive PCCP technique in unstable pertrochanteric femur fractures provides a promising therapy option especially with regard to surgical time, radiographic screening time and failure rate. Lag screw sliding was low. There was no advantage of the intramedullary device PFN.

  6. Pulsed electromagnetic fields for postmenopausal osteoporosis and concomitant lumbar osteoarthritis in southwest China using proximal femur bone mineral density as the primary endpoint: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Liu, Hui-Fang; He, Hong-Chen; Yang, Lin; Yang, Zhou-Yuan; Yao, Ke; Wu, Yuan-Chao; Yang, Xi-Biao; He, Cheng-Qi

    2015-06-10

    Osteoporosis (OP) and osteoarthritis (OA) are prevalent skeletal disorders among postmenopausal women. Coexistence is common especially that of postmenopausal osteoporosis (PMO) and lumbar OA. An hypothesis has been raised that OP and OA might share the same pathogenic mechanism, and pulsed electromagnetic fields (PEMFs) were reported to have anti-osteoporosis and anti-osteoarthritis properties, but this suggestion was based primarily on biomarker data. Therefore, whether these two effects could take place simultaneously has not yet been investigated. This randomized controlled trial (RCT) is designed to explore the effect of PEMFs for PMO and concomitant lumbar OA. The study will include PMO patients (postmenopausal women; aged between 50 and 70 years; have been postmenopausal for at least 5 years and diagnosed with OP using proximal femur T-score) with concomitant lumbar OA (patients with confounding disorders like diabetes, hypertension, hyperlipidemia, and previous fracture history, etcetera, will be excluded) will be randomly assigned to two arms: PEMFs group and sham PEMFs group. There will be 25 participants in each arm (50 in total) and the outcome assessment, including the primary endpoint (proximal femur bone mineral density), will be performed at 5 weeks, 3 months and 6 months after enrollment. PMO and lumbar OA are prominent public health problem, especially for postmenopausal women. We hope this RCT will provide scientific evidence to primary care of the postmenopausal women regarding the use of these nonpharmaceutical, noninvasive modalities, PEMFs, in managing PMO and lumbar OA. Chinese Clinical Trial Registry: ChiCTR-TRC-14005156 (28 August 2014).

  7. Pelvis width associated with bone mass distribution at the proximal femur in children 10–11 years old

    Science.gov (United States)

    Cardadeiro, Graça; Baptista, Fátima; Janz, Kathleen F.; Rodrigues, Luís A.; Sardinha, Luís B.

    2015-01-01

    Differences in skeletal geometry may generate different patterns of mechanical loading to bone. Impact and muscle loading during physical activity have been shown to influence skeletal geometry. The purpose of this study was to compare geometric measures of the pelvis and proximal femur (PF) of young children and to analyze the contribution and potential interaction of these geometric measures with physical activity on PF bone mass distribution. Participants were 149 girls and 145 boys, aged 10–11 years. Total body and left hip DXA scans were used to derive pelvic and PF geometric measures and PF bone mineral density (BMD) at the femoral neck (FN), trochanter (TR), and intertrochanter (IT). These subregions were used to represent bone mass distribution via three BMD ratios: FN:PF, TR:PF, and IT:PF. Physical activity was objectively measured using accelerometry, and maturity was estimated as the years of distance from peak height velocity. When compared to boys, girls had a wider pelvic diameter and greater interacetabular distances (p pelvis than boys, which accounted for proportionally greater BMD of the TR than other subregions of the PF. PMID:23744478

  8. Estimation of Purkait's triangle method and alternative models for sex assessment from the proximal femur in the Spanish population.

    Science.gov (United States)

    Djorojevic, Mirjana; Roldán, Concepción; Botella, Miguel; Alemán, Inmaculada

    2016-01-01

    The current study was undertaken to test the validity and reproducibility of the Purkait triangle method and some alternative proposals for sex prediction from the proximal femur in the adult population of Spain. To that end, sexual dimorphism of the maximum femoral head diameter and the minimum femoral neck diameter were also evaluated. The study was conducted on 186 femora (109 males and 77 females) taken from the San José collection of identified individuals (Southern Spain). Discriminant function analyses (DFA) employing the jackknife procedure for cross-validations were considered. Overall, more than 94% of individuals of both sexes were correctly classified. The most dimorphic single variable from the triangle method was the intertrochanteric apex distance (BC) that reached 85.5% accuracy, falling below those obtained for the femoral head and femoral neck diameter, respectively, (89.8 and 91.9%). Combining BC with the neck diameter, the predictive ability increased to 92.5%; when femoral head diameter was added to the latter two, the classification success rate improved further up to 94.6% (94.1% after cross-validation). We conclude that the classification success rates of the Purkait's method remained considerably below any of those obtained with the models proposed in the present study which proved to be a much better and more reliable choice both as single predictors and in combination with other variables.

  9. A method for designing plates in treatments of proximal humeral fracture and distal radial fracture

    Directory of Open Access Journals (Sweden)

    Lin Wang

    2016-11-01

    Full Text Available The purpose of this paper was to quickly design fixation plates for fractured proximal humerus and distal radius according to the requirements of surgical treatment. Therefore, a new method to quickly design cloverleaf plate appropriate for proximal humerus and volar plate appropriate for distal radius is put forward. First, three-dimensional (3D reconstruction models of fractured proximal humerus and distal radius were generated based on deforming mean parametric models of proximal humerus and distal radius, respectively. Second, based on region-of-interest marked on the 3D reconstruction model of proximal humerus and distal radius, abutted surfaces of cloverleaf plate and volar plate were established, respectively. Then, parametric abutted surface was established after setting rational parameters for the surface of the cloverleaf plate. Parametric abutted surface of volar plate was established using the same method. Finally, parametric cloverleaf plate and volar plate are generated through thickening their respective parametric abutted surfaces. The parametric plates, acting as templates, accelerate and simplify the design process and therefore allow users to construct plate with editing valid parameters easily. Group of cloverleaf plates and volar plates with different sizes were generated quickly, showing that the proposed method is feasible and effective.

  10. The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures.

    Science.gov (United States)

    Kim, Tae In; Choi, Jun Ha; Kim, Sae Hoon; Oh, Joo Han

    2016-09-01

    The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared. A search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are responsible for the fracture treatment and shoulder diseases.

  11. Bilateral undisplaced insufficiency neck of femur fractures associated with short-term steroid use: a case report

    Directory of Open Access Journals (Sweden)

    Gurdezi Sabahat

    2008-03-01

    Full Text Available Abstract Introduction We present an interesting and unusual case of a 61-year-old woman with bilateral, undisplaced, stress neck of femur fractures associated with short-term steroid use. Insufficiency fractures of the neck of femur without preceding trauma have been described in the literature, although bilateral involvement is infrequent. These fractures have been associated with strenuous exercise, seizures, renal osteodystrophy, fluoride treatment, long-term corticosteroid use, amenorrhoea, abnormal anatomy and osteomalacia due to nutritional and/or hormonal factors. Case Presentation The case we present differs from other published reports, in that the patient's symptoms developed acutely after only a short course of steroids and with no associated trauma or strenuous exercise. It is also the only case described where no operative intervention was required. Conclusion Our case reiterates the importance of considering insufficiency or stress fractures in high-risk patients who present with musculoskeletal pain. Institution of bone protection should also be considered in these patients. Morbidity related to delayed treatment has been well documented, so a high level of clinical suspicion is imperative.

  12. Simultaneous Bilateral Femur Neck Fracture in A Young Adult with Chronic Renal Failure- A Case Report and Review of Literature

    Science.gov (United States)

    V, Sathyanarayana; Patel, Maulik Tulsibhai; S, Raghavan; D, Naresh

    2015-01-01

    Introduction: Pathological bilateral femoral neck fracture due to renal osteodystrophy is rare. This is a report of a chronic renal failure patient who had sustained bilateral intra-capsular displaced fracture neck of femur following an episode of convulsion and the difficulties encountered in early diagnosis and treatment. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure are also discussed. Case Report: A 23 years old male patient admitted with h/o dysuria, pyuria and loss of appetite since 3 months. He was a known case of chronic renal failure and reflux nephropathy. On investigating, patient’s renal parameters were high and he was started with haemodialysis. The next day patient had c/o bilateral hip pain and inability to move bilateral lower limbs following an episode of seizure. Radiograph of pelvis showed vertical sub capital fractures of bilateral neck of femur. In this patient, considering his age, general condition & prognosis, an elective surgery in the form of bilateral uncemented modular bipolar hemiarthroplasty was done. Conclusion: Overall risk of hip fracture among patients with chronic renal failure is considerably higher than in the general population, independent of age and gender. Simultaneous spontaneous bilateral fractures of the femoral neck are rare and a delayed diagnosis is usual. The study of etiological factors of these fractures is essential to guide us in choosing the treatment of choice. Obviously patient’s age, life expectancy as well as renal co morbidity has an influence over deciding treatment and outcome. PMID:27299091

  13. The Relationship between Osteoarthritis of the Knee and Bone Mineral Density of Proximal Femur: A Cross-Sectional Study from a Korean Population in Women

    OpenAIRE

    Im, Gun-Il; Kwon, Oh-jin; Kim, Chang Hee

    2014-01-01

    Background The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. Methods One hundred ninety-five female patients who had knee pain and radiologica...

  14. Implant-related Fractures in Children With Proximal Femoral Osteotomy: Blade Plate Versus Screw-side Plate Constructs.

    Science.gov (United States)

    Jain, Amit; Thompson, John M; Brooks, Jaysson T; Ain, Michael C; Sponseller, Paul D

    2016-01-01

    Implant design may affect risk of fracture, especially in the proximal femur, which has been shown to have the highest risk of implant-related fracture (IRF). Blade plate (BPL) and screw-side plate (SSP) implants are used to stabilize proximal femoral osteotomies (PFOs). Our goal was to compare BPL and SSP constructs with regard to the rate, location, and timing of IRF in children undergoing PFOs. We retrospectively reviewed clinical and radiographic records from 1 pediatric orthopaedic practice from 1995 through 2010. We identified 734 children 18 years or younger who underwent PFO with a BPL (480 patients) or an SSP (254 patients). Manufacture and style of implants were consistent throughout this period. There were no significant differences between the 2 groups in terms of mean age, sex, race, or diagnosis. The 2 groups were compared with respect to the rate, location, and timing of IRF. The t, Z, χ, and Fisher exact tests were used to analyze the data (statistical significance, Ptimes to fracture were 3.8±2.9 and 2.4±2.3 years (P=0.39) in the BPL and SSP groups, respectively. The risk of IRF in children after PFO is substantial. Despite differences in design, there was no significant difference between BPL and SSP implants with respect to IRF risk. Level III.

  15. Missed posterior shoulder dislocation with malunited proximal humerus fracture

    Directory of Open Access Journals (Sweden)

    Kumar Sunil

    2013-12-01

    Full Text Available 【Abstract】Posterior dislocation of the shoulder may be missed or neglected at initial presentation especially in developing countries. We present a case of 40-year-old In- dian man who had 3-month missed posterior dislocation of the right shoulder along with malunited fracture of the ana- tomical neck of the humerus. Open reduction and stabiliza- tion with modified McLaughlin procedure was performed. Rotational osteotomy of proximal humerus had to be per- formed as supplementary procedure to keep the humeral head stable in glenoid cavity during functional range of movements. The patient had excellent result of the shoulder at 3 years follow-up. Key words: Shoulder dislocation; Humerus; Osteotomy

  16. The Reversed Less Invasive Stabilisation System-Distal Femur Technique: Application in an Adult Patient with Osteogenesis Imperfecta Sustaining a Femoral Fracture.

    Science.gov (United States)

    Hanke, Markus S; Keel, Marius Johann; Todorski, Inga A; Bastian, Johannes Dominik

    2017-01-01

    The aim of this study was to report the surgical management and to discuss the options for fracture fixation in an adult patient with osteogenesis imperfecta (OI) who sustained a trochanteric femoral fracture after a simple fall from standing position. As a result of multiple fractures during childhood, this adult patient with OI presented with a short stature. The radiographs revealed a displaced, intertrochanteric fracture with subtrochanteric extension of the left femur. The intramedullary canal was narrow, the femur presented with a severe bowing deformity, and the bone quality was poor. The implant of choice was plating using the reversed less invasive stabilisation system-distal femur (LISS-DF) technique. This technique was introduced for the management of subtrochanteric fractures in the elderly with poor bone stock. In addition, a locking plate attached to the LISS-DF allowed for additional screw placement at the apex of the curvature of the femur although the plate was not in line with the femur at this site. Cerclages were used for metaphyseal reduction and fixation. 4-month postoperatively, the patient was ambulatory without any assistance with full weight bearing. At the latest follow-up 1-year postoperatively, the patient was still free of complaints and at her preinjury activity level. The presented technique was successful as a salvage procedure in a rare case of adult OI presenting with a femoral fracture with characteristics influencing the decision-making in treatment options.

  17. Supracondylar skeletal traction and open interlocking nailing for neglected fracture of the shaft of femur - Retrospective study.

    Science.gov (United States)

    Krishnakumar, R; Thiruvenkitaprasad, G; Kaliaperumal, Dayanand; Sundaram, Nandkumar

    2013-09-01

    Neglected trauma is a common problem faced by Orthopaedic surgeons practicing in developing countries. Nothing much in English literature is available regarding the practical difficulties and guidelines for treating neglected trauma of long bones. In our institution from November 2003 to October 2009 we treated 25 cases of neglected fracture of shaft of femur. Patients underwent either of three types of management protocols depending upon the preoperative manual traction radiographs. The fracture was fixed with open interlocking nail. Primary bone grafting and bone shortening procedures were not performed in any of the patient. The fractures united in all patients at an average duration of 17 weeks. Two patients had limb length discrepancy. Careful preoperative evaluation is mandatory for good results. Preoperative skeletal traction and two stage surgical procedure may be required to avoid limb length discrepancy and neurovascular complication.

  18. A comparative study of fracture shaft of femur in adults treated with broad dynamic compression plate versus intramedullary interlocking nail

    Directory of Open Access Journals (Sweden)

    Sushil Thapa

    2016-08-01

    Full Text Available Background and Objectives: Diaphyseal femur fracture is one of the commonest fractures to present in an emergency room. The objective of the study was to compare femoral shaft fractures treated using nail with those using plate and screws. Patients and Methods: We studied a total of 62 patients of fracture shaft of femur admitted in the Bharatpur Hospital, Bharatpur, Chitwan and National Academy of Medical Sciences, BirHospital,Kathmandu. Two cases were lost to follow up. Thirty cases were treated with plating and 30 cases with nailing. The age group was from 16-30 years. Fifty-three were male and seven were females. Fifty-eight patients had closed fracture and two had Gustillo Anderson grade I openfracture. Result: Time from injury to surgery was 19 days on an average. Mean time for union was more in patients treated by plating, 19.46 weeks as compared to nailing 14.78 weeks. We found one case of infection with plating and breakage of plate in four patients. One patient with nailing did not show any signs of healing and two had failure in case of nailing. Our series revealed 23(38.3% excellent, five (8.3% good and two (3.3% poor results in patients who had nailing while 15 (25.5% excellent, nine (15% good, one (1.7% fair and five (8.3% poor in patients who had plating out of 30 patients in each group. Conclusion:In our study we found that there was no significant difference in outcomes between plating and intramedullary nailing of femoral diaphysis fracture in terms of union, infection and implant failure.JCMS Nepal. 2016;12(2:66-9.

  19. Early Definitive Fixation of an Open Periprosthetic Femur Fracture in the Polytraumatized Patient: A Case Report and Review of the Literature.

    Science.gov (United States)

    Aleem, Ilyas S; Bhandari, Mohit; Elizalde, Sebastian Rodriguez

    2016-01-01

    Periprosthetic fractures of the femur after total hip arthroplasty are increasing in frequency. In the polytraumatized patient with long-bone fracture, an ongoing debate exists regarding early definitive stabilization versus initial damage control orthopaedics, followed by delayed fixation. It remains to be seen whether this rationale applies to the polytraumatized patient with periprosthetic fracture. We present the case of a 73-years old Caucasian woman who sustained bilateral Gustillo-Anderson grade III open femur fractures; the fracture on the right was a Vancouver C open periprosthetic fracture after cemented total hip arthroplasty. After massive fluid resuscitation in the trauma bay she was taken to the intensive care unit in a hemodynamically unstable condition. She was subsequently operated and underwent early definitive fixation of both femurs with the rationale of potentially reducing pulmonary complications and promoting early mobilization. Early definitive stabilization versus delayed fixation in the polytraumatized patient with an open periprosthetic femur fracture is reviewed. Although several treatment algorithms based on fracture classification and implant stability exist, further study is required to delineate the preferred method and timeline of fixation for this growing cohort of patients.

  20. Cumulative Alendronate Dose and the Long-Term Absolute Risk of Subtrochanteric and Diaphyseal Femur Fractures: A Register-Based National Cohort Analysis

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia Agnete; Eastell, Richard

    2010-01-01

    Context: Bisphosphonates are the mainstay of anti-osteoporotic treatment and are commonly used for a longer duration than in the placebo-controlled trials. A link to development of atypical subtrochanteric or diaphyseal fragility fractures of the femur has been proposed, and these fractures...... are currently the subject of a U.S. Food and Drug Administration review. Objective: Our objective was to examine the risk of subtrochanteric/diaphyseal femur fractures in long term users of alendronate. Design: We conducted an age- and gender-matched cohort study using national healthcare data. Patients...

  1. Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment

    NARCIS (Netherlands)

    Sanders, R.J.; Thissen, L.G.; Teepen, J.C.; Kampen, A. van; Jaarsma, R.L.

    2011-01-01

    BACKGROUND: Since its introduction, there has been controversy about the use of locking plates in the treatment of proximal humeral fractures. Have they really improved the functional outcome after a proximal humeral fracture or should nonsurgical treatment have a more prominent role? In order to

  2. No difference between two types of exercise after proximal phalangeal fracture fixation: a randomised trial

    Directory of Open Access Journals (Sweden)

    Lauren Miller

    2016-01-01

    Conclusions: Constrained and unconstrained exercises has similar effects after open reduction and internal fixation of proximal phalangeal fracture. Registration: Australian New Zealand Clinical Trials Registry (ACTRN12610000294055. [Miller L, Crosbie J, Wajon A, Ada L (2016 No difference between two types of exercise after proximal phalangeal fracture fixation: a randomised trial. Journal of Physiotherapy 62: 12–19

  3. Coronal subluxation of the proximal tibia relative to the distal femur after opening wedge high tibial osteotomy.

    Science.gov (United States)

    Akamatsu, Yasushi; Ohno, Satoshi; Kobayashi, Hideo; Kusayama, Yoshihiro; Kumagai, Ken; Saito, Tomoyuki

    2017-01-01

    The coronal subluxation of the proximal tibia relative to the distal femur is a common radiological finding in patients with knee osteoarthritis. The purpose was to evaluate whether the coronal subluxation was corrected after opening wedge high tibial osteotomy (OWHTO), and whether this subluxation was one cause of inconsistency between the actual and predicted alignments (correction loss). Fifty-one patients (55 knees) were treated with OWHTO. The change of location between the intersection points of the femoral and tibial axes on the tibial plateau (subluxation-C), the change of location between the lines through the most lateral points of the lateral femoral and tibial condyles (subluxation-L), and joint space angle (JSA) were compared in standing knee radiographs before and one year after OWHTO. The subluxation-C and subluxation-L were converted to a percentage of the tibial plateau width. The mean subluxation-C of 6.5% before OWHTO significantly increased to a mean subluxation-C of 7.3% one year after OWHTO. The mean subluxation-L of 6.3% and JSA of 4.5° before OWHTO significantly decreased to a subluxation-L of 1.8% and JSA of 3.3° one year after OWHTO. The change in subluxation-L correlated with the change in femorotibial angle and correction loss (r=0.634, Pfemur after OWHTO. This medial shift correlated with the correction loss. The coronal subluxation might be one cause of correction loss. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2014-01-01

    Full Text Available Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB and intra- venous (IV fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB and Intravenous fentanyl group (FENT. In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000 was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 μg/kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020. Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049. Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027. Patient acceptance was less in group FENT (P = 0.000031. Conclusion: Femoral nerve block provides better analgesia, patient

  5. Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus :A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ibrahima Farikou

    2014-01-01

    Full Text Available Introduction: The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice. Case Report: The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa. Conclusion: Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures. Keywords: Femur fracture; Cesarean section; Fibroid; Breech presentation; Africa.

  6. The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures

    OpenAIRE

    Kim, Tae In; Choi, Jun Ha; Kim, Sae Hoon; Oh, Joo Han

    2016-01-01

    Background The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. Methods A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 year...

  7. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures.

    Science.gov (United States)

    Zhang, Wen; Zeng, Langqing; Liu, Yanjie; Pan, Yao; Zhang, Wei; Zhang, Changqing; Zeng, Bingfang; Chen, Yunfeng

    2014-01-01

    The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures. Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed. Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (Pproximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P ≤ 0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture. Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.

  8. Training improves agreement among doctors using the Neer system for proximal humeral fractures in a systematic review

    DEFF Research Database (Denmark)

    Brorson, Stig; Hróbjartsson, Asbjørn

    2008-01-01

    OBJECTIVE: To systematically review studies of observer agreement among doctors classifying proximal humeral fractures according to the Neer system. STUDY DESIGN AND SETTING: A systematic review. We searched for observational studies in which doctors classified proximal humeral fractures according...

  9. Variable Flip Angle 3D Fast Spin-Echo Sequence Combined with Outer Volume Suppression for Imaging Trabecular Bone Structure of the Proximal Femur

    Science.gov (United States)

    Han, Misung; Chiba, Ko; Banerjee, Suchandrima; Carballido-Gamio, Julio; Krug, Roland

    2014-01-01

    Purpose To demonstrate the feasibility of using a variable flip angle 3D fast spin-echo (3D VFA-FSE) sequence combined with outer volume suppression for imaging of trabecular bone structure at the proximal femur in vivo at 3T. Materials and Methods The 3D VFA-FSE acquisition was optimized to minimize blurring and to provide high signal-to-noise ratio (SNR) from bone marrow. Outer volume suppression was achieved by applying three quadratic-phase radio-frequency pulses. The SNR and trabecular bone structures from 3D VFA-FSE was compared with those from previously demonstrated multiple-acquisition 3D balanced steady-state free precision (bSSFP) using theoretical simulations, ex vivo experiments, and in vivo experiments. Results Our simulation demonstrated that 3D VFA-FSE can provide at least 35% higher SNR than 3D bSSFP, which was confirmed by the ex vivo and in vivo experiments. The ex vivo experiments demonstrated a good correlation and agreement between bone structural paramters obtained with the two sequences. The proposed sequence depicted trabecular bone structure at the proxiaml femur in vivo well without visible suppression artifacts and provided a mean SNR of 11.0. Conclusion The reduced-FOV 3D VFA-FSE sequence can depict the trabecular bone structure of the proximal femur in vivo with minimal blurring and high SNR efficiency. PMID:24956149

  10. Early Definitive Fixation of an Open Periprosthetic Femur Fracture in the Polytraumatized Patient: A Case Report and Review of the Literature

    OpenAIRE

    Ilyas S Aleem; Bhandari, Mohit; Elizalde, Sebastian Rodriguez

    2016-01-01

    Introduction: Periprosthetic fractures of the femur after total hip arthroplasty are increasing in frequency. In the polytraumatized patient with long-bone fracture, an ongoing debate exists regarding early definitive stabilization versus initial damage control orthopaedics, followed by delayed fixation. It remains to be seen whether this rationale applies to the polytraumatized patient with periprosthetic fracture. Case presentation: We present the case of a 73-years old Caucasian woman who ...

  11. What Sport Activity Levels Are Achieved in Patients After Resection and Endoprosthetic Reconstruction for a Proximal Femur Bone Sarcoma?

    Science.gov (United States)

    Hobusch, Gerhard M; Bollmann, Jakob; Puchner, Stephan E; Lang, Nikolaus W; Hofstaetter, Jochen G; Funovics, Philipp T; Windhager, Reinhard

    2017-03-01

    patients available for study, we could not determine that prosthetic failures were associated with sport activity levels. Patients who survive primary malignant bone tumors in the proximal femur reconstructed by megaprostheses are able to perform some sports activities. The estimates of activity levels made in this study probably are best-case estimates, given that some patients were lost to followup; patients unaccounted for might not be doing as well as those represented here. Also, the degree to which sports participation influences implant durability remains, for the most part, unanswered; studies with more patients and longer followup will be needed to determine to what degree prosthesis survivorship relates to sporting activity levels. Most patients perform low-impact sports and at a lower level than they had preoperatively. Because this is a preliminary study of a select group of patients, further information is necessary to weight the benefits of higher sports activity levels against potential risks. If this can be confirmed in a larger number of patients, the information may guide surgeons in their discussion with patients preoperatively and give them some objective assessment of what to expect regarding sports activities. Level IV, therapeutic study.

  12. COMPARATIVE STUDY OF MANAGEMENT OF INTERTROCHANTERIC FRACTURES (TYPE 3 AND 4 BOYD AND GRIFFIN CLASSIFICATION BY DYNAMIC HIP SCREW OR PROXIMAL FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Sunkara Dinesh Chowdary

    2017-06-01

    Full Text Available BACKGROUND Intertrochanteric fractures are one the common fractures encountered in today’s orthopaedic practice. Intertrochanteric fractures are devastating injuries that most commonly affect the elderly population, but not increased in the younger population. In young and healthy individuals, the injury results from high energy trauma, whereas in the elder age group, most of the fractures are osteoporotic resulting from a trivial fall. MATERIALS AND METHODS This study was conducted in Konaseema Institute of Medical Sciences, Amalapuram, from July 2013 to September 2016. During this period, adult patients with pertrochanteric fractures of femur were classified according to Boyd and Griffin classification and 40 patients were selected according to inclusion criteria. This study was conducted with due emphasis for clinical observation and analysis of results after surgical management of these fractures of femur with dynamic hip screw or proximal femoral nailing. RESULTS Anatomical results were assessed by presence or absence of shortening, range of movements and deformities. 70% of the cases had good results in PFN series as compared to 65% in DHS series. Functional results were assessed in the 40 cases. These constituted of 20 cases in PFN series and 20 cases in DHS series. In PFN series, results were excellent results in 7 cases, good in 6 cases, fair in 2 cases and poor in 5 cases. In DHS series, results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 4 cases. CONCLUSION An intertrochanteric fracture of the femur is common in the elderly due to osteoporosis and in young due to high velocity trauma. As the fracture is more common in the elderly, early reduction and internal fixation increases patient comfort, facilitates nursing care, helps in early mobilisation of the patient and decreases the duration of hospitalisation. Anatomical reduction can be achieved by closed manipulation or open methods. As the incidence of

  13. [Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur].

    Science.gov (United States)

    López-Vega, M; Gil-Monzó, E R; Rodrigo-Pérez, J L; López-Valenciano, J; Salanova-Paris, R H; Peralta-Nieto, J; Morales-Suárez, M M

    2015-01-01

    The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  14. FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES OF FEMUR MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    Madhusudhana

    2015-10-01

    Full Text Available INTRODUCTION : Incidence of distal femur fractures is approximately 37 per 1 , 00,000 person - years.¹Distal femoral fractures has two different injury mechanisms, high energy trauma and low energy trauma. In high - energy trauma, the problem of restoring the function in a destroyed knee joint persists. Complex knee ligament injuries frequently occur additionally to extensive cartilage injuries. In elderly patients, extreme osteoporosis represents a particular problem for anchoring the implant. 2 Supracondylar and inter condylar fractures often are unstable and comminuted and tend to occur in the elderly or those with multiple injuries. Treatment options are many with varied results. The final outcome would depend upon the type of fracture, stabilization of fixation and and perhaps patient general condition. 3 The options for operative treatment are traditional plating techniques that require compression of the implant to the femoral shaft (blade plate, Dynamic Condylar Screw, non - locking condylar buttress plate, antegrade nailing fixation, retrograde nailing, sub muscular locked internal fixation and external fixation. 4 However, as the complexity of fractures needing treatment has changed from simple extra - articular supra - condylar types to inter - condylar and metaphyseal comminuted types, these implants may not be ideal. Double plating, and more recently, locked plating techniques have been advocated 5 . However with double plating there is often extensive soft tissue stripping on both sides of the femur, resulting in reduced blood supply and potential non - union and failure of the implants 6 . The LCP is a single beam construct where the strength of its fixation is equal to the sum of all screw - bone interfaces rather than a single screw’s axial stiffness or pullout resistance as seen in unlocked plates 7,8 . Its unique biomechanical function is based on splinting rather than compression resulting in flexible stabilization

  15. An unusual case of simultaneous bilateral neck of femur fracture following electrocution injury-A case report and review of literature

    Science.gov (United States)

    Nekkanti, Supreeth; Vijay, C; Theja, JS Sujana; RaviShankar, R; Raj, Sumit

    2016-01-01

    Introduction: Simultaneous bilateral fractures of the neck of femur is rare. Hypocalcemia, epilepsy, osteoporosis and electrical injuries are known to cause similar injuries. Case Report: We report a case of a 43-year-old male who sustained an electrical shock injury following which he fell from a height of around 4 feet. Radiological studies confirmed bilateral transcervical neck of femur fracture. Laboratory investigations revealed the patient had extremely low levels of vitamin D (11.1ng/ml). Patient was treated with three 6.5 mm cannulated cancellous screws on each side. Patient had good functional outcome at the end of one year. Conclusion: We report this case as a rare etiological combination of hypovitaminosis D and electrical injury causing bilateral neck of femur fracture. Such injuries should be diagnosed at the earliest and goal of treatment should be to preserve both the hip joints. Early management would avoid potential complications like non-union and avascular necrosis. PMID:28116275

  16. Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures

    DEFF Research Database (Denmark)

    Bahrs, Christian; Stojicevic, Tanja; Tanja, Stojicevic

    2014-01-01

    PURPOSE: Proximal humeral fractures are common and frequently associated with osteoporosis. Little is known about the association between the patho-anatomical fracture pattern of proximal humeral fractures and patient characteristics. The purpose of this six year longitudinal registry analysis...... of proximal humeral fractures was to study overall numbers, certain predefined pathoanatomical patterns and distribution compared with specific patient characteristics. METHODS: Data of patients treated between 2006 and 2011 in a country hospital that provides care >95 % of the city's hospitalised patients...... hundred and fifteen proximal humeral fractures (67% women/33% men; mean age 66 years, range 19-99) were analysed. During the study period, an overall increase of 42.5% was found: according to AO classification, 46% were type A, 22% type B and 32% type C. Based on the Neer classification, 86% were...

  17. [Clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures].

    Science.gov (United States)

    Liu, Junchuan; Di, Jun; Zhao, Changping; Yao, Shuangquan; Zhu, Lian; Wang, Bo; Ren, Dong

    2014-12-23

    To explore the clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures. A total of 284 hospitalized patients of proximal humerus fractures over 60 years of age cases from October 2009 to February 2012 were randomly divided into two groups of locking proximal humeral plate (LPHP) and PHILOS (n = 142 each). And the clinical efficacies of two groups were compared. For PHILOS and LPHP groups, the fracture healing periods were (11.64 ± 3.81) and (14.95 ± 3.95) weeks. And there was statistical significance (P 0.05). Both PHILOS and LPHP are effective in the treatment of senile proximal humeral fractures.However, the former is conducive to fracture healing and has shorter healing time and lowered postoperative pain.

  18. Axillary Artery Injury Associated with Proximal Humerus Fracture: A Report of 6 Cases

    Directory of Open Access Journals (Sweden)

    Rinne M. Peters

    2017-01-01

    Full Text Available Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of axillary artery injury. We present 6 cases of axillary artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.

  19. Three-dimensional micro-level computational study of Wolff's law via trabecular bone remodeling in the human proximal femur using design space topology optimization.

    Science.gov (United States)

    Boyle, Christopher; Kim, Il Yong

    2011-03-15

    The law of bone remodeling, commonly referred to as Wolff's Law, asserts that the internal trabecular bone adapts to external loadings, reorienting with the principal stress trajectories to maximize mechanical efficiency creating a naturally optimum structure. The goal of the current study was to utilize an advanced structural optimization algorithm, called design space optimization (DSO), to perform a micro-level three-dimensional finite element bone remodeling simulation on the human proximal femur and analyse the results to determine the validity of Wolff's hypothesis. DSO optimizes the layout of material by iteratively distributing it into the areas of highest loading, while simultaneously changing the design domain to increase computational efficiency. The result is a "fully stressed" structure with minimized compliance and increased stiffness. The large-scale computational simulation utilized a 175 μm mesh resolution and the routine daily loading activities of walking and stair climbing. The resulting anisotropic trabecular architecture was compared to both Wolff's trajectory hypothesis and natural femur samples from literature using a variety of visualization techniques, including radiography and computed tomography (CT). The results qualitatively revealed several anisotropic trabecular regions, that were comparable to the natural human femurs. Quantitatively, the various regional bone volume fractions from the computational results were consistent with quantitative CT analyses. The global strain energy proceeded to become more uniform during optimization; implying increased mechanical efficiency was achieved. The realistic simulated trabecular geometry suggests that the DSO method can accurately predict bone adaptation due to mechanical loading and that the proximal femur is an optimum structure as the Wolff hypothesized. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

  20. Proximal femoral periprosthetic fracture fixation with a hooked ...

    African Journals Online (AJOL)

    The advent and increasing use of joint replacement for various pathologies has led to a new group of fractures- the periprosthetic fractures. The hip joint is no exception to this group, a fair share of these fractures do occur around the hip joint. The management of these fractures is complex and usually needs application of ...

  1. Treatment of Femur Fractures in Preschool Children with Double Pin Technique: Immediate Incorporated Hip Spica Casting by Two K-Wires.

    Science.gov (United States)

    Memisoglu, Kaya; Atmaca, Halil; Kesemenli, Cumhur Cevdet

    2015-12-01

    The immediate hip spica casting is a popular treatment method for femoral fractures in the pediatric age group. Femoral shortening is the unacceptable result for the treatment. In this technique, we tried to describe the immediate spica casting technique pinning with double K-wire in preschool children and evaluate the results with this method. Sixteen patients (ten boys and six girls) are treated with this technique. Patients were treated under general anesthesia in the operating room. K-wire was introduced in the supracondylar area of the femur passing from the lateral to the medial side through both cortexes, and removed from the skin in the medial section. A second K-wire was introduced through the lateral side of the proximal fragment. While an assistant was applying traction to the pin to maintain the reduction, the lower extremity was put in a spica cast on the fractured side, while the knee joint on the other side was excluded from the spica casting process. The angulation after hip spica cast applied was 9.1° (range 7°-12°) on the frontal plane and 8.9° (range 5°-17°) on the sagittal plane. After spica cast removal, it was 8.5° (range 5°-13°) on the frontal plane and 9° (range 5°-17°) on the sagittal plane. No significant difference was found. The final mean leg length discrepancy was 4.8 mm (range 0-10 mm) at the time of cast removal. This technique may be effective for femoral diaphyseal fractures in preschool children to combine the spirits of external fixation with hip spica casting in one construct in order to correct angular deformities and length discrepancies.

  2. The rate of hip osteoarthritis in patients with proximal femoral fractures versus hip contusion

    OpenAIRE

    Robstad, B.; Frihagen, F.; Nordsletten, L.

    2011-01-01

    Summary We found no difference in the rate of radiological hip osteoarthritis in the injured hip when comparing 349 patients with proximal femoral fractures and 112 patients with hip contusion. There was, however, a tendency for more osteoarthritis in patients with trochanteric fractures than in patients with femoral neck fractures. Introduction Osteoarthritis (OA) and osteoporotic fractures are two age-related disorders associated with considerable morbidity. There is a clinical impression o...

  3. The Classic: An Account of a Case of Fracture and Distortion of the Pelvis, Combined with an Unusual Form of Dislocation of the Femur

    OpenAIRE

    Moore, Charles Hewitt

    2012-01-01

    This Classic Article is a reprint of the original work by C.H. Moore, An account of a Case of Fracture and Distortion of the Pelvis, combined with an unusual form of Dislocation of the Femur. An accompanying biographical sketch of C.H. Moore is available at DOI 10.1007/s11999-012-2424-2. The Classic Article is © 1851 and is reprinted from Moore CH. An account of a Case of Fracture and Distortion of the Pelvis, combined with an unusual form of Dislocation of the Femur. Med Chir Trans. 1851;34:...

  4. Management of proximal humeral fractures in the nineteenth century: an historical review of preradiographic sources

    DEFF Research Database (Denmark)

    Brorson, Stig

    2011-01-01

    The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding ...... of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed.......The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding...

  5. High prevalence of spine–femur bone mineral density discordance and comparison of vertebral fracture risk assessment using femoral neck and lumbar spine bone density in Korean patients.

    Science.gov (United States)

    Seok, Hannah; Kim, Kwang Joon; Kim, Kyoung Min; Rhee, Yumie; Cha, Bong Soo; Lim, Sung-Kil

    2014-07-01

    The aim of this study was to evaluate the prevalence of spine–femur discordance, and to compare the effectiveness of femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) for estimation of the risk of vertebral fractures. Women who were evaluated with dual energy X-ray absorptiometry between January 2001 and December 2005 were enrolled in this study. Vertebral fracture risk was calculated using initial FN and LS BMD. The follow-up vertebral X-rays from all subjects were reviewed, and the calculated estimated risk using the Fracture Risk Assessment Tool (FRAX(®)) was compared with the actual prevalence of vertebral fractures during the follow-up period. Among a total of 443 women with a mean age of 58.5 years, 130 women (29.3 %) demonstrated femur–spine discordance (i.e., a difference between FN and LS BMD of [1 SD). Most subjects having discordance showed lower LS BMD (73.1 %) compared to FN BMD. During the mean 7-year follow-up period, 12 (2.7 %) vertebral fractures occurred. In cases with high estimated fracture risk ([20 % for estimated fracture risk), using LSBMD significantly reflected the actual vertebral fracture in total subjects [odds ratio (OR) 19.29, 95 % confidence interval (CI) 4.21–88.46], in subjects with spine–femur discordance (OR 16.00, 95 % CI 1.91–134.16), and in subjects with spine–femur discordance having lower LSBMD (OR 20.67, 95 % CI 1.63–262.71). In comparison, the estimated risk using FN BMD did not reflect the actual occurrence of vertebral fractures. In conclusion, a significant number of Korean subjects exhibited spine–femur discordance, and LS BMD might be more appropriate for estimation of vertebral fracture risk.

  6. Surgical Management of 3 and 4-Part Proximal Humerus Fractures with Locking Plates in Elderly

    Directory of Open Access Journals (Sweden)

    Emrah Kovalak

    2017-05-01

    Full Text Available Aim: Proximal humeral fractures are approximately 5% of all fractures and, %15-20 is displaced and unstable. By the introduction of locking plates there used to be a substantial rise in the osteosynthesis of the 3 and 4-part proximal humeral fractures. But there is still a lack of consensus for the optimal treatment of these complex fractures. In this retrospective study, we aimed to evaluate the functional outcomes and prognostic factors of 3 and 4-part proximal humerus fractures treated with locking plate osteosynthesis in elderly. Material and Method: 53 patients with displaced 3 and 4-part proximal humeral fractures treated with locking plate osteosynthesis between 2010 and 2015 were included. The fractures were classified according to Neer classification system. Outcomes were assessed by Constant-Murley scoring system (CMS, visual analog pain scale and plain radiographs. In reference to range of motion, forward elevation and abduction of the arm were measured.Results: No statistically significant differences found between the 3- part and 4- part fractures in CMS, forward elevation and, abduction (p>0.05. Pain was significantly higher in 4-part fractures (p=0.035. CMS, forward elevation, and abduction were inversely correlated with age and delay in surgery. There was statistical significance between the patients had complications and those not in terms of CMS, forward elevation and, abduction (p=0.029, p=0.017 and p=0.024. Discussion: Functional outcomes of locking plate fixation of proximal humerus fractures are associated with patient related factors, fracture pattern, surgeon and, the implant. When indications are carefully selected, locking plate osteosynthesis yield good outcomes in surgical treatment of 3 or 4-part proximal humerus fractures.

  7. The reliability and reproducibility of the Hertel classification for comminuted proximal humeral fractures compared with the Neer classification

    NARCIS (Netherlands)

    Iordens, Gijs I. T.; Mahabier, Kiran C.; Buisman, Florian E.; Schep, Niels W. L.; Muradin, Galied S. R.; Beenen, Ludo F. M.; Patka, Peter; van Lieshout, Esther M. M.; den Hartog, Dennis

    2016-01-01

    The Neer classification is the most commonly used fracture classification system for proximal humeral fractures. Inter- and intra-observer agreement is limited, especially for comminuted fractures. A possibly more straightforward and reliable classification system is the Hertel classification. The

  8. The reliability and reproducibility of the Hertel classification for comminuted proximal humeral fractures compared with the Neer classification

    NARCIS (Netherlands)

    G.I.T. Iordens (Gijs); K.C. Mahabier (Kiran); F.E. Buisman (Florian); N.W.L. Schep (Niels); G.S. Muradin (Galied); L.F.M. Beenen (Ludo); P. Patka (Peter); E.M.M. van Lieshout (Esther); D. den Hartog (Dennis)

    2016-01-01

    markdownabstract_Introduction_ The Neer classification is the most commonly used fracture classification system for proximal humeral fractures. Inter- and intra-observer agreement is limited, especially for comminuted fractures. A possibly more straightforward and reliable classification system is

  9. Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: a prospective study.

    Science.gov (United States)

    Bahrs, Christian; Schmal, Hagen; Lingenfelter, Erich; Rolauffs, Bernd; Weise, Kuno; Dietz, Klaus; Helwig, Peter

    2008-02-17

    A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems. The classification was developed to evaluate whether a very detailed classification exceeding the analysis of fractured parts may be a valuable tool. Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics were used to determine reliability. An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts. Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology. Although the MTM-classification covers a wide spectrum of fracture types, our results indicate that the precise topographic and morphological description is not delivering reproducible results. Therefore, simplicity in fracture classification may be more useful than extensive approaches, which are not adequately reliable to address current classification problems.

  10. [Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options].

    Science.gov (United States)

    Unglaub, F; Langer, M F; Hahn, P; Müller, L P; Ahrens, C; Spies, C K

    2016-02-01

    Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.

  11. Prospects of implant with locking plate in fixation of subtrochanteric fracture: experimental demonstration of its potential benefits on synthetic femur model with supportive hierarchical nonlinear hyperelastic finite element analysis

    Directory of Open Access Journals (Sweden)

    Latifi Mohammed

    2012-04-01

    Full Text Available Abstract Background Effective fixation of fracture requires careful selection of a suitable implant to provide stability and durability. Implant with a feature of locking plate (LP has been used widely for treating distal fractures in femur because of its favourable clinical outcome, but its potential in fixing proximal fractures in the subtrochancteric region has yet to be explored. Therefore, this comparative study was undertaken to demonstrate the merits of the LP implant in treating the subtrochancteric fracture by comparing its performance limits against those obtained with the more traditional implants; angle blade plate (ABP and dynamic condylar screw plate (DCSP. Materials and Methods Nine standard composite femurs were acquired, divided into three groups and fixed with LP (n = 3, ABP (n = 3 and DCSP (n = 3. The fracture was modeled by a 20 mm gap created at the subtrochanteric region to experimentally study the biomechanical response of each implant under both static and dynamic axial loading paradigms. To confirm the experimental findings and to understand the critical interactions at the boundaries, the synthetic femur/implant systems were numerically analyzed by constructing hierarchical finite element models with nonlinear hyperelastic properties. The predictions from the analyses were then compared against the experimental measurements to demonstrate the validity of each numeric model, and to characterize the internal load distribution in the femur and load bearing properties of each implant. Results The average measurements indicated that the constructs with ABP, DCPS and LP respectively had overall stiffness values of 70.9, 110.2 and 131.4 N/mm, and exhibited reversible deformations of 12.4, 4.9 and 4.1 mm when the applied dynamic load was 400 N and plastic deformations of 11.3, 2.4 and 1.4 mm when the load was 1000 N. The corresponding peak cyclic loads to failure were 1100, 1167 and 1600 N. The errors

  12. Age estimation in a sub-adult Western Australian population based on the analysis of the pelvic girdle and proximal femur.

    Science.gov (United States)

    Sullivan, Siobhan; Flavel, Ambika; Franklin, Daniel

    2017-10-16

    The accurate and precise estimation of skeletal age by a forensic anthropologist is both a professional and judicial requirement. When unknown skeletal remains are referred to the anthropologist, the estimation of the requisite biological attributes (e.g., age and sex) should accordingly be based on the application of population-specific standards (statistical data). Deviations from the latter practice may result in reduced accuracy and compromised identification. Towards informing appropriate forensic practice, the aim of the present study is to develop statistically quantified age estimation models for a contemporary sub-adult Western Australian population based on the timing of fusion in the os coxa and proximal femur. The study sample comprises 562 known age and sex MDCT scans (292 male, 270 female) representing contemporary Western Australian individuals birth through 30 years of age. Scans are viewed in multi-planar reconstructed (MPR) and/or three-dimensionally reconstructed images using OsiriX(®). Fusion status is scored according to a three-stage system across a total of nine sites in the proximal femur and os coxae. Observer accordance, bilateral asymmetry and sex-specific variation in fusion timing are statistically quantified. Polynomial regression is used to formulate age prediction models; transition analysis is used to calculate age ranges and determine the mean age for transition between an unfused, fusing and fused status. Observer accordance in stage assignation is acceptable (ϰ=0.79) and there is no significant bilateral variation in fusion timing. It was found that the mean age of commencement of fusion is significantly earlier (∼2 years) in females. The accuracy (SEE) of the polynomial models ranges from ±3.29 to ±3.80 years and the transition analysis shows that fusion of the iliac crest is delayed in comparison to other attributes of os coxa and proximal femur. Results of the present study confirm that the pelvic girdle and proximal

  13. The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

    Directory of Open Access Journals (Sweden)

    J. Harding

    2013-01-01

    Full Text Available Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection. Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

  14. A scale-space curvature matching algorithm for the reconstruction of complex proximal humeral fractures.

    Science.gov (United States)

    Vlachopoulos, Lazaros; Székely, Gábor; Gerber, Christian; Fürnstahl, Philipp

    2018-01-01

    The optimal surgical treatment of complex fractures of the proximal humerus is controversial. It is proven that best results are obtained if an anatomical reduction of the fragments is achieved and, therefore, computer-assisted methods have been proposed for the reconstruction of the fractures. However, complex fractures of the proximal humerus are commonly accompanied with a relevant displacement of the fragments and, therefore, algorithms relying on the initial position of the fragments might fail. The state-of-the-art algorithm for complex fractures of the proximal humerus requires the acquisition of a CT scan of the (healthy) contralateral anatomy as a reconstruction template to address the displacement of the fragments. Pose-invariant fracture line based reconstruction algorithms have been applied successful for reassembling broken vessels in archaeology. Nevertheless, the extraction of the fracture lines and the necessary computation of their curvature are susceptible to noise and make the application of previous approaches difficult or even impossible for bone fractures close to the joints, where the cortical layer is thin. We present a novel scale-space representation of the curvature, permitting to calculate the correct alignment between bone fragments solely based on corresponding regions of the fracture lines. The fractures of the proximal humerus are automatically reconstructed based on iterative pairwise reduction of the fragments. The validation of the presented method was performed on twelve clinical cases, surgically treated after complex proximal humeral fracture, and by cadaver experiments. The accuracy of our approach was compared to the state-of-the-art algorithm for complex fractures of the proximal humerus. All reconstructions of the clinical cases resulted in an accurate approximation of the pre-traumatic anatomy. The accuracy of the reconstructed cadaver cases outperformed the current state-of-the-art algorithm. Copyright © 2017 Elsevier B

  15. Bilateral Humerus and Right Femur Fracture in a Newborn after Cesarean Section for Breech Presentation in a Twin Pregnancy: A Very Rare Case Report

    Science.gov (United States)

    Rahul, P; Grover, Amit Rakesh; Ajoy, S M

    2017-01-01

    Introduction: The most common fractures during vaginal delivery occur in the clavicle, humerus, and femur. Cesarean section reduces the chances of a child having a birth injury. However, in some difficult extractions, long bone fractures may occur. Cesarean section further reduces the incidence of birth injuries, especially in a breech delivery. Maneuvers employed during cesarean section, energetic traction, improper uterine incisions, and contracted uterus may cause these injuries. In the medical literature, there are few articles highlighting the occurrence of long bone fractures during cesarean section. There has been no case reported with a combined bilateral humerus and femur fracture in the medical literature. Case Report: A 2-day-old neonate born after cesarean section for breech presentation in a twin pregnancy presented with restricted movements of both his arms and right leg. Infantogram revealed bilateral humerus and right femur fracture. Biochemical tests were normal, and there were no other findings on clinical examination. There was no evidence of child abuse or any positive family history. Child was splinted for 3 weeks. X-rays suggested good callus at the fracture site of the right femur and bilateral humerus fracture were united. Conclusion: To conclude, we would like to emphasize that long bone fractures can happen with cesarean section also. To prevent such untoward complications, during delivery of the baby the surgeon should be very careful, avoid energetic traction and should plan his incisions. Appropriate relaxation of the uterus must be achieved. Clavicles and other long bones should be palpated after a difficult delivery. However, it is important to note that long bone fractures in children heal rapidly without the need for any major intervention. PMID:28630830

  16. Surgeons agree more on treatment recommendations than on classification of proximal humeral fractures

    DEFF Research Database (Denmark)

    Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik

    2012-01-01

    Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations....

  17. The factors influencing the decision making of operative treatment for proximal humeral fractures

    NARCIS (Netherlands)

    Hageman, M.G.; Jayakumar, P.; King, J.D.; Guitton, T.G.; Doornberg, J.N.; Ring, D.; Poelhekke, L.M.S.J.

    2015-01-01

    BACKGROUND: The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information.

  18. Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway-pilot study.

    Science.gov (United States)

    Gilchrist, Nigel; Dalzell, Kristian; Pearson, Scott; Hooper, Gary; Hoeben, Kit; Hickling, Jeremy; McKie, John; Yi, Ma; Chamberlain, Sandra; McCullough, Caroline; Gutenstein, Marc

    2017-05-12

    The increasing elderly population and subsequent rise in total hip fracture(s) in this group means more effective management strategies are necessary to improve efficiency. We have changed our patient care strategy from the emergency department (ED), acute orthopaedic wards, operating theatre, post-operation and rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All clinical data and actions were captured, integrated and displayed on a weekly basis using 'signalfromnoise' (SFN) software. The initial four months analysis of this project showed significant improvement in patient flow within the hospitals. The overall length of stay was reduced by four days. Time in ED was reduced by 30 minutes, and the wait for rehabilitation reduced by three days. Overall time in rehabilitation reduced by 3-7 days depending on facility. On average, fast track patients spent 95 less hours in hospital, resulting in 631 bed days saved in this period, with projected savings of NZD700,000. No adverse effects were seen in mortality, readmission and functional improvement status. Fractured neck of femur has increasing clinical demand in a busy tertiary hospital. Length of stay, co-morbidities and waiting time for theatres are seen as major barriers to treatment for these conditions. Wait for rehabilitation can significantly lengthen hospital stay; also poor communication between the individual hospital management facets of this condition has been an ongoing issue. Lack of instant and available electronic information on this patient group has also been seen as a major barrier to improvement. This paper demonstrates how integration of service components that are involved in fractured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practice. This paper indicates that cooperation between health professionals and practitioners can

  19. Structural Analysis and Optimization of the Support Device Used for a Proximal Fracture of the Femur

    Science.gov (United States)

    2008-12-01

    and 2700 N in the S/I direction. The final loading condition involves the forces of climbing a stair . These forces are applied on the femoral head...perform actions like walk, climbing stairs or lifting. In a dynamic locking distal-screw configuration, the two screws separated by 20 mm yielded the... biomechanics , fluid flow and many more. FEA /FEM are also benefactors of the advancement of technology. As computer processing advancements take place, it

  20. Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model.

    Science.gov (United States)

    Flinck, Marianne; von Heideken, Johan; Janarv, Per-Mats; Wåtz, Veronica; Riad, Jacques

    2015-02-01

    The treatment for length-unstable diaphyseal femur fractures among school-age children is commonly intramedullary elastic nails, with or without end caps. Another possible treatment is the semi-rigid pediatric locking nail (PLN). The purpose of this biomechanical study was to assess the stability of a length-unstable oblique midshaft fracture in a synthetic femur model stabilized with different combinations of intramedullary elastic nails and with a PLN. Twenty-four femur models with an intramedullary canal diameter of 10.0 mm were used. Three groups with various combinations of titanium elastic nails (TEN) with end caps and one group with a PLN were tested. An oblique midshaft fracture was created, and the models underwent compression, rotation, flexion/extension, and a varus/valgus test, with 50 and 100 % of the forces generated during walking in corresponding planes. We present the results [median (range)] from 100 % loading during walking. In axial compression, the PLN was less shortened than the combination with two 4.0-mm TEN [by 4.4 (3.4-5.4) mm vs. 5.2 (4.8-6.6) mm, respectively; p = 0.030]. No difference was found in shortening between the PLN and the four 3.0-mm TEN [by 7.0 (3.3-8.4) mm; p = 0.065]. The two 3.0-mm TEN did not withstand the maximum shortening of 10.0 mm. In external rotation, the PLN rotated 12.0° (7.0-16.4°) while the TEN models displaced more than the maximum of 20.0°. No model withstood a maximal rotation of 20.0° internal rotation. In the four-point bending test, in the coronal and the sagittal plane, all combinations except the two 3.0-mm TEN in extension withstood the maximum angulation of 20.0°. PLN provides the greatest stability in all planes compared to TEN models with end caps, even though the difference from the two 4.0-mm or four 3.0-mm TEN models was small.

  1. Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Frich, Lars H; Winther, Annika

    2011-01-01

    There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries.......There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries....

  2. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures.

    Directory of Open Access Journals (Sweden)

    Wen Zhang

    Full Text Available BACKGROUND: The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs in the locking proximal humeral plate for treating proximal humerus fractures. METHODS: Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed. RESULTS: Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001. When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P ≤ 0.0207. Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture. CONCLUSIONS: Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.

  3. Mechanical evaluation of adjunctive fixation for prevention of periprosthetic femur fracture with the Zurich cementless total hip prosthesis.

    Science.gov (United States)

    Pozzi, Antonio; Peck, Jeffrey N; Chao, Peini; Choate, Christina J; Barousse, Dan; Conrad, Bryan

    2013-06-01

    To evaluate whether cerclage wire or a lateral plate increases the peak-torque load to failure, compared to femora without adjunctive fixation, in femora implanted with Zurich Cementless stems. In vitro biomechanical study. Paired femora from adult dogs (n = 24) weighing 28-35 kg. Pairs of femora were implanted with a stem and randomly assigned to 2 treatment groups: cerclage or plate. Within each pair, either 3 loop cerclage wires or a laterally applied 12-hole Advanced Locking Plate System 10-mm plate (ALPS 10) were implanted in a femur, whereas the contralateral femur acted as control with no adjunctive fixation. After application of a static axial load each specimen was loaded to failure in torsion. Peak torque load at failure was compared between femora with each adjunctive fixation and the control using a paired t-test; P plated group (P plates and with cerclage were 13.9% and 7.2% stronger in torsion than the femora without fixation, respectively. Adjunctive fixation with a laterally applied ALPS 10 may aid in the prevention of peri-prosthetic fractures associated with Zurich Cementless medium stems. © Copyright 2013 by The American College of Veterinary Surgeons.

  4. Tissue-implant interface at an absorbable fracture fixation plug made of polylactide in cancellous bone of distal rabbit femur.

    Science.gov (United States)

    Pihlajamäki, H; Böstman, O; Manninen, M; Päivärinta, U; Rokkanen, P

    1994-01-01

    The tissue-implant interface at a self-reinforced poly-L-lactide (SR-PLLA) expansion plug implanted in distal rabbit femoral cancellous bone was studied histologically, histomorphometrically, and microradiographically in 35 rabbits during consolidation of a transverse transcondylar osteotomy fixed with the SR-PLLA expansion plug. The absorbable plug for internal fixation of fractures and osteotomies measured 4.5 mm in diameter and 30 mm in length and had an expandable distal locking blade system. The femoral specimens were harvested in groups of 5-10 rabbits after a follow-up time of 3, 6, 12, and 24 weeks. The intact contralateral femur served as a control. Vigorous osteogenic response to the implant was already observed at 3 weeks postoperatively, and the osteoid surface fraction at 24 weeks was still significantly higher than in the unoperated contralateral femur. Incomplete union of the osteotomy seemed to result in increased fibrous tissue formation at the tissue-implant boundary. No signs of degradation of the SR-PLLA was observed within the entire follow-up period. The number of inflammatory cells at the tissue-implant interface was low. Consequently, the short-term biocompatibility of the implant was deemed acceptable. Clinical application of the expansion plug is being planned.

  5. Bilateral Traumatic Fracture of Neck of Femur in a Child: A Case Report

    Directory of Open Access Journals (Sweden)

    D Dhar

    2013-07-01

    Full Text Available Bilateral femoral neck fractures are rare in the pediatric age group, and only a few cases have been reported following major trauma in children. A 9-year old girl presented with bilateral femoral neck fractures following a motor vehicle accident. The patient was managed with early operative fixation of the fractures with a successful outcome. This case highlights the importance of awareness of the occurrence of bilateral femoral neck fractures in the polytrauma patients. This case is presented due to its rarity.

  6. Use of inhaled and oral glucocorticoids, severity of inflammatory disease and risk of hip/femur fracture : a population-based case-control study

    NARCIS (Netherlands)

    de Vries, F.|info:eu-repo/dai/nl/303546670; Pouwels, S.|info:eu-repo/dai/nl/34158990X; Lammers, J.W.J.; Leufkens, H.G.M.|info:eu-repo/dai/nl/075255049; Bracke, M.|info:eu-repo/dai/nl/185443354; Cooper, C.; van Staa, T.P.|info:eu-repo/dai/nl/304827762

    BACKGROUND: Patients using higher dosages of inhaled or oral glucocorticoids (GCs) have an increased risk of hip/femur fractures. The role of the underlying disease in the aetiology of this increased risk has not been widely studied. OBJECTIVE: To evaluate the contribution of the underlying disease

  7. Measurements of bone mineral density in the lumbar spine and proximal femur using lunar prodigy and the new pencil-beam dual-energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Dongil [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Seoul (Korea, Republic of); Kim, Deog-Yoon [Kyung Hee University, Department of Nuclear Medicine, College of Medicine, Seoul (Korea, Republic of); Han, Chung Soo [Kyung Hee University, Department of Orthopedic Surgery, College of Medicine, Seoul (Korea, Republic of); Kim, Seonwoo [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Samsung Medical Center, Biostatistics Unit, Samsung Biomedical Research Institute, Seoul (Korea, Republic of); Bok, Hae Sook [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Huh, Wooseong [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Division of Nephrology, Samsung Medical Center, Seoul (Korea, Republic of); Ko, Jae-Wook [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Division of Clinical Pharmacology, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Hong, Sung Hwa [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

    2010-11-15

    We evaluated the correlation of the absolute bone mineral density (BMD) values of the lumbar spine and standard sites of the proximal femur obtained from a Lunar Prodigy and the newly developed pencil-beam dual-energy X-ray absorptiometry (Dexxum). Between June 2008 and December 2008, 79 Korean volunteers were enrolled. Measurements were obtained on the same day using both densitometers. The absolute BMD values (g/cm{sup 2}) from the two densitometers were evaluated using Pearson's correlation analysis with Bonferroni's correction for the three clinically important sites. In order to evaluate precision, we performed duplicate Dexxum measurements, and calculated the within-subject coefficient of variation (WSCV). The Pearson's correlation coefficient (r) of BMD values for the total proximal femur, femoral neck, and lumbar spine by the two densitometers were 0.926, 0.948, and 0.955 respectively, and the null hypotheses of r = 0.8 were all rejected (p < 0.001 by one-sided Z-test with Fisher's z-transformation for each site). The T-scores (r {>=} 0.842) and Z-scores (r {>=} 0.709) also showed strong positive correlations. The duplicate BMD values of Dexxum showed a high level of precision (WSCV {<=} 4.27%). Dexxum measurements of BMD, T-scores, and Z-scores showed a strong linear correlation with those measured on Lunar Prodigy. (orig.)

  8. OUTCOME OF UNCEMENTED UNIPOLAR HEMIARTHROPLASTY IN FRACTURE NECK OF FEMUR, IN GERIATRIC PATIENTS IN RELATION TO BONE QUALITY

    Directory of Open Access Journals (Sweden)

    Mehraj Din

    2015-09-01

    Full Text Available BACKGROUND: Osteoporosis plays an important role in pathogenesis of fracture neck of femur in mobile elderly. Hemiarthroplasty is most common mode of management of femoral neck fractures in elderly in developing world. We report the outcome of uncemented hemiarthropl asty in elderly patients with a femoral neck fracture in relation to bone quality of patient as estimated by Dual energy x ray absorptiometry (DEXA scan. MATERIALS AND METHODS: 75 uncemented hemiarthroplasties for femoral neck fractures were performed in elderly patients more than 70 years of age between August 2008 and April 2012. The clinical, radiological results and bone mineral density of 65 hips in 65 patients who could be followed up were analyzed. For all cases Austin Moore prosthesis was implanted . RESULTS: The mean age of the patients was 79.96±7.21 years ( 7 1 to 96 years. 44 patients were women and 21 were men. Average duration of follow - up was 18.59±11.53 months ( R ange 4 to 44 months. The mean Harris Hip Score in patients with osteopenia was 80 .29±13.29 and in patients with osteoporosis it was 79.96 ± 11.67 at the time of the last follow - up. There was no significant difference in mean Harris hi p score in osteoporotic and non - osteoporotic patient’s p value 0.923. Out of 65 patients whose results were assessed in our study 48 patients (73.8% had osteoporosis and 17 patients (26.1% had Osteopenia. None of the patients in our study had a normal bone density. The mean T Score as measured on DEXA scan was - 3.74±1.57. CONCLUSION: Uncemented hemiarthro plasty for elderly patients more than 70 years of age with a femoral neck fracture showed satisfactory short - term results with no relationship to the bone quality

  9. Treatment of unstable intertrochanteric fractures of the femur through hip arthroplasty in the elderly:A report of 56 cases

    Directory of Open Access Journals (Sweden)

    Chuan-lin DU

    2011-12-01

    Full Text Available Objective To investigate the treatment effect of hip arthroplasty for unstable intertrochanteric fractures of the femur in the elderly.Methods Fifty-six elderly patients(25 males and 31 females,aged 75 to 92 years with mean of 83 years with unstable intertrochanteric fractures hospitalized from January 2005 to June 2010 were involved in the present study.According to the Evan’s fracture classification,22 cases were classified as type III,24 as type IV,and 10 as type V.All the patients received bone-cement type hip arthroplasty,and the treatment effects,perioperative complications,and follow-up results were observed.Results The operation was completed successfully for all patients.The postoperative complications included,two cases of deep venous thrombosis,two cases of transient psychotic disorder,and two cases of pseudomembranous colitis,all of which,were cured via symptomatic treatment.Three patients have had complications with pulmonary embolism and two with fractures around the prosthesis four months after discharge.Two patients died of pulmonary infection and multiple organ failure,respectively.The Harris hip score were excellent for the 21 cases and good for 26 cases.The excellent and good rating was 83.9% after six months from operation.No joint infection or dislocation occurred during the follow-up period of 12 to 20 months(mean of 16 months.Conclusion Hip arthroplasty has been proven to be an effective treatment for unstable intertrochanteric fractures in the elderly with less surgery trauma and complications.It also allowed early ambulation and improved the quality of life of the patients.

  10. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus.

    NARCIS (Netherlands)

    Rutten, M.J.C.M.; Jager, G.J.; Waal Malefijt, M.C. de; Blickman, J.G.

    2007-01-01

    The aim of this study was to describe a new sonographic sign of bone fracture and to determine if it can be helpful in decreasing the number of missed fractures of the proximal humerus. Ultrasound (US) of the shoulder was performed in 57 consecutive patients with shoulder pain and/or disability

  11. Controversies in the intramedullary nailing of proximal and distal tibia fractures.

    Science.gov (United States)

    Tejwani, Nirmal; Polonet, David; Wolinsky, Philip R

    2014-10-01

    Management of tibia fractures by internal fixation, particularly intramedullary nails, has become the standard for diaphyseal fractures. However, for metaphyseal fractures or those at the metaphyseal-diaphyseal junction, choice of fixation device and technique is controversial. For distal tibia fractures, nailing and plating techniques may be used, the primary goal of each being to achieve acceptable alignment with minimal complications. Different techniques for reduction of these fractures are available and can be applied with either fixation device. Overall outcomes appear to be nearly equivalent, with minor differences in complications. Proximal tibia fractures can be fixed using nailing, which is associated with deformity of the proximal short segment. A newer technique-suprapatellar nailing-may minimize these problems, and use of this method has been increasing in trauma centers. However, most of the data are still largely based on case series. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

  12. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique.

    Science.gov (United States)

    Konrad, G; Bayer, J; Hepp, P; Voigt, C; Oestern, H; Kääb, M; Luo, C; Plecko, M; Wendt, K; Köstler, W; Südkamp, N

    2010-03-01

    The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate. One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six month,and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up. Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture. Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the

  13. Management of the proximal tibia fractures by mini external fixation: A case series of 30 cases

    Directory of Open Access Journals (Sweden)

    Samar K Biswas

    2014-01-01

    Full Text Available Background: Management of high velocity trauma is a challenging problem because of morbidity of trauma and sometime residual problems of failure of proper healing of fractures with the restriction of movements of knee, shortening, and added risk of compartment syndrome in the proximal tibia fracture. There is always risk of post-operative infection and infected non-union in extensive open surgical procedure and internal fixation. Hence, there is always look out for the middle path procedure for a solution to the above said problems with the added advantage of less hospital stay and early return to work by minimal invasive procedure and stabilization of fracture reduction by multiple K-wire fixation with a frame applied externally. Stabilization of fracture with reduced pain allows early movements of neighbouring joint knee and ankle; hence, reduces the chances of fracture diseases. With this we have been stimulated to take-up the study of managing the proximal tibia fracture by mini external fixator. Aim: The aim of this study was to manage proximal tibia fractures by mini external fixator and evaluate the results and efficacy of this method. Material and Method: A total of 30 patients having proximal tibial fractures admitted at our center between 2008 and 2010 were taken and the procedure carried out was closed manipulative reduction and stabilization with mini external fixator. All acute proximal tibia fractures including tibial plateau fractures above 17 years of age of either sex were included in the study. Fracture more than 3 weeks old were excluded from the study. Result: Out of 30 cases 13 were excellent, 14 cases good, and 3 showed fair. It was found that type 5 and 6 of Schatzker′s classification have lesser outcome type of fractures Conclusion: We have found that management of the proximal tibia fractures by mini external fixation method has a better outcome. Early mobilization of knee in the proximal tibia fractures after

  14. Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital.

    Science.gov (United States)

    Fjalestad, Tore; Strømsøe, Knut; Blücher, Judith; Tennøe, Bjørn

    2005-06-01

    Patients with proximal humeral fractures are mostly elderly. In addition to the proximal humeral fracture, they often have other injuries related to poor bone quality. The surgical treatment of proximal humeral fractures in elderly patients with comminuted fractures is associated with several problems and a high frequency of complications. The aims of this study were to evaluate patients with a proximal humeral fracture treated in a hospital, assess the outcome of the fracture treatment, and decide whether surgical treatment of displaced proximal humeral fractures is superior to conservative treatment or not. Patients with fractures of the proximal part of the humerus treated in our hospital were followed during two different periods (14 and 10 months). The study in the first time period was retrospective in design, while in the second period the patients were followed prospectively. Seventy patients, (71% women) with a mean age of 71 years, were included in the study. A functional test was performed within 12-14 months after the injury using a modified Rowe shoulder score. Surgical treatment was performed in 15 patients (21%). Neither the surgical approach nor the implants used for osteosynthesis were standardized. Fifty-five patients (79%) were treated conservatively with a modified Velpeau bandage or a sling. The fractures were classified according to AO into type A (27%), type B (58%) and type C (14%). Osteoporotic risk factors were present in many of the patients, mainly characterized by other skeletal injuries than the proximal humeral fracture (43%). In the group of complex, displaced, non-impacted fractures B2, B3, C2, C3 included (20 fractures), the group treated conservatively had a mean Rowe score of 48/75 (64% of maximum score) and SD 16.8, while in the surgically treated group the mean score was 28/75 (38% of maximum score) and SD 8.1. The difference between the two treatments was significant, with a p-value of 0.01 in favour of the conservatively

  15. Mono- versus polyaxial locking plates in distal femur fractures - a biomechanical comparison of the Non-Contact-Bridging- (NCB) and the PERILOC-plate.

    Science.gov (United States)

    El-Zayat, Bilal Farouk; Efe, Turgay; Ruchholtz, Steffen; Khatib, Salim; Timmesfeld, Nina; Krüger, Antonio; Zettl, Ralph

    2014-11-06

    The aim of this cadaveric study was to compare a polyaxial (NCB®, Zimmer) to a fixed-angle monoaxial locking plate (PERILOC®, Smith & Nephew) in comminuted fractures of the distal femur regarding stability of the construct. Up to date there is no published biomechanical data concerning polyaxial plating in cadaveric distal femurs. Fourteen formalin fixed femora were scanned by dual-energy x-ray absorptiometry. As fracture model an unstable supracondylar comminuted fracture was simulated. Fractures were pairwise randomly fixed either with a mono- (group A) or a polyaxial (group B) distal femur plate. The samples were tested in a servohydraulic mechanical testing system starting with an axial loading of 200 N following an increase of 200 N in every step with 500 cycles in every sequence up to a maximum of 2 000 N. The end points were implant failure or relevant loss of reduction. Data records included for each specimen time, number of cycles, axial load and axial displacement. Statistical analysis was performed using the exact Wilcoxon signed rank test. The mean donor age at the time of death was 75 years. The bone mass density (BMD) of the femurs in both groups was comparable and showed no statistically significant differences. Five bones failed before reaching the maximum applied force of 2000 N. Distribution curves of all samples in both groups, showing the plastic deformation in relation to the axial force, showed no statistically significant differences. Operative stabilization of distal femur fractures can be successfully and equally well achieved using either a monoaxial or a polyaxial locking plate. Polyaxial screw fixation may have advantages if intramedullary implants are present.

  16. Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures

    DEFF Research Database (Denmark)

    Bahrs, Christian; Schmal, Hagen; Lingenfelter, Erich

    2008-01-01

    BACKGROUND: A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems. The classification was developed to evaluate whether a very detailed classification exceeding the analysis of fractured parts may be a valuable...... tool. METHODS: Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics we