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Sample records for bisphosphonate-associated femoral fracture

  1. Prophylactic bilateral intramedullary femoral nails for bisphosphonate-associated signs of impending subtrochanteric hip fracture.

    PubMed

    Yoon, Richard S; Beebe, Kathleen S; Benevenia, Joseph

    2010-04-01

    In the short and midterm, bisphosphonates have proven highly efficacious in the prevention of low-energy fractures, but long-term results and adverse effects have yet to be definitively identified. Of particular concern are emerging reports of long-term bisphosphonate users presenting with unusual low-energy subtrochanteric femur fractures. Perhaps associated with hyperactive bone remodeling leading to an eventually weakened bony architecture, the efficacy of longer-term bisphosphonate use has come into question, especially in those with >5 years of therapy.This article describes a case of a 65-year-old woman with a 10-year history of bisphosphonate use who presented with prodromal thigh pain and characteristic radiographic findings indicative of potential impending subtrochanteric insufficiency fracture. Supported by reports in the literature, unique characteristics of a certain clinical picture warn of potential bisphosphonate-associated subtrochanteric hip fracture; to our knowledge, we present the first reported prophylactic bilateral femoral intramedullary nailing to prevent fragility fracture. A deeper look into the biochemistry behind associated bony weakness caused by long-term incorporation of bisphosphonates is needed, especially if an endpoint to the therapy is to be determined. However, with mounting clinical evidence supporting the risk of bisphosphonate-associated fragility fracture, a characteristic radiographic appearance and clinical presentation cannot be ignored. In the interim, elective surgery may be an efficacious alternative in the treatment of an expected, readily preventable fracture.

  2. [Femoral neck fracture].

    PubMed

    Gierer, P; Mittlmeier, T

    2015-03-01

    The incidence of femoral neck fractures increases exponentially with rising age. Young patients are rarely affected but when they are it is mostly due to high energy accidents, whereas older patients suffer from femoral neck fractures by low energy trauma due to osteoporotic changes of the bone mineral density. Treatment options have not essentially changed over the last few years. Non-operative treatment may be a choice in non-dislocated and impacted fractures. Due to the high risk of secondary fracture displacement prophylactic screw osteosynthesis is recommended even in Garden type I fractures. Osteosynthetic fracture stabilization with cannulated screws or angle stable sliding screws, is usually applied in non-displaced fractures and fractures in younger patients. Older patients need rapid mobilization after surgery; therefore, total hip arthroplasty and hemiarthroplasty are commonly used with a low incidence of secondary complications. In addition to sufficient operative treatment a guideline conform osteoprosis therapy should be initiated for the prophylaxis of further fractures and patients should undertake a suitable rehabilitation.

  3. [Pathogenesis of atypical femoral fracture].

    PubMed

    Iwata, Ken; Mashiba, Tasuku

    2016-01-01

    We demonstrated microdamage accumulation in the fracture sites in the patients of subtrochanteric atypical femoral fracture with long term bisphosphonate therapy and of incomplete shaft fracture of lateral femoral bowing without bisphosphonate therapy. Based on these findings, pathogenesis of atypical femoral fracture is revealed stress fracture caused by accumulation of microdamages between distal to the lesser trochanter and proximal to the supracondylar flare in the femur in association with severely suppressed bone turnover and/or abnormal lower limb alignment, that causes stress concentration on the lateral side cortex of the femur. PMID:26728533

  4. Pseudopathologic fracture of the femoral neck

    SciTech Connect

    Pope, T.L. Jr.; Keats, T.E.; Goldner, R.; Stelling, C.B.; Logan, M.

    1981-11-01

    We have seen two cases of traumatic subcapital fractures of the femoral neck which resembled pathologic fractures on plain radiography. We have named this entity pseudopathologic fracture of the femoral neck and offer suggestions for why it occurs.

  5. Unusual presentation of a femoral stress fracture

    PubMed Central

    Ejnisman, Leandro; Wajnsztejn, Andre; Queiroz, Roberto Dantas; Ejnisman, Benno

    2013-01-01

    Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation. PMID:23283621

  6. Subchondral insufficiency fracture of the femoral head after internal fixation for femoral neck fracture: histopathological investigation.

    PubMed

    Sonoda, Kazuhiko; Yamamoto, Takuaki; Motomura, Goro; Kido, Hidehiko; Iwamoto, Yukihide

    2014-08-01

    Late segmental collapse after internal fixation for femoral neck fracture is the phenomenon observed in post-traumatic osteonecrosis of the femoral head (ON), which has generally been reported to occur over a year or more after internal fixation. Subchondral insufficiency fracture of the femoral head (SIF) has also been recognized to cause femoral head collapse, however, only two cases of SIF after internal fixation for femoral neck fracture have been reported. We report a case with femoral head collapse observed 5 months after internal fixation for femoral neck fracture, which was histopathologically diagnosed as SIF. Clinically, differentiating SIF from ON is important because some cases of SIF have been reported to heal without surgical treatments. The timing of femoral head collapse after femoral neck fracture may be different between SIF and post-traumatic ON.

  7. Prospective evaluation of femoral head viability following femoral neck fracture

    SciTech Connect

    Binkert, B.; Kroop, S.A.; Nepola, I.V.; Grantham, A.S.; Alderson, P.O.

    1984-01-01

    The bone scans of 33 patients (pts) with recent subcapital fractures (fx) of the femur were evaluated prospectively to determine their value in predicting femoral head visability. Each of the 33 pts (ll men, 22 women, age range 30-92) had a pre-operative bone scan within 72 hrs of the fx (23 pts within 24 hrs). Anterior and posterior planar views of both hips and pinhole views (50% of pts) were obtained 2 hrs after administration of Tc-99m HDP. The femoral head was classified as perfused if it showed the same activity as the opposite normal side or if it showed only slightly decreased activity. Femoral heads showing absent activity were classified as nonperfused. Overall, 20 of the 33 pts showed a photopenic femoral head on the side of the fx. Only 2 pts showed increased activity at hte site of the fx. Internal fixation of the fx was performed in 23 pts, 12 of whom had one or more follow-up scans. Five of these 12 pts showed absent femoral head activity on their initial scan, but 2 showed later reperfusion. The other 7 pts showed good perfusion initially, with only 1 later showing decreased femoral head activity. The other 10 pts (7 of whom had absent femoral head activity) had immediate resection of the femoral head and insertion of a Cathcart prosthesis. The results suggest that femoral head activity seen on a bone scan in the immediate post-fx period is not always a reliable indicator of femoral head viability. Decreased femoral head activity may reflect, in part, compromised perfusion secondary to post-traumatic edema, with or without anatomic disruption of the blood supply.

  8. EPIDEMIOLOGICAL STUDY OF CHILDREN DIAPHYSEAL FEMORAL FRACTURES

    PubMed Central

    Hoffmann, Cassiano Ricardo; Traldi, Eduardo Franceschini; Posser, Alexandre

    2015-01-01

    Objective: To evaluate the personal, fracture, treatment and complication characteristics among patients with pediatric femoral shaft fractures attended at the pediatric orthopedic service of the Joana de Gusmão Children's Hospital. Methods: This was a retrospective cross-sectional study on a population consisting of patients with femoral shaft fractures, aged between birth and 14 years and 11 months, who were divided into four age groups. Information was obtained from medical records and was transferred to a survey questionnaire to present personal, fracture, treatment and complication variables. Results: The study population consisted of 96 patients. Their mean age was 6.8 years. The cases were predominantly among males, comprising closed fractures on the right side, in the middle third with a single line. Regarding fracture etiology, traffic accidents predominated overall in the sample. Most of the patients (74 to 77.1%) presented femoral fractures as their only injury. Conservative treatment predominated in the group younger than six years of age, and surgical treatment in the group aged 6 to 14 years and 11 months. The complications observed until bone union were: discrepancy, infection and movement limitation. The mean time taken for consolidation was 9.6 ± 2.4 weeks, varying with age. Conclusion: The features of these fractures were similar to those described in the literature and the treatment used showed good results. The Joana de Gusmão Children's Hospital has used the treatment proposed in the literature for pediatric femoral shaft fractures. PMID:27042619

  9. Optimizing Stability in Femoral Neck Fracture Fixation.

    PubMed

    Ye, Ye; Hao, Jiandong; Mauffrey, Cyril; Hammerberg, E Mark; Stahel, Philip F; Hak, David J

    2015-10-01

    Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants. PMID:26488776

  10. Atypical periprosthetic femoral fracture: a case report.

    PubMed

    Woo, S B; Choi, S T; Chan, W L

    2016-08-01

    We report an 82-year-old woman who underwent fixation with a long-spanning cable-plate for a bisphosphonate-induced Vancouver B1 periprosthetic femoral fracture. Non-union and breakage of the plate occurred at 16 months and necessitated revision surgery using a long-stem femoral prosthesis augmented with a cable-plate construct. Bone union was achieved eventually after 10 months. PMID:27574277

  11. [Medial femoral neck fracture. Controversies in treatment].

    PubMed

    Raaymakers, E L F B; Schafroth, M

    2002-02-01

    The treatment of the medial femoral neck fracture remains controversial until today. The goal of this paper is therefore, based on the literature, to show guidelines for optimal treatment: conservative treatment vs. operation, osteosynthesis vs. prosthesis, timing for osteosynthesis, open vs. closed reduction, choice of implant for osteosynthesis, postoperative treatment (weight bearing vs. non weight bearing), Pauwels-Osteotomy vs. prosthesis in cases op pseudarthrosis, femoral head prosthesis vs. total hip arthroplasty, bipolar vs. monopolar femoral head prosthesis, choice of classification. Further we want to point out which statements are evidence based and where we need further investigation.

  12. Spontaneous stress fractures of the femoral neck

    SciTech Connect

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

    1985-02-01

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

  13. Femoral shaft stress fractures in athletes.

    PubMed

    Hershman, E B; Lombardo, J; Bergfeld, J A

    1990-01-01

    Stress fractures of the femoral shaft in athletes occur most commonly in the proximal third of the femur. They can, however, also be found in the mid- or distal third. Conservative treatment is highly successful in healing these fractures without complications. Athletes can usually return to activity in 8 to 14 weeks. Recognition of the symptoms characteristic of these fractures (vague thigh pain, diffuse tenderness, no trauma) will assist early diagnosis. Early definitive diagnosis can be made by radionuclide scanning or later, by plain radiography, if symptoms have been present for a sufficient period. Diagnosis is not limited to novice runners since runners with significant mileage, or baseball or basketball players, can develop femoral shaft stress fractures.

  14. Femoral fractures in the extremely elderly

    PubMed Central

    Guido, Giulio; Giannotti, Stefano; Bottai, Vanna; Ghilardi, Marco; Bianchi, Maria Giulia; Ceglia, Michael James

    2011-01-01

    Summary At the Trauma Unit of Pisa we performed an observational study reviewing nineties that about 200 patients were treated and underwent surgery for femoral neck fracture from 1998 to 2005. The clinical and radiographic results obtained were discrete, with a mortality of 42.5%, the survivors are still having a good quality of life. PMID:22461814

  15. Navigated femoral shaft fracture treatment: current status.

    PubMed

    Hawi, Nael; Haentjes, Jonas; Suero, Eduardo M; Liodakis, Emmanouil; Krettek, Christian; Stübig, Timo; Hüfner, Tobias; Citak, Musa

    2012-01-01

    Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15° compared to the contralateral femur is seen as an indication for revision. With the development of computer-assisted surgery, new possibilities for performing torsion control and correction intraoperatively has been introduced. These methods also allow for navigation-assisted definition of the optimal incision site, intramedullary access, femoral nail and interlocking. The main problem lies in the extra time of surgery, which is due to performing all the steps of the surgery navigated. The solution for this problem is "hybrid navigation", in which the surgeon can select the steps he needs from the navigation system, depending on his experience or surgical technique.

  16. Bipolar hemiarthroplasty in femoral neck fractures.

    PubMed

    Malhotra, R; Arya, R; Bhan, S

    1995-01-01

    Thirty-two elderly patients with a femoral neck fracture treated by bipolar hemiarthroplasty and 36 patients (matched for age) with an Austin-Moore hemiarthroplasty were followed-up and compared. Bipolar replacement resulted in a higher percentage of satisfactory results, less postoperative pain, greater range of movement, more rapid return to unassisted activity, fewer unsatisfactory results and no acetabular erosion. The device functioned as bipolar in all the cases studied for inner-bearing motion.

  17. Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases.

    PubMed

    Lee, Kyung-Jae; Min, Byung-Woo; Jang, Hyung-Kyu; Ye, Hee-Uk; Lim, Kyung-Hwan

    2015-09-01

    Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature. PMID:27536624

  18. Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures

    PubMed Central

    Moon, Kyoung Ho; Shin, Joong Sup; Shin, Eun Ho; Ahn, Chi Hoon; Choi, Geon Hong

    2016-01-01

    Background Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. Methods This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). Results Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. Conclusions The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures. PMID:27247738

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

    PubMed

    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. PMID:25566556

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

    PubMed

    Devkota, Pramod; Ahmad, Shiraz

    2013-09-01

    Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

  1. Use of Huckstep nail in the periimplant femoral shaft fracture

    PubMed Central

    Kim, Hong Kyun; Noh, Kyu Cheol; Chung, Kook Jin; Hwang, Ji Hyo

    2012-01-01

    87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations. PMID:23325980

  2. Femoral neck shaft angle in men with fragility fractures.

    PubMed

    Tuck, S P; Rawlings, D J; Scane, A C; Pande, I; Summers, G D; Woolf, A D; Francis, R M

    2011-01-01

    Introduction. Femoral neck shaft angle (NSA) has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric), symptomatic vertebral (91), and distal forearm (67) fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm(2): lumbar spine, femoral neck, and total femur) measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately), nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P = 0.001), but larger in those with distal forearm fractures (129.8° versus 128.5°: P = 0.01). Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  3. Correlation Between Femoral Neck Shaft Angle and Surgical Management in Trainees With Femoral Neck Stress Fractures.

    PubMed

    Chalupa, Robyn L; Rivera, Jessica C; Tennent, David J; Johnson, Anthony E

    2016-01-01

    The most common overuse injury leading to medical discharge of military recruits is a stress fracture. One of the high-risk stress fractures is of the lateral femoral neck which risks osteonecrosis of the femoral head, the need for arthroplasty and permanent disability. To prevent fracture progression early surgical intervention is recommended. Surgical repairs are performed in about 25% of cases of femoral neck stress fractures at military treatment facilities. Hip geometry is an important intrinsic risk for stress fractures. Loads in the average loading direction will not cause a fracture, but loads of extreme magnitude or extreme orientation may. The purpose of this study was to determine if, in the presence of femoral neck stress fracture, there is a correlation between femoral neck shaft angle, surgical treatment and outcomes. The results of this study suggest there is no correlation between return to full military duty rates, treatment, femoral neck shaft angle or fracture grade on MRI. Patients who underwent surgical fixation had greater fracture grade and pain than those that did not have surgery. Individuals who did not return to duty tended to have higher pain scores at initial evaluation.

  4. Femoral neck trabecular patterns predict osteoporotic fractures.

    PubMed

    Lee, Richard L; Dacre, Jane E; Hart, Deborah J; Spector, Tim D

    2002-07-01

    In this paper we show that texture analysis of femoral neck trabecular patterns can be used to predict osteoporotic fractures. The study is based on a sample of 123 women aged 44-66 years with and without fractures. We analyzed trabecular patterns using the Co-occurrence Matrix texture analysis algorithm and compared the predictive utility of the textural data with densitometry. Logistic regression was used to estimate the predictive utility, exp(B), of clinical and textural data per standard deviation. Reproducibility was also demonstrated using paired films at 1-year intervals (CoV=4.5%). Bone mass estimated by DEXA measurements of the spine and hip were the most predictive of fractures giving a two-fold increase in fractures per s.d. bone mass loss (95% CI: 1.2-3.1, p<0.005). Age was also highly predictive with fracture risk increasing by 1.07-fold per year (95% CI: 1.01-1.14, p<0.02). Trabecular texture was found to give a lower, but significant, prediction of fracture of 1.5-fold per s.d. trabecular pattern loss (95% CI: 0.96-2.31, p<0.05). Combining age, weight, and trabecular texture increased the fracture prediction to 1.78-fold per s.d. (95% CI: 1.19-2.67). Combining trabecular texture with densitometry increased the predictive ability to 2.06-fold per s.d. (95% CI: 1.32-3.22) and combined with age and weight as well increased exp(B) to 2.1-fold per s.d. (95% CI: 1.32-3.35). This shows that osteoporotic trabecular texture changes can be "measured." Moreover, the combination of age, weight, and trabecular texture is more predictive than either alone. We propose therefore that this trabecular texture analysis is both reproducible and clinically meaningful. The application of such methods could be used to improve the estimation of fracture risk in conjunction with other clinical data, or where densitometry data cannot be obtained (e.g., in retrospective studies). PMID:12148717

  5. Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture

    PubMed Central

    Han, Jun

    2016-01-01

    Background Proximal femoral geometry may be a risk factor of osteoporotic hip fractures. However, there existed great differences among studies depending on race, sex and age of subjects. The purpose of the present study is to analyze proximal femoral geometry and bone mineral density (BMD) in the osteoporotic hip fracture patients. Furthermore, we investigated proximal femoral geometric parameters affecting fractures, and whether the geometric parameters could be an independent risk factor of fractures regardless of BMD. Methods This study was conducted on 197 women aged 65 years or more who were hospitalized with osteoporotic hip fracture (femur neck fractures ; 84, intertrochanteric fractures; 113). Control group included 551 women who visited to check osteoporosis. Femur BMD and proximal femoral geometry for all subjects were measured using dual energy X-ray absorptiometry (DXA), and compared between the control and fracture groups. Besides, proximal femoral geometric parameters associated with fractures were statistically analyzed. Results There were statistically significant differences in the age and weight, cross-sectional area (CSA)/length/width of the femoral neck and BMD of the proximal femur between fracture group and control group. BMD of the proximal femur in the control group was higher than in the fracture group. For the femoral neck fractures group, the odds ratio (OR) for fractures decrease in the CSA and neck length (NL) of the femur increased by 1.97 times and 1.73 times respectively, regardless of BMD. The OR for fractures increase in the femoral neck width increased by 1.53 times. In the intertrochanteric fracture group, the OR for fractures increase in the femoral neck width increased by 1.45 times regardless of BMD. Conclusions We found that an increase of the femoral neck width could be a proximal femoral geometric parameter which plays important roles as a risk factor for fracture independently of BMD. PMID:27622182

  6. Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture

    PubMed Central

    Han, Jun

    2016-01-01

    Background Proximal femoral geometry may be a risk factor of osteoporotic hip fractures. However, there existed great differences among studies depending on race, sex and age of subjects. The purpose of the present study is to analyze proximal femoral geometry and bone mineral density (BMD) in the osteoporotic hip fracture patients. Furthermore, we investigated proximal femoral geometric parameters affecting fractures, and whether the geometric parameters could be an independent risk factor of fractures regardless of BMD. Methods This study was conducted on 197 women aged 65 years or more who were hospitalized with osteoporotic hip fracture (femur neck fractures ; 84, intertrochanteric fractures; 113). Control group included 551 women who visited to check osteoporosis. Femur BMD and proximal femoral geometry for all subjects were measured using dual energy X-ray absorptiometry (DXA), and compared between the control and fracture groups. Besides, proximal femoral geometric parameters associated with fractures were statistically analyzed. Results There were statistically significant differences in the age and weight, cross-sectional area (CSA)/length/width of the femoral neck and BMD of the proximal femur between fracture group and control group. BMD of the proximal femur in the control group was higher than in the fracture group. For the femoral neck fractures group, the odds ratio (OR) for fractures decrease in the CSA and neck length (NL) of the femur increased by 1.97 times and 1.73 times respectively, regardless of BMD. The OR for fractures increase in the femoral neck width increased by 1.53 times. In the intertrochanteric fracture group, the OR for fractures increase in the femoral neck width increased by 1.45 times regardless of BMD. Conclusions We found that an increase of the femoral neck width could be a proximal femoral geometric parameter which plays important roles as a risk factor for fracture independently of BMD.

  7. Bilateral Femoral Neck Stress Fracture in Child: A Case Report

    PubMed Central

    Lee, Gun-Woo; Yoon, Taek-Rim; Eshnazarovich, Eshnazarov Kamolhuja

    2016-01-01

    A femoral neck stress fracture in child is rare, particularly in bilateral case. It is easy to miss initially or may be misdiagnosed. The authors experienced a case of bilateral femoral neck stress fracture in a 10-year-old boy with bilateral hip. The patient was successfully healed by conservative treatment. We report this rare case with a review of the literature. A femoral neck stress fracture should be included in the differential diagnosis in children who present with sustained hip or groin pain. PMID:27777920

  8. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    PubMed Central

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion. PMID:27512218

  9. Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures.

    PubMed

    Wang, Tao; Sun, Jun-Ying; Zha, Guo-Chun; Jiang, Tao; You, Zhen-Jun; Yuan, De-Jing

    2014-12-01

    Femoral head necrosis is a rare but devastating complication following femoral neck fracture. The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. The aim of this study was to analyze the risk factors for femoral head necrosis after internal fixation in femoral neck fracture. This retrospective study included 166 patients with femoral neck fractures treated with surgical reduction and internal fixation at the authors' institution from January 2004 to December 2008. Eight patients died for reasons unrelated to the surgery, and 12 patients were lost to follow-up. The remaining 146 patients (146 fractures) were followed until union or until conversion to total hip arthroplasty. The patients included 61 males and 85 females with an average age of 47.5 years (range, 18-68 years). The authors analyzed the following factors: age, sex, Garden classification, reduction quality, surgical methods, injury-to-surgery interval, preoperative traction, weight-bearing time, and implant removal. All patients were followed for a mean of 52 months (range, 6-90 months). The incidence of femoral head necrosis was 14.4% (21/146). Garden classification (P=.012), reduction quality (P=.008), implant removal (P=.020), and preoperative traction (P=.003) were significantly associated with femoral head necrosis. Patient age (P=.990), sex (P=.287), injury-to-surgery interval (P=.360), weight-bearing time (P=.868), and surgical methods (P=.987) were not significantly associated with femoral head necrosis. In multivariate logistic regression analysis, implant removal was not a significant risk factor for femoral head necrosis development (P=.498). Garden classification, reduction quality, and preoperative traction had a significant effect on femoral head necrosis development. PMID:25437087

  10. Exactech Opteon Femoral Component Fracture 12 Years after Arthroplasty

    PubMed Central

    Patel, Shaun P.; Antoci, Valentin; Kadzielski, John J.; Vrahas, Mark S.

    2016-01-01

    Arthroplasty implant fracture is a rare but critical complication that requires difficult revision surgery, often with poor results, patient disability, and significant cost. Several reports show component fracture either at the stem or at the neck interface after a relatively short postoperative course. We report such failure after 12 years, suggesting no safe period after which femoral implant fracture does not occur. PMID:26955493

  11. [The changes of bone architecture in atypical femoral fracture].

    PubMed

    Yamamoto, Noriaki; Shimakura, Taketoshi; Takahash, Hideaki

    2013-07-01

    The feature of atypical femoral fracture is stress induced cortical bone reaction. It was considered to be the accumulation of microdamage which come from increasing of mechanical stress by femoral lateral bowing, and the decreased of ability of microdamage repair system. PMID:23811584

  12. Bilateral midshaft femoral fractures in an adolescent baseball player.

    PubMed

    Ju, D G; Mogayzel, P J; Sponseller, P D; Familiari, F; McFarland, E G

    2016-07-01

    Bone disease, specifically low bone mineral density, is a common and undertreated complication that begins during childhood in patients with cystic fibrosis (CF). This case describes a male baseball player, aged 14years, with undiagnosed CF who sustained a left midshaft femoral fracture while running toward base; 8months later, he sustained a right midshaft femoral fracture under similar conditions. After the second fracture, further evaluation revealed low bone mineral density and CF. There is no previously published report of pathologic fractures occurring in the femoral shaft in an athlete with undiagnosed CF. Patients with CF have a higher fracture rate. Low-energy fractures of major bones in athletically active individuals should be viewed with suspicion for an underlying process.

  13. Bilateral midshaft femoral fractures in an adolescent baseball player.

    PubMed

    Ju, D G; Mogayzel, P J; Sponseller, P D; Familiari, F; McFarland, E G

    2016-07-01

    Bone disease, specifically low bone mineral density, is a common and undertreated complication that begins during childhood in patients with cystic fibrosis (CF). This case describes a male baseball player, aged 14years, with undiagnosed CF who sustained a left midshaft femoral fracture while running toward base; 8months later, he sustained a right midshaft femoral fracture under similar conditions. After the second fracture, further evaluation revealed low bone mineral density and CF. There is no previously published report of pathologic fractures occurring in the femoral shaft in an athlete with undiagnosed CF. Patients with CF have a higher fracture rate. Low-energy fractures of major bones in athletically active individuals should be viewed with suspicion for an underlying process. PMID:26927602

  14. Femoral neck shortening after internal fixation of a femoral neck fracture.

    PubMed

    Zielinski, Stephanie M; Keijsers, Noël L; Praet, Stephan F E; Heetveld, Martin J; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M M

    2013-07-01

    This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome. PMID:23823040

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

    PubMed Central

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

    2014-01-01

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. PMID:25015169

  16. Displaced femoral neck fractures: is there a standard of care?

    PubMed

    Macaulay, William; Yoon, Richard S; Parsley, Brian; Nellans, Kate W; Teeny, Steven M

    2007-09-01

    Many factors must be considered in treating displaced femoral neck fractures. For younger patients, ORIF is preferred, whereas arthroplasty is the better option for elderly patients. For institutionalized elderly patients with a low activity level or impaired mental status, the choice should be hemiarthroplasty (either unipolar or bipolar). For high-demand, active patients, evidence continues to mount toward THA as the favored treatment option. However, there is a need for larger clinical trials to demonstrate the most cost-effective way to treat sub-populations of an ever-growing number of patients with displaced femoral neck fractures.

  17. Occult fracture of the femoral neck associated with extensive osteonecrosis of the femoral head: A case report

    PubMed Central

    Fukui, Kiyokazu; Kaneuji, Ayumi; Matsumoto, Tadami

    2015-01-01

    Introduction Although the subchondral portion of the femoral head is a common site for collapse in osteonecrosis of the femoral head (ONFH), femoral-neck fracture rarely occurs during the course of ONFH. We report a case of occult insufficiency fracture of the femoral neck without conditions predisposing to insufficiency fractures, occurring in association with ONFH. Presentation of case We report a case of occult fracture of the femoral neck due to extensive ONFH in a 60-year-old man. No abnormal findings suggestive of ONFH were identified on radiographs, and the fracture occurred spontaneously without any trauma or unusual increase in activity. The patient’s medical history, age, and good bone quality suggested ONFH as a possible underlying cause. Contrast-enhanced magnetic resonance imaging was useful in determining whether the fracture was caused by ONFH or was instead a simple insufficiency fracture caused by steroid use. Discussion The patient was treated with bipolar hemiarthroplasty, but if we had not suspected ONFH as a predisposing condition, the undisplaced fracture might have been treated by osteosynthesis, and this would have led to nonunion or collapse of the femoral head. To avoid providing improper treatment, clinicians should consider ONFH as a predisposing factor in pathologic fractures of the femoral neck. Conclusion ONFH should be included in the differential diagnosis of insufficiency fracture of the femoral neck. PMID:26275737

  18. The Association of Femoral Neck Stress Fractures with Femoral Acetabular Impingement

    PubMed Central

    Safran, Marc R.; Goldin, Michael; Anderson, Christian; Fredericson, Michael; Stevens, Kathryn J.

    2013-01-01

    Objectives: To determine if there is an increased incidence of femoral acetabular impingement (FAI) in patients presenting with stress fractures of the femoral neck. Methods: After IRB approval, the imaging studies of 25 athletes (22 females, 3 males, mean age 26, range 19 - 39 years) with femoral neck stress injuries were assessed for the presence of features suggesting FAI, including acetabular retroversion, coxa profunda, abnormal femoral head-neck junction, fibrocystic change, os acetabulae, labral tear and chondral injury. All subjects had to have an adequate AP Pelvis radiograph, a lateral radiograph of the affected hip, and an MRI of the affected hip. The alpha angle, anterior offset ratio, and center to edge (CE) angle were measured on radiographs. The grade of stress injury was determined on MR images. All images and measurements were made by a musculoskeletal fellowship trained radiologist, a fellowship trained orthopaedic surgeon, an orthopaedic sports medicine fellow and a physical medicine and rehabilitation resident. Charts were reviewed to determine treatment of the stress fracture, outcome and final follow up, as well as to determine if the patient had any further treatment for their hip. Results: Of the 25 hips (18 right, 7 left) with femoral neck stress reactions, 9 were grade 2 (bone marrow edema), 5 were grade 3 (high T2 and low T1 marrow signal), and 11 were grade 4 (stress fracture). Twenty patients (80%) had coxa profunda - where the floor of the cotyloid fossa touches or extends beyond the ilioischial line (incidence in general population is 15.2% of males, and 19.4% of females). Coxa profunda, defined by the floor of the cotyloid fossa touching or extending beyond the ilioischial line and a center edge angle of more than 35o, was present in 28% of subjects. Acetabular retroversion as assessed by the crossover sign was present in 42% (normal incidence is 5% of population). Center edge angle was greater than 35o in 20% and greater than 40 o

  19. Conservative treatment of a femoral neck fracture following nail removal.

    PubMed

    Legnani, Claudio; Dondi, Alessandra; Pietrogrande, Luca

    2013-07-01

    With increased longevity, the management of fragility fractures in the elderly is becoming more frequent. In particular, hip fractures have considerable importance due to the significant morbidity and mortality. A 67-year-old woman underwent intramedullary nail (IMN) removal inserted for a pertrochanteric fracture that had occurred 20 months earlier. This was indicated due to continuous discomfort related to the protruding apex of the implant over the great trochanter. Due to pain persistence two days after surgery, a computed tomography (CT) scan was performed, documenting a minimally displaced impacted subcapital femoral neck fracture. Conservative management with close radiographic follow-up was conducted. After six months, the patient had returned to previous daily activities and a satisfactory range of motion was achieved without pain on walking. The purpose of our paper is to discuss the decision of removing hardware in the elderly osteoporotic patient and to analyze the possibility to conservatively treat an impacted minimally displaced subcapital fracture occurring after the removal of an IMN inserted previously for the treatment of a trochanteric fracture. In the elderly population with decreased bone quality, the removal of intramedullary implants of the proximal femur should be carefully evaluated, and osteoporotic patients undergoing reduction and fixation of femoral fractures should be encouraged to start antiosteoporotic therapy (bisphosphonate, teriparatide) to reduce the risk of further bone loss. Conservative treatment should be considered for the management of lesser symptomatic minimally displaced impacted fractures, where the inherent stability of the fracture allows rapid healing without further surgical attempts.

  20. Symptomatic atypical femoral fractures are related to underlying hip geometry.

    PubMed

    Taormina, David P; Marcano, Alejandro I; Karia, Raj; Egol, Kenneth A; Tejwani, Nirmal C

    2014-06-01

    The benefits of bisphosphonates are well documented, but prolonged use has been associated with atypical femur fractures. Radiographic markers for fracture predisposition could potentially aid in safer medication use. In this case-control designed study, we compared hip radiographic parameters and the demographic characteristics of chronic bisphosphonate users who sustained an atypical femoral fracture with a group of chronic bisphosphonate users who did not sustain an atypical femur fracture and also a group who sustained an intertrochanteric hip fracture. Radiographic parameters included were neck-shaft angle (NSA), hip-axis length (HAL) and center-edge angle (CE). Multivariate regression was used to evaluate the relationship between radiographic measures and femur fracture. Receiver-operating characteristic analysis determined cut-off points for neck-shaft angle and risk of atypical femur fracture. Ultimately, pre-fracture radiographs of 53 bisphosphonate users who developed atypical fracture were compared with 43 asymptomatic chronic bisphosphonate users and 64 intertrochanteric fracture patients. Duration of bisphosphonate use did not statistically differ between users sustaining atypical fracture and those without fracture (7.9 [±3.5] vs. 7.7 [±3.3] years, p=0.7). Bisphosphonate users who fractured had acute/varus pre-fracture neck-shaft angles (p<0.001), shorter hip-axis length (p<0.01), and narrower center-edge angles (p<0.01). Regression analysis revealed associations between neck-shaft angle (OR=0.89 [95% CI=0.81-0.97; p=0.01), center edge angle (OR=0.89 [95% CI=0.80-0.99]; p=0.03), and BMI (OR=1.15 [95% CI=1.02-1.31; p=0.03) with fracture development. ROC curve analysis (AUC=0.67 [95% CI=0.56-0.79]) determined that a cut-off point for neck-shaft angle <128.3° yielded 69% sensitivity and 63% specificity for development of atypical femoral fracture. Ultimately, an acute/varus angle of the femoral neck, high BMI, and narrow center-edge angle were

  1. [Treatment of femoral neck fractures using a total hip prosthesis].

    PubMed

    Ansorge, D; Hack, U

    1983-01-01

    From October 1. 1977 to December 1. 1982 106 patients suffering from fractures of the femoral neck (n = 75) or necroses of the femoral head and nonunions of the neck fracture respectively (n = 33) underwent total hip replacement by TEP (type Müller-Charnley). The results obtained were much better in comparison to other methods of treatment: less complications, shortening of in-hospital stay (average 21.1 days) and satisfactory till good late results in 82.8%. The mortality rate came up to 13.9% (fractures: 20.0%, necrosis of the head and nonunion: 0.0%). Concerning complications we observed wound infections 0.9%, dislocations 1.9%, twice fractures of the thigh bone, twice loosening of the shaft of the prosthesis and once its fracture. The authors emphasize that in spite of the good results obtained for the time being total hip replacement for fractures of the femoral neck should be reserved to special wards.

  2. Treatment of bisphosphonates-associated osteonecrosis

    PubMed Central

    Migliorati, Cesar A.; Hupp, Wendy S.; Migliorati, Erica K.J.

    2007-01-01

    This mini-review will focus on the management of a patient with bisphosphonate-associated osteonecrosis (BON). In order to review the subject the authors report a case of a patient with prostate cancer and metastatic bone disease who was treated with zoledronic acid. Prior to cancer the patient was treated with risedronate for osteopenia but had discontinued this treatment when cancer was diagnosed. During the description of each aspect of the case, a discussion of the rationale used for the case management is presented with support of the available literature. Aspects of interest include the diagnosis of BON, the risk factor for BON for this particular patient, the decision making process for the management of acute and long-term oral cavity problems, and the introduction of high intensity laser therapy to help control pain and reduce infection and local bacterial load. PMID:22460756

  3. A case of femoral fracture in klippel trenaunay syndrome.

    PubMed

    Nahas, Sam; Wong, Fabian; Back, Diane

    2014-01-01

    We present a case of Klippel Trenaunay syndrome (KTS) who presented with severe bilateral knee osteoarthritis (OA). Preoperative planning was commenced for a total knee replacement (TKR). Whilst on the waiting list the patient suffered a fall and sustained a complete femoral diaphysis fracture. Conservative management in the form of skin traction was initially chosen as significant extra- and intramedullary vascular malformations posed an increased risk of perioperative bleeding. This failed to progress to union, and so open reduction and internal fixation was performed. This subsequently resulted in on-going delayed union, which was subsequently managed with low intensity pulsed ultrasound (LIPUS, otherwise known as Exogen (Bioventus. exogen. Secondary exogen, 2012)). There are only two previous documented cases of femoral fracture in KTS. This is the first report of a patient with this rare syndrome receiving this treatment. We discuss the management of fracture in this challenging group of patients. PMID:25478269

  4. Conservative management of femoral shaft fractures in children.

    PubMed

    Moses, T; Pan, K L; Razak, M

    1998-09-01

    Thirty-two children with femoral shaft fractures were treated conservatively with initial skin traction followed by an additional period in a spica cast. After 12 to 20 months of follow up, none had any pain and all of them were attending school without problems. Shortening of more than 2 cm occurred in 6 (19%) of the 32 patients. The most important factor associated with shortening was an overlap of more than 2 cm of shortening of the fracture ends at the time of cast fitting. The average compensatory overgrowth at final assessment was 7 mm. Angular deformity did not pose a problem. This is a safe, simple and practical method to treat childhood femoral shaft fractures.

  5. Concurrent femoral neck fractures following pelvic irradiation: a case report

    PubMed Central

    2009-01-01

    Introduction Fracture of the neck of the femur is common in older people. It often occurs in a single hip, with osteoporosis being the most common cause. Sometimes this fracture may also occur following pelvic irradiation, though this is not common. To the best of our knowledge, we present the first reported case in Nigeria of concurrent bilateral fractures of the femoral neck following pelvic irradiation. Case presentation A 74-year-old Nigerian woman presented at our surgical outpatients department with a 5-month history of pain in both hips and a 4-month history of inability to walk. She had had pelvic irradiation for carcinoma of the cervix 2 years earlier. Pelvic radiographs confirmed bilateral subcapital neck fractures. Conclusion Patients with hip pain who have been treated with pelvic irradiation should be thoroughly investigated for hip fractures. PMID:20066055

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

    SciTech Connect

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

    1985-04-01

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

  7. Osteochondral Fractures of the Lateral Femoral Trochlea in Young Athletes

    PubMed Central

    Walsh, Stewart

    2016-01-01

    Method: Between May 2012 and September 2014 cluster of five patients with large osteochondral fractures of the lateral femoral trochlea were treated at our institution. These all occurred in high level male athletes, one at a decathlete and the other four soccer players. The MRI scan showed a characteristic appearance of a large subchondral fracture involving most of the lateral femoral trochlea. All patients were symptomatic. The patients were treated with open reduction and internal fixation using headless compression screws. The operative technique and short term results will be outlined. Results: Fixation appears successful in most cases. Conclusion: This appears to be a repetitive trauma related injury that occurs in young high-level athletes.

  8. Outcome and incidence of periprosthetic supracondylar femoral fractures in TKA

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: Periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) are infrequent, but is a devastating complication. The purpose of this study was to evaluate the incidence and outcomes of periprosthetic supracondylar femoral fractures following TKA using nonoperative as well as open reduction and internal fixation (ORIF) techniques. Materials and Methods: Between January 2004 and December 2010, we followed 3,920 operated patients of total knee arthroplasty (TKA) and identified 23 patients with periprosthetic supracondylar fractures. A retrospective analysis of the records of these patients was conducted. Details regarding pre fracture status, treatment offered and the present status were also recorded and analyzed. Time from index arthroplasty to periprosthetic fracture ranged from five days to six years. There were 17 women and 6 men and the average age was 68.26 years (range 52-83 years). Of the 23 patients, 20 patients were treated by operative method, whereas only three patients with relatively undisplaced fractures were treated nonoperatively. Results: The total incidence of periprosthetic fractures in operated cases of TKA was 0.58%. Three patients had infection after surgery. As per radiological assessment, two of three conservatively treated cases had malunion, whereas among 20 cases treated operatively, 16 had primary union with one malunion. Two patients had union after bone grafting, whereas two had nonunion. The average reduction in the knee score after fracture was 20.53%. Twenty one patients were able to achieve limited but independent activity. Conclusions: Desirable results for periprosthetic fractures can be obtained if proper and timely intervention is done, taking into account the other comorbid conditions. However, short duration of followup and small number of patients were major limiting factors in this study. PMID:24379465

  9. The Economic Burden of Femoral Neck Fractures in Jamaica.

    PubMed

    Vaughan, K D; Gordon, C; Ducasse, G; Williams, S

    2014-09-01

    Osteoporotic femoral neck fractures are increasing as the population ages. There is a significant cost to care for patients with such fractures. We prospectively analysed the in-hospital cost of managing 85 patients admitted to the University Hospital of the West Indies (UHWI) with such fractures. The majority of patients were females, 78.8%, and the mean age of the cohort was 83.7 years. There was a significant difference in the mean preoperative delay and length of stay between those patients treated publicly as compared to those treated privately, 9.6 vs 3.1 days and 18.9 vs 8.8 days, respectively. The mean acute cost of those treated publicly was 39% of the cost of those treated privately, J$110 878.80 vs J$284 287.61. The economic cost per year to the country for the acute management of femoral neck fractures was calculated at J$46 264 528.76 which is 0.30% of the 2005-2006 budgetary allocation for health. This cost was significantly associated with the length of hospital stay and the number of complications developed.

  10. The Economic Burden of Femoral Neck Fractures in Jamaica

    PubMed Central

    Vaughan, KD; Gordon, C; Ducasse, G; Williams, S

    2014-01-01

    ABSTRACT Osteoporotic femoral neck fractures are increasing as the population ages. There is a significant cost to care for patients with such fractures. We prospectively analysed the in-hospital cost of managing 85 patients admitted to the University Hospital of the West Indies (UHWI) with such fractures. The majority of patients were females, 78.8%, and the mean age of the cohort was 83.7 years. There was a significant difference in the mean preoperative delay and length of stay between those patients treated publicly as compared to those treated privately, 9.6 vs 3.1 days and 18.9 vs 8.8 days, respectively. The mean acute cost of those treated publicly was 39% of the cost of those treated privately, J$110 878.80 vs J$284 287.61. The economic cost per year to the country for the acute management of femoral neck fractures was calculated at J$46 264 528.76 which is 0.32% of the 2005-2006 budgetary allocation for health. This cost was significantly associated with the length of hospital stay and the number of complications developed. PMID:25781282

  11. Operative management of Hoffa fracture of the femoral condyle.

    PubMed

    Sahu, Ramji Lal; Gupta, Pratiksha

    2014-01-01

    Hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been reported in the literature. These fractures are due to high energy trauma and conservative treatment generally yields poor results, but rigid internal fixation allows early functional rehabilitation and decreases the incidence of complications. The purpose of the study was to prospectively analyse the clinico-radiological and functional outcome following open surgical treatment. From July 2005 to July 2010, 22 patients (14 males and 8 females) were recruited from Emergency and outpatient department having closed and open Hoffa fracture of the femoral condyle. All patients were operated under general or spinal anesthesia. Post-operatively, all the patients were followed for 12 months. Fractures were united in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of fracture pattern. Fractures were reduced anatomically in all except in one patient. During follow-up, there were no losses of reduction or fixation. Full weight bearing were started in the mean time of 8.8 weeks. Mean duration of hospital stay were 9.8 days. Complications were stiffness and pain in one patient, collateral laxity in one patient and progression of arthritis in one patient. The results were excellent in 90.90% and good in 9.09% patients. Finally, we conclude that the early anatomical reduction and rigid fixation with screws provide best results and minimal complications. PMID:25130151

  12. Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly

    PubMed Central

    Togrul, Emre; Kose, Ozkan

    2015-01-01

    Background The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment. Methods Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit. Results The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed. Conclusions Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures. PMID:26640625

  13. Bone impregnated hip screw in femoral neck fracture: Clinicoradiological results

    PubMed Central

    Sundar Raj, PK; Nuuman, Jiju A; Pattathil, Amish Sunder

    2015-01-01

    Background: Femoral neck fractures are treated either by internal fixation or arthroplasty. Usually, cannulated cancellous screws are used for osteosynthesis of fracture neck of femur. The bone impregnated hip screw (BIHS) is an alternative implant, where osteosyntehsis is required in femoral neck fracture. Materials and Methods: The BIHS is a hollow screw with thread diameter 8.3 mm, shank diameter 6.5 mm and wall thickness 2.2 mm and holes in the shaft of the screw with diameter 2 mm, placed in a staggered fashion. Biomechanical and animal experimental studies were done. Clinical study was done in two phases: Phase 1 in a group of volunteers, only with BIHS was used in a pilot study and phase 2 comparative study was done in a group with AO cannulated screws and the other group treated with BIHS. Results: In the phase 1 study, out of 15 patients, only one patient had delayed union. In phase 2, there were 78 patients, 44 patients in BIHS showed early union, compared to the rest 34 cases of AO cannulated screws Out of 44 patients with BIHS, 41 patients had an excellent outcome, 2 had nonunions and one implant breakage was noted. Conclusions: Bone impregnated hip screw has shown to provide early solid union since it incorporates the biomechanical principles and also increases the osteogenic potential and hence, found superior to conventional cannulated cancellous screw. PMID:26015608

  14. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures

    PubMed Central

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-01-01

    Abstract The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation. One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head. Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH. There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications. PMID:26632739

  15. Intramedullary nailing of acute femoral shaft fractures using manual traction without a fracture table.

    PubMed

    Karpos, P A; McFerran, M A; Johnson, K D

    1995-02-01

    Intramedullary (IM) nails were prospectively placed in 32 consecutive femoral shaft fractures without the use of a fracture table. All fractures were reduced using manual traction. Pathologic and nonacute fractures and those requiring a reconstruction nail were excluded. The results are compared with results of two prior study groups from this institution that underwent IM nailing with or without a fracture table using a femoral distractor. Ten patients had unstable spine or pelvis fractures. Four nailings followed exploratory laparotomy. Twelve patients underwent two or more procedures on the lower extremities under the same preparation and drape. Six fractures were open. Sixty-seven percent of results were anatomic, 27% had < 5 mm lengthening/shortening or < 5 degree varus/valgus, and 7% had > 5 mm lengthening/shortening or > 5 degree varus/valgus. Average operative time was 95 min. No complications occurred that were attributable to the technique. Compared with the prior study groups, no statistical difference in the fracture types or results was found. However, operative time was significantly less in the manual traction group (p < .05). We feel that this technique is a safe, simple, and effective alternative to using a fracture table. The technique is especially useful in the polytrauma patient, significantly decreasing anesthetic time.

  16. [Progress in diagnosis and treatment of ipsilateral femoral neck and shaft fracture].

    PubMed

    Du, C G; Zhang, Y Z; Chen, W

    2016-07-01

    Ipsilateral femoral neck and shaft fractures are rare injuries, which are often caused by high-energy trauma and combined with multiple injuries, such as thoracic and abdominal injury, head injuries, and fractures of other sites.Delayed or missed diagnosis of the ipsilateral femoral neck fracture often occurs.When patients with femoral shaft fractures caused by high-energy trauma are admitted into hospital, physical examination should be conducted carefully.In addition to femoral shaft fractures, radiographs of the ipsilater hip and knee joints should been taken, simultaneously taking into consideration the potential effect of anteversion angle on the demonstration of femoral neck fracture.Computed tomograph and magnetic resonance imaging are advised to perform if necessary to facilitate early and accurate diagnosis of ipsilateral femoral neck fracture.Comprehensive evaluation should be done based on age, physical condition, associated injuries as well as fracture site, classification and injury severity.Accordingly, proper and reasonable surgical plan is made.During the operation, anatomical reduction of the fractures, especially femoral neck fractures, should be achieved, and then fixed with appropriate internal implants.Besides, attention should also be paid to the treatment of associated injuries as well as the prevention and management of complications. PMID:27373484

  17. Outcome after conservatively managed intracapsular fractures of the femoral neck

    PubMed Central

    Green, NL; Sudahar, T; Makwana, NK; Whittaker, JP

    2015-01-01

    Introduction In 2012, 2.6% of hip-fracture patients in the UK were treated conservatively. There is little data on outcome for these patients. However, one study demonstrated that though 30-day mortality is higher, mortality over the rest of the year is comparable with that in surgical groups. Therefore, we assessed conservatively managed patients in our unit. Methods Patients with intracapsular fractures of the femoral neck treated by conservative means between 2010 and 2012 inclusive were identified. Data were collected: American Society of Anaesthesiologists (ASA) grade, Nottingham Hip Fracture Score (NHFS), mobility, mortality (30 days and one year) and pain levels. Results Thirty-two patients formed the study cohort. Mean age was 85.6 years. Median ASA grade was 4. Mortality at 30 days and one year was 31.3% and 56.3%, respectively. There was one case of pneumonia and one of infection. Pressure sores or venous thromboembolism were not documented. Three patients underwent surgery once their health improved. In general, mobility was decreased, but 30.8% of patients could mobilise with two aids or a frame. Only two cases had ongoing problems with pain. Conclusions Our data are similar to those published previously. Our patients were likely to have higher mortality data due to selection bias. Thirty-day mortality was significantly higher than the national average, but patients surviving 30 days had a prevalence of mortality similar to those managed by surgical means. Despite mobility decreasing from the pre-admission status, a considerable number of patients were free of pain and could mobilise. These data suggest that conservative management of intracapsular fractures of the femoral neck can produce acceptable results. PMID:26263935

  18. Efficiency of the Lausanne Clinical Pathway for Proximal Femoral Fractures

    PubMed Central

    Fleury, Nicole; Chevalley, François; Rubli, Eve; Coti, Pauline; Farron, Alain; Jolles, Brigitte M.

    2015-01-01

    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 hospitalization 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 hospitalization 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 stabilized afterwards. The goal of 90% of patients undergoing surgery within 48 h of arrival in the emergency department was surpassed in 2013 (93.1%). Furthermore, we observed an improvement in the clinical indicators. Conclusion: 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. PMID:25745631

  19. Bilateral spontaneous fracturing of the femoral neck in a patient with renal osteodystrophy.

    PubMed

    Garcia, Flavio Luís; Dalio, Renato Bellini; Sugo, Arthur Tomotaka; Picado, Celso Hermínio Ferraz

    2014-01-01

    We report a case of bilateral fracturing of the femoral neck in a patient with renal osteodystrophy who was treated by means of osteosynthesis. In this type of patient, there is a need to remain watchful for the possibility of occurrences of spontaneous fracturing of the femoral neck, even if the initial radiographic examination is normal. PMID:26229859

  20. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail.

    PubMed

    Gomes, Pedro Luciano Teixeira; Castelo, Luís Sá; Lopes, António Lemos; Maio, Marta; Miranda, Adélia; Dias, António Marques

    2016-01-01

    Proximal femoral nails with a helical blade are a new generation of implants used for treating transtrochanteric fractures. The blade design provides rotational and angular stability for the fracture. Despite greater biomechanical resistance, they sometimes present complications. In the literature, there are some reports of cases of perforation of the femoral head caused by helical blades. Here, a clinical case of medial migration of the helical blade through the femoral head and acetabulum into the pelvic cavity is presented.

  1. Hip arthroplasty after treatment failure in intertrochanteric femoral fractures.

    PubMed

    Gagała, Jacek; Blacha, Jan; Twaróg, Zbigniew

    2005-10-28

    Background. Treatment failure in intertrochanteric fractures of the femur leads to pain and limitations of limb function. Methods of treatment allowing for union in order to preserve the proximal femur are undertaken in younger patients. Older patients who have poor quality bone stock and bone loss in the proximal femur are treated with hip arthroplasty. The aim of our study was to perform a long-range follow-up on patients treated with hip arthroplasty after failure of peritrochanteric fracture treatment. Material and methods. We studied 10 patients (6 men and 4 women, average age 61 years) seen after treatment failure in peritrochanteric fractures during the period 1998 - 2003 in the Orthopedics and Traumatology Departament at the Skubiszewski Medical University of Lublin. Seven patients were treated with hemiarthroplasty, and three with total hip replacement. Three long femoral stems were used. Results. One patent died in the early postoperative period. There were two dislocations of hip replacements. An increase in Harris Hip Score was noted, from an average 25 points preoperatively to an average 85 points in long-term follow-up. There was one revision arthroplasty due to breakage of the ceramic cup and head of a Mittelmeier prosthesis. Conclusions. Patients treated with hip arthroplasty after treatment failures in peritrochanteric fractures of the femur can achieve a pain-free hip and good limb function.

  2. Efficacies of surgical treatments based on Harris hip score in elderly patients with femoral neck fracture

    PubMed Central

    Liang, Chengwei; Yang, Fengjian; Lin, Weilong; Fan, Yongqian

    2015-01-01

    Aim: To compare the efficacies of four surgical treatments, i.e., total hip arthroplasty (THA), internal fixation (IF), hemiarthroplasty (HA), and artificial femoral head replacement (artificial FHR), by performing a network meta-analysis based on Harris hip score (HHS) in elderly patients with femoral neck fracture. Methods: In strict accordance with specific inclusion and exclusion criteria, randomized controlled trails (RCTs) were screened and selected from a larger group of studies that were retrieved through a comprehensive search of scientific literature databases, further complimented by manual search. The resultant high-quality data from final selected studies were analyzed using Stata 12.0 software. Results: A total of 3680 studies were initially retrieved from database search, and 15 RCTs were eventually incorporated into this meta-analysis, containing 1781 elderly patients who had undergone various surgical treatments for femoral neck fracture (THA group = 604; HA group = 604; IF group = 495; artificial FHR group = 78). Our major result revealed a statistically significant difference in HHS of femoral neck fracture when HA and IF groups were compared with THA. No differences were detected in the HHS of femoral neck fracture undergoing artificial FHR and THA. The surface under the cumulative ranking curves (SUCRA) value of HHS, in elderly patients with femoral neck fracture after surgery, revealed that IF has the highest value. Conclusions: The current network meta-analysis results suggest that IF is the superlative surgical procedure for femoral neck fracture patients, and IF significantly improves the HHS in femoral neck fracture patients. PMID:26221216

  3. Fracture toughness of human femoral neck: effect of microstructure, composition, and age.

    PubMed

    Yeni, Y N; Norman, T L

    2000-05-01

    The effects of porosity and pore size; osteonal area, size, and density; mineral content; water content; wet and dry apparent densities; and age on mode I (tensile) and mode II (shear) strain energy release rate were investigated for femoral neck cortical bone from human cadavers aged >/=50 years. The results suggest that porosity- and density-based parameters that are related to bone quantity are more consistently determinant for femoral neck fracture toughness than morphology-based parameters that are related to microstructural organization. Bone features examined here were more explanatory for shear than tension fracture toughness. Tension and shear fracture toughness did not change with age, unlike in previous reports investigating the femoral and tibial shaft. It was concluded that the femoral neck is different from the femoral and tibial shaft in terms of its microstructure and composition and in its relationship of fracture toughness to its constituents and age. PMID:10773590

  4. Rehabilitation in peripheral non femoral fractures: a review

    PubMed Central

    Mangone, Giuseppe; Postiglione, Marco; Pasquetti, Pietro

    2010-01-01

    This paper is a short review of the available information on peripheral non femoral fractures (PNFF) which are strictly related to osteoporosis. Particular attention is focused on wrist fractures in view of their frequent occurrence as indicated by world wide statistics. Of special interest is the definition of risk groups (old age), risk areas (developed countries) and risk factors. Reference is made to 2008 WHO guidelines for fracture risk assessment. PNFF are a serious concern to health authorities because their high incidence in constant growth, causes a serious burden on the health budget. The pathway of patient care is described, from initial evaluation (including bone fragility, multi-morbidity and risk factors) to specific diagnosis and treatment. The multiplicity of etiological factors involved requires multidisciplinary approach. This aspect justifies the importance given to rehabilitation, which is the longest part of patient care and is strictly connected to preventive measures. There is ample reference to falls, to exercises, to appropriate sports, to complications and to active and passive mobilization. The paper suggests research in areas related to PNFF, to health economics, epidemiology, prevention, health education, training and multidisciplinary coordination. PMID:22461292

  5. HEMIARTHROPLASTY IN THE TREATMENT FRACTURES OF THE FEMORAL NECK

    PubMed Central

    Ono, Nelson Keiske; de Andrade Lima, Guilherme Didier; Honda, Emerson Kiyoshi; Polesello, Giancarlo Cavalli; Guimarães, Rodrigo Pereira; Júnior, Walter Ricioli; de Queiroz, Marcelo Cavalheiro

    2015-01-01

    Objective: To epidemiologically and clinically evaluate patients with displaced femoral neck fractures that were surgically treatment with cemented hip hemiarthroplasty. Methods: All patients with displaced femoral neck fractures (Garden III and IV) who underwent cemented hip hemiarthroplasty using a unipolar prosthesis (Thompson), by means of a posterolateral access between June 2005 and September 2008 were retrospectively evaluated. Results: Seventy patients were initially evaluated. Their mean age was 83.1 years. The patients were predominantly female (84.3%). Thirty-six patients were monitored as outpatients for periods ranging from 10 to 48 months (mean of 26.5 months). Fifteen patients were lost to follow-up. Nineteen patients died, and the mortality rate within the first year was 25.4%. Patients classified as ASA III had a mortality rate of 25.7% and ASA II patients, a rate of 12.1%. Two patients had symptomatic deep vein thrombosis; one patient had an operative wound infection; and none of the patients presented hip dislocation. Most of the patients did not experience pain. Twelve patients (33%) showed deterioration of their walking ability. Conclusion: There were no cases of hip dislocation. Patients classified as ASA III had a higher mortality rate than did patients with ASA I or II. There was a worsening of walking ability in 33% of the patients. No revision due to loosening or pain was needed for any patient. Thirty patients did not present any pain (83.3%), four presented moderate pain (11.1%) and two presented intense pain (5.5%). PMID:27022567

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

    PubMed

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

    2005-11-01

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

  7. A case of an atypical femoral fracture associated with bacterial biofilm--pathogen or bystander?

    PubMed

    Howe, T S; Ehrlich, G D; Erlich, G; Koh, J S B; Ng, A C M; Costerton, W

    2013-05-01

    We report a case of an 86-year-old woman with an atypical femoral fracture (AFF) who was treated with intramedullary nailing followed by lateral femoral plating. She developed a second femoral shaft fracture distal to the intramedullary nail which required a second operation. Biopsy of the periosteum overlying the site of the initial proximal AFF was sent for pathogen analysis. Using the Ibis T5000 platform and the BAC plate assay, a polymicrobial infection was diagnosed consisting of Bifidobacterium subtile and Pseudomonas mendocina. This raises the possibility that bacterial infections may play some role in atypical fractures of the femur.

  8. Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report.

    PubMed

    Won, Yougun; Lee, Gi Soo; Kim, Sang Bum; Kim, Sun Joong; Yang, Kyu Hyun

    2016-11-01

    As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposures and implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenient and able to lessen surgical time without morbidity of the donor site associated with the harvest. PMID:27593886

  9. Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report

    PubMed Central

    Won, Yougun; Kim, Sang Bum; Kim, Sun Joong; Yang, Kyu-Hyun

    2016-01-01

    As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposures and implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenient and able to lessen surgical time without morbidity of the donor site associated with the harvest. PMID:27593886

  10. Cortical screw support in femoral neck fractures. A radiographic analysis of 87 fractures with a new mensuration technique.

    PubMed

    Lindequist, S

    1993-06-01

    In 87 femoral neck fractures, operated on with 2 von Bahr screws and followed for up to 2 years, the positions of the fixating screws were determined with a new mensuration technique which compensates for the variations in hip rotation in routine radiographs. The union rate of the fractures was related to the position of the screws. A posterior placement of the proximal screw and an inferior placement of the distal screw in both the femoral head and neck improved the outcome substantially.

  11. "Atypical femoral fractures" during bisphosphonate exposure in adult hypophosphatasia.

    PubMed

    Sutton, Roger A L; Mumm, Steven; Coburn, Stephen P; Ericson, Karen L; Whyte, Michael P

    2012-05-01

    We report a 55-year-old woman who suffered atypical subtrochanteric femoral fractures (ASFFs) after 4 years of exposure to alendronate and then zolendronate given for "osteoporosis." Before alendronate treatment, she had low bone mineral density. After several months of therapy, metatarsal stress fractures began. Bisphosphonate (BP) administration was stopped following the ASFFs, and the adult form of hypophosphatasia (HPP) was diagnosed from low serum alkaline phosphatase (ALP) activity, high endogenous levels of two natural substrates for the "tissue-nonspecific" isoenzyme of ALP (TNSALP), and a heterozygous mutation within the gene that encodes this enzyme. Experience with other HPP families showed that her mutation (Arg71His) with a second defective TNSALP allele can cause severe HPP in infancy, and when heterozygous can cause mild HPP featuring premature loss of deciduous teeth in children. Because the skeletal disease of HPP results from extracellular accumulation of the TNSALP substrate inorganic pyrophosphate (PPi) and its inhibitory effect on mineralization, perhaps HPP patients or carriers will have adverse effects from BPs. BPs are analogues of PPi and can suppress bone turnover but also deactivate TNSALP. Our report is the first of BP exposure preceding ASFFs in adult HPP. To explore a potential role for TNSALP deactivation in ASFFs, mutation analysis of TNSALP should be studied in a cohort of these patients. Meanwhile, clinicians must suspect HPP when clinical or laboratory clues include premature loss of primary dentition, pseudofractures or recurrent poorly healing metatarsal stress fractures, a family history suggestive of HPP, or low serum ALP activity. If HPP is documented, BP treatment might be avoided. To establish the diagnosis of HPP, assays for two natural substrates for TNSALP and TNSALP mutation analysis are available in commercial laboratories. With positive findings, radiological or bone biopsy evidence of acquired osteomalacia would

  12. Proximal Femoral Nail Antirotation Versus Reverse Less Invasive Stabilization System-distal Femur for Treating Proximal Femoral Fractures

    PubMed Central

    Jiang, Xuan; Wang, Ying; Ma, XinLong; Ma, JianXiong; Wang, Chen; Zhang, ChengBao; Han, Zhe; Sun, Lei; Lu, Bin

    2016-01-01

    Abstract The aim of this study was to compare the effectiveness and safety of 2 surgical techniques that are used to treat proximal femoral fractures. A systematic literature search (up to December 2014) was conducted in Medline, Embase, PubMed, and The Cochrane Central Register of Controlled Trials to screen for studies comparing proximal femoral nail antirotation (PFNA) with less invasive stabilization system–distal femur (LISS-DF) for proximal femoral fractures. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed. A total of 7 studies with 361 patients who satisfied the eligibility criteria included 3 randomized controlled trials and 4 case-controlled trials associated with PFNA versus LISS in treating proximal femoral fractures. Our results demonstrated that there was a significant reduction in hospital stay and time to weight-bearing ambulation and bone healing for PFNA compared with LISS (odds ratio [OR] −1.48, 95% confidence interval [CI] −2.92 to −0.05; OR −7.08, 95% CI −8.32 to −5.84; OR −2.71, 95% CI −4.76 to 0.67). No statistically significant difference was observed between the 2 groups for operative time, blood loss volume, Harris hip score, and incidence of complications. Based on the results of this analysis, we inferred that PFNA is safer and more effective than reverse LISS-DF in patients undergoing osteosynthesis for proximal femoral fractures, and that PFNA is associated with reduced hospital stays and reduced time to weight-bearing ambulation and bone healing. Nonetheless, in certain cases in which PFNA is not suitable due to abnormal structure of the proximal femur or particularly unstable fractures, the LISS plate technique could be a useful alternative. PMID:27057840

  13. Cross-match protocols for femoral neck fractures--finding one that can work.

    PubMed Central

    Khan, A. M.; Mushtaq, N.; Giannakas, K.; Sochart, D. H.; Andrews, J. G.

    2004-01-01

    BACKGROUND: Cross-match practice for patients with femoral neck fractures continues to cause concern due to a failure of compliance to the existing protocols. To address this issue, a number of studies were conducted over a 3-year period. METHODS: First, the existing cross-match practice for patients admitted with femoral neck fractures was reviewed to demonstrate the deficiencies within the system. Second, the opinion of anaesthetic and orthopaedic trainees was assessed regarding blood requirements for different femoral neck fractures following surgery and the justification of their perceptions. RESULTS: A summation of the studies is reported which demonstrates the reasons for the poor compliance to previous protocols. CONCLUSIONS: A simple and effective protocol is provided that has helped reduce pre-operative cross-matching of femoral neck fractures from 71% to 16.7% when assessed 2 years after its introduction. PMID:15005938

  14. Special topic: Ipsilateral femoral neck and shaft fractures--does evidence give us the answer?

    PubMed

    Boulton, Christina L; Pollak, Andrew N

    2015-03-01

    Ipsilateral fractures of the femoral neck and shaft are rare, high-energy injuries that typically occur in young polytrauma patients. The associated fracture of the neck is often vertical in nature and is more frequently non-displaced than in isolated femoral neck fractures. Historically the diagnosis of an associated femoral neck fracture was delayed or missed in approximately one third of cases. Studies have shown that detection can be significantly improved with the implementation of a protocolized approach to hip imaging in all patients with femoral shaft fractures. Prompt recognition of an associated femoral neck fracture allows for timely stabilization and may decrease the risks of non-union and avascular necrosis. In contrast, failure to recognize a non-displaced or minimally displaced associated neck fracture prior to fixation of the shaft can lead to displacement, a decrease in neck fixation options, a technically challenging secondary procedure and increased risk of long-term sequelae. A vast array of treatment strategies have been described for this combined injury. Published options range from spica casting to open reduction and internal fixation of both fractures and include almost all conceivable combinations in between. While timely surgical stabilization is now universally recommended for both shaft and neck, no consensus exists as to the most appropriate method of fixation for either fracture. Most authors recommend prompt, but not emergent, surgery with priority given to anatomic reduction and stabilization of the neck fracture by either closed or open methods. Fixation of the shaft fracture follows as patient condition allows. The rare nature of this injury makes it very challenging to study and most published series' are retrospective with very small sample sizes. In short, no scientificallycompelling study is available to definitively support any one implant choice or method of stabilzation over another for the treatment of associated fractures

  15. [Assessment of the results of rehabilitation treatment after osteosynthesis of femoral trochanter fractures with Gamma nails].

    PubMed

    Kotela, Paweł; Bednarenko, Marcin; Kotela, Ireneusz

    2010-01-01

    The work presents the results of the rehabilitation after osteosynthesis of femoral trochanter fractures with the Gamma nails. Femoral trochanter fractures usually affect the elderly and senile patients, which require the use of appropriate methods of operation as well as intense rehabilitation. Early and intense post-operational management, based on physiotherapy has advantageous effects on the process of mobilization of the patients. In the majority of them it allows to regain the pre-traumatic ability, mobility and activity. PMID:20684340

  16. Expert tibia nail for subtrochanteric femoral fracture to prevent thermal injury

    PubMed Central

    Lee, Kyung-Jae; Min, Byung-Woo; Jung, Jae-Hoon; Kang, Mi-Kyung; Kim, Min-Ji

    2015-01-01

    Introduction Subtrochanteric femoral fractures are relatively uncommon, accounting for 7–15% of all hip fractures and treatment of these fractures are considered challenge for orthopaedic surgeons. Although several treatment options are reported with up to 90% of satisfactory results, the choice of the appropriate implant is still a matter of debate. Some authors reported thermal injury after reaming for intramedullary nail fixation in patients with narrow medullary canal. Presentation of case A 21-year-old female patient was admitted to our hospital because of right subtrochanteric femoral fracture. The narrowest diameter of medullary canal of her femur was about 7 mm but she refused open reduction and internal fixation with plate due to large scar formation. We used expert tibia nail instead of femoral intramedullary nail to prevent thermal injury. Discussion Subtrochanteric femoral fractures are difficult to treat because of their biomechanical and anatomical characteristics. Although several implants are reported for the surgical treatment of these fractures, intramedullary nails have been advocated due to their biological and biomechanical advantages. However, under certain circumstances with associated injury or anatomic difference we might consider another treatment options. Conclusion Expert tibia nail may be considered one of the treatment options for subtrochanteric femoral fracture with narrow medullary canal. We also emphasize the importance of preoperative evaluation of the medullary canal size for these risky fractures. PMID:25839435

  17. Simultaneous, bilateral, complete atypical femoral fractures after long-term alendronate use.

    PubMed

    Higgins, Mark; Morgan-John, Sam; Badhe, Sachin

    2016-12-01

    Over the past decade there have been increasing reports of atypical femoral fractures (AFFs) associated with bisphosphonate use. Reported cases of bilateral involvement usually refer to sequential injuries, or a complete fracture with an incomplete injury to the contralateral limb. In this case report we describe simultaneous, bilateral, complete atypical femoral fractures following a simple fall. A history of prodromal pain, previous radiological evidence of cortical thickening and long term alendronate therapy for osteoporosis secondary to corticosteroid treatment paint a classical picture of the presentation of an atypical fracture pattern of which orthopaedic surgeons should be aware. PMID:27570414

  18. Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report

    PubMed Central

    YU, XIAOLONG; NIE, TAO; ZHANG, BIN; DAI, MIN; LIU, HUCHENG; ZOU, FAN

    2016-01-01

    Hemangioma is a common disease; however, intramuscular hemangioma (IH) presenting with a pathological fracture is extremely rare. The present study reports a case of a 46-year-old male patient that suffered from IH of the right thigh, presenting with a pathological femoral fracture. The patient was initially diagnosed with a traumatic femoral fracture, and routine open reduction and internal fixation were performed at a local hospital. However, 20 days subsequent to surgery, gradual swelling and soreness around the incision were observed. The incision eventually ruptured during squatting for bowel movement, which led to extensive blood loss. Based on computed tomography (CT) and deep femoral artery arteriography, IH presenting with a pathological femoral fracture was diagnosed. The patient underwent artery embolization, from which he recovered well. At the 6-month follow-up, the femoral fracture was revealed to have healed, and a CT scan demonstrated no evidence of recurrence; however, continuous observation using CT is required in order to determine the long-term outcome. To the best of our knowledge, this is the first case of a misdiagnosed pathological femoral fracture in a patient with IH reported in the English literature. PMID:27347124

  19. Medial femoral condyle fracture following traumatic allogenic bone transfer – A case report

    PubMed Central

    Kondreddi, Vamsi; Roy, Kishore; Yalamanchili, Ranjith Kumar

    2015-01-01

    Open fractures can cause an “out-in” injury, wherein a foreign body can penetrate the skin causing fracture. There are few reports of allogenic bone getting embedded in soft tissue, but one causing fracture to the host bone has not been reported till date. We present a case, wherein a large cortical bony fragment from one individual penetrated the thigh of another person causing fracture of medial femoral condyle during a head-on collision involving two motorbikes. PMID:26155058

  20. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture

    PubMed Central

    Ozaki, Yu; Ochi, Hironori; Watari, Taiji; Matsumoto, Mikio; Kaneko, Kazuo

    2016-01-01

    Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture.

  1. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases

    PubMed Central

    Nakamura, Junichi; Takahashi, Kazuhisa

    2016-01-01

    Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga. PMID:27293934

  2. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases.

    PubMed

    Miyamoto, Shuichi; Nakamura, Junichi; Iida, Satoshi; Suzuki, Chiho; Ohtori, Seiji; Orita, Sumihisa; Takahashi, Kazuhisa

    2016-01-01

    Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga. PMID:27293934

  3. Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

    PubMed Central

    Toro, Giuseppe; Calabrò, Giampiero; Toro, Antonio; de Sire, Alessandro; Iolascon, Giovanni

    2015-01-01

    Summary Distal femoral fractures have typically a bimodal occurrence: in young people due to a high-energy trauma and in older people related to a low-energy trauma. These fractures are associated to a very high morbidity and mortality in elderly. Distal femoral fractures might be treated with plates, intramedullary nails, external fixations, and prosthesis. However, difficulties in fracture healing and the rate of complications are important clinical issues. The purpose of this retrospective review was to present our experience in treatment of distal femoral fracture in a sample of older people in order to evaluate the technical pitfalls and strategies used to face up the fractures unsuccessfully treated with locking plates. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. We considered ‘unsuccessfully treated’ the cases with healing problems or hardware failures. Of the 12 patients (9 females and 3 males; mean aged 68.75 ± 3.31 years) included, we observed 3 ‘unsuccessfully cases’, 2 due to nonunions and 1 due to an early hardware failure, all treated using a condylar blade plate with a bone graft. One patient obtained a complete fracture healing after 1 year and in the other cases there was a nonunion. We observed as most common technical pitfalls: inadequate plate lengthening, fracture bridging, and number of locking screws. The use of locking plates is an emerging technique to treat these fractures but it seems more challenging than expected. In literature there is a lack of evidences about the surgical management of distal femoral fractures that is still an important challenge for the orthopaedic surgeon that has to be able to use all the fixation devices available. PMID:27134634

  4. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management.

    PubMed

    Arastu, M H; Kokke, M C; Duffy, P J; Korley, R E C; Buckley, R E

    2013-09-01

    Coronal plane fractures of the posterior femoral condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior femoral condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the femoral condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures. PMID:23997126

  5. Atypical femoral diaphyseal and subtrochanteric fractures and their association with bisphosphonates

    PubMed Central

    Leung, Frankie; Lau, Tak-Wing; To, Michael; Luk, Keith Dip-Kei; Kung, Annie Wai Chee

    2009-01-01

    Antiresorptive bisphosphonate agents are the mainstay of treatment for osteoporosis in both men and postmenopausal women. However, recent studies have raised concerns about the oversuppression of bone turnover related to the long-term use of bisphosphonates. Cases of atypical femoral diaphyseal and subtrochanteric fracture were reported recently in patients on long-term alendronate, and oversuppression of bone turnover was postulated to be the cause. We retrospectively reviewed all patients with femoral diaphyseal and subtrochanteric fracture presented between July 2003 and June 2008, and identified 10 patients who reported prior bisphosphonate use. Bone formation markers of all these patients were in the low range. Although the incidence of bisphosphonate-related atypical fracture accounts for an extremely low percentage of the total number of femoral diaphyseal and subtrochanteric fractures, we observed a steady increase from 0% in 2003 to 2004 to 25% in 2007 to 2008. PMID:21686468

  6. Atypical femoral fracture due to chronic use of bisphosphonates: case report.

    PubMed

    Temponi, Eduardo Frois; de Carvalho Junior, Lúcio Honório; Costa, Lincoln Paiva

    2015-01-01

    The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established. Nonetheless, it is known that their chronic use is more related to fractures with a pattern differing from that of classical osteoporotic fractures. Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis. There are few studies guiding the diagnosis and management of these fractures, thus making it difficult to achieve better results. In this report, we present the case of an elderly patient with an atypical femoral fracture that was managed in accordance with guidance from the American Society for Bone and Mineral Research.

  7. Atypical femoral fracture due to chronic use of bisphosphonates: case report☆

    PubMed Central

    Temponi, Eduardo Frois; de Carvalho Junior, Lúcio Honório; Costa, Lincoln Paiva

    2015-01-01

    The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established. Nonetheless, it is known that their chronic use is more related to fractures with a pattern differing from that of classical osteoporotic fractures. Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis. There are few studies guiding the diagnosis and management of these fractures, thus making it difficult to achieve better results. In this report, we present the case of an elderly patient with an atypical femoral fracture that was managed in accordance with guidance from the American Society for Bone and Mineral Research. PMID:26401508

  8. Association between injury to the retinacula of Weitbrecht and femoral neck fractures: anatomical and clinical observations

    PubMed Central

    Mei, Jiong; Ni, Ming; Wang, Guoliang; Jia, Guangyao; Liu, Shiwei; Cui, Xueliang; Jiang, Chao; Wang, Hua; Dai, Yahui; Quan, Kun; Chen, Rui

    2015-01-01

    Currently, there is no objective indicator for surgical procedures in elderly patients with femoral neck fractures. The purpose of this study was to determine the severity of damage to the retinacula of Weitbrecht based on the type of femoral neck fracture, anatomical and clinical observations. Data from 44 patients treated with artificial femoral head replacement were analyzed for the association between Garden type fracture and severity of injury to Weitbrecht’s retinacula. Additionally, 18 cases (Pauwels type III fracture) after Watson-Jones surgical approach and internal fixations were used to investigate the bone healing and femoral head necrosis. Among 44 patients (Garden type was III-IV, 79.6%), significant associations were found between Garden type fracture and lateral (P < 0.001), anterior (P = 0.045), and medial (P = 0.004) retinacular injury. Significant positive Spearman correlation coefficients between Garden type and the severity of injury to Weitbrecht’s retinacula were Ρ = 0.561 with P < 0.001 for lateral, Ρ = 0.338 with P = 0.025 for anterior, and Ρ = 0.469 with P = 0.001 for medial retinacula. Additionally, 4 out of 18 Pauwels type III fracture cases were observed severe damages on Weitbrecht’s retinacula and resulting bone necrosis. In conclusion, this study provided the anatomical and histological correlations between fracture displacement and degree of retinacula injury. PMID:26770357

  9. Malunion in displaced intracapsular fracture of femoral neck: A rare case.

    PubMed

    Verma, Nikhil; Singh, M P; Ul Haq, Rehan; Aggarwal, Aditya N; Jain, Anuj

    2015-01-01

    Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and cannulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane (coxa valga or coxa vara). We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side (Garden type 4 and Pauwel type 3). The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the radiographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture. PMID:26777718

  10. A simple new technique for the removal of fractured femoral stems: a case report

    PubMed Central

    2014-01-01

    Introduction The removal of broken femoral stems has become a major issue in revision surgery, and is a technically difficult and time-consuming procedure. Case presentation We present a case of a fracture of a cementless long femoral stem in a 65-year-old, white Caucasian man. The distal part was removed with a special longitudinal osteotomy through the anterior cortex extending distally for 10cm. It was then followed by a transversal osteotomy 2cm below the tip of the femoral stump to allow enough space for two locking pliers. Simultaneously using a lamina spreader on the distal part, the broken stem was extracted while hammering on two locking pliers. Conclusions We developed a simple and easy technique for the removal of a broken femoral stem that can be applied to all kinds of femoral stems and intramedullary nails regardless of their cross section. We used ordinary surgical instruments and spared the remaining bone stock. PMID:24886067

  11. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture

    PubMed Central

    Andersen, Michelle F.; Jakobsen, Thomas; Bensen, Anne S.; Krarup, Niels

    2015-01-01

    Introduction: Acute displaced femoral neck fractures are often treated with cemented hemiarthroplasty (HA). There is increasing evidence that total hip arthroplasty (THA) may be a better alternative, but the degree to which the fixation of the femoral stem used affects the outcome is not fully known. The aim of this study is to compare rates of operative complications and implant survival following THA treatment of displaced femoral neck fractures with either a cemented or an uncemented femoral stem. Methods: The study consists of two groups of patients (N = 334), who were treated for a displaced femoral neck fracture with THA at the Regional Hospital of Viborg during 2007–2012. The first group (50.9%) had uncemented (Corail®) stem while the second group (49.1%) had cemented (Exeter®) stem implanted. Nearly all patients had uncemented dual mobility cup (Saturne®) as acetabular component and were followed up to three months postoperatively. Data regarding rates of implant survival and operative complications were obtained by retrospective review of medical records. Results: We found a statistically significant difference regarding rates of postoperative reoperation with 1.2% (95% CI 0.005–0.03) for cemented and 5.9% (95% CI 0.02–0.09) for uncemented stem (p = 0.02). The main causes for reoperation were peri-prosthetic fractures and deep infections. There was no difference regarding dislocation or peroperative complications. Rates of dislocation were 4.3% (95% CI 0.012–0.07) for cemented and 3.5% (95% CI 0.008–0.06) for uncemented stem (p = 0.72). Rates of peroperative complications were 6.1% (95% CI 0.024–0.1) for cemented and 8.2% (95% CI 0.04–0.12) for uncemented stem (p = 0.1). Discussion: Our results indicate that cemented femoral stem is superior to cementless when rates of reoperation are compared. PMID:27163081

  12. Subchondral Insufficiency Fracture of the Femoral Head Caused by Excessive Lateralization of the Acetabular Rim

    PubMed Central

    Kimura, Tetsuya; Goto, Tomohiro; Hamada, Daisuke; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    We present a case of a 53-year-old woman with subchondral insufficiency fracture (SIF) of the femoral head without history of severe osteoporosis or overexertion. Plain radiographs showed acetabular overcoverage with excessive lateralization of the acetabular rim. A diagnosis of SIF was made by typical MRI findings of SIF. The lesion occurred at the antipodes of the extended rim. Increased mechanical stress over the femoral head due to impingement against the excess bone was suspected as a cause of SIF. The distinct femoral head deformity is consistent with this hypothesis. This is the first report of SIF associated with acetabular overcoverage. PMID:27293935

  13. UNSTABLE FEMORAL FRACTURES TREATED WITH TITANIUM ELASTIC INTRAMEDULLARY NAILS, IN CHILDREN

    PubMed Central

    Soni, Jamil Faissal; Schelle, Gisele; Valenza, Weverley; Pavelec, Anna Carolina; Souza, Camila Deneka Arantes

    2015-01-01

    Objective: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. Method: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR, between April 2002 and March 2008, with a minimum follow-up of 36 months. The epidemiological data, angular deviations, leg shortening and bone consolidation were evaluated. Results: The medical files of 113 cases operated between April 2002 and March 2008 were reassessed. From these, 24 cases of unstable femoral diaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. Conclusions: The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children. PMID:27047868

  14. Fracture mechanics of human cortical bone: The relationship of geometry, microstructure and composition with the fracture of the tibia, femoral shaft and the femoral neck

    NASA Astrophysics Data System (ADS)

    Yeni, Yener Nail

    Bone fracture is a major health problem in old population with its complications leading to mortality and morbidity. Therapies mostly involve preventing bone mass loss. Individuals with high bone mass, however, may still suffer fractures suggesting that additional components such as bone microstructure and composition may be responsible for increased fracture risk in the elderly. The relationship of bone constituents with bone fragility, however, is not well-understood. A better understanding of these relationships will help improving therapies by controlling the relevant biological processes. Bone is a composite material with many constituents such as osteons embedded with vascular channels, collagen fibers, mineral crystals, etc. The nature of interfacing between these constituents makes bone a more complex material. Bone also has a structure that adapts itself, both internally and externally, to better fit its needs. This suggested that, unlike man-made materials, a relationship between material properties and structural properties may exist. Because bone has some similarities with engineering composite materials and also experiences microcracks, a fracture mechanics approach would be more appropriate for investigating its fragility. Choosing mode I and mode II fracture toughness (Gsb{Ic} and Gnsb{IIc}, respectively) as indicators of bone fragility, their relationship with bone microstructure (porosity, osteon morphology, mineral crystal imperfection and microdamage), composition (density, mineral, organic, water and collagen content) and macrostructure (thickness, diameter and moment of inertia of the shaft and angle between the femoral neck and femoral shaft from different views) was investigated. Use of x-ray radiogrammetry for detecting the latter was tested. Differences among the femoral shaft, femoral neck and the tibia were investigated for an age range of 22-94 years. In general, fracture toughness increased with increasing bone quantity. However, the

  15. Midterm Results of Consecutive Periprosthetic Femoral Fractures Vancouver Type A and B

    PubMed Central

    Trieb, Klemens; Fiala, Rainer; Briglauer, Christian

    2016-01-01

    Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow-up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications. PMID:27777712

  16. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture.

    PubMed

    Gillespie, James A; Marsh, Andrew G; Patil, Sanjeev R

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture-dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  17. Fibrous dysplasia, shepherd's crook deformity and an intra-capsular femoral neck fracture.

    PubMed

    Al-Mouazzen, Louay; Rajakulendran, Karthig; Ahad, Nurul

    2013-11-01

    Fibrous dysplasia (FD) is a rare bone disorder in which normal medullary bone is replaced by fibro-osseous tissue. It typically presents in childhood with pain, skeletal deformities, gait abnormalities and occasionally, fatigue fractures. The management of FD remains a challenge. Surgical procedures have been developed to provide symptom relief, correct skeletal deformity and offer mechanical support in cases at risk of fracture. However, there is a paucity of data on the management of acute femoral neck fractures in the adult population with FD. We report the case of a 23-year-old man with a shepherd's crook deformity secondary to FD, who sustained an intra-capsular femoral neck fracture whilst playing football. The patient initially underwent closed reduction and internal fixation with cannulated screws. However, during the procedure, a guide wire broke whilst inside the femoral head. The patient was referred to the senior author, who undertook a second operation to remove the metalwork and correct the varus deformity using a closing-wedge femoral osteotomy, whilst achieving osteosynthesis at the fracture site. At 1-year follow-up, the patient is pain-free and demonstrates a full range of movement. These cases can be technically demanding and carry a greater risk of complication. It is important that preoperative planning is undertaken and surgery performed by individuals with experience in managing FD and complex femoral neck fractures. Correction of the skeletal deformity whilst fixing the fracture will help restore the mechanical axis and reduce the risk of a recurrent fracture. PMID:24036944

  18. Identification of Differentially Expressed Gene after Femoral Fracture via Microarray Profiling

    PubMed Central

    Zhong, Donggen

    2014-01-01

    We aimed to investigate differentially expressed genes (DEGs) in different stages after femoral fracture based on rat models, providing the basis for the treatment of sport-related fractures. Gene expression data GSE3298 was downloaded from Gene Expression Omnibus (GEO), including 16 chips. All femoral fracture samples were classified into earlier fracture stage and later fracture stage. Total 87 DEGs simultaneously occurred in two stages, of which 4 genes showed opposite expression tendency. Out of the 4 genes, Rest and Cst8 were hub nodes in protein-protein interaction (PPI) network. The GO (Gene Ontology) function enrichment analysis verified that nutrition supply related genes were enriched in the earlier stage and neuron growth related genes were enriched in the later stage. Calcium signaling pathway was the most significant pathway in earlier stage; in later stage, DEGs were enriched into 2 neurodevelopment-related pathways. Analysis of Pearson's correlation coefficient showed that a total of 3,300 genes were significantly associated with fracture time, none of which was overlapped with identified DEGs. This study suggested that Rest and Cst8 might act as potential indicators for fracture healing. Calcium signaling pathway and neurodevelopment-related pathways might be deeply involved in bone healing after femoral fracture. PMID:25110652

  19. Total Hip Arthroplasty for Failed Internal Fixation After Femoral Neck Fracture Versus That for Acute Displaced Femoral Neck Fracture: A Comparative Study.

    PubMed

    Yang, Zhouyuan; Liu, Huifang; Xie, Xiaowei; Tan, Zhen; Qin, Tianqiang; Kang, Pengde

    2015-08-01

    The outcome of total hip arthroplasty (THA) for failed internal fixation after femoral neck fracture (FNF) versus that for acute displaced femoral neck fracture is still controversial. This study retrospectively analyzed a consecutive series of 130 THAs for acute displaced FNF (64, group I) and for failed internal fixation (66, group II). Results showed THAs in group II were more technically demanding procedures with longer operative time and larger amounts of drainage compared to that in group I. Furthermore, multivariate analysis revealed that the associations between THAs (group II) and hip complications were notable (OR=4.15, P=0.017). These increased risks should be paid much attention to, not only for choosing the appropriate treatment option, but also for providing effective perioperative care.

  20. A large amount of microdamages in the cortical bone around fracture site in a patient of atypical femoral fracture after long-term bisphosphonate therapy.

    PubMed

    Iwata, Ken; Mashiba, Tasuku; Hitora, Toshiaki; Yamagami, Yoshiki; Yamamoto, Tetsuji

    2014-07-01

    A breast cancer patient developed an atypical femoral fracture after 9 years of bisphosphonate therapy for the treatment of multiple bone metastases. We histopathologically analyzed the femoral cortical bone at the fracture site and the iliac cancellous bone. Four months prior to the fracture, the patient had experienced pain in the right femur and underwent plain radiography and bone scintigraphy which revealed cortical thickening and radioisotope accumulation at each site, respectively. The patient had also experienced a non-traumatic fracture at the same site on the contralateral side 2 years earlier. Based on these findings, atypical femoral fracture was diagnosed and intramedullary nailing performed. A cortical bone specimen taken from near the fracture site during surgery showed marked microdamages, and analysis of the iliac cancellous bone specimen revealed severely suppressed bone turnover. These findings suggest that microdamage and severely suppressed bone turnover are associated with atypical femoral fracture reported in this patient with long-term bisphosphonate therapy.

  1. Management of neglected femoral neck fracture in above knee amputated limb: A case report.

    PubMed

    Meena, Umesh; Meena, Ramesh; S, Balaji; Gaba, Sahil

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a chal- lenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected. PMID:26917032

  2. Biomechanical optimization of subject-specific implant positioning for femoral head resurfacing to reduce fracture risk.

    PubMed

    Miles, Brad; Kolos, Elizabeth; Appleyard, Richard; Theodore, Willy; Zheng, Keke; Li, Qing; Ruys, Andrew J

    2016-07-01

    Peri-prosthetic femoral neck fracture after femoral head resurfacing can be either patient-related or surgical technique-related. The study aimed to develop a patient-specific finite element modelling technique that can reliably predict an optimal implant position and give minimal strain in the peri-prosthetic bone tissue, thereby reducing the risk of peri-prosthetic femoral neck fracture. The subject-specific finite element modelling was integrated with optimization techniques including design of experiments to best possibly position the implant for achieving minimal strain for femoral head resurfacing. Sample space was defined by varying the floating point to find the extremes at which the cylindrical reaming operation actually cuts into the femoral neck causing a notch during hip resurfacing surgery. The study showed that the location of the maximum strain, for all non-notching positions, was on the superior femoral neck, in the peri-prosthetic bone tissue. It demonstrated that varus positioning resulted in a higher strain, while valgus positioning reduced the strain, and further that neutral version had a lower strain. PMID:27098752

  3. Surgical prevention of femoral neck fractures in elderly osteoporotic patients. A literature review

    PubMed Central

    Chiarello, Eugenio; Tedesco, Giuseppe; Cadossi, Matteo; Capra, Paola; Terrando, Silvio; Miti, Andrea; Giannini, Sandro

    2016-01-01

    Summary Fragility fractures of the femur are one of the major causes of morbidity and mortality worldwide. The incidence of new contralateral hip fractures in elderly osteoporotic patients ranges from 7 to 12% within 2 years after the first fracture. Secondary prevention can be divided in: pharmacological therapy based on the prescription of anti-osteoporotic drugs with different mechanism of action and non-pharmacological therapy which is based on modification of environmental risk factors, on a healthy diet with daily supplements of calcium and vitamin D and calcium and on the use of hip protectors. Recently a new form of prevention is becoming achievable: surgical prevention; the rationale of surgical reinforcement is the need to increase the resistance of the femoral neck to the compression and distraction forces acting on it. In this paper we analyse all the experimental and “on the market” device available for the surgical prevention of femoral neck fracture. PMID:27252744

  4. Profunda femoris artery pseudoaneurysm following revision for femoral shaft fracture nonunion

    PubMed Central

    Valli, Federico; Teli, Marco GA; Innocenti, Marco; Vercelli, Ruggero; Prestamburgo, Domenico

    2013-01-01

    Femoral artery pseudoaneurysms (FAPs) have been described following internal fixation of intertrocantheric, subtrocantheric and intracapsular femoral neck fractures as well as core decompression of the femoral head. The diagnosis of FAP is usually delayed because of non-specific clinical features like pain, haematoma, swelling, occasional fever and unexplained anaemia. Because of the insidious onset and of the possible delayed presentation of pseudoaneurysms, orthopaedic and trauma surgeons should be aware of this complication. We report a case of Profunda Femoris arterial branch pseudoaneurysm, diagnosed in a 40-year-old male 4 wk after revision with Kuntscher intramedullary nail of a femoral shaft nonunion. The diagnosis was achieved by computed tomography angiography and the lesion was effectively managed by endovascular repair. The specific literature and suggestions for treatment are discussed in the paper. PMID:23878785

  5. Rigid Intramedullary Nailing of Femoral Shaft Fractures for Patients Age 12 and Younger: Indications and Technique.

    PubMed

    Martus, Jeffrey E

    2016-06-01

    Femoral shaft fractures are common injuries in the pediatric and adolescent age groups. Rigid intramedullary nailing is an excellent treatment option for older children and adolescents, particularly for length-unstable fractures and larger patients (>49 kg). Appropriate indications, contraindications, and preoperative assessment are described. The rigid nailing surgical technique is detailed including positioning, operative steps, pearls, and pitfalls. Complications and the reported outcomes of lateral trochanteric entry nailing are reviewed from the published series. PMID:27100036

  6. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture

    PubMed Central

    Gillespie, James A.; Marsh, Andrew G.; Patil, Sanjeev R.

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture–dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  7. Adjuvant Teriparatide Therapy for Surgical Treatment of Femoral Fractures; Does It Work?

    PubMed Central

    Kim, Jung Taek; Jeong, Hyung Jun; Lee, Soong Joon; Kim, Hee Joong

    2016-01-01

    Purpose Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects. Materials and Methods Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed. Results Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea. Conclusion Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur. PMID:27777917

  8. The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital.

    PubMed

    Rasit, A H; Mohammad, A W; Pan, K L

    2006-02-01

    Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.

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

    PubMed

    Zhu, Qing-hua; Ye, Tian-wen; Guo, Yong-fei; Wang, Chong-li; Chen, Ai-min

    2013-01-01

    Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS). Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV fracture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the broken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixation was easily finished. The patient had an uneventful recovery without avascular necrosis of femoral head or non-union of the fracture at one year's follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful. PMID:23910678

  10. The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures

    PubMed Central

    Jo, Suenghwan; Lee, Hyeon Jun

    2016-01-01

    Purpose This study aims to determine the correlation between the fracture patterns and the complications in patients with femoral neck fracture treated with internal fixation. Materials and Methods The study comprises 45 patients with femoral neck fracture treated with multiple screws or compression hip screw between May 2008 and April 2012. The mean age was 48 years at the time of the surgery and the mean duration from initial injury to surgery was 20 hours. The fracture patterns were identified according to the anatomical location, the Garden classification and the Pauwels classification. The occurrence of nonunion and avascular necrosis were reviewed with clinical results including Harris hip score and Lunceford hip function test. The correlation between the fracture pattern and occurrence of complications were analyzed. Results Fracture site union was achieved in 40 hips with the average union time of 17 weeks. Five nonunions occurred which showed high likelihood to occur in subcapital type, displaced (Garden stage III or IV) and Pauwels type III fractures (P<0.05). Avascular necrosis was developed in 10 hips which was mostly in subcapital type and Pauwels type III fracture but no statistical significance was found (P>0.05). The mean Harris hip score was 91 points, and Lunceford functional results were excellent in 15 hips, good in 24, fair in 4 and poor in 2. Conclusion There was high risk of nonunion in subcapital type fracture, displaced fracture (Garden stage III and IV) and vertically oriented fracture (Pauwels type III). Careful attention is needed in these fracture types. PMID:27536642

  11. The Trends in Treatment of Femoral Neck Fractures in the Medicare Population from 1991 to 2008

    PubMed Central

    Miller, Benjamin J.; Lu, Xin; Cram, Peter

    2013-01-01

    Background: We examined trends in the treatment of femoral neck fractures over the last two decades. Methods: We used Medicare Part A administrative data to identify patients hospitalized for closed femoral neck fracture from 1991 to 2008. We used codes from the International Classification of Diseases, Ninth Revision, to categorize treatment as nonoperative, internal fixation, hemiarthroplasty, and total hip arthroplasty. We examined differences in treatment according to hospital hip fracture volume, hospital location (rural or urban), and teaching status. Results: Our sample consisted of 1,119,423 patients with intracapsular hip fractures occurring from 1991 to 2008. We found a generally stable trend over time in the percentage of patients managed with nonoperative treatment, internal fixation, hemiarthroplasty, and total hip arthroplasty. We found little difference in surgical treatment across different groups of hospitals (high volume compared with low volume, urban compared with rural, and teaching compared with nonteaching). The percentage of acute care hospitals treating hip fractures remained fairly constant (74.8% in 1991 to 1993 and 69.0% in 2006 to 2008). The median number of hip fractures treated per hospital did not change (thirty-three in 1991 to 1993 and thirty-three in 2006 to 2008). There was no increase in the percentage of fractures treated in high-volume hospitals over time (57.7% in 1991 to 1993 and 57.1% in 2006 to 2008) and little reduction in the percentage of fractures treated in low-volume hospitals (5.8% in 1991 to 1993 and 5.5% in 2006 to 2008). Conclusions: There has been little change in the trends of operative and nonoperative treatment for proximal femoral fractures over the last two decades, and there was little evidence of regionalization of hip fracture treatment to higher-volume hospitals. PMID:24048563

  12. Treatment of ununited femoral neck fractures in young adults using low-intensity pulsed ultrasound: Report of 2 cases

    PubMed Central

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

    2016-01-01

    Introduction Delayed union and non-union of displaced femoral neck fractures remains a difficult clinical problem for orthopaedic surgeons. In the physiologically young patient, every effort should be made to preserve the native hip joint. We present two cases of ununited femoral neck fractures in young adults who were successfully treated with low-intensity pulsed ultrasound (LIPUS) and showed satisfactory results. Presentation of case 1 A 41-year-old woman was involved in a motor vehicle crash and was diagnosed with displaced femoral neck fracture. Eleven months after internal fixation, a computed tomography (CT) scan revealed the presence of non-union of the femoral neck. LIPUS treatment was therefore initiated. After eight months, the fracture was completely consolidated. Presentation of case 2 A 39-year-old man was involved in a cycling accident and was diagnosed with displaced femoral neck fracture. Thirteen weeks after internal fixation, a CT scan revealed delayed union of the femoral neck. LIPUS treatment was therefore initiated. After six months, the fracture was completely consolidated. Conclusion We suggest use of LIPUS as a possible treatment approach for delayed union and non-union of displaced femoral neck fractures in young patients before considering further surgical intervention. PMID:26942332

  13. The biomechanical effect of bone quality and fracture topography on locking plate fixation in periprosthetic femoral fractures.

    PubMed

    Leonidou, Andreas; Moazen, Mehran; Lepetsos, Panagiotis; Graham, Simon M; Macheras, George A; Tsiridis, Eleftherios

    2015-02-01

    Optimal management of periprosthetic femoral fractures (PFF) around a well fixed prosthesis (Vancouver B1) remains controversial as adequate fixation needs to be achieved without compromising the stability of the prosthesis. The aim of this study was to highlight the effect of bone quality i.e. canal thickness ratio (CTR), and fracture topography i.e. fracture angle and its position in relation to the stem, on the biomechanics of a locking plate for a Vancouver B1 fracture. A previously corroborated simplified finite element model of a femur with a cemented total hip replacement stem was used in this study. Canal thickness ratio (CTR) and fracture topography were altered in several models and the effect of these variations on the von Mises stress on the locking plate as well as the fracture displacement was studied. Increasing the CTR led to reduction of the von Mises stress on the locking plate as well as the fracture movement. In respect to the fracture angle with the medial cortex, it was shown that acute angles resulted in lower von Mises stress on the plate as opposed to obtuse angles. Furthermore, acute fracture angles resulted in lower fracture displacement compared to the other fractures considered here. Fractures around the tip of the stem had the same biomechanical effect on the locking plate. However, fractures more distal to the stem led to subsequent increase of stress, strain, and fracture displacement. Results highlight that in good bone quality and acute fracture angles, single locking plate fixation is perhaps an appropriate management method. On the contrary, for poor bone quality and obtuse fracture angles alternative management methods might be required as the fixation might be under higher risk of failure. Clinical studies for the management of PFF are required to further support our findings.

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

    PubMed

    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.

  15. Interlocking intramedullary nail stabilization of a femoral fracture in a dog with osteomyelitis.

    PubMed

    Muir, P; Johnson, K A

    1996-10-01

    Complications developed in a dog that underwent intramedullary pin and cerclage wire fixation of a comminuted femoral fracture. The fracture was unstable, the intramedullary pin protruded through the skin over the hip, and Staphylococcus sp was isolated from the fracture site. The loose pin was removed, and the fracture was restabilized with a 6.0-mm interlocking intramedullary nail and 3 interlocking screws. Cephalexin was given orally for 6 weeks. Eight weeks after the second surgery, the fracture was healed radiographically. Seventeen months later, the dog had a persistent mild lameness that was associated with low-grade osteomyelitis. The lameness resolved after the implants were removed, and antibiotics were administered. In human beings, interlocking intramedullary nail stabilization is an accepted treatment for open and contaminated fractures. Chronic infection of bone may be attributable to bacteria in biofilm surrounding implants, necessitating implant removal for resolution.

  16. Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty - why?

    PubMed

    Bonnin, M P; Neto, C C; Aitsiselmi, T; Murphy, C G; Bossard, N; Roche, S

    2015-06-01

    The aim of this study was to investigate the relationship between the geometry of the proximal femur and the incidence of intra-operative fracture during uncemented total hip arthroplasty (THA). We studied the pre-operative CT scans of 100 patients undergoing THA with an uncemented femoral component. We measured the anteroposterior and mediolateral dimensions at the level of division of the femoral neck to calculate the aspect ratio of the femur. Wide variations in the shape of the femur were observed, from round, to very narrow elliptic. The femurs of women were narrower than those of men (p < 0.0001) and small femurs were also narrower than large ones. Patients with an intra-operative fracture of the calcar had smaller and narrower femurs than those without a fracture (p < 0.05) and the implanted Corail stems were smaller in those with a fracture (mean size 9 vs 12, p < 0.0001). The variability of the shape of the femoral neck at the level of division contributes to the understanding of the causation of intra-operative fractures in uncemented THA. PMID:26033052

  17. MANAGEMENT OF BILATERAL FEMORAL NECK FRACTURE IN A NONAGENARIAN PATIENT--CASE REPORT.

    PubMed

    Popescu, D; Trandabaţ, C; Puha, B; Veliceasa, B; Alexa, O

    2016-01-01

    Simultaneous bilateral femoral neck fracture is rare injury. Cases with this type of fracture have been reported in the literature since the 1950s, following the introduction of electroconvulsive therapy which generates violent hip muscle contractions. In young patients' simultaneous bilateral femoral neck fracture results from high energy trauma (car accident or fall from height) in a normal bone. Pathological changes in bone structure occurring in chronic kidney disease, vitamin D deficiency, osteomalacia, osteoporosis, metabolic imbalances and administration of corticosteroids explain the occurrence of this particular type of fracture following low-energy trauma. We present the case of a 90-year-old female patient who suffered a simple fall from her own height resulting in a Garden IV bilateral femoral neck fracture. Our therapeutic option in this patient was bilateral uncemented bipolar hemiarthroplasty in a single session using a single tray of sterile surgical instruments and two sterile drapes. Postoperative outcome was very good, allowing the initiation of functional recovery on the first postoperative day. Uncemented hemiarthroplasty proved to be a good choice in such a patient in the associated diseases may trigger the risk of cardiovascular disturbances specific to bone cement implantation syndrome. PMID:27483720

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

    PubMed

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

    2011-06-01

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

  19. Chondroblastoma: a rare cause of femoral neck fracture in a teenager.

    PubMed

    Paloski, Michael D; Griesser, Michael J; Jacobson, Mark E; Scharschmidt, Thomas J

    2011-09-01

    Chondroblastomas usually present in the epiphyseal region of bones in skeletally immature patients. These uncommon, benign tumors are usually treated with curettage and use of a bone-void filler. Here we report a case of a hip fracture secondary to an underlying chondroblastoma in a 19-year-old woman. Open biopsy with intraoperative frozen section pointed toward a diagnosis of chondroblastoma. Extended curettage was performed, followed by cryotherapy with a liquid nitrogen gun and filling of the defect with calcium phosphate bone substitute. The femoral neck fracture was stabilized with a sliding hip screw construct. The patient progressed well and continued to regain functional status. A final pathology report confirmed the lesion to be a chondroblastoma. Clinicians should have heightened awareness of a pathologic lesion in a young person presenting with a femoral neck fracture and should consider the uncommon differential diagnosis that the lesion is located in the greater trochanter apophysis.

  20. Chondroblastoma: a rare cause of femoral neck fracture in a teenager.

    PubMed

    Paloski, Michael D; Griesser, Michael J; Jacobson, Mark E; Scharschmidt, Thomas J

    2011-09-01

    Chondroblastomas usually present in the epiphyseal region of bones in skeletally immature patients. These uncommon, benign tumors are usually treated with curettage and use of a bone-void filler. Here we report a case of a hip fracture secondary to an underlying chondroblastoma in a 19-year-old woman. Open biopsy with intraoperative frozen section pointed toward a diagnosis of chondroblastoma. Extended curettage was performed, followed by cryotherapy with a liquid nitrogen gun and filling of the defect with calcium phosphate bone substitute. The femoral neck fracture was stabilized with a sliding hip screw construct. The patient progressed well and continued to regain functional status. A final pathology report confirmed the lesion to be a chondroblastoma. Clinicians should have heightened awareness of a pathologic lesion in a young person presenting with a femoral neck fracture and should consider the uncommon differential diagnosis that the lesion is located in the greater trochanter apophysis. PMID:22022682

  1. Pathologic Femoral Neck Fracture Due to Fanconi Syndrome Induced by Adefovir Dipivoxil Therapy for Hepatitis B.

    PubMed

    Lee, Yoon-Suk; Kim, Byung-Kook; Lee, Ho-Jae; Dan, Jinmyoung

    2016-06-01

    In Fanconi syndrome, hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids, glucose, urate, and phosphate. We present a rare case of a 43-year-old Korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to Fanconi syndrome. He had been receiving low-dose adefovir dipivoxil (ADV, 10 mg/day) for the treatment of chronic hepatitis B virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction. The incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture. After cessation of ADV and correction of hypophosphatemia with oral phosphorus supplementation, the patient's clinical symptoms, such as bone pain, muscle weakness, and laboratory findings improved. PMID:27247753

  2. Management of Femoral Shaft Fracture in Klippel-Trenaunay Syndrome with External Fixator

    PubMed Central

    Gupta, Yogendra; Jha, Ranjib Kumar; Karn, Navin Kumar; Sah, Sanjaya Kumar; Mishra, Bibhuti Nath; Bhattarai, Manoj Kumar

    2016-01-01

    Klippel-Trenaunay syndrome (KTS) is a rare complex malformation characterized by the clinical triad of capillary malformations, soft tissue and bone hypertrophy, and venous/lymphatic malformation. Fractures of long bones in such cases are challenging to treat. A 12-year-old female with this syndrome presented with femoral shaft fracture of right thigh. She was initially kept on skeletal traction for two weeks and then she underwent closed reduction and immobilization with external fixator with uneventful intraoperative and postoperative period. Fracture united at four and half months. PMID:26885423

  3. Cost comparison of cementless versus cemented hemiarthroplasty for displaced femoral neck fractures.

    PubMed

    Tripuraneni, Krishna R; Carothers, Joshua T; Junick, Daniel W; Archibeck, Michael J

    2012-10-01

    Hip hemiarthroplasties are frequently performed for displaced femoral neck fractures. The purpose of this study was to identify the costs associated with cementless and cemented hemiarthroplasties, compare operative times, and identify complications. The hypothesis was that cementless hemiarthroplasties cost less than cemented hemiarthroplasties, require less operative time, and have fewer perioperative complications. A retrospective review was conducted of 2 surgeons' patients admitted for displaced femoral neck fractures between 2006 and 2010. Group 1 included 45 patients who underwent monopolar hemiarthroplasties with cementless femoral components via a standard posterior approach by a single surgeon. Group 2 included 49 patients who underwent monopolar hemiarthroplasties with cemented femoral components via a modified lateral approach by a single surgeon. Surgical and anesthesia times and the cost of implants and accessories were recorded. The cost for cementless components was $3275.60 (femoral stem, $2800; monopolar head, $400; sleeve, $75.60), whereas the cost of cemented components was $3694.47 (femoral stem, $1800; monopolar head, $400; sleeve, $75.60, 3 Simplex with tobramycin cement packets, $1221; cement mixer/irrigator with tip/centralizer and plug/pressurizer, $197.87), a cost savings of 12.7% ($418.87). Operative time was significantly reduced in group 1 vs group 2 (mean, 32.9 vs 56.1 minutes, respectively; P<.01). Anesthesia time was also significantly reduced in group 1 (mean, 82.3 vs 102.9 minutes, respectively; P<.01). The difference in mean anesthetic times demonstrates an overall cost savings of 18.6%, or $1161.30. No difference in complications was noted between the groups perioperatively. Regional cost variances, vendor-hospital contracts, and surgeons' operative times are factors that may influence cost savings. This study demonstrates significantly lower operative and anesthetic times and observable cost savings with cementless femoral

  4. Bisphosphonate-associated osteonecrosis: a clinician's reference to patient management.

    PubMed

    Grewal, Varinder S; Fayans, Edgar P

    2008-08-01

    Bisphosphonates (BPs), as inhibitors of osteoclasts, are widely used in the management of metastatic bone disease and in the prevention of osteomalacia and osteoporosis. Recent cases of bone necrosis of the jaws have been associated with the use of bisphosphonate therapy. A case is presented of a patient with osteonecrosis of the maxilla with a history of long-term bisphosphonate therapy for metastatic breast cancer. The authors treated the patient and suggest appropriate patient management guidelines with reference to current knowledge. Although a definitive treatment for bisphosphonate-associated osteonecrosis has not yet been established, clinicians must be aware of the pharmacologic properties of several bisphosphonates currently available and their indications, susceptible risk factors in the development of osteonecrosis of the jaws, the clinical signs and symptoms, and recommendations for patient management, including prevention and early recognition. BPs, potent inhibitors of osteoclast-mediated bone resorption, were first introduced more than 20 years ago. Since then, they have been used widely in the management of bone diseases, including hypercalcemia related to malignancy, myeloma-related bone disease, Paget's disease and osteoporosis. They have also been shown to inhibit tumor cell proliferation and inhibit angiogenesis. These additional features have made BPs useful in the treatment of metastatic disease, including breast and prostate cancer, resulting in a rise in the medical use of these drugs. However, recent reports suggest that BPs, particularly the nitrogen-containing BPs pamidronate (Aredia) and zoledronic acid (Zometa), both manufactured by Novartis of East Hanover, NJ, are capable of causing bisphosphonate-associated osteonecrosis of the jaw (BON). With 2.5 million patients treated with pamidronate and/or zoledronate worldwide, BON occurs in about one per 10,000 treated patients (Novartis, unpublished data, 2004). Currently, the total number

  5. Oral bisphosphonate associated osteonecrosis of the jaws: three case reports.

    PubMed

    Malden, N J; Pai, A Y

    2007-07-28

    Bisphosphonate associated osteonecrosis of the jaws (BONJ) has been well documented recently in relation to intravenous preparations of the drug. These are most commonly used as part of the management of hypercalcaemia of malignancy and metastatic bone disease but BONJ can also occur in association with oral bisphosphonate use. The oral preparations can also be prescribed in the management of metastatic bone disease but are more commonly used for the prevention and treatment of osteoporosis. Three case reports are presented in which alendronate, risedronate and ibandronate have been associated with osteonecrosis of the jaws. A review of the recent literature is used in the discussion of the management of these cases. The authors conclude, in agreement with other published authors, that prevention and early detection could be improved to reduce the occurrence and severity of this condition. However when BONJ is diagnosed, the early application of a closely monitored conservative regimen, with consideration given to discontinuation of the bisphosphonate, may give the best chance of containing or resolving the condition.

  6. Bilateral simultaneous femoral neck fracture mimicking abdominal pain in a cerebral palsy patient.

    PubMed

    Mariani, P; Buttaro, M; Comba, F; Zanotti, E; Ali, P; Piccaluga, F

    2014-01-01

    Simultaneous bilateral femoral neck fractures are unusual lesions, generally associated with an underlying condition which causes impaired bone mineralization, triggered by an increased bone stress. We present a 24-year-old cerebral palsy patient, who was previously evaluated in another institution due to inability to walk, interpreted as abdominal pain. No alteration in blood analysis or abdominal X-rays was found. As no response to treatment was observed, a new abdominal X-ray was taken, which incidentally depicted bilateral medial femoral neck fracture. He was referred to our practice after a resection arthroplasty was offered in another institution. After admission, bilateral one-stage THA was performed. Several reports emphasize bone disease as a major precipitating factor, and there is an increased incidence of hip fractures in chronic epilepsy, renal osteodystrophy, and chronic steroid use. Femoral head resection has been proven to be effective in immobilized patients, whereas this was not a reasonable option in this patient who presented walking ability. Despite the treatment election, primary care physicians should be aware of and alert to the possibility of fractures in patients with neurological disorders and calcium metabolism alterations. Late diagnosis of orthopedic injuries in this type of patients may lead to permanent disability. PMID:25506016

  7. Association of low-energy femoral shaft fractures and bisphosphonate use.

    PubMed

    Fowler, John R; Craig, Matthew R

    2012-01-16

    The purpose of this study was to elaborate on the association between the use of bisphosphonates and low-energy femoral shaft fractures. A retrospective review was performed between January 2000 and January 2010 to identify patients older than 65 years who sustained femoral shaft diaphyseal fractures (Orthopaedic Trauma Association classification 32 A [extra-articular], B [partial articular/unicondylar], or C [complete articular/bicondylar]) using ICD-9 code 821.01. After exclusion criteria were applied, 77 patients remained for analysis. A total of 66 patients had no history of bisphosphonate therapy, and 11 patients had received bisphosphonate therapy for >2 years prior to admission. All 11 patients in the bisphosphonate group had sustained a low-energy fall from a standing height or lower. In 9 of 11 (82%) patients in the bisphosphonate group, radiographs resembled transverse shaft fractures with lateral cortical beaking that have been observed in patients on chronic bisphosphonate therapy.Our series echoes the findings of other authors, who found that bisphosphonate use is associated with lateral cortical beaking and low-energy, transverse fractures of the femoral shaft. Further research is needed to determine if specific medications and length of treatment are important risk factors.

  8. Prophylactic proton pump inhibitors in femoral neck fracture patients - A life - and cost-saving intervention.

    PubMed

    Singh, R; Trickett, R; Meyer, Cer; Lewthwaite, S; Ford, D

    2016-07-01

    Introduction Acute gastrointestinal stress ulceration is a common and serious complication of trauma. Prophylactic proton pump inhibitors (PPIs) or histamine receptor antagonists have been used in poly-trauma, burns and head and spinal injuries, as well as on intensive care units, for the prevention of acute gastric stress ulcers. Methods We prospectively studied the use of prophylactic PPIs in with femoral neck fracture patients, gathering data on all acute gastric ulcer complications, including coffee-ground vomiting, malena and haematemesis. We then implemented a treatment protocol in which all patients were given prophylactic PPIs, again prospectively collecting all data. Results Five hundred and fifteen patients were included. Prior to prophylactic PPI, 15% of patients developed gastric stress ulcer complications, with 3% requiring acute intervention with oesophagogastroduodenoscopy (OGD), 5% requiring transfusions and 4% experiencing surgical delays. All patients had delayed discharges. Following PPI implementation, no patients developed gastric stress ulcer complications. Conclusions Femoral neck fracture patients create a substantial workload for orthopaedic units. The increasingly elderly population often have comorbidities, and concomitantly use medications with gastrointestinal side effects. This, combined with the stress of a fracture and preoperative starvation periods increases the risk of gastric ulcers. Here, the use of prophylactic PPIs statistically reduced the incidence of gastric stress ulcers in patients with femoral neck fractures, resulting in fewer surgical delays, reduced length of hospital stay and reduced stress ulcer-related mortality. PMID:27055405

  9. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls

    PubMed Central

    Chen, Antonia F.

    2015-01-01

    Management of periprosthetic fractures around the femoral stem after total hip arthroplasty (THA) represents a significant challenge and optimal treatment remains controversial. The most common treatment paradigm involves treating fractures around a well-fixed stem with osteosynthesis, whereas fractures around a loose stem require revision arthroplasty and those with poor bone require augmentation with bone graft. Paradoxically, the literature reports a higher rate of failure for osteosynthesis around prostheses considered to be well-fixed. Such a high rate of poor outcomes may result not only from difficult fracture fixation and compromised biologic healing, but also from unrecognized peri-implant pathology. Therefore, proper preoperative and intraoperative evaluation is key, and a subset of patients may benefit from alternative management. We review the appropriate methods for evaluation and treatment of Vancouver type B fractures with particular emphasis on avoiding missteps that can lead to failure. PMID:26539451

  10. Subject specific finite element modeling of periprosthetic femoral fracture using element deactivation to simulate bone failure.

    PubMed

    Miles, Brad; Kolos, Elizabeth; Walter, William L; Appleyard, Richard; Shi, Angela; Li, Qing; Ruys, Andrew J

    2015-06-01

    Subject-specific finite element (FE) modeling methodology could predict peri-prosthetic femoral fracture (PFF) for cementless hip arthoplasty in the early postoperative period. This study develops methodology for subject-specific finite element modeling by using the element deactivation technique to simulate bone failure and validate with experimental testing, thereby predicting peri-prosthetic femoral fracture in the early postoperative period. Material assignments for biphasic and triphasic models were undertaken. Failure modeling with the element deactivation feature available in ABAQUS 6.9 was used to simulate a crack initiation and propagation in the bony tissue based upon a threshold of fracture strain. The crack mode for the biphasic models was very similar to the experimental testing crack mode, with a similar shape and path of the crack. The fracture load is sensitive to the friction coefficient at the implant-bony interface. The development of a novel technique to simulate bone failure by element deactivation of subject-specific finite element models could aid prediction of fracture load in addition to fracture risk characterization for PFF. PMID:25937546

  11. Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture

    PubMed Central

    Kim, Yeesuk; Kim, Joon-Kuk; Joo, Il-Han; Hwang, Kyu-Tae

    2016-01-01

    Purpose We investigated the incidence and time of dislocation and other factors associated with dislocation of bipolar hemiarthroplasty related to the treatment of femoral neck fracture in old age patients. Materials and Methods Between January 2002 and April 2014, 498 femoral neck fractures (467 patients) were treated with bipolar hemiarthroplasty and included in this study. All surgeries were performed using the postero-lateral approach. The incidence of dislocation was investigated. A comparative analysis between a control group and dislocation group was performed with respect to patient factors including age, gender, body mass index, comorbidities, the ASA (American Society of Anesthesiologists) score, mental status and center-edge angle, and surgical factors including type of femoral stem, leg length discrepancy, femoral offset and method of short external rotator (SER) reconstruction. Results The incidence of dislocation was 3.8%, and the dislocation occurred on average 2.2 months (range, 0.6-6.5 months) after operation. No difference in patient-related factors was observed between the two groups. However, a smaller center edge (CE) angle was observed in the dislocation group (42.1°±3.2° vs. 46.9°±5.4°, P<0.001), and significantly lower incidence of dislocation was observed in tendon to bone repair group (0.7% vs 7.8%, P<0.001). Conclusion SERs should be repaired using the tendon-to-bone repair method to reduce dislocation rate in elderly patients who undergo bipolar hemiarthroplasty using the postero-lateral approach due to femoral neck fracture. In addition, patients with smaller CE angle should be carefully monitored due to high incidence of dislocation. PMID:27536652

  12. EPIDEMIOLOGICAL AND RADIOLOGICAL EVALUATION OF FEMORAL SHAFT FRACTURES: STUDY OF 200 CASES

    PubMed Central

    de Moraes, Frederico Barra; da Silva, Luciano Lucindo; Ferreira, Fábio Vieira; Ferro, Ademar Martins; da Rocha, Valney Luís; Teixeira, Kim-Ir-Sen Santos

    2015-01-01

    Objective: to evaluate epidemiological and radiological characteristics of the femoral shaft fractures, surgically treated from 1990 to 2005 at Hospital de Acidentados – Clínica Santa Isabel – in Goiânia, Goiás, aiming to contribute to better preventive and therapeutic measures planning to adopt on those fractures. Methods: 200 patients' files and x-rays with femoral shaft fractures have been retrospectively evaluated. Patients below the age of 10 years were not included because the treatment for this group was conservative. 25 files have been discarded for not supplying all the necessary data to the study. The patients were assessed for sex, age, side of the fracture, bone exposure, mechanisms of trauma, classification of the fractures, associated trauma, time for bone healing and types of surgical devices. Statistic analyses were made by chi-squared, Fisher and Student's-t tests, adopting as a significance level p<0.05. Results: significant results (p < 0.05) were found in: 70% of men, 80% closed fractures and 65% of women above the age of 60. Fractures resulting from simple falls were more frequent in women, above 60 years old, with simpler traces, and the ones caused by projectiles of firearm in men, from 20 to 60 years, with unstable traces. Trampling accidents were prevalent among youngsters between 10 and 19 years old. Car accidents showed all the types of fractures, mostly associated to other traumas, reaching its peak incidence in the age group of 20-30 years. The treatment with Küntscher Nail resulted in a longer mean consolidation time, as well as fractures with unstable traces (B3,C1,C2,C3). Conclusion: we found a bi-modal characteristic the femoral shaft fractures, consistently to literature data, where the high energy mechanisms (traffic accidents, high falls and wounds from firearms), have been more frequent in young adults, men, generating unstable traces of fractures, with more serious associated trauma, while the other group with low

  13. Questioning the association between bisphosphonates and atypical femoral fractures.

    PubMed

    Pazianas, Michael; Kim, Se-min; Yuen, Tony; Sun, Li; Epstein, Sol; Zaidi, Mone

    2015-01-01

    Bisphosphonates are the first-line treatment for osteoporosis. Structurally, they are stable analogues of pyrophosphate and therefore exhibit a high affinity for bone mineral. They reduce bone loss by attenuating the ability of the osteoclast to resorb bone, decreasing activation frequency, and the rate of remodeling. Large prospective randomized placebo-control trials provide unequivocal evidence for a reduction in the incidence of fractures. Impressively, 40 years since their first use in patients, the safety profile of bisphosphonates has been equally reassuring. Questions have arisen lately as to whether bisphosphonates could cause atypical fractures, a rare type of atraumatic or minimal trauma femur fracture occurring below the great trochanter. This question has prompted calls for a broader examination of the long-term effects of bisphosphonate use. An attempt by the Food and Drug Administration to garner consensus and provide definitive views was not successful. This has led to continued anxiety among treating physicians and patients alike, resulting in an overall reduction in prescriptions for bisphosphonates and for osteoporosis therapies in general. Here, we provide an overview of the current data on atypical fractures and bisphosphonate use.

  14. Hip arthroplasty for failed treatment of proximal femoral fractures.

    PubMed

    D'Arrigo, Carmelo; Perugia, Dario; Carcangiu, Alessandro; Monaco, Edoardo; Speranza, Attilio; Ferretti, Andrea

    2010-10-01

    Failed treatment of an intertrochanteric fracture typically leads to profound functional disability and pain. Salvage treatment with hip arthroplasty may be considered. The aim of this study was to evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. Twenty-one patients were treated in our hospital with hip arthroplasty for failed treatment of intertrochanteric hip fracture. There were sixteen women and five men with a mean age of 75.8 years (range 61-85 years). Fourteen patients had failure of a previous nail fixation procedure, five had failure of a plate fixation, one of hip screws fixation and one of Ender nail fixation. In 19 out of 21 patients we performed a total hip arthroplasty-14 cases used modular implants with long-stems and five cases used a standard straight stem. In 2 of 21 cases we used a bipolar hemiarthroplasty. A statistically significant improvement was found comparing pre and postoperative conditions (p < 0.05). Our experience confirms that total hip arthroplasty is a satisfactory salvage procedure after failed treatment of an intertrochanteric fracture in elderly patients with few serious orthopaedic complications and acceptable clinical outcomes. PMID:19572131

  15. Augmentation of femoral neck fracture fixation with an injectable calcium-phosphate bone mineral cement.

    PubMed

    Stankewich, C J; Swiontkowski, M F; Tencer, A F; Yetkinler, D N; Poser, R D

    1996-09-01

    The first goal of this study was to determine if augmentation with an injectable, in situ setting, calcium-phosphate cement that is capable of being remodeled and was designed to mimic bone mineral significantly improved the strength and stiffness of fixation in a cadaveric femoral neck fracture model. The second goal was to determine if greater increases in fixation strength were achieved as the bone density of the specimen decreased. Sixteen pairs of fresh cadaveric human femora with a mean age of 70.9 years (SD = 17.2 years) were utilized. The bone density of the femoral neck was measured with dual-energy x-ray absorptiometry. The femoral head was impacted vertically with the femoral shaft fixed in 12 degrees of adduction using a materials testing machine to create a fully displaced fracture. Following fracture, 30% inferior comminution was created in each specimen. One randomly chosen femur from each pair underwent anatomic reduction and fixation with three cannulated cancellous bone screws, 7 mm in diameter, in an inverted triangle configuration. The contralateral femur underwent the same fixation augmented with calcium-phosphate cement. Specimens were preconditioned followed by 1.000 cycles to one body weight (611.6 N) at 0.5 Hz to simulate single-limb stance loading. The stiffness in the first cycle was observed to be significantly greater in cement-augmented specimens compared with unaugmented controls (p < 0.05). After cycling, each specimen was loaded at 10 mm/min until complete displacement of the fracture surface and failure of fixation occurred. Specimens augmented with bone mineral cement failed at a mean of 4,573 N (SD = 1,243 N); this was significantly greater (p < 0.01) than the mean for controls (3,092 N, SD = 1,258 N). The relative improvement in fixation strength (augmented/control x 100%) was not inversely correlated to femoral neck bone density (p = 0.25, R2 = 0.09), was weakly correlated to the volume of cement injected (p = 0.07, R2 = 0

  16. Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years.

    PubMed

    Fyodorov, I; Sturm, P F; Robertson, W W

    1999-01-01

    Twenty-one patients between the ages of 8 and 12 years with 23 femoral-shaft fractures underwent dynamic compression plating (DCP) between August 1993 and February 1996. Eleven patients had isolated femoral-shaft fractures, five had associated long-bone injuries, and five had multiple organ injuries. A 4.5-mm DCP plate was used in each case. Patients were kept non-weight bearing with crutches for an average of 8 weeks. Hardware failure occurred in two patients at 6 weeks. One was treated with revision plating, and the other, with spica casting. Both healed uneventfully. No other complications occurred. All patients were radiographically and clinically healed at last follow-up.

  17. Displaced fractures of the femoral shaft in children. Unique features and therapeutic options.

    PubMed

    Greene, W B

    1998-08-01

    The decision analysis for managing femoral shaft fractures in children should included such factors as the possibility of child abuse, overgrowth, and the potential for remodeling. Direct and indirect costs must be understood. Factors to consider in determining treatment include the age of the child, the extent of the soft tissue injury, and associated injuries. Non-operative methods, universally used in the past to treat these injuries, still are indicated, but operative modalities should be considered for a greater number of pediatric femoral fractures. Early enthusiasm for external fixation and rigid intramedullary rodding has been tempered by a greater awareness of their particular complications. The role of flexible intramedullary rodding, however, is expanding.

  18. Atypical femoral fractures in association with bisphosphonate therapy: a case series.

    PubMed

    Rheinboldt, Matthew; Harper, Derrick; Stone, Michael

    2014-10-01

    Well-established clinically as frontline therapy in the management of osteoporosis, bisphosphonates have been shown in numerous trials to be highly effective in reducing the risk of both vertebral and hip fractures. More recently, however, in a multitude of exhaustive case reviews, attention has been raised to the small but by now well-established link between prolonged bisphosphonate usage and the risk for atypical subtrochanteric femoral stress fractures. We present herein a trio of illustrative cases highlighting both clinical presentation and characteristic radiological findings thereof, as well as a discussion of the background, management, and natural history of these oftentimes problematic injuries.

  19. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review.

    PubMed

    Tripathy, Sujit Kumar; Sen, Ramesh Kumar; Goyal, Tarun

    2016-01-01

    Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy. PMID:27512214

  20. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review

    PubMed Central

    Tripathy, Sujit Kumar; Sen, Ramesh Kumar; Goyal, Tarun

    2016-01-01

    Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0–31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56–96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy. PMID:27512214

  1. Atypical Femoral Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research.

    PubMed

    Yang, Kyu Hyun; Min, Byung Woo; Ha, Yong-Chan

    2015-08-01

    Bisphosphonate (BP) is a useful anti-resorptive agent which decreases the risk of osteoporotic fracture by about 50%. However, recent evidences have shown its strong correlation with the occurrence of atypical femoral fracture (AFF). The longer the patient takes BP, the higher the risk of AFF. Also, the higher the drug adherence, the higher the risk of AFF. It is necessary to ask the patients who are taking BP for more than 3 years about the prodromal symptoms such as dull thigh pain. Simple radiography, bone scan, and magnetic resonance imaging (MRI) are good tools for the diagnosis of AFF. The pre-fracture lesion depicted on the hip dual energy X-ray absorptiometry (DXA) images should not be missed. BP should be stopped immediately after AFF is diagnosed and calcium and vitamin D (1,000 to 2,000 IU) should be administered. The patient should be advised not to put full weight on the injured limb. Daily subcutaneous injection of recombinant human parathyroid hormone (PTH; 1-34) is recommended if the patient can afford it. Prophylactic femoral nailing is indicated when the dreaded black line is visible in the lateral femoral cortex, especially in the subtrochanteric area. PMID:26389082

  2. KIRSCHNER WIRE VERSUS TITANIUM ELASTIC NAILS IN PEDIATRIC FEMORAL SHAFT FRACTURES

    PubMed Central

    Isik, Cengiz; Kurtulmus, Tuhan; Saglam, Necdet; Saka, Gursel; Akpinar, Fuat; Sarman, Hakan

    2015-01-01

    ABSTRACT Objective: To evaluate the effectiveness of intramedullary fixation using the Kirschner-wire (K-wire) compared to the titanium elastic nail (TEN) in pediatric femoral shaft fractures. Methods: A sample of 42 pediatric patients with a mean age of 6.55±2.42 years (range 4-11 years) presenting femoral shaft fractures underwent intramedullary fixation using the K-wire or TEN. Results: There was no significant difference found between groups, of which 16 (38.1%) patients were treated with K-wire and 26 (61.9%) patients were treated with TEN in terms of union duration. Moreover, none of the patients showed nonunion or a delayed union. Conclusions: The use of adjusted K-wire instead of TEN in the intramedullary fixation of femoral shaft fractures in selected children may be an advantageous surgical option due to the lower cost, easy accessibility and no need for a second surgery for implant removal. Level of Evidence III, Retrospective Study. PMID:26981033

  3. Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture.

    PubMed

    Chen, Johnathan; Abel, Mark F; Fox, Michael G

    2015-10-01

    Salter Harris II fractures of the distal femur are associated with a high incidence of complications, especially premature physeal closure. Many risk factors for this high rate of premature physeal closure have been proposed. More recently, entrapment of periosteum within the physis has been suggested as an additional predisposing factor for premature physeal closure. The radiographic diagnosis of entrapped soft tissues, including periosteum, can be suggested in the setting of a Salter-Harris II fracture when the fracture does not reduce and physeal widening >3 mm remains. We report a patient who sustained a distal femoral Salter-Harris II fracture following a valgus injury. The patient had persistent distal medial physeal widening >5 mm following attempted reduction. A subsequent MRI revealed a torn periosteum entrapped within the distal femoral physis. Following removal of the periosteum, the patient developed a leg length discrepancy which required physiodesis of the contralateral distal femur. We present this case to raise awareness of the importance of having a high index of suspicion of periosteal entrapment in the setting of Salter-Harris II fractures since most consider entrapped periosteum an indication for surgery.

  4. Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures.

    PubMed

    Brand, Stephan; Ettinger, Max; Omar, Mohamed; Hawi, Nael; Krettek, Christian; Petri, Maximilian

    2015-01-01

    Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies. PMID:26401164

  5. Atypical femoral fractures and bisphosphonate use: current evidence and clinical implications

    PubMed Central

    Saita, Yoshitomo; Kaneko, Kazuo

    2015-01-01

    Osteoporosis is a disease characterized by a low bone volume and deterioration of the bone quality, which increases the risk of low-energy fractures. Bisphosphonate (BP) treatment increases the bone mass and reduces the risk of fractures in patients with osteoporosis by suppressing bone resorption. In spite of its clinical benefits, the long-term use of BPs has been linked to the occurrence of atypical femoral fractures (AFFs). Although the evidence had been controversial regarding the association between the occurrence of AFFs and BP use, more recent studies with radiographic adjudication have indicated the significant associations between them. However, the pathogenesis of AFFs is not completely understood. The most popular hypothesis has suggested that the suppression of bone turnover by BPs is responsible; however, some recent reports have implied the involvement of pathophysiological alterations of the bone quality and fracture repair process. In this review, we summarize and discuss the epidemiology, risk factors and pathology of AFFs. PMID:26137208

  6. Hemiprosthesis for Femoral Neck Fractures in the Elderly: A Retrospective Study of 319 Patients

    PubMed Central

    Prokop, Axel; Chmielnicki, Marc

    2016-01-01

    Background In geriatric patients with Pauwels types II and III femoral neck fractures, hemiprosthesis is the therapy of choice. Objectives This study was conducted to analyze the results after cemented hemiprosthesis placement, the first year after surgery. Patients and Methods This retrospective study was conducted on 319 patients over 70 years with displaced femoral neck fractures treated surgically at our hospital from 2007 to 2012. All medical information was available including retrospective posthospital discharge records as well as inpatient course and one-year mortality. Results From a total of 319 patients, 78% (n = 249) were female and 22% (n = 70) were male, with the mean age of 83.6 years. Seventeen percent of the patients suffered from heart failure, 23% from diabetes, and 19% from renal insufficiency. Time to surgery averaged one day postinjury. Average operative time skin-to-skin was 50 minutes. Seventy-three percent of the patients could mobilize independently on discharge. Of the remaining patients, 2/3 had already lost independent mobilization prior to the fracture. Hospital mortality averaged 5% (national average in Germany: 8%), and 30-day and 90-day mortality rates were 5% and 15%, respectively. Within one year, 22% of the patients died (national average: 27%). Also, 14 patients were re-admitted, for contralateral prosthetic implantation (n = 7) or revision after the periprosthetic fracture (n = 5). Fifty-three percent of the patients were admitted to hospital during the year for other diseases (national average: 54%). Conclusions Hemiprosthesis placement for displaced femoral neck fractures is a common and safe procedure. Despite recent decreases in hospital mortality, the risk of death remains more than twice as high within one year than that for uninjured patients of the same age. PMID:27800463

  7. [Psychological and social aspects of fractures of the femoral neck].

    PubMed

    Herman, J; Koldová, Z; Bretsnajdrová, M; Minácová, A

    1991-03-01

    At the Second Surgical Clinic of the Faculty Hospital with Policlinic in Olomouc 72 patients with fractures of the proximal end of the femur were treated. Sixty-four patients were operated and eight were treated primarily by conservative methods or death occurred before the planned operation. A total of 14 patients were discharged to domestic treatment, 32 patients were referred to other institutions, mostly sanatoria for the chronically sick. In the whole group a total of 61 various complications were recorded, 26 patients died during hospitalization at the surgical department, another four patients in other institutions. In addition to these somatic complications the authors investigated also psychosocial aspects. From the investigation ensues that in addition to adequate supervision and care few people have adequate social contacts, despite the fact that they do not live alone. In these patients we are more frequently faced with pessimism, fear or actual loss of interest in the future. In the care of these patients an important part is played by personal contact, a true emotional relationship and interest in the patient's problems. Our aim should be not only healing of the fracture but also mental wellbeing, optimism and mental balance, because patients then tolerate better certain restrictions and complaints.

  8. Comparison of Femoral Neck Stress Fractures in Pediatric versus Young Adult Athletes

    PubMed Central

    Heyworth, Benton E.; Quinn, Bridget; Ehrlichman, Lauren; Bixby, Sarah; Ackerman, Kathryn; Yen, Yi-Meng; Boyle, Matthew John; Kim, Young-Jo; Millis, Michael B.

    2016-01-01

    Objectives: To compare the demographics, metabolic bone health, radiologic features, treatment approaches and recurrence rates of pediatric versus young adult athletes with femoral neck stress fractures. Methods: A retrospective review was performed on all patients <45 years-old who were diagnosed with a femoral neck stress fracture at a single tertiary-care referral center from 2003-2015. Patients who had undergone previous hip surgery or had primary bone disorders/lesions were excluded. Variables analyzed included demographics, presenting symptoms, metabolic bone health (laboratory results, Dexa scores, menstrual history, eating disorder history), imaging, treatment approach and clinical course. Results: Forty-nine patients (mean age 21.4 years, range 5-44, 78% females) met study inclusion criteria, including 28 pediatric patients (mean age 14.4 years, range 5-19 years, 71% females) and 21 young adults (mean age 30.8 years, range 20-44 years, 86% females). A higher percentage of females was seen with each increasing decade of age, with 50% of pediatric patients under 11 years-old being male. Mean BMI was lower (p=0.04) in the pediatric group (20.6 kg/m2 +/-3.42) than the adult group (21.8 kg/m2 +/-2.04). Pain was the presenting complaint in all patients, with pain localized to the groin in 80% of cases. Participation in running sports was higher for the young adult cohort (86%) than the pediatric cohort (50%), while multiple sports were played more by pediatric patients (29%) than young adults (5%). History of previous acute fractures (2%) and previous stress fractures (14%) was identical between groups. Delayed menarche was recorded in 6% of pediatric patients, and menstrual irregularity was reported in 29% and 33% of pediatric and adult females, respectively. The base of the femoral neck was most common location for fracture in both pediatric (67%) and adult (81%) groups, while transcervical fractures were more likely to occur in pediatric (29%) than adult

  9. Periprosthetic femoral fracture--a biomechanical comparison between Vancouver type B1 and B2 fixation methods.

    PubMed

    Moazen, Mehran; Mak, Jonathan H; Etchels, Lee W; Jin, Zhongmin; Wilcox, Ruth K; Jones, Alison C; Tsiridis, Eleftherios

    2014-03-01

    Current clinical data suggest a higher failure rate for internal fixation in Vancouver type B1 periprosthetic femoral fracture (PFF) fixations compared to long stem revision in B2 fractures. The aim of this study was to compare the biomechanical performance of several fixations in the aforementioned fractures. Finite element models of B1 and B2 fixations, previously corroborated against in vitro experimental models, were compared. The results indicated that in treatment of B1 fractures, a single locking plate can be without complications provided partial weight bearing is followed. In case of B2 fractures, long stem revision and bypassing the fracture gap by two femoral diameters are recommended. Considering the risk of single plate failure, long stem revision could be considered in all comminuted B1 and B2 fractures. PMID:24035619

  10. Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty

    PubMed Central

    Kim, Min-Wook; Lee, Jung-Ho; Park, Ji-Hoon

    2015-01-01

    Purpose We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA). Materials and Methods From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up. Results Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture. Conclusion Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type. PMID:27536618

  11. An Effective Approach for Optimization of a Composite Intramedullary Nail for Treating Femoral Shaft Fractures.

    PubMed

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

    2015-12-01

    The high stiffness of conventional intramedullary (IM) nails may result in stress shielding and subsequent bone loss following healing in long bone fractures. It can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. This paper introduces a new approach for the optimization of a fiber-reinforced composite nail made of carbon fiber (CF)/epoxy based on a combination of the classical laminate theory, beam theory, finite-element (FE) method, and bone remodeling model using irreversible thermodynamics. The optimization began by altering the composite stacking sequence and thickness to minimize axial stiffness, while maximizing torsional stiffness for a given range of bending stiffnesses. The selected candidates for the seven intervals of bending stiffness were then examined in an experimentally validated FE model to evaluate their mechanical performance in transverse and oblique femoral shaft fractures. It was found that the composite nail having an axial stiffness of 3.70 MN and bending and torsional stiffnesses of 70.3 and 70.9 N⋅m², respectively, showed an overall superiority compared to the other configurations. It increased compression at the fracture site by 344.9 N (31%) on average, while maintaining fracture stability through an average increase of only 0.6 mm (49%) in fracture shear movement in transverse and oblique fractures when compared to a conventional titanium-alloy nail. The long-term results obtained from the bone remodeling model suggest that the proposed composite IM nail reduces bone loss in the femoral shaft from 7.9% to 3.5% when compared to a conventional titanium-alloy nail. This study proposes a number of practical guidelines for the design of composite IM nails.

  12. An Effective Approach for Optimization of a Composite Intramedullary Nail for Treating Femoral Shaft Fractures.

    PubMed

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

    2015-12-01

    The high stiffness of conventional intramedullary (IM) nails may result in stress shielding and subsequent bone loss following healing in long bone fractures. It can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. This paper introduces a new approach for the optimization of a fiber-reinforced composite nail made of carbon fiber (CF)/epoxy based on a combination of the classical laminate theory, beam theory, finite-element (FE) method, and bone remodeling model using irreversible thermodynamics. The optimization began by altering the composite stacking sequence and thickness to minimize axial stiffness, while maximizing torsional stiffness for a given range of bending stiffnesses. The selected candidates for the seven intervals of bending stiffness were then examined in an experimentally validated FE model to evaluate their mechanical performance in transverse and oblique femoral shaft fractures. It was found that the composite nail having an axial stiffness of 3.70 MN and bending and torsional stiffnesses of 70.3 and 70.9 N⋅m², respectively, showed an overall superiority compared to the other configurations. It increased compression at the fracture site by 344.9 N (31%) on average, while maintaining fracture stability through an average increase of only 0.6 mm (49%) in fracture shear movement in transverse and oblique fractures when compared to a conventional titanium-alloy nail. The long-term results obtained from the bone remodeling model suggest that the proposed composite IM nail reduces bone loss in the femoral shaft from 7.9% to 3.5% when compared to a conventional titanium-alloy nail. This study proposes a number of practical guidelines for the design of composite IM nails. PMID:26458035

  13. Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws. A review of the literature

    PubMed Central

    Bagan, Jose V.

    2016-01-01

    Background Bisphosphonates (BPs) and other antiresorptive agents such as denosumab are widely prescribed for the treatment of osteoporosis and are also used in patients with multiple myeloma and metastatic breast or prostate cancer for avoiding bone reabsorption and fractures that result in increased morbidity-mortality among such individuals. Material and Methods We made a bibliographic search to analyze the concept, diagnosis and the different classifications for bisphosphonate-associated osteonecrosis of the jaws. Results Osteonecrosis of the jaws (ONJ) is an important complication of exposure to BPs or other antiresorptive agents, and although its prevalence is low, it can pose management problems. The definition, diagnosis and classification of osteonecrosis have evolved since Marx reported the first cases in 2003. Conclusions The present study offers a literature review and update on the existing diagnostic methods and classification of the disorder, with a view to facilitating earlier and more effective treatment. Key words:Osteonecrosis, jaws, bisphosphonates. PMID:26827066

  14. The Intramedullary Nailing of Adult Femoral Shaft Fracture by the Way of Open Reduction is a Disadvantage or Not?

    PubMed

    Burç, Halil; Atay, Tolga; Demirci, Demir; Baykal, Y Barbaros; Kirdemir, Vecihi; Yorgancigil, Hüseyin

    2015-12-01

    The purpose of this study is that to evaluate superiority and results of open technique in the treatment of femoral shaft fracture with interlocking intramedullary nailing. The retrospective study is designed to evaluate results of our technique. In this study, the patients that were admitted to the Orthopedics and Traumatology Department of University Hospital that is third level of trauma center. We claim that open technique is not a disadvantage during union process over closed technique in treatment of femoral shaft fracture with interlocking nailing. In this study, 44 patients that were consulted for adult femoral shaft fracture between January 2008 to July 2010 were included. Patients with open fractures, gunshot wounds, neurovascular injuries, and patients that did not have isolated femoral diaphysis fractures were excluded from the study. Clinical and radiological results of the patients were checked periodically. The open interlocking intramedullary nailing was used in treatment. Complete union rate was 90.9 % in 40 patients who were treated with open interlocking intramedullary nailing for adult femoral shaft fracture, and nonunion rate was 9.1 % in four patients. Mean union time was 18.3 weeks (12-36 weeks). Evaluation of 44 patients according to Thoresen criteria was excellent in 22 patients, good in 6 patients, and bad in 4 patients. We think that open technique is an acceptable technique because all results of our study were similar to results of closed intramedullary nailing technique in literature and some advantages of open technique over closed technique.

  15. ANALYSIS OF THE SEGMENTAL IMPACTION OF FEMORAL HEAD FOLLOWING AN ACETABULAR FRACTURE SURGICALLY MANAGED

    PubMed Central

    Guimarães, Rodrigo Pereira; Kaleka, Camila Cohen; Cohen, Carina; Daniachi, Daniel; Keiske Ono, Nelson; Honda, Emerson Kiyoshi; Polesello, Giancarlo Cavalli; Riccioli, Walter

    2015-01-01

    Objective: Correlate the postoperative radiographic evaluation with variables accompanying acetabular fractures in order to determine the predictive factors for segmental impaction of femoral head. Methods: Retrospective analysis of medial files of patients submitted to open reduction surgery with internal acetabular fixation. Within approximately 35 years, 596 patients were treated for acetabular fractures; 267 were followed up for at least two years. The others were excluded either because their follow up was shorter than the minimum time, or as a result of the lack of sufficient data reported on files, or because they had been submitted to non-surgical treatment. The patients were followed up by one of three surgeons of the group using the Merle d'Aubigné and Postel clinical scales as well as radiological studies. Results: Only tow studied variables-age and amount of postoperative reductionshowed statistically significant correlation with femoral head impaction. Conclusions: The quality of reduction-anatomical or with up to 2mm residual deviation-presents a good radiographic evolution, reducing the potential for segmental impaction of the femoral head, a statistically significant finding. PMID:27004191

  16. Analysis of mechanical strength to fixing the femoral neck fracture in synthetic bone type Asnis

    PubMed Central

    Freitas, Anderson; Lula, Welder Fernandes; de Oliveira, Jonathan Sampaio; Maciel, Rafael Almeida; Souto, Diogo Ranier de Macedo; Godinho, Patrick Fernandes

    2014-01-01

    OBJECTIVE: To analyze the results of biomechanical assays of fixation of Pauwels type III femoral neck fracture in synthetic bone, using 7.5mm cannulated screws in inverted triangle formation, in relation to the control group. METHODS: Ten synthetic bones were used, from a domestic brand, divided into two groups: test and control. In the test group, a 70° tilt osteotomy of the femoral neck was fixated using three cannulated screws in inverted triangle formation. The resistance of this fixation and its rotational deviation were analyzed at 5mm displacement (phase 1) and 10mm displacement (phase 2). The control group was tested in its integrity until the fracture of the femoral neck occurred. The Mann-Whitney test was used for group analysis and comparison. RESULTS: The values in the test group in phase 1, in samples 1-5, showed a mean of 579N and SD =77N. Rotational deviations showed a mean of 3.33°, SD = 2.63°. In phase 2, the mean was 696N and SD =106N. The values of the maximum load in the control group had a mean of 1329N and SD=177N. CONCLUSION: The analysis of mechanical strength between the groups determined a statistically significant lower value in the test group. Level of Evidence III, Control Case. PMID:25246851

  17. Evaluation of fracture topography and bone quality in periprosthetic femoral fractures: A preliminary radiographic study of consecutive clinical data.

    PubMed

    Leonidou, Andreas; Moazen, Mehran; Skrzypiec, Daniel M; Graham, Simon M; Pagkalos, Joseph; Tsiridis, Eleftherios

    2013-12-01

    The unique configuration of periprosthetic femoral fractures (PFFs) is a major determinant of the subsequent management. The aim of this preliminary study was to investigate potential relationships between fracture angle (FA), fracture level (FL) and bone quality of Vancouver type B PFF. The FA, FL and the canal thickness ratio (CTR) were quantified for 27 patient X-rays. The CTR is an indicator of the underlying bone quality. Relationships between these factors were studied for the whole X-ray set, for a subgroup involving fracture above the tip of the stem and for subgroups with stable and unstable implants. When considering all cases, no significant correlation was found between the FA and any other measurement. Considering only cases with unstable implants, a statistically significant correlation was found between the FA and the FL (R(2)=0.489, p=0.002). No correlation was found between FA and any other measurement for stable implants suggesting that FA could be considered as an independent factor when classifying B1 fractures. Considering all cases, a weak correlation was found between CTR and FL (R(2)=0.152, p=0.044) suggesting that fractures below the tip of the stem may indicate a lower bone quality. This preliminary study suggests that the effect of FA on the optimal management of Vancouver type B1 fractures could be considered, independent of the quality of the bone or fracture position. Furthermore, fractures around or below the tip of the stem may suggest a poor bone quality. Larger number of patients is required to confirm these initial findings.

  18. Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

    PubMed Central

    Zielinski, Stephanie M.; Keijsers, Noël L.; Praet, Stephan F.E.; Heetveld, Martin J.; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M.M.

    2014-01-01

    Objectives To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design Secondary cohort study to a randomized controlled trial. Setting Multicenter trial in the Netherlands, including 14 academic and non-academic hospitals Patients Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention None (observatory study) Main outcome measurements Patient characteristics, SF-12, and WOMAC scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis. Results Of 248 internal fixation patients (median age 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower WOMAC score (median 73 versus 90, P=0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio −8.9 versus 0.4, P=0.013) and a significant greater loss of abduction strength (median −25.4 versus −20.4 N, P=0.025). Conclusion Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture. PMID:24835623

  19. Fracture risk in the femoral hip region: A finite element analysis supported experimental approach.

    PubMed

    Tsouknidas, Alexander; Anagnostidis, Kleovoulos; Maliaris, Georgios; Michailidis, Nikolaos

    2012-07-26

    The decrease of bone mineral density (BMD) is a multifactorial bone pathology, commonly referred to as osteoporosis. The subsequent decline of the bone's micro-structural characteristics renders the human skeletal system, and especially the hip, susceptible to fragility fractures. This study represents a systematic attempt to correlate BMD spectrums to the mechanical strength characteristics of the femoral neck and determine a fracture risk indicator based on non-invasive imaging techniques. The BMD of 30 patients' femurs was measured in vivo by Dual-energy X-ray absorptiometry (DXA). As these patients were subjected to total hip replacement, the mechanical strength properties of their femurs' were determined ex-vivo using uniaxial compression experiments. FEA simulations facilitated the correlation of the DXA measurements to the apparent fracture risk, indicating critical strain values during complex loading scenarios. PMID:22648146

  20. A New Case of Fracture of a Modular Femoral Neck Device After a Total Hip Arthroplasty

    PubMed Central

    Trieb, Klemens; Stadler, Nicola

    2015-01-01

    This report addresses a new case of a modular femoral neck fracture after total hip arthroplasty. A now seventy-three-year- old overweight female underwent total hip replacement of the right hip because of osteoarthritis in the year 2002. Then, years later, the head and the polyethylene were changed due to wear. In October 2014, the patient was transferred from the trauma department of her hometown to our department after she had slipped and fallen directly on her right hip. The x-rays done at the trauma department have shown no periprosthetic fracture but a fracture of the modular neck. Therefore, the patient was transferred to our department in order to undergo a revision arthroplasty with change of the stem and head after splitting the femur. PMID:26157528

  1. Fracture risk in the femoral hip region: A finite element analysis supported experimental approach.

    PubMed

    Tsouknidas, Alexander; Anagnostidis, Kleovoulos; Maliaris, Georgios; Michailidis, Nikolaos

    2012-07-26

    The decrease of bone mineral density (BMD) is a multifactorial bone pathology, commonly referred to as osteoporosis. The subsequent decline of the bone's micro-structural characteristics renders the human skeletal system, and especially the hip, susceptible to fragility fractures. This study represents a systematic attempt to correlate BMD spectrums to the mechanical strength characteristics of the femoral neck and determine a fracture risk indicator based on non-invasive imaging techniques. The BMD of 30 patients' femurs was measured in vivo by Dual-energy X-ray absorptiometry (DXA). As these patients were subjected to total hip replacement, the mechanical strength properties of their femurs' were determined ex-vivo using uniaxial compression experiments. FEA simulations facilitated the correlation of the DXA measurements to the apparent fracture risk, indicating critical strain values during complex loading scenarios.

  2. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty.

    PubMed

    Macaulay, William; Pagnotto, Michael R; Iorio, Richard; Mont, Michael A; Saleh, Khaled J

    2006-05-01

    The incidence of femoral neck fracture among the elderly in the United States is expected to increase dramatically because of the anticipated explosion in the population aged 65 years and older, increased life expectancy, and the rising incidence of osteoporosis. The resulting public health implications may be significant, with annual hospital admissions resulting from hip fracture projected to increase to 700,000 by 2050, and with annual spending on hip fracture care expected to exceed 15 billion dollars within a few years. The decision to perform internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA must be based on patient mental status, living arrangement, level of independence and activity, and bone and joint quality.

  3. Spontaneous supracondylar femoral fracture in an HIV patient in lotus position.

    PubMed

    Pinto Neto, Lauro F S; Eis, Sergio Ragi; Miranda, Angelica Espinosa

    2011-01-01

    Bone disorders have been described in patients chronically infected with human immunodeficiency virus (HIV). A case of spontaneous supracondylar femoral fracture that occurred in a 58-year-old monk during meditation is reported. His AIDS disease was controlled with combination antiretroviral therapy. Vitamin D and calcium had been added 3yr before since osteoporosis was detected by dual-energy X-ray absorptiometry (DXA). At the time of the fracture, the patient was on treatment with 35mg every week of sodium risedronate, 1000mg of calcium, and 400IU of Vitamin D every day. Clinical use of DXA for HIV patients should be considered as a routine measure to help reducing risk for fractures. PMID:21295744

  4. Percutaneous manipulation of intra-articular debris after fracture-dislocation of the femoral head or acetabulum.

    PubMed

    Marecek, Geoffrey S; Routt, M L Chip

    2014-09-01

    Traumatic fracture-dislocation of the hip usually warrants prompt management by closed manipulative reduction. In some patients, debris malpositioned between the femoral head and the acetabular dome obstructs a completely concentric reduction of the injured hip. To avoid damage to the articular surfaces, the debris between them should be removed in a timely fashion. Techniques for removal include open approaches with or without fracture fixation or hip arthroscopy. Fracture fixation and hip arthroscopy have associated risks and potential complications, may require special equipment, and may not be familiar to all surgeons. The authors present a simple fluoroscopically guided technique for the percutaneous removal of intra-articular debris between the femoral head and the acetabular dome after traumatic femoral head or acetabular fracture-dislocation.

  5. Progression of a Fracture Site Impaction as a Prognostic Indicator of Impacted Femoral Neck Fracture Treated with Multiple Pinning

    PubMed Central

    Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup

    2012-01-01

    Background We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. Methods There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. Results There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). Conclusions Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant. PMID:22379557

  6. Development of femoral bone fracture model simulating muscular contraction force by pneumatic rubber actuator.

    PubMed

    Sen, Shin; Ando, Takehiro; Kobayashi, Etsuko; Miyamoto, Hideaki; Ohashi, Satoru; Tanaka, Sakae; Joung, Sanghyun; Park, Il-Hyung; Sakuma, Ichiro

    2014-01-01

    In femoral fracture reduction, orthopedic surgeons must pull distal bone fragments with great traction force and return them to their correct positions, by referring to 2D-fluoroscopic images. Since this method is physically burdensome, the introduction of robotic assistance is desirable. While such robots have been developed, adequate control methods have not yet been established because of the lack of experimental data. It is difficult to obtain accurate data using cadavers or animals because they are different from the living human body's muscle characteristics and anatomy. Therefore, an experimental model for simulating human femoral characteristics is required. In this research, human muscles are reproduced using a McKibben-type pneumatic rubber actuator (artificial muscle) to develop a model that simulates typical femur muscles using artificial muscles.

  7. Could Patient Undergwent Surgical Treatment for Periprosthetic Femoral Fracture after Hip Arthroplasty Return to Their Status before Trauma?

    PubMed Central

    Zheng, Long; Lee, Woo-Yong; Kang, Chan; Noh, Chang-Kyun

    2016-01-01

    Purpose The purpose of this study was to compare preoperative clinical outcomes before occurrence of periprosthetic femoral fracture (status before trauma) with postoperative clinical outcomes (status after operation) in patients with periprosthetic femoral fracture after hip arthroplasty. Materials and Methods A retrospective review was performed of all periprosthetic femoral fracture after hip arthroplasty treated surgically at our institution from January 2010 to January 2014. Among 29 patients who underwent surgical treatment for periprosthetic femoral fracture after hip arthroplasty, 3 patients excluded because of non-union of the fracture site. The clinical outcomes were determined by using visual analogue scale for pain (VAS), Harris hip score (HHS), and ambulatory ability using Koval classification. VAS, HHS and ambulatory ability was assessed for all the included patients at the last follow-up of status before trauma and after operation. Results The mean VAS, HHS and ambulatory ability at the last follow-up of status before trauma was 2.2 (range, 0-4), 78.9 (range, 48-92) and 1.9 (range, 1-5), respectively. The mean VAS, HHS and ambulatory ability at the last follow-up of status after operation was 3.1 (range, 1-5), 68.4 (range, 46-81) and 2.9 (range, 2-6), respectively. The clinical outcome of VAS, HHS and ambulatory ability were significantly worsened after surgical treatment for periprosthetic femoral fracture (P=0.010, P=0.001, and P=0.002, respectively). Conclusion Patients with periprosthetic femoral fracture after hip arthroplasty could not return to their status before trauma, although patients underwent appropriate surgical treatment and the fracture union achieved. PMID:27536650

  8. [Early results of proximal femoral fractures treated with FENIX modular hemiarthroplasty].

    PubMed

    Görski, Radosław; Górecki, Andrzej; Olszewski, Paweł; Biedrzycki, Jerzy; Skowronek, Paweł

    2010-01-01

    The article discusses preliminary clinical results in patients with proximal femoral fractures treated with hemiarthroplasty using a FENIX implant. The study group comprised 41 subjects aged 69 to 97 (median age 82.3 year). The follow-up study provided data on 26 subjects (63.4%), among which 15 attended the check-up, 5 subjects refused to visit at the Department and 6 subjects were reported as deceased. Median follow-up period amounted to 6.8 month (1 to 22 months). General hospitalization-related complications occurred in 8 patients (19.5%). During hospitalization no deaths occurred, in the deceased group 3 patients died within 12 months after surgery, while another 3 died after the twelve-month postoperative period (median of 13.3%). According to Merle d'Aubigne-Postel score favorable long-term results were observed in 9 patients (59.9%), 13 patients regained the level of motor function similar to the functional ability prior to fracture. The need to postpone the surgery due to general health status and impaired pre-operative motor function are significant negative prognostic factors. The results obtained were compared with previous efficacy studies on femoral fracture treatment using an Austin-Moore implant. Functional ability and self-reliance was higher in the FENIX group. FENIX arthroplasty effectively helps patients regain self-reliance and motor function thanks to its modular characteristics and anatmoical construction. PMID:20496778

  9. Autograft Transfer from the Ipsilateral Femoral Condyle in Depressed Tibial Plateau Fractures

    PubMed Central

    Sferopoulos, N.K

    2014-01-01

    Introduction : The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes. Methods : The autograft group included 18 patients with depressed tibial plateau fractures treated with autogenous bone grafting from the ipsilateral femoral condyle following open reduction and internal fixation. According to Schatzker classification, there were 9 type II, 4 type III, 2 type IV and 3 type V lesions. The average time to union and the hospital charges were compared with the bone substitute group. The latter included 17 patients who had an excellent outcome following treatment of split and/or depressed lateral plateau fractures, using a similar surgical technique but grafting with bone substitutes (allografts). Results : Excellent clinical and radiological results were detected in the autograft group after an average follow-up of 28 months (range 12-37). The average time to union in the autograft group was 14 weeks (range 12-16), while in the bone substitute group it was 18 weeks (range 16-20). The mean total cost was 1276 Euros for the autograft group and 2978 Euros for the bone substitute group. Discussion : The use of autogenous graft from the ipsilateral femoral condyle following open reduction and internal fixation of depressed tibial plateau fractures provided enough bone to maintain the height of the tibial plateau and was not associated with any donor site morbidity. Using this method, the surgical time was not significantly elongated and the rehabilitation was not affected. It also exhibited faster fracture healing without postoperative loss of reduction and it was less expensive than the use of bone substitutes. PMID:25317215

  10. EPIDEMIOLOGICAL CHARACTERISTICS AND CAUSES OF PROXIMAL FEMORAL FRACTURES AMONG THE ELDERLY

    PubMed Central

    Neto, José Soares Hungria; Dias, Caio Roncon; de Almeida, José Daniel Bula

    2015-01-01

    Objective: The social and economic cost of proximal femoral fractures is high, due the morbidity and mortality relating to the fracture itself, among other factors. Despite the importance of this issue, studies on this topic are still scarce in Brazil. This was a retrospective, observational and cross-sectional (ecological) study with the aims of outlining an epidemiological profile for proximal femoral fractures among the elderly and analyzing the causes of these fractures and the physical characteristics of patients admitted to a single university hospital in São Paulo. Methods: This was a study on medical records over a one-year period, with group comparisons using the chi-square test; p > 0.05 was considered significant. Results: Ninety-four individuals were evaluated: predominantly female (2:1); 81-85 years of age; body mass index within normal limits; white and Asian patients (p > 0.05). The vast majority of the fractures occurred through low-energy trauma and inside the patients’ homes (p > 0.05). After excluding the trauma resulting from high-energy events, over 39% occurred as the patients were moving from sitting to standing up or were using stairs, and approximately 40% occurred while they were standing still or walking. A greater number of cases corresponded to the cold seasons of the year (p > 0.05); Conclusion: Most injuries occurred inside the patients’ own homes and had low-energy causes. Thus, some accidents might be avoided through simple low-cost measures that guide the elderly regarding situations of risk, which would bring major quality-of-life benefits and significant decreases in morbidity, mortality and the socioeconomic costs of this increasingly frequent problem. PMID:27027070

  11. Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup

    PubMed Central

    Catena, Nunzio; Sénès, Filippo M; Riganti, Simone; Boero, Silvio

    2014-01-01

    Background: In children less than 6 years, the treatment of femoral shaft fracture is often non surgical, using closed reduction and casting. The literature reports many experience about this type of trauma but none of these has a long term followup. We present a retrospective study on a group of femoral diaphyseal fractures treated nonsurgically in children up to 6 years of age, with a minimum of 10 year followup. Materials and Methods: 48 cases (36 males/12 females) with femoral diaphyseal fractures treated between January 1988 and December 1998 were reviewed. Patients with fractures due to obstetrical trauma and pathologic fractures were excluded. The mean age of the patients was 3.3 ± 1.1 years (range 5 months-6 years). Right side was involved in 21 cases (44%), and left side in 27 cases (56%). In 34 cases (71%), closed reduction was performed and hip spica was applied with the hip and knee flexed to 45°. In 8 cases (17%), skeletal traction was applied to perform fracture reduction and the traction pin was embedded in plaster while in the remaining 6 cases (12%), the Delitala pressure apparatus was applied after casting. Results: All fractures healed in our study. There were no complications (infection or vascular nervous issues, axial deviations, consolidation delays, or pseudoarthrosis). In 13 cases (27%), followup examinations showed mean lengthening of 1.3 ± 0.75 (range 0.5-2.5 cm) of the fractured lower limb. All these patients were treated with skin traction before treatment and presented with 2.08 ± 0.28 cm mean initial femoral shortening. In 1 case (2%) with 2.5 cm lengthening, epiphysiodesis of the ipsilateral knee was performed. No patients showed prolonged difficulty with gait disorders. Conclusion: On the basis of our results conservative treatment of femoral shaft fractures in children can be considered less invasive and safe procedure. PMID:24600060

  12. Effect of Teriparatide on Healing of Atypical Femoral Fractures: A Systemic Review

    PubMed Central

    Lee, Seong-Hyun

    2015-01-01

    Background Bisphosphonates (BPs) are the most commonly used anti-osteoporotic drugs, which have been proven to reduce the risk of osteoporotic fractures. However, use of BPs, particularly for long periods of time, is associated with an increased risk of atypical femoral fracture (AFF). Healing of BP-associated AFF is usually delayed because of suppressed bone turnover. Teriparatide (TPTD), a recombinant form of parathyroid hormone (PTH), enhances bone healing in patients with delayed healing or non-union. Methods In this study, we summarized and performed a systemic review of the published literature on treatment of AFF using TPTD. Results Although there is a lack of level 1 studies on the evidence of TPTD in promoting bone union in AFFs, this systemic review of the available literature revealed that TPTD works positively in AFFs, and we put together the evidence that TPTD is a viable treatment option for enhancing fracture healing in AFFs. Conclusions While anecdotal evidence of beneficial effects of TPTD on fracture healing offer limited guidance for clinical decision making, a better understanding of the role of TPTD in fracture healing may be elucidated with future prospective trials. PMID:26713309

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

    PubMed

    Naik, Monappa-A; Sujir, Premjit; Tripathy, Sujit-Kumar; Vijayan, Sandeep; Hameed, Shamsi; Rao, Sharath-K

    2013-01-01

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

  14. Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients

    PubMed Central

    2011-01-01

    Background Total hip replacement is considered the best option for treatment of displaced intracapsular fractures of the femoral neck (FFN). The size of the femoral head is an important factor that influences the outcome of a total hip arthroplasty (THA): implants with a 28 mm femoral head are more prone to dislocate than implants with a 32 mm head. Obviously, a large head coupled to a polyethylene inlay can lead to more wear, osteolysis and failure of the implant. Ceramic induces less friction and minimal wear even with larger heads. Methods A total of 35 THAs were performed for displaced intracapsular FFN, using a 32 mm alumina-alumina coupling. Results At a mean follow-up of 80 months, 33 have been clinically and radiologically reviewed. None of the implants needed revision for any reason, none of the cups were considered to have failed, no dislocations nor breakage of the ceramic components were recorded. One anatomic cementless stem was radiologically loose. Conclusions On the basis of our experience, we suggest that ceramic-on-ceramic coupling offers minimal friction and wear even with large heads. PMID:21284879

  15. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    PubMed Central

    Keyhani, Sohrab; Vaziri, Arash Sharafat; shafiei, Hossein; Mardani-Kivi, Mohsen

    2015-01-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction. PMID:26110183

  16. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

    PubMed Central

    Baksi, D D; Pal, A K; Baksi, D P

    2016-01-01

    Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG) were excluded. Thus, out of 244 patients, 208 (85.3%) untreated nonunion and 36 (14.7%) following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN) femoral head was found histologically in 135 (54.3%) and radiologically in 48 (19.7%) patients. The patients were operated by open reduction of fracture, cannulated hip

  17. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research.

    PubMed

    Shane, Elizabeth; Burr, David; Ebeling, Peter R; Abrahamsen, Bo; Adler, Robert A; Brown, Thomas D; Cheung, Angela M; Cosman, Felicia; Curtis, Jeffrey R; Dell, Richard; Dempster, David; Einhorn, Thomas A; Genant, Harry K; Geusens, Piet; Klaushofer, Klaus; Koval, Kenneth; Lane, Joseph M; McKiernan, Fergus; McKinney, Ross; Ng, Alvin; Nieves, Jeri; O'Keefe, Regis; Papapoulos, Socrates; Sen, Howe Tet; van der Meulen, Marjolein C H; Weinstein, Robert S; Whyte, Michael

    2010-11-01

    Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of

  18. Femoral neck stress fracture in a female athlete: a case report

    PubMed Central

    Avrahami, Daniel; Pajaczkowski, Jason A.

    2012-01-01

    Objective The purpose of this case report is to describe chiropractic rehabilitation of a master's-level athlete with proximal femoral stress fracture and provide a brief discussion of stress fracture pathology. Clinical Features A 41-year-old female master's-level endurance athlete presented with chronic groin pain later diagnosed and confirmed by magnetic resonance imaging as a stress fracture of the femoral neck. After diagnosis, the patient was referred to a doctor of chiropractic at week 1 of the non–weight-bearing physical rehabilitation process. At that time, the patient presented with sharp and constant groin pain rated 6/10 on a numeric rating scale. Intervention and Outcome This patient avoided weight-bearing activity for 8 weeks while cross-training and was able to return to her sport after this period. The patient was progressed through a series of non–weight-bearing strengthening exercises for the lower extremity. Myofascial release therapy was performed on the gluteal, hip flexor, and groin muscle groups to improve range of motion. Motion palpation testing the lumbar and sacroiliac joints was performed during each session, and manipulative therapy was performed when necessary. The patient was seen once a week for 8 weeks. Reevaluation was performed at week 8; at that time, the patient reported no groin pain (0/10). The patient was discharged from care and referred back to the supervising physician for clearance to return to sporting activities. One month after discharge, she reported that she was pain free and had fully returned to sport activities. Conclusion This case report demonstrates the importance of a through clinical history, physical examination, and magnetic resonance imaging in the accurate diagnosis of a patient with chronic groin pain and that chiropractic care can contribute to rehabilitation programs for these injuries. PMID:23843760

  19. Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures

    PubMed Central

    Fu, Xin; Xu, Gui-Jun; Li, Zhi-Jun; Du, Chang-Ling; Han, Zhe; Zhang, Tao; Ma, Xinlong

    2015-01-01

    Abstract The purpose of this study was to employ a new three-dimensional (3D) reconstruction and modeling method to measure displacement of undisplaced femoral neck fractures (Garden stages I and II). We also aimed to evaluate the effectiveness of the Garden classification for determining the displacement of undisplaced femoral neck fractures. A total of 120 consecutive patients with undisplaced femoral neck fractures were enrolled between 2012 and 2014, including 60 within the Garden I group and 60 within the Garden II group. The displacements of the femoral head center (d1) and the lowest point of the fovea capitis femoris (d2) and rotational displacement of the femoral head (α) in the 3D model were measured with 3D computed tomography reconstruction and modeling. Five observers, trauma surgeons, were asked to found the centers of the femoral heads and the deepest points of the foveae. The intraobserver and inter-observer agreements were calculated using Fleiss’ kappa. The inter-observer and intra-observer kappa values were 0.937 and 0.985, respectively. Current method has good reliability. We discovered that many participants in our study had been misclassified by an anterior–posterior radiograph as having an “incomplete” fracture. In incomplete fracture of Garden stage I group, the average displacements d1 and d2 were 3.69 ± 1.77 mm and 14.51 ± 1.91 mm, respectively. The mean α was 4.91° ± 2.49°. For impacted fracture of Garden stage I, significant spatial displacement in the impacted fractures was observed (d1: 6.22 ± 3.36 mm; d2: 10.30 ± 5.73 mm; and α: 17.83° ± 10.72°). Similarly, significant spatial displacement was observed among the Garden stage II group (d1: 7.16 ± 4.58 mm; d2: 12.95 ± 8.25 mm; and α: 18.77° ± 9.10°). There was no significant difference in α, d1, and d2 between impacted fracture and Garden stage II groups (P > 0.05). However, significant differences were found between

  20. Fracture of Uncemented Revision Femoral Stems in three Arthroplasty Patients: A Case Series with three different brands

    PubMed Central

    Merchant, Rajiv; Kelly, Ian; Quinlan, John

    2014-01-01

    Introduction: Fracture of stems in primary total hip arthroplasty is a known complication and has been attributed to varus positioning, excessive weight of the patient, resorption of the femoral calcar and failure of the cement mantle. Fractures in uncemented revision femoral stems are rare and are attributed to reduction in proximal support either in the form of bone loss or an extended trochanteric osteotomy [ETO] against a distally well- fixed stem. Also, undersized stems and high BMI to increase the risk of stem fracture. Case Report: We report 3 cases of uncemented revision stem fractures. Case 1 is a 77 year old male, Case 2 is a 71- year-old female, case 3 an 82-year-old male. All three patients had significant proximal femoral osteolysis. All three had an extended trochanteric osteotomy for the revision surgery. The hips had remained in-situ for 4, 2 and 5 years respectively prior to fracture. Conclusion: When planning complex revision cases involving long uncemented stems, attention should be given to the above-mentioned variables. ETO non-union and proximal bone loss play an important role in stem fractures. Stem failure can occur irrespective of the make, and factors such as adequate stem size and good diaphyseal fit are non negotiable. PMID:27298992

  1. Computer-assisted navigation of a complex femoral shaft fracture: instruction in three steps--a technical note.

    PubMed

    Claassen, L; Hawi, N; Ettinger, M; Stukenborg-Colsman, Ch; Liodakis, E; Citak, M

    2013-01-01

    The procedure of computer-assisted navigation of femoral shaft fractures is well described. Nevertheless, its use is less common. An unclear disposal and longer operation times might be two reasons. The aim of this technical note is to render assistance concerning the ideal disposal of the setup.

  2. Tissue level microstructure and mechanical properties of the femoral head in the proximal femur of fracture patients

    NASA Astrophysics Data System (ADS)

    Lü, Linwei; Meng, Guangwei; Gong, He; Zhu, Dong; Gao, Jiazi; Fan, Yubo

    2015-04-01

    This study aims to investigate the regional variations of trabecular morphological parameters and mechanical parameters of the femoral head, as well as to determine the relationship between trabecular morphological and mechanical parameters. Seven femoral heads from patients with fractured proximal femur were scanned using a micro-CT system. Each femoral head was divided into 12 sub-regions according to the trabecular orientation. One trabecular cubic model was reconstructed from each sub-region. A total of 81 trabecular models were reconstructed, except three destroyed sub-regions from two femoral heads during the surgery. Trabecular morphological parameters, i.e. trabecular separation (Tb.Sp), trabecular thickness (Tb.Th), specific bone surface (BS/BV), bone volume fraction (BV/TV), structural model index (SMI), and degree of anisotropy (DA) were measured. Micro-finite element analyses were performed for each cube to obtain the apparent Young's modulus and tissue level von Mises stress distribution under 1 % compressive strain along three orthogonal directions, respectively. Results revealed significant regional variations in the morphological parameters (). Young's moduli along the trabecular orientation were significantly higher than those along the other two directions. In general, trabecular mechanical properties in the medial region were lower than those in the lateral region. Trabecular mechanical parameters along the trabecular orientation were significantly correlated with BS/BV, BV/TV, Tb.Th, and DA. In this study, regional variations of microstructural features and mechanical properties in the femoral head of patients with proximal femur fracture were thoroughly investigated at the tissue level. The results of this study will help to elucidate the mechanism of femoral head fracture for reducing fracture risk and developing treatment strategies for the elderly.

  3. Atypical femoral fracture in a 51-year-old woman: Revealing a hypophosphatasia.

    PubMed

    Maman, Esther; Briot, Karine; Roux, Christian

    2016-05-01

    We report a 51-year old woman who suffered 2 atypical subtrochanteric femoral fractures (AFFs). She had a history of several metatarsal fractures. She had a normal bone densitometry. An adult form of hypophosphatasia (HPP) was diagnosed from low serum alkaline phosphatase (ALP), and tissue nonspecific isoenzyme of ALP (TNSALP) mutation analysis revealing 2 heterozygous mutations: c.299C>T (p. T100M) and c.571G>A (p. E191K). Low ALP is the hallmark of the diagnosis of HPP; which is associated in adults with premature loss of deciduous teeth, recurrent metatarsal stress fractures, and joints and tendons disorders. The incidence of AFFs in the population is 5.9 per 100,000 person-years. Physicians and patients with bone fragility must pay attention to prodromal pain, which require urgent radiographic evaluation of both femurs. Rheumatoid arthritis, use of glucocorticoids, and proton pump inhibitors have been associated with an excess risk of AFFs. Healthy subjects carrying a TNSALP mutation with low ALP value may be exposed to develop AFF spontaneously or while receiving potent anti-resorptive drugs. Low ALP must be checked as a cause of bone fragility. PMID:26992955

  4. Simultaneous Bilateral Femoral Neck Stress Fracture in a Young Stone Mason

    PubMed Central

    Khadabadi, Nikhil A.; Patil, Kiran S.

    2015-01-01

    Unilateral stress fractures of the femoral neck are very uncommon and bilateral involvement is even rarer. They commonly occur in athletes, military recruits, older persons, or individuals with underlying metabolic disorders and very seldom in normal individuals. We present a rare case of simultaneous bilateral fracture neck of femur in a 25-year-old man who came with complaints of pain in bilateral groin for 1 month. There was no history of trauma or history suggestive of excessive activity prior to the onset of pain, but there was history of lifting heavy weights daily. On evaluation with MRI scan bilateral fracture of the femur neck was diagnosed and patient was operated on bilaterally with internal fixation done using dynamic hip screw. Patient then regained his routine activity over a period of 6 months and on follow-up at 1 year no avascular necrosis changes were seen in the femur head. We presented this case because of its unusual presentation and the diagnostic challenge it poses. PMID:26101680

  5. Biomechanical analysis and clinical effects of bridge combined fixation system for femoral fractures.

    PubMed

    Wang, Da-xing; Xiong, Ying; Deng, Hong; Jia, Fu; Gu, Shao; Liu, Bai-lian; Li, Qun-hui; Pu, Qi; Zhang, Zhong-Zi

    2014-09-01

    This work aimed to compare the stress distribution and mechanical properties of our bridge combined fixation system and commonly used metal locking plate screw system by finite element analysis and by using the Zwick/Z100 testing machine. In addition, we also investigated the clinical outcome of our bridge combined fixation system for femoral fractures in 59 patients from June 2005 to January 2013. As a result, the stress distribution in the bone plate and screws of metal locking plate screw system during walking and climbing stairs was significantly lower than that of metal locking plate screw system. No significant difference in the displacement was observed between two systems. The equivalent bending stiffness of bridge combined fixation system was significantly lower than that of metal locking plate screw system. There were no significant differences in the bending strength, yield load, and maximum force between two systems. All the cases were followed up for 12-24 months (average 18 months). The X-ray showed bone callus was formed in most patients after 3 months, and the fracture line was faint and disappeared at 6-9 months postoperatively. No serious complications, such as implant breakage and wound infection, occurred postoperatively. According to self-developed standard for bone healing, clinical outcomes were rated as excellent or good in 55 out of 59 patients (success rate: 93.2%). Therefore, our findings suggest that our bridge combined fixation system may be a promising approach for treatment of long-bone fractures.

  6. COMPARISON OF VOLUMES OCCUPIED BY DIFFERENT INTERNAL FIXATION DEVICES FOR FEMORAL NECK FRACTURES

    PubMed Central

    Lauxen, Daniel; Schwartsmann, Carlos Roberto; Silva, Marcelo Faria; Spinelli, Leandro de Freitas; Strohaecker, Telmo Roberto; Souza, Ralf Wellis de; Zimmer, Cinthia Gabriely; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2015-01-01

    Objective: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. Methods: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. Results: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). Conclusions: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS. PMID:27047886

  7. Subchondral Insufficiency Fracture of the Femoral Head treated with Core Decompression and Bone Void Filler Support

    PubMed Central

    Patel, Hiren; Kamath, Atul F.

    2016-01-01

    Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks. Total hip arthroplasty (THA) has been commonly used if the patient does not respond to the initial protected weight bearing treatment. We present a case of a 48-year-old male with SIFFH who was treated with core hip decompression and bone void filler as a hip-preserving alternative to THA. The patient has an excellent clinical and radiographic result at final follow up. Core hip decompression with bone void filler is a less invasive alternative to THA, and may be a preferred initial treatment strategy for SIFFH in the young and active patient who has failed conservative measures. PMID:27517074

  8. Humeral cortical thickness in female Bantu - its relationship to the incidence of femoral neck fracture

    SciTech Connect

    Bloom, R.A.; Pogrund, H.

    1982-03-01

    Measurements of the humeral cortical thickness demonstrate that generalised osteoporosis in female Bantu commences in the fifth decade and gradually increases until, in the ninth decade, all subjects are osteoporotic. The combined cortical thickness (CCT) of the humerus in young adults is very similar to that found previously in a white London population and the loss of cortex with age is very similar. It is concluded that the known low incidence of femoral neck fracture in Bantu is not due to a lower incidence of generalised osteoporosis but to environmental factors. The chief environmental factor postulated is the greater amount of physical work performed by the Bantu. A more careful mode of walking is suggested as a subsidiary cause.

  9. Improve the Efficiency of Surgery for Femoral Shaft Fractures with A Novel Instrument: A Randomized Controlled Trial

    PubMed Central

    Hsu, Peichun; Qin, Hui; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Objective To improve the efficacy of closed reduction and wire guiding during intramedullary nail internal fixation in femoral shaft fractures. Methods A novel instrument was designed and manufactured. Sixty-eight patients were enrolled from February 2011 to December 2013. The instrument designed was used during the operation in the experimental group, but not in the control group. Results All patients exhibited fracture union, excluding 1 patient in the experimental group and 2 in the control group who had non-union; all of whom achieved fracture union with reoperation. There were no statistically significant differences in operative blood loss or duration of hospital stay between the groups (P > 0.05). The operative time, frequency of wire drilling, and number of open reduction cases, were significantly smaller in the experimental group than in the control group (P < 0.05). Conclusion Femoral shaft fractures are difficult to reduce using general methods; the novel instrument showed high clinical value and proved effective and safe in assisting with closed reduction and intramedullary nail fixation for femoral shaft fractures. Trial Registration ChiCTR ChiCTR-ICR-15007335 PMID:27115752

  10. Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

    PubMed Central

    2012-01-01

    We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249 PMID:22906214

  11. [Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure].

    PubMed

    Kazimoğlu, Cemal; Yağdi, Serhan; Karapinar, Hasan; Sener, Muhittin

    2007-01-01

    Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.

  12. Combined with Bone Marrow-Derived Cells and rhBMP-2 for Osteonecrosis after Femoral Neck Fractures in Children and Adolescents: A case series

    PubMed Central

    Gao, Fuqiang; Sun, Wei; Guo, Wanshou; Wang, Bailiang; Cheng, Liming; Li, Zirong

    2016-01-01

    Osteonecrosis of the femoral head (ONFH) following femoral neck fractures is a rare, yet severe, disorder in children and adolescents. This study evaluated the effectiveness of core decompression (CD) combined with implantation of bone marrow–derived cells (BMDC) and rhBMP-2 for osteonecrosis of femoral head (ONFH) after femoral neck fractures in children and adolescents. This study included 51 patients, aged 11.4–18.1 years, with ARCO stages I–III ONFH after femoral neck fractures between 2004 and 2010. The hips were divided into two groups based on whether the lateral pillar of the femoral head (LPFH) was preserved: LPFH and non-LPFH groups. All patients were followed up clinically and radiographically for a minimum of 5 years. 44 patients (86.3%) had improved clinical outcome. Radiologically, 9 of the 51 hips (17.6%) exhibited collapse onset or progression of the femoral head or narrowing of the hip joint space, and one patient in the non-LPFH group required hip arthroplasty due to the worsened syndrome. The technique provided an effective therapeutic option for children and adolescents with ONFH following femoral neck fractures. It relieves hip pain and prevents the progression of osteonecrosis in young patients lasting more than 5 years after surgery. PMID:27477836

  13. Cement augmentation of implants--no general cure in osteoporotic fracture treatment. A biomechanical study on non-displaced femoral neck fractures.

    PubMed

    Hofmann-Fliri, Ladina; Nicolino, Tomas I; Barla, Jorge; Gueorguiev, Boyko; Richards, R Geoff; Blauth, Michael; Windolf, Markus

    2016-02-01

    Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non-displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut-out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non-augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load-cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non-augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non-displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. PMID:26177609

  14. A rare case of bilateral non-weight bearing posterior aspect of lateral femoral condyle osteochondral fracture and its management.

    PubMed

    Shaikh, Aamir Hassan; Stanclik, Jaroslaw; Murphy, Paul G D

    2014-01-01

    Osteochondral fracture of the lateral femoral condyle can be a real challenging injury to diagnose on initial presentation. The authors report a rare case of bilateral involvement of posterior aspect of lateral femoral condyle osteochondral fracture in a young 15-year-old boy. This was managed with excision of these osteochondral fragments, as the site involved was on the posterior non-weight bearing area of the femur along with chronicity of the injury dictating excision as a reasonable choice of management. Good outcome for such injury is based on an early diagnosis and prompt treatment along with an early rehabilitation for such cases. Our patient has an excellent 2 years outcome with a Knee Society score of 95 after undergoing excision of these osteochondral fragments in both knees in succession.

  15. Risk factors for the effect of anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures.

    PubMed

    Akaoka, Yusuke; Yamazaki, Hiroshi; Kodaira, Hiroyuki; Kato, Hiroyuki

    2016-07-01

    To examine the effect of oral anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures and to identify the risk factors associated with perioperative blood loss.Retrospective cross-sectional study.In a retrospective cross-sectional study, we treated 334 consecutive patients with proximal femoral fractures (100 who received anticoagulant or antiplatelet drugs and 234 who did not) and an overall mean age of 85.5 years (standard deviation 8.2 years). We performed retrospective multivariate analysis to determine the independent factors related to perioperative decreases in the hemoglobin (Hb) level, a proxy for blood loss.Multivariate analysis confirmed that anticoagulant or antiplatelet drugs significantly affected decreases in the Hb level (regression coefficient [RC], 0.61; 95% confidence interval [CI], 0.14-1.08; P = 0.01). In addition to anticoagulant or antiplatelet drugs, multivariate analysis confirmed that the fracture type (Orthopedic Trauma Association classification A2: RC, 1.19; 95% CI, 0.71-1.67; P < 0.01; A3: RC, 2.47; 95% CI, 1.41-3.53; P < 0.01), platelet count (RC, -0.08; 95% CI, -0.12 to -0.04; P < 0.01), and operative time (RC, 0.02; 95% CI, 0.004-0.03; P = 0.01) affected the decreases in Hb level.The use of anticoagulants and antiplatelet agents is an independent risk factor for perioperative blood loss following proximal femoral fractures. Fracture type, platelet count, and operative time also affect perioperative blood loss. The fracture type was the greatest contributing factor to perioperative blood loss.Level of evidence grade: Prognostic level III.

  16. Strains caused by daily loading might be responsible for delayed healing of an incomplete atypical femoral fracture.

    PubMed

    Gustafsson, Anna; Schilcher, Jörg; Grassi, Lorenzo; Aspenberg, Per; Isaksson, Hanna

    2016-07-01

    Atypical femoral fractures are insufficiency fractures in the lateral femoral diaphysis or subtrochanteric region that mainly affect older patients on bisphosphonate therapy. Delayed healing is often seen in patients with incomplete fractures (cracks), and histology of bone biopsies shows mainly necrotic material inside the crack. We hypothesized that the magnitude of the strains produced in the soft tissue inside the crack during normal walk exceeds the limit for new bone formation, and thereby inhibit healing. A patient specific finite element model was developed, based on clinical CT images and high resolution μCT images of a biopsy from the crack site. Strain distributions in the femur and inside the crack were calculated for load cases representing normal walk. The models predicted large strains inside the crack, with strain levels above 10% in more than three quarters of the crack volume. According to two different tissue differentiation theories, bone would only form in less than 1-5% of the crack volume. This can explain the impaired healing generally seen in incomplete atypical fractures. Furthermore, the microgeometry of the crack highly influenced the strain distributions. Hence, a realistic microgeometry needs to be considered when modeling the crack. Histology of the biopsy showed signs of remodeling in the bone tissue adjacent to the fracture line, while the crack itself contained mainly necrotic material and signs of healing only in portions that seemed to have been widened by resorption. In conclusion, the poor healing capacity of incomplete atypical femoral fractures can be explained by biomechanical factors, and daily low impact activities are enough to cause strain magnitudes that prohibit bone formation. PMID:27113528

  17. Prediction of incident hip fracture with the estimated femoral strength by finite element analysis of DXA Scans in the study of osteoporotic fractures.

    PubMed

    Yang, Lang; Palermo, Lisa; Black, Dennis M; Eastell, Richard

    2014-12-01

    A bone fractures only when loaded beyond its strength. The purpose of this study was to determine the association of femoral strength, as estimated by finite element (FE) analysis of dual-energy X-ray absorptiometry (DXA) scans, with incident hip fracture in comparison to hip bone mineral density (BMD), Fracture Risk Assessment Tool (FRAX), and hip structure analysis (HSA) variables. This prospective case-cohort study included a random sample of 1941 women and 668 incident hip fracture cases (295 in the random sample) during a mean ± SD follow-up of 12.8 ± 5.7 years from the Study of Osteoporotic Fractures (n = 7860 community-dwelling women ≥67 years of age). We analyzed the baseline DXA scans (Hologic 1000) of the hip using a validated plane-stress, linear-elastic finite element (FE) model of the proximal femur and estimated the femoral strength during a simulated sideways fall. Cox regression accounting for the case-cohort design assessed the association of estimated femoral strength with hip fracture. The age-body mass index (BMI)-adjusted hazard ratio (HR) per SD decrease for estimated strength (2.21; 95% CI, 1.95-2.50) was greater than that for total hip (TH) BMD (1.86; 95% CI, 1.67-2.08; p < 0.05), FN BMD (2.04; 95% CI, 1.79-2.32; p > 0.05), FRAX scores (range, 1.32-1.68; p < 0.0005), and many HSA variables (range, 1.13-2.43; p < 0.005), and the association was still significant (p < 0.05) after further adjustment for hip BMD or FRAX scores. The association of estimated strength with incident hip fracture was strong (Harrell's C index 0.770), significantly better than TH BMD (0.759; p < 0.05) and FRAX scores (0.711-0.743; p < 0.0001), but not FN BMD (0.762; p > 0.05). Similar findings were obtained for intracapsular and extracapsular fractures. In conclusion, the estimated femoral strength from FE analysis of DXA scans is an independent predictor and performs at least as well as FN BMD in predicting incident

  18. A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients

    PubMed Central

    Park, Bong-Ju; Min, Woong-Bae

    2015-01-01

    Purpose To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. Materials and Methods From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). Results Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. Conclusion In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation. PMID:27536619

  19. Hypovitaminosis D and Other Risk Factors of Femoral Neck Fracture in South Indian Postmenopausal Women: A Pilot Study

    PubMed Central

    Selvan, Sivan Arul; Asha, Hesarghatta Shyamasunder; Thomas, Nihal; Venkatesh,, Krishnan; Oommen, Anil Thomas; Mathai, Thomas; Seshadri, MandalamSubramanian

    2015-01-01

    Background Non-communicable diseases like hip fractures are a significant problem in a developing country like India. The risk factors for hip fractures vary according to local practices and the availability of preventive health care delivery systems. There is paucity of data on risk factors for hip fracture in the south Indian population. Aim This study was undertaken to assess risk factors associated with femoral neck (FN) fracture in South Indian postmenopausal women along with subsequent one year mortality. Materials and Methods One hundred four postmenopausal women with FN fracture and 104 age and BMI matched controls were included. Sedative use, visual impairment and other relevant risk factors were assessed. Bone biochemistry and Bone Mineral Density (BMD) were evaluated. A telephonic interview was done at the end of one year to ascertain the well-being. Results Sedative use, visual impairment, low FN BMD and vitamin-D deficiency (<20 ng/ml) were seen more in fracture subjects compared to controls (p≤0.05). At the end of one year, 20% of the fracture subjects and 5% of the controls had died (p=0.001). Conclusion Risk factors identified in our study are potentially correctable, and needs special attention in an Indian context to prevent hip fractures. PMID:26266149

  20. Efficacy Evaluation for the Treatment of Subcapital Femoral Neck Fracture in Young Adults by Capsulotomy Reduction and Closed Reduction

    PubMed Central

    Liu, Cong; Liu, Meng-Ting; Li, Peng; Xu, Hong-Hai

    2015-01-01

    Background: Subcapital femoral neck fracture in young adults has many complications, and the incidence is increasing year-by-year. The selection of the proper operation method to avoid them is an ambiguous matter. This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and internal fixation in young adults. Methods: From March 2003 to February 2010, 65 young patients with subcapital femoral neck fractures were treated, including 39 males and 26 females with average age of 34.5 years (range, 19–50 years); 29 cases of the left side and 36 cases of the right side. They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting. The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score. The observation criteria involved the length of the incision, blood loss, operation time, nonunion rate, avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score. Results: Four of 65 patients were lost follow-up, and the follow-up rate was 93.8%, the average follow-up time was 38.7 months (range, 33–47 months). In Group A, the incision length was 5.1 ± 2.2 cm, blood loss was 84.0 ± 13.2 ml, and operation time was 52.9 ± 10.2 min. In Group B, the incision length was 15.4 ± 4.6 cm, blood loss was 396.0 ± 21.3 ml, and operation time was 116.5 ± 15.3 min. Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B. ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B. Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B. The above index of two groups was considered statistically significant (P < 0.05). Conclusions: Capsulotomy and internal fixation with iliac bone grafting can improve

  1. Estimated lean mass and fat mass differentially affect femoral bone density and strength index but are not FRAX independent risk factors for fracture.

    PubMed

    Leslie, William D; Orwoll, Eric S; Nielson, Carrie M; Morin, Suzanne N; Majumdar, Sumit R; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A

    2014-11-01

    Although increasing body weight has been regarded as protective against osteoporosis and fractures, there is accumulating evidence that fat mass adversely affects skeletal health compared with lean mass. We examined skeletal health as a function of estimated total body lean and fat mass in 40,050 women and 3600 men age ≥50 years at the time of baseline dual-energy X-ray absorptiometry (DXA) testing from a clinical registry from Manitoba, Canada. Femoral neck bone mineral density (BMD), strength index (SI), cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) were derived from DXA. Multivariable models showed that increasing lean mass was associated with near-linear increases in femoral BMD, CSA, and CSMI in both women and men, whereas increasing fat mass showed a small initial increase in these measurements followed by a plateau. In contrast, femoral SI was relatively unaffected by increasing lean mass but was associated with a continuous linear decline with increasing fat mass, which should predict higher fracture risk. During mean 5-year follow-up, incident major osteoporosis fractures and hip fractures were observed in 2505 women and 180 men (626 and 45 hip fractures, respectively). After adjustment for fracture risk assessment tool (FRAX) scores (with or without BMD), we found no evidence that lean mass, fat mass, or femoral SI affected prediction of major osteoporosis fractures or hip fractures. Findings were similar in men and women, without significant interactions with sex or obesity. In conclusion, skeletal adaptation to increasing lean mass was positively associated with BMD but had no effect on femoral SI, whereas increasing fat mass had no effect on BMD but adversely affected femoral SI. Greater fat mass was not independently associated with a greater risk of fractures over 5-year follow-up. FRAX robustly predicts fractures and was not affected by variations in body composition. PMID:24825359

  2. Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: derivation and validation of a hybrid system.

    PubMed

    Leslie, William D; Lix, Lisa M

    2011-03-01

    The World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) computes 10-year probability of major osteoporotic fracture from multiple risk factors, including femoral neck (FN) T-scores. Lumbar spine (LS) measurements are not currently part of the FRAX formulation but are used widely in clinical practice, and this creates confusion when there is spine-hip discordance. Our objective was to develop a hybrid 10-year absolute fracture risk assessment system in which nonvertebral (NV) fracture risk was assessed from the FN and clinical vertebral (V) fracture risk was assessed from the LS. We identified 37,032 women age 45 years and older undergoing baseline FN and LS dual-energy X-ray absorptiometry (DXA; 1990-2005) from a population database that contains all clinical DXA results for the Province of Manitoba, Canada. Results were linked to longitudinal health service records for physician billings and hospitalizations to identify nontrauma vertebral and nonvertebral fracture codes after bone mineral density (BMD) testing. The population was randomly divided into equal-sized derivation and validation cohorts. Using the derivation cohort, three fracture risk prediction systems were created from Cox proportional hazards models (adjusted for age and multiple FRAX risk factors): FN to predict combined all fractures, FN to predict nonvertebral fractures, and LS to predict vertebral (without nonvertebral) fractures. The hybrid system was the sum of nonvertebral risk from the FN model and vertebral risk from the LS model. The FN and hybrid systems were both strongly predictive of overall fracture risk (p < .001). In the validation cohort, ROC analysis showed marginally better performance of the hybrid system versus the FN system for overall fracture prediction (p = .24) and significantly better performance for vertebral fracture prediction (p < .001). In a discordance subgroup with FN and LS T-score differences greater than 1 SD, there was a significant

  3. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study.

    PubMed

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-08-01

    Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case-control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218-20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138-9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001-1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06-5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007-44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103-59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656-38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver

  4. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

    PubMed Central

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-01-01

    Abstract Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF. We retrospectively analyzed the clinical data of 89 cases of PFF, and a case–control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty. The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218–20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138–9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001–1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06–5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007–44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103–59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656–38.966, P = 0.01) were all risk factors. Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take

  5. Dose-Effect Relationships for Femoral Fractures After Multimodality Limb-Sparing Therapy of Soft-Tissue Sarcomas of the Proximal Lower Extremity

    SciTech Connect

    Pak, Daniel; Vineberg, Karen A.; Griffith, Kent A.; Sabolch, Aaron; Chugh, Rashmi; Biermann, Janet Sybil; Feng, Mary

    2012-07-15

    Purpose: We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). Methods and Materials: We examined 131 patients with proximal lower extremity STS who received limb-sparing surgery and external-beam radiation therapy between 1985 and 2006. Five (4%) patients sustained pathologic femoral fractures. Dosimetric analysis was limited to 4 fracture patients with full three-dimensional dose information, who were compared with 59 nonfracture patients. The mean doses and volumes of bone (V{sub d}) receiving specified doses ({>=}30 Gy, 45 Gy, 60 Gy) at the femoral body, femoral neck, intertrochanteric region, and subtrochanteric region were compared. Clinical predictive factors were also evaluated. Results: Of 4 fracture patients in our dosimetric series, there were three femoral neck fractures with a mean dose of 57.6 {+-} 8.9 Gy, V30 of 14.5 {+-} 2.3 cc, V45 of 11.8 {+-} 1.1 cc, and V60 of 7.2 {+-} 2.2 cc at the femoral neck compared with 22.9 {+-} 20.8 Gy, 4.8 {+-} 5.6 cc, 2.5 {+-} 3.9 cc, and 0.8 {+-} 2.7 cc, respectively, for nonfracture patients (p < 0.03 for all). The femoral neck fracture rate was higher than at the subtrochanteric region despite lower mean doses at these subregions. All fracture sites received mean doses greater than 40 Gy. Also, with our policy of prophylactic femoral intramedullary nailing for high-risk patients, there was no significant difference in fracture rates between patients with and without periosteal excision. There were no significant differences in age, sex, tumor size, timing of radiation therapy, and use of chemotherapy between fracture and nonfracture patients. Conclusions: These dose-volume toxicity relationships provide RT optimization goals to guide future efforts for reducing pathologic fracture rates. Prophylactic femoral intramedullary nailing may also reduce fracture risk for susceptible patients.

  6. The effectiveness of the antegrade reamed technique: the experience and complications from 415 traumatic femoral shaft fractures

    PubMed Central

    Papadimitriou, George; Theodoratos, Gerasimos; Papanikolaou, Anastasios; Maris, John

    2009-01-01

    This retrospective study presents the experience gained through use of reamed femoral nails and reports results and respective complications. This study included 415 femur fractures (312 men and 101 women with a mean age of 27.8 years) that were treated from 1993 to 2004. The fractures were classified according to AO, and 74 open fractures were included and typed according to the Gustilo classification. Dynamic nailing was performed for nearly all type A fractures and static nailing for types B and C. After a mean follow-up of 1.5 years, union rate was 97.8%. The complications were: 9 non-unions, 14 delayed-unions, 4 torsional malunions, 6 limb length discrepancies (shortening) and 30 nerve pareses due to traction. Deep venous thrombosis (DVT) occurred below the knee in 4 patients, while there were recorded 3 pulmonary and 2 fat embolisms, 1 superficial and 1 deep infection. There were 28 broken screws identified postoperatively. Logistic regression analysis revealed that type B and C were associated with increased risk of complications, with respective odds ratios of 3.1 (95% CI = 1.3–7.2, P = 0.011) and 4.3 (95% CI = 1.8–10.3, P = 0.001) when compared to type A patterns. All patients returned to their activities in a mean time of 10 months. Intramedullary nailing is still the treatment of choice for femoral shaft fractures, but knowledge of potential complications and their association with certain fracture patterns is needed. PMID:19936887

  7. Retrograde Intramedullary Nailing with a Blocking Pin Technique for Reduction of Periprosthetic Supracondylar Femoral Fracture after Total Knee Arthroplasty: Technical Note with a Compatibility Chart of the Nail to Femoral Component

    PubMed Central

    Hamada, Daisuke; Takasago, Tomoya; Tsutsui, Takahiko; Suzue, Naoto; Sairyo, Koichi

    2014-01-01

    Periprosthetic fractures after total knee arthroplasty (TKA) present a clear management challenge, and retrograde intramedullary nails have recently gained widespread acceptance in treatment of these fractures. In two cases, we found a blocking screw technique, first reported by Krettek et al., was useful in the reduction of the fractures. Both patients attained preinjury mobility after intramedullary nailing. Moreover, we present a chart summarizing the notch designs of various femoral components because some prosthetic knee designs are not amenable to retrograde nailing. We hope this will be helpful in determining indications for retrograde nailing in periprosthetic fractures after TKA. PMID:25574411

  8. Combined lateral femoral epicondylar osteotomy and a submeniscal approach for the treatment of a tibial plateau fracture involving the posterolateral quadrant.

    PubMed

    Yoon, Yong-Cheol; Sim, Jae-Ang; Kim, Dong-Hyun; Lee, Beom-Koo

    2015-02-01

    Exposure of a tibial plateau fracture involving the posterolateral quadrant is challenging, and several approaches for treating these fractures have been introduced. However, these approaches may have limited applicability, and they can potentially cause neurovascular, musculotendinous, or ligamentous injury of the posterolateral corner. Lateral femoral epicondylar osteotomy has been used for meniscal transplantation, total knee arthroplasty, and the treatment of posterolateral articular disorders of the femur and tibia. We encountered a case of a tibial plateau fracture involving the posterolateral quadrant without an anterior-extending fracture line. We successfully exposed, reduced, and fixed the fracture using combined lateral femoral epicondylar osteotomy and a submeniscal approach. This combined modality can be used as an alternative surgical technique for the treatment of tibial plateau fractures involving the posterolateral quadrant. PMID:25548115

  9. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis

    PubMed Central

    Hierholzer, Christian; von Rüden, Christian; Pötzel, Tobias; Woltmann, Alexander; Bühren, Volker

    2011-01-01

    Background: Two major therapeutic principles can be employed for the treatment of distal femoral fractures: retrograde intramedullary (IM) nailing (RN) or less invasive stabilization on system (LISS). Both operative stabilizing systems follow the principle of biological osteosynthesis. IM nailing protects the soft-tissue envelope due to its minimally invasive approach and closed reduction techniques better than distal femoral locked plating. The purpose of this study was to evaluate and compare outcome of distal femur fracture stabilization using RN or LISS techniques. Materials and Methods: In a retrospective study from 2003 to 2008, we analyzed 115 patients with distal femur fracture who had been treated by retrograde IM nailing (59 patients) or LISS plating (56 patients). In the two cohort groups, mean age was 54 years (17–89 years). Mechanism of injury was high energy impact in 57% (53% RN, 67% LISS) and low-energy injury in 43% (47% RN, 33% LISS), respectively. Fractures were classified according to AO classification: there were 52 type A fractures (RN 31, LISS 21) and 63 type C fractures (RN 28, LISS 35); 32% (RN) and 56% (LISS) were open and 68% (RN) and 44% (LISS) were closed fractures, respectively. Functional and radiological outcome was assessed. Results: Clinical and radiographic evaluation demonstrated osseous healing within 6 months following RN and following LISS plating in over 90% of patients. However, no statistically significant differences were found for the parameters time to osseous healing, rate of nonunion, and postoperative complications. The following complications were treated: hematoma formation (one patient RN and three patients LISS), superficial infection (one patient RN and three patients LISS), deep infection (2 patients LISS). Additional secondary bone grafting for successful healing 3 months after the primary operation was required in four patients in the RN (7% of patients) and six in the LISS group (10% of patients

  10. Low-intensity pulsed ultrasound accelerates rat femoral fracture healing by acting on the various cellular reactions in the fracture callus.

    PubMed

    Azuma, Y; Ito, M; Harada, Y; Takagi, H; Ohta, T; Jingushi, S

    2001-04-01

    Low-intensity pulsed ultrasound (LIPUS) has been shown to accelerate fracture healing in both animal models and clinical trials, but the mechanism of action remains unclear. In fracture healing, various consecutive cellular reactions occurred until repair. We investigated whether the advanced effects of LIPUS depended on the duration and timing of LIPUS treatment in a rat closed femoral fracture model to determine the target of LIPUS in the healing process. Sixty-nine Long-Evans male rats that have bilateral closed femoral fractures were used. The right femur was exposed to LIPUS (30 mW/cm2 spatial and temporal average [SATA], for 20 minutes/day), and the left femur was used as a control. Rats were divided into four groups according to timing and duration of treatment (Ph-1, days 1-8; Ph-2, days 9-16; Ph-3, days 17-24; throughout [T], days 1-24 after the fracture). Animals were killed on day 25. After radiographs and microfocus X-ray computed tomography (muCT) tomograms were taken, the hard callus area (HCA), bone mineral content (BMC) at the fracture site, and mechanical torsion properties were measured, and histological analysis was conducted. Interestingly, the maximum torque of the LIPUS-treated femur was significantly greater than that of the controls in all groups without any changes in HCA and BMC. The multiviewing of three-dimensional (3D) muCT reconstructions and histology supported our findings that the partial LIPUS treatment time was able to accelerate healing, but longer treatment was more effective. These results suggest that LIPUS acts on some cellular reactions involved in each phase of the healing process such as inflammatory reaction, angiogenesis, chondrogenesis, intramembranous ossification, endochondral ossification, and bone remodeling.

  11. Systemic treatment with vanadium absorbed by Coprinus comatus promotes femoral fracture healing in streptozotocin-diabetic rats.

    PubMed

    Wang, Guangbin; Wang, Jiashi; Fu, Yonghui; Bai, Lunhao; He, Ming; Li, Bin; Fu, Qin

    2013-03-01

    The purpose of this study was to analyze the impact of vanadium absorbed by Coprinus comatus (VACC) on fracture healing in streptozotocin-diabetic rats. Forty-five male Wistar rats used were divided into three groups: normal rats (control), diabetic rats, and diabetic rats treated with VACC. A standardized fracture-healing model with a stable plate fixation was established for the rat femoral fracture. After a 4-week stable fixation, callus quality was assessed by microcomputerized tomography and histological and biomechanical examinations. In addition, bone samples were obtained to evaluate the content of mineral substances in bones. Compared with the diabetic group, vanadium treatment significantly increased bone mineral content and biomechanical strength and improved microstructural properties of the callus. The ultimate load was increased by 29.1 % (P<0.05), and the total bone volume of callus enhanced by 11.2 % (P<0.05) at 4 weeks post fracture. Vanadium also promoted callus bone formation, which caused a 35.5 % increase in the total area of callus. However, VACC did not accelerate the fracture repair process in histological analysis. In conclusion, the current study suggests that systemic treatment with vanadium could promote fracture healing in streptozotocin-diabetic rats.

  12. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement?

    PubMed Central

    2010-01-01

    Background Femoral neck fractures in the elderly are frequent, represent a great health care problem, and have a significant impact on health insurance costs. Reconstruction options using hip arthroplasty include unipolar or bipolar hemiarthroplasty (HA), and total hip arthroplasty (THA). The purpose of this review is to discuss the indications, limitations, and pitfalls of each of these techniques. Methods The Pubmed database was searched for all articles on femoral neck fracture and for the reconstruction options presented in this review using the search terms "femoral neck fracture", "unipolar hemiarthroplasty", "bipolar hemiarthroplasty", and "total hip arthroplasty". In addition, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were then reviewed with regard to the different techniques, outcome and complications of the distinct reconstruction options. Results THA yields the best functional results in patients with displaced femoral neck fractures with complication rates comparable to HA. THA is beneficially implanted using an anterior approach exploiting the internervous plane between the tensor fasciae latae and the sartorius muscles allowing for immediate full weight-bearing. Based on our findings, bipolar hemiarthroplasty, similar to unipolar hemiarthroplasty, cannot restorate neither anatomical nor biomechanical features of the hip joint. Therefore, it can only be recommended as a second line of defense-procedure for patients with low functional demands and limited live expectancy. Conclusions THA is the treatment of choice for femoral neck fractures in patients older than 60 years. HA should only be implanted in patients with limited life expectancy. PMID:20961437

  13. Preoperative Factors and Early Complications Associated With Hemiarthroplasty and Total Hip Arthroplasty for Displaced Femoral Neck Fractures

    PubMed Central

    Buerba, Rafael A.; Leslie, Michael P.

    2014-01-01

    Displaced femoral neck fractures are common injuries in the elderly individuals. There is controversy about the best treatment with regard to total hip arthroplasty (THA) versus hemiarthroplasty. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to evaluate the preoperative risk factors associated with the decision to perform THA over hemiarthroplasty. We also evaluate the risk factors associated with postoperative complications after each procedure. Patients older than 50 years undergoing hemiarthroplasty or THA after fracture in the NSQIP database from 2007 to 2010 were compared to each other in terms of preoperative medical conditions, postoperative complications, and length of stay. Multivariate logistic regression models were used to adjust for preoperative risk factors for undergoing a THA versus a hemiarthroplasty and for complications after each procedure. In all, 783 patients underwent hemiarthroplasty and 419 underwent THA for fracture. Hemiarthroplasty patients had longer hospital stays. On multivariate logistic regression, the only significant predictor for having a THA after fracture over hemiarthroplasty was being aged 50 to 64 years. The patient characteristics/comorbidities that favored having a hemiarthroplasty were age >80 years, hemiplegia, being underweight, having a dependent functional status, being on dialysis, and having an early surgery. High body mass index, American Society of Anesthesiologists (ASA) class, gender, and other comorbidities were not predictors of having one procedure over another. Disseminated cancer and diabetes were predictive of complications after THA while being overweight, obese I, or a smoker were protective. High ASA class and do-not-resuscitate status were significant predictors of complications after a hemiarthroplasty. This study identified clinical factors influencing surgeons toward performing either THA or hemiarthroplasty for elderly patients

  14. Increased risk of major depression in the three years following a femoral neck fracture--a national population-based follow-up study.

    PubMed

    Chang, Chih-Yu; Chen, Wen-Liang; Liou, Yi-Fan; Ke, Chih-Chi; Lee, Hua-Chin; Huang, Hui-Ling; Ciou, Li-Ping; Chou, Chu-Chung; Yang, Mei-Chueh; Ho, Shinn-Ying; Lin, Yan-Ren

    2014-01-01

    Femoral neck fracture is common in the elderly, and its impact has increased in aging societies. Comorbidities, poor levels of activity and pain may contribute to the development of depression, but these factors have not been well addressed. This study aims to investigate the frequency and risk of major depression after a femoral neck fracture using a nationwide population-based study. The Taiwan Longitudinal Health Insurance Database was used in this study. A total of 4,547 patients who were hospitalized for femoral neck fracture within 2003 to 2007 were recruited as a study group; 13,641 matched non-fracture participants were enrolled as a comparison group. Each patient was prospectively followed for 3 years to monitor the occurrence of major depression. Cox proportional-hazards models were used to compute the risk of major depression between members of the study and comparison group after adjusting for residence and socio-demographic characteristics. The most common physical comorbidities that were present after the fracture were also analyzed. The incidences of major depression were 1.2% (n = 55) and 0.7% (n = 95) in the study and comparison groups, respectively. The stratified Cox proportional analysis showed a covariate-adjusted hazard ratio of major depression among patients with femoral neck fracture that was 1.82 times greater (95% CI, 1.30-2.53) than that of the comparison group. Most major depressive episodes (34.5%) presented within the first 200 days following the fracture. In conclusion, patients with a femoral neck fracture are at an increased risk of subsequent major depression. Most importantly, major depressive episodes mainly occurred within the first 200 days following the fracture.

  15. ANESTHETIC MANAGEMENT OF FEMORAL FRACTURE REPAIR IN A PATIENT WITH CERVICAL MYELOPATHY, AUTONOMIC DYSFUNCTION, AND DIFFICULT AIRWAY.

    PubMed

    Vellore, Ajay R; Robards, Christopher B; Clendenen, Steven R

    2016-02-01

    Spinal stenosis is a potentially serious condition that can lead to myelopathies and autonomic instability, both of which, as a result, may complicate anesthetic management. Additionally, neuraxial anesthesia appears to increase the risk of worsened neurological outcomes in this population. A 56-year-old female with spinal stenosis, autonomic dysfunction, and known difficult airway who required anesthesia for repair of a femur fracture is presented. After pre-operative arterial line and femoral block placement, an ultrasound guided subarachnoid block was safely placed. This supports the notion that in the appropriate setting, a safe, successful neuraxial blockade can be performed when a general anesthetic may be fraught with more risk. PMID:27382821

  16. Bisphosphonate-associated osteonecrosis of the jaw: a six-year history of a case.

    PubMed

    Hewson, I D

    2011-09-01

    Patients with multiple myeloma are usually treated with IV bisphosphonates soon after diagnosis. Bisphosphonate administration has been associated with bisphosphonate-associated osteonecrosis of the jaw (BONJ). BONJ can occur spontaneously; the most common spontaneous site is at the lingual aspect of the posterior mandible. The condition can continue to expose more bone well after bisphosphonates have been discontinued. This report describes the development and progression of a spontaneous BONJ of the mandible in an individual with multiple myeloma. The area of exposed bone slowly increased in size and eventually became mobile. Removal of the sequestrum provided a temporary respite from exposed bone and resolution of symptoms, but there was a recurrence of exposed bone that required further sequestrum removal.

  17. Impact of intraprosthetic drilling on the strength of the femoral stem in periprosthetic fractures: A finite element investigation.

    PubMed

    Brand, Stephan; Bauer, Michael; Petri, Maximilian; Schrader, Julian; Maier, Hans J; Krettek, Christian; Hassel, Thomas

    2016-07-01

    Treatment of periprosthetic femur fractures after total hip arthroplasty remains a major challenge in orthopedic surgery. Recently, a novel surgical technique using intraprosthetic screw fixation has been suggested. The purpose of this study was to evaluate the influence of drilling the femoral hip stem on integrity and strength of the implant. The hypothesis was that intraprosthetic drilling and screw fixation would not cause the load limit of the prosthesis to be exceeded and that deformation would remain within the elastic limit. A sawbone model with a conventional straight hip stem was used and a Vancouver C periprosthetic fracture was created. The fracture was fixed with a nine-hole less invasive stabilization system plate with two screws drilled and inserted through the femoral hip stem. Three different finite element models were created using ANSYS software. The models increased in complexity including joint forces and stress risers from three different dimensions. A variation of drilling positions was analyzed. Due to the complexity of the physiological conditions in the human femur, the most complex finite element model provided the most realistic results. Overall, significant changes in the stresses to the prosthesis caused by the drilling procedure were observed. While the stresses at the site of the bore hole decreased, the load increased in the surrounding stem material. This effect is more pronounced and further the holes were apart, and it was found that increasing the number of holes could counteract this. The maximum load was still found to be in the area of the prosthesis neck. No stresses above the load limit of titanium alloy were detected. All deformations of the prosthesis stem remained in the elastic range. These results may indicate a potential role for intraprosthetic screw fixation in the future treatment of periprosthetic femur fractures. PMID:27272200

  18. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report.

    PubMed

    Okamoto, Shinichi; Arai, Yuji; Hara, Kunio; Tsuzihara, Takashi; Kubo, Toshikazu

    2010-01-01

    This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad. PMID:20205723

  19. Early intramedullary nailing of femoral shaft fracture on outcomes in patients with severe chest injury: A meta-analysis

    PubMed Central

    Jiang, Meng; Li, Changli; Yi, Chengla; Tang, Shaotao

    2016-01-01

    Early intramedullary nailing (IMN) within the first 24 hours for multiply injured patients with femoral fracture and concomitant severe chest injury is still controversial. This review aimed to investigate the association between early IMN and pulmonary complications in such patients. We searched the literature up to Jan 2016 in the main electronic databases (PubMed, Web of Science, Cochrane library databases) to identify eligible studies. Data were extracted and analyzed using a Mantel–Haenszel method with random-effects model to estimate pooled odds ratio (OR) and 95% confidence intervals (CIs). Seven retrospective cohort studies were identified eventually. The pooled estimates demonstrated that the application of early IMN did not significantly increase the risk of adult respiratory distress syndrome (ARDS) (OR, 0.65; 95% CI: 0.38–1.13), mortality (OR, 0.79; 95% CI: 0.43–1.47), pneumonia (OR, 0.92; 95% CI: 0.55–1.54), multiple organ failure (MOF) (OR, 0.87; 95% CI: 0.45–1.71) and pulmonary embolism (OR, 1.81; 95% CI: 0.28–11.83). In subgroup analysis according to the type of IMN (reamed or undreamed), we did not find any significant difference either. Our results indicated that early IMN of femoral shaft fracture was not associated with increased rates of pulmonary complications in severe chest-injured patients. PMID:27457468

  20. Early intramedullary nailing of femoral shaft fracture on outcomes in patients with severe chest injury: A meta-analysis.

    PubMed

    Jiang, Meng; Li, Changli; Yi, Chengla; Tang, Shaotao

    2016-01-01

    Early intramedullary nailing (IMN) within the first 24 hours for multiply injured patients with femoral fracture and concomitant severe chest injury is still controversial. This review aimed to investigate the association between early IMN and pulmonary complications in such patients. We searched the literature up to Jan 2016 in the main electronic databases (PubMed, Web of Science, Cochrane library databases) to identify eligible studies. Data were extracted and analyzed using a Mantel-Haenszel method with random-effects model to estimate pooled odds ratio (OR) and 95% confidence intervals (CIs). Seven retrospective cohort studies were identified eventually. The pooled estimates demonstrated that the application of early IMN did not significantly increase the risk of adult respiratory distress syndrome (ARDS) (OR, 0.65; 95% CI: 0.38-1.13), mortality (OR, 0.79; 95% CI: 0.43-1.47), pneumonia (OR, 0.92; 95% CI: 0.55-1.54), multiple organ failure (MOF) (OR, 0.87; 95% CI: 0.45-1.71) and pulmonary embolism (OR, 1.81; 95% CI: 0.28-11.83). In subgroup analysis according to the type of IMN (reamed or undreamed), we did not find any significant difference either. Our results indicated that early IMN of femoral shaft fracture was not associated with increased rates of pulmonary complications in severe chest-injured patients. PMID:27457468

  1. Proximal femoral replacement in the management of acute periprosthetic fractures of the hip: a competing risks survival analysis

    PubMed Central

    Colman, Matthew; Choi, Lisa; Chen, Antonia; Crossett, Lawrence; Tarkin, Ivan; McGough, Richard

    2014-01-01

    To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000–2010. Three groups were defined: PFR (n=21), REV (n=19), and ORIF (n=57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups (p=0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (p=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation. PMID:23856062

  2. A Cost-effectiveness Analysis of the Arthroplasty Options for Displaced Femoral Neck Fractures in the Active, Healthy, Elderly Population

    PubMed Central

    Slover, James; Hoffman, Michael V.; Malchau, Henrik; Tosteson, Anna N.A.; Koval, Kenneth J.

    2009-01-01

    Purpose: This study was performed to explore the cost-effectiveness of total hip replacement compared with hemiarthroplasty in the treatment of displaced femoral neck fractures in active otherwise healthy older patients in whom the optimum treatment is believed to be an arthroplasty procedure. Methods: A Markov decision model was used to determine whether total hip arthroplasty or hemiarthroplasty was most cost-effective for the management of a displaced femoral neck fracture in this patient population. Results: Total hip arthroplasty was associated with an average cost $3,000 more than hemiarthroplasty, and the average quality-adjusted life year gain was 1.53. The incremental cost-effectiveness ratio associated with the total hip replacement treatment strategy is $1960 per quality-adjusted life-year. Conclusion: Currently available data support the use of total hip arthroplasty as the more cost-effective treatment strategy in this specific population. The increased upfront cost appears to be offset by the improved functional results when compared with hemiarthroplasty in this select patient group. PMID:18701245

  3. Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture

    PubMed Central

    Kang, Jeong Hoon; Jung, Sung

    2015-01-01

    Purpose The current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry. Materials and Methods Seventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis. Results At the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C. Conclusion Bipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture. PMID:27536631

  4. A missense single nucleotide polymorphism, V114I of the Werner syndrome gene, is associated with risk of osteoporosis and femoral fracture in the Japanese population.

    PubMed

    Zhou, Heying; Mori, Seijiro; Tanaka, Masashi; Sawabe, Motoji; Arai, Tomio; Muramatsu, Masaaki; Mieno, Makiko Naka; Shinkai, Shoji; Yamada, Yoshiji; Miyachi, Motohiko; Murakami, Haruka; Sanada, Kiyoshi; Ito, Hideki

    2015-11-01

    Werner syndrome is a rare autosomal recessive disorder caused by mutations in the human WRN gene and characterized by the early onset of normal aging symptoms. Given that patients with this disease exhibit osteoporosis, the present study aimed to determine whether the WRN gene contributes to the etiology of osteoporosis. A genetic association study of eight non-synonymous polymorphisms in the WRN gene and the incidence of femoral fracture was undertaken in 1,632 consecutive Japanese autopsies in which 140 patients had experienced the fracture during their lifetime. The results were validated in 251 unrelated postmenopausal Japanese women with osteoporosis and 269 non-institutionalized, community-dwelling Japanese adults. A statistically significant association was observed between rs2230009 (c.340G > A)--which results in a Val to Ile substitution--and fracture risk; the incidence of femoral fracture increased dose-dependently with the number of A alleles (p = 0.0120). Femoral neck bone and whole bone densities were lower among postmenopausal women with osteoporosis and community-dwelling adults, respectively, if they were of the AG instead of the GG genotype. The results suggest that Japanese subjects bearing at least one A allele of rs2230009 of the WRN gene are at a significantly higher risk of femoral fracture, possibly due to decreased bone density.

  5. Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction.

    PubMed

    Parada, Stephen A; Makani, Amun; Stadecker, Monica J; Warner, Jon J P

    2015-10-01

    Proximal humerus fractures are common injuries that can require operative treatment. Different operative techniques are available, but the hallmark of fixation for 3- and 4-part fractures is a locking-plate-and-screw construct. Despite advances in this technology, obtaining anatomical reduction and fracture union can be difficult, and complications (eg, need for revision) are not uncommon. These issues can be addressed by augmenting the fixation with an endosteally placed fibular allograft. Although biomechanical and clinical results have been good, the technique can lead to difficulties in future revision to arthroplasty, a common consequence of failed open reduction and internal fixation. The technique described, an alternative to placing a long endosteal bone graft, uses a trapezoidal, individually sized pedestal of allograft femoral head to facilitate the reduction and healing of the humeral head and tuberosity fragments in a displaced 3- or 4-part fracture of the proximal humerus. It can be easily incorporated with any plate-and-screw construct and does not necessitate placing more than 1 cm of bone into the humeral intramedullary canal, limiting the negative effects on any future revision to arthroplasty.

  6. [Body temperature regulation as a prognostic criterion for the postoperative period in patients with femoral fractures].

    PubMed

    Samokhin, A V

    2002-01-01

    Frequency is studied of adequate, redundant, inert, and reduced types of thermoreactivity in healthy subjects and patients with fractures. Definition of type of thermoreactivity to cooling in patients with fractures of the thighbone permits prognosticating the course of the bone fracture healing process. The symptom of distal hyperthermia/hypothermia is unspecific but is regarded as a supplementary index of the type of thermoreactivity and character of the course of the fracture healing process. PMID:12073260

  7. Meta-Analysis of a Complex Network of Non-Pharmacological Interventions: The Example of Femoral Neck Fracture

    PubMed Central

    Nizard, Rémy; Ravaud, Philippe

    2016-01-01

    Background Surgical interventions raise specific methodological issues in network meta-analysis (NMA). They are usually multi-component interventions resulting in complex networks of randomized controlled trials (RCTs), with multiple groups and sparse connections. Purpose To illustrate the applicability of the NMA in a complex network of surgical interventions and to prioritize the available interventions according to a clinically relevant outcome. Methods We considered RCTs of treatments for femoral neck fracture in adults. We searched CENTRAL, MEDLINE, EMBASE and ClinicalTrials.gov up to November 2015. Two reviewers independently selected trials, extracted data and used the Cochrane Collaboration’s tool for assessing the risk of bias. A group of orthopedic surgeons grouped similar but not identical interventions under the same node. We synthesized the network using a Bayesian network meta-analysis model. We derived posterior odds ratios (ORs) and 95% credible intervals (95% CrIs) for all possible pairwise comparisons. The primary outcome was all-cause revision surgery. Results Data from 27 trials were combined, for 4,186 participants (72% women, mean age 80 years, 95% displaced fractures). The median follow-up was 2 years. With hemiarthroplasty (HA) and total hip arthroplasty (THA) as a comparison, risk of surgical revision was significantly higher with the treatments unthreaded cervical osteosynthesis (OR 8.0 [95% CrI 3.6–15.5] and 5.9 [2.4–12.0], respectively), screw (9.4 [6.0–16.5] and 6.7 [3.9–13.6]) and plate (12.5 [5.8–23.8] and 7.8 [3.8–19.4]). Conclusions In older women with displaced femoral neck fractures, arthroplasty (HA and THA) is the most effective treatment in terms of risk of revision surgery. Systematic Review Registration PROSPERO no. CRD42013004218. Level of Evidence Network Meta-Analysis, Level 1. PMID:26735922

  8. Biodegradable nanofiber-membrane for sustainable release of lidocaine at the femoral fracture site as a periosteal block: In vitro and in vivo studies in a rabbit model.

    PubMed

    Chou, Ying-Chao; Cheng, Yi-Shiun; Hsu, Yung-Heng; Yu, Yi-Hsun; Liu, Shih-Jung

    2016-04-01

    The aim of this study was to evaluate the efficacy of a biodegradable, lidocaine-embedded, nanofibrous membrane for the sustainable analgesic release onto fragments of a segmental femoral fracture site. Membranes of three different lidocaine concentrations (10%, 30%, and 50%) were produced via an electrospinning technique. In vitro lidocaine release was assessed by high-performance liquid chromatography. A femoral segmental fracture, with intramedullary Kirschner-wire fixation and polycaprolactone stent enveloping the fracture site, was set-up in a rabbit model for in vivo assessment of post-operative recovery of activity. Eighteen rabbits were randomly assigned to three groups (six rabbits per group): group A comprised of rabbits with femoral fractures and underwent fixation; group B comprised of a comparable fracture model to that of group A with the implantation of lidocaine-loaded nanofibers; and group C, the control group, received only anesthesia. The following variables were measured: change in body weight, food and water intake before and after surgery, and total activity count post-surgery. All membranes eluted effective levels of lidocaine for more than 3 weeks post-surgery. Rabbits in group B showed faster recovery of activity post-operatively, compared with those in group A, which confirmed the pain relief efficacy of the lidocaine-embedded nanofibers. Nanofibers with sustainable lidocaine release have adequate efficacy and durability for pain relief in rabbits with segmental long bone fractures.

  9. Salvage of failed osteosynthesis of an intracapsular fracture of the femoral neck using two cannulated compression screws and a vascularised iliac crest bone graft.

    PubMed

    Xiaobing, Y; Dewei, Z

    2015-07-01

    We evaluated the outcome of treatment of nonunion of an intracapsular fracture of the femoral neck in young patients using two cannulated screws and a vascularised bone graft. A total of 32 patients (15 women and 17 men, with a mean age of 36.5 years; 20 to 50) with failed internal fixation of an intracapsular fracture were included in the study. Following removal of the primary fixation, two cannulated compression screws were inserted with a vascularised iliac crest bone graft based on the ascending branch of the lateral femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved in 27 hips (84%). A total of five patients with a mean age of 40.5 years (35 to 50) had a persistent nonunion and underwent total hip arthroplasty as also did two patients whose fracture united but who developed osteonecrosis of the femoral head two years post-operatively. Statistical analysis showed that younger patients achieved earlier and more reliable union (p < 0.001). The functional outcome, as assessed by the Harris Hip score, was better in patients aged < 45 years compared with those aged > 45 years (p < 0.001). These findings suggest that further fixation using two cannulated compression screws and a vascularised iliac crest bone graft is an effective salvage treatment in patients aged < 45 years, in whom osteosynthesis of a displaced intracapsular fractures of the femoral neck has failed.

  10. Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008–2013) in Kyoto prefecture, Japan

    PubMed Central

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu

    2016-01-01

    Summary Background The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Methods Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. Results There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had “uncertain” as the cause of injury than trochanteric fracture in all age groups. Conclusions Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures. PMID:27252738

  11. Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius) pedicle bone grafting in neglected femoral neck fracture in physiologically active patients

    PubMed Central

    Mishra, Pankaj Kumar; Gupta, Anuj; Gaur, Suresh Chandra

    2014-01-01

    Background: Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture. Materials and Methods: This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm) were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction. Results: 14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4%) patients. All patients were within the age group of 15-51 years (average 38 years) with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks). Conclusion: Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients. PMID:25298553

  12. [THE USE OF THE METHOD FOR DETERMINING THE "ORTHOPEDIC INDEX" IN THE TREATMENT OF PATIENTS WITH FEMORAL NECK FRACTURE].

    PubMed

    Brizhan', L K; Buriachenko, B P; Varfolomeev, D I; Maksimov, B I; Mantserov, K M; Davydov, D V

    2015-01-01

    The choice of surgical strategy for the treatment of femoral neck fracture is a serious challenge to modern traumatology and orthopedics. Group I of this study was comprised of patients in whom orthopedic age was determined by our original method including assessment of the quality of life based on the SF-36 questionnaire. The somatic state of the patients was evaluated from the Charlson index and bone quality in the surgical area by densitometry. Patients of the control group were treated by the standard methods adopted in this country and abroad. It was shown that the difference between orthopedic and calendar ages results in the increase of the frequency of complications. The clinical and statistical results of the study indicate that the new method permits to reduce the number of revision interventions, decrease postoperative lethality, and improve the patients' quality of life. PMID:26117924

  13. [Infection following centro-medullary nailing of diaphyseal femoral and tibial fractures].

    PubMed

    Lortat-Jacob, A; Sutour, J M; Beaufils, P

    1986-01-01

    The authors have treated 51 cases of infection arising after intramedullary nailing of the femur or tibia. In 3 cases amputation was required, 48 united, but 10 were still draining. The final result was obtained after an average of 15 months. An average of four procedures per patient were needed. All the cases were septic non-unions at the onset of treatment, except 18 cases which had already united. In these cases, simple removal of the femoral nail led to rapid healing. In contrast, healing was less easy to obtain in the tibia. In 33 septic non-unions, 12 femoral and 21 tibial, the best results at the femoral level were obtained by retaining the nail in situ. At the tibial level, retention of the nail was rarely followed by bony union. Removal of the nail and the use of external fixation gave good results for the infection, but rarely resulted in bony union (1 case out of 14). The failures were treated by further operation of bone resection and grafting. The authors recommend, in cases of tibial septic non-union after nailing that primary removal of the nail should be associated with bony resection and external fixation, followed by reconstructive grafting, either by open cancellous grafting extending to the fibula or conventional tibio fibular grafting. In 8 cases, 7 in the femur and 1 in the tibia, the infection extended throughout the entire diaphysis and in 3 of these cases, a large diaphyseal resection was required. PMID:3823510

  14. [Implantation of bipolar prosthesis for treatment of medial femoral neck fractures in the elderly--clinical and radiographic outcome].

    PubMed

    Müller, C A; Bayer, J; Szarzynski, E; Südkamp, N P

    2008-12-01

    In our study, we retrospectively evaluated 203 patients with medial or lateral femoral neck fractures who received 210 bipolar prosthesis (7 bilateral implantations) at our institution. 204 patients underwent cemented bipolar hemiarthroplasty. These included 149 females and 54 males with a median age of 82 (46-97) years. At the time of surgery 144 patients (71%) suffered from more than 3 medical conditions. We conducted our follow-up examination at a median of 27.9 months after the operation, at which time 97 patients (48%) had already died. On examination, 17% of our 76 patients had a Harris hip score between 90 and 100 and 20% between 80 and 89 or 70 and 79, respectively. 43% had a score of less than 70. In 20 patients (57%) we found radiographic evidence of periarticular ossification. Signs of loosening according to Gruen were found in 7 out of 35 patients, with no apparent clinical correlation. Surgery-related complications were noted in 15% of our 203 patients--mostly, with 10 cases each, wound infections and postoperative haematomas. In 3 cases of deep wound infection, a removal of the prosthesis was necessary, leading to a Girdlestone hip in one case. Postoperative hip dislocations occurred in 3.4% and intraoperative femur fissures were encountered in 1% of our patients. There were no cases of nerve damage or protrusion of the acetabulum reported. 43% of our patients developed a general complication--mainly cardiological or vascular problems, nephrological or urinary tract diseases, pulmonary or neurological complications. Hip arthroplasty is predominantly applied in older patients, most of them suffering from at least one medical condition at the time of surgery that influences their hospital course. This is why especially the overall physical condition of elderly patients has to be taken seriously into account when planning surgical treatment of femoral neck fractures. In our retrospective study, we have shown that implantation of a bipolar hip prosthesis

  15. [A case of acute chronic respiratory failure due to fat embolism syndrome after the left femoral neck fracture].

    PubMed

    Oda, Keishi; Kawanami, Toshinori; Yatera, Kazuhiro; Ogoshi, Takaaki; Kozaki, Minako; Nagata, Shuya; Nishida, Chinatsu; Yamasaki, Kei; Ishimoto, Hiroshi; Mukae, Hiroshi

    2011-09-01

    A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5 mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. Her respiratory status was stable just after the transfer; however, she was transferred to the intensive care unit and started to receive mechanical ventilation due to rapidly progressive respiratory failure on the fourth day after admission. Chest X-ray and computed tomography revealed rapid progression of bilateral ground-glass attenuations, and acute exacerbation of interstitial pneumonia was clinically suspected. However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome.

  16. Who Will Walk Again? Effects of Rehabilitation on the Ambulatory Status in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fracture

    PubMed Central

    Ang, Mu Liang; Kwek, Ernest Beng Kee

    2015-01-01

    Introduction: Femoral neck fractures in elderly patients result in significant reduction in mobility. Deconditioning takes place quickly without early ambulation postsurgery. A recent Cochrane review found inconclusive evidence on the rehabilitation protocol required to effectively restore patients’ prefracture mobility status. This study was conducted to determine the effects of different rehabilitation approaches on the functional and mobility outcomes of elderly patients after hip hemiarthroplasty for femoral neck fractures. Materials and Methods: We enrolled consecutive patients aged >65 years, admitted into a tertiary orthopedic unit from January to December 2010, who had undergone hip hemiarthroplasty. They were divided into 3 cohorts: (a) home with outpatient rehabilitation, (b) intensive short rehabilitation, and (c) extended slow-stream rehabilitation. Clinical variables were collected along with outcome variables of Modified Harris Hip Score, Parker Mobility Score (PMS), and the return to near premorbid ambulatory status at 1 year (PMS decrease of ≤2). Results: A total of 133 patients were recruited and followed up for a year. The 3 cohorts were found to be comparable for prefall cardiovascular diseases, PMS, and Katz Index, although it was found that in the slow-stream cohort, there was a greater percentage of patients with previous cerebrovascular accidents. Patients in the intensive short rehabilitation cohort were found to have a higher proportion of patients returning to prefracture mobility, with the odds ratio of 2.3478 (95% confidence interval: 1.0667 to 5.1674; P = .042) after multivariate analysis. Conclusions: Elderly patients >65 years who had undergone hemiarthroplasty would likely benefit most from an intensive inpatient rehabilitation program. PMID:26328231

  17. Bisphosphonate Associated Osteonecrosis of the Jaw: An Update on Pathophysiology, Risk Factors, and Treatment

    PubMed Central

    Rasmusson, Lars

    2014-01-01

    Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly. PMID:25254048

  18. Femoral nerve block Intervention in Neck of Femur fracture (FINOF): study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Hip fractures are very painful leading to lengthy hospital stays. Conventional methods of treating pain are limited. Non-steroidal anti-inflammatories are relatively contraindicated and opioids have significant side effects.Regional anaesthesia holds promise but results from these techniques are inconsistent. Trials to date have been inconclusive with regard to which blocks to use and for how long. Interpatient variability remains a problem. Methods/Design This is a single centre study conducted at Queen’s Medical Centre, Nottingham; a large regional trauma centre in England. It is a pragmatic, parallel arm, randomized controlled trial. Sample size will be 150 participants (75 in each group). Randomization will be web-based, using computer generated concealed tables (service provided by Nottingham University Clinical Trials Unit). There is no blinding. Intervention will be a femoral nerve block (0.5 mls/kg 0.25% levo-bupivacaine) followed by ropivacaine (0.2% 5 ml/hr−1) infused via a femoral nerve catheter until 48 hours post-surgery. The control group will receive standard care. Participants will be aged over 70 years, cognitively intact (abbreviated mental score of seven or more), able to provide informed consent, and admitted directly through the Emergency Department from their place of residence. Primary outcomes will be cumulative ambulation score (from day 1 to 3 postoperatively) and cumulative dynamic pain scores (day 1 to 3 postoperatively). Secondary outcomes will be cumulative dynamic pain score preoperatively, cumulative side effects, cumulative calorific and protein intake, EUROQOL EQ-5D score, length of stay, and rehabilitation outcome (measured by mobility score). Discussion Many studies have shown the effectiveness of regional blockade in neck of femur fractures, but the techniques used have varied. This study aims to identify whether early and continuous femoral nerve block can be effective in relieving pain and enhancing mobilization

  19. The influence of informal caregivers on the rehabilitation of the elderly in the postoperative period of proximal femoral fracture.

    PubMed

    Rocha, Suelen Alves; Avila, Marla Andréia Garcia de; Bocchi, Silvia Cristina Mangini

    2016-03-01

    Objective To analyze the influence of informal caregivers on the functional independence of older adults in the postoperative period of proximal femoral fracture due to falls. Method It is an integrative review of a corpus for analysis that gathered 23 articles, between 2002 and 2012, from databases "Literatura Latino-Americana e do Caribe em Ciências da Saúde" (Latin-American and Caribbean Health Sciences Literature in Health Sciences), Cumulative Index to Nursing and Allied Health Literature, US National Library of Medicine and Scopus. Results There was a predominance of studies by Chinese authors and nurses. The analysis of the studies evidenced that falls followed by fractures lead to dependence of older adults and, consequently, an overload to caregivers. Moreover, older adults and caregivers showed a need for support in the rehabilitation process. Conclusions Informal caregivers still need to be included in care planning and to be qualified for such care by health professionals, since they positively influence functional independence in the postoperative period.

  20. Influence of various types of damage on the fracture strength of ceramic femoral heads.

    PubMed

    Wuttke, Viola; Witte, Hartmut; Kempf, Katrin; Oberbach, Thomas; Delfosse, Daniel

    2011-12-01

    Ceramic-on-ceramic articulations are a frequently used bearing for total hip replacements. This success mainly is due to their excellent tribological properties. Ceramics can withstand high pressure loads due to its brittleness but only low bending stresses. A ceramic ball head fracture is the result of subcritical crack growth. This kind of fracture in vivo can abet by damage or contamination of the stem cone. The main goal of this work is to provide a risk assessment of different possible damage mechanisms and contaminations that may result in lower fracture strength of a ceramic ball head. To simulate potential causes, different types and dimensions of metal wire, foils, hair, and lubricants were inserted between the ceramic ball head and the metal cone of the stem. The test results clearly show that fracture strength is negatively influenced by most of the inhomogeneities between the cone and the head because they increase the peak stresses acting on a part of the ceramic ball head. The results of this article clearly confirm the demand for an undamaged taper fit "free of contamination" between the ceramic head and the metal cone during implantation.

  1. Revision total hip arthroplasty after removal of a fractured well-fixed extensively porous-coated femoral component using a trephine.

    PubMed

    Amanatullah, D F; Siman, H; Pallante, G D; Haber, D B; Sierra, R J; Trousdale, R T

    2015-09-01

    When fracture of an extensively porous-coated femoral component occurs, its removal at revision total hip arthroplasty (THA) may require a femoral osteotomy and the use of a trephine. The remaining cortical bone after using the trephine may develop thermally induced necrosis. A retrospective review identified 11 fractured, well-fixed, uncemented, extensively porous-coated femoral components requiring removal using a trephine with a minimum of two years of follow-up. The mean time to failure was 4.6 years (1.7 to 9.1, standard deviation (sd) 2.3). These were revised using a larger extensively porous coated component, fluted tapered modular component, a proximally coated modular component, or a proximal femoral replacement. The mean clinical follow-up after revision THA was 4.9 years (2 to 22, sd 3.1). The mean diameter of the femoral component increased from 12.7 mm (sd 1.9) to 16.2 mm (sd 3.4; p > 0.001). Two revision components had radiographic evidence of subsidence that remained radiographically stable at final follow-up. The most common post-operative complication was instability affecting six patients (54.5%) on at least one occasion. A total of four patients (36.4%) required further revision: three for instability and one for fracture of the revision component. There was no statistically significant difference in the mean Harris hip score before implant fracture (82.4; sd 18.3) and after trephine removal and revision THA (81.2; sd 14.8, p = 0.918). These findings suggest that removal of a fractured, well-fixed, uncemented, extensively porous-coated femoral component using a trephine does not compromise subsequent fixation at revision THA and the patient's pre-operative level of function can be restored. However, the loss of proximal bone stock before revision may be associated with a high rate of dislocation post-operatively. PMID:26330584

  2. Assessment of mortality risk in elderly patients after proximal femoral fracture.

    PubMed

    Meessen, Jennifer M T A; Pisani, Salvatore; Gambino, Maria L; Bonarrigo, Domenico; van Schoor, Natasja M; Fozzato, Stefania; Cherubino, Paolo; Surace, Michele F

    2014-02-01

    Mortality after hip fracture is a major problem in the Western world, but its mechanisms remain uncertain. This study assessed the 2-year mortality rate after hip fracture in elderly patients by including hospital factors (eg, intervention type, surgical delay), underlying health conditions, and, for a subset, lifestyle factors (eg, body mass index, smoking, alcohol). A total of 828 patients (183 men) 70 to 99 years old experiencing a hip fracture in 2009 in the province of Varese were included in the study. The risk factors for death were assessed through Kaplan-Meier analysis and Cox proportional hazards analysis. Hip fracture incidence per 1000 persons was higher in women (8.4 vs 3.7 in men) and in elderly patients (12.4 for 85-99 years vs 4.4 for 70-84 years). The mortality rate after 1, 6, 12, and 24 months was 4.7%, 16%, 20.7%, and 30.4%, respectively. For the province of Varese, sex (hazard ratio, 0.39 for women), age group (hazard ratio, 2.2 for 85-99 years), and Charlson Comorbidity Index score (hazard ratio, 2.06 for score greater than 1) were found to be statistically significant. The 2-year mortality rate in hip fractures is associated with sex, age, and comorbidities. Male sex, age older than 85 years, and Charlson Comorbidity Index score greater than 1 are associated with a higher risk. Surgical delay was significant in the Kaplan-Meier survival time analysis but not in the Cox hazard analysis, suggesting that early surgery reduces risk in patients with numerous comorbidities. PMID:24679208

  3. Better Axial Stiffness of a Bicortical Screw Construct Compared to a Cable Construct for Comminuted Vancouver B1 Proximal Femoral Fractures.

    PubMed

    Griffiths, Jamie T; Taheri, Arash; Day, Robert E; Yates, Piers J

    2015-12-01

    The aim of this study was to biomechanically evaluate the Locking attachment plate (LAP) construct in comparison to a Cable plate construct, for the fixation of periprosthetic femoral fractures after cemented total hip arthroplasty. Each construct incorporated a locking compression plate with bi-cortical locking screws for distal fixation. In the Cable construct, 2 cables and 2 uni-cortical locking screws were used for proximal fixation. In the LAP construct, the cables were replaced by a LAP with 4 bi-cortical locking screws. The LAP construct was significantly stiffer than the cable construct under axial load with a bone gap (P=0.01). The LAP construct offers better axial stiffness compared to the cable construct in the fixation of comminuted Vancouver B1 proximal femoral fractures.

  4. [Spinal anesthesia using a low dose of isobaric bupivacaine in a patient with pulmonary artery hypertension and mixed obstructive and restrictive lung disease undergoing repeated femoral fracture surgery].

    PubMed

    Uzawa, Koji; Hakone, Masako; Nakazawa, Harumasa; Yasuda, Hiroyuki; Moriyama, Kiyoshi; Yorozu, Tomoko

    2014-02-01

    A 75-year-old woman with primary pulmonary hypertension was on medical therapy and ambulatory oxygen inhalation therapy for 7 years. The patient had right femoral fracture and was admitted to our hospital. She had also suffered from asthma for 2 years, and her vital capacity was 1.35 l with forced expiratory volume in 1 second 0.79 l, and with her mean pulmonary artery pressure 60 mmHg. Open reduction and internal fixation were performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg, and the patient was discharged on postoperative 31 day with no major complications. One year after the surgery, she had left femoral fracture, and surgery was performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg. With its minimal effects on hemodynamics, we speculate that spinal anesthesia using a low dose of isobaric bupivacaine can be a choice for patients with pulmonary hypertension. PMID:24601108

  5. The curative effect comparison between prolonged third generation of gamma nail and prolonged dynamic hip screw internal fixation in treating femoral intertrochanteric fracture and the effect on infection.

    PubMed

    He, Wenye; Zhang, Wei

    2015-03-01

    The objective was to explore the curative effect of prolonged third generation of gamma nail (pTGN) and prolonged dynamic hip screw (pDHS) internal fixation in treating femoral intertrochanteric fracture, and analyze the incidence rate of infection for better clinical diagnosis and treatment. Sixty five patients with femoral intertrochanteric fracture during February, 2011-February, 2013 were selected and divided into two groups, with one receiving pTGN (control group) and the other one receiving pDHS internal fixation (observation group). The clinical effects of two groups were compared. In control group, the excellent and good rate was 78.13 %, the total effective rate was 87.5 %, and the total complication rate was 6.24 %; in observation group, the excellent and good rate was 78.79 %, the total effective rate was 90.91 %, the total complication rate was 6.06 %; there was no statistical difference between two groups (p > 0.05). The operation time, the intraoperative fluoroscopy time, and the total blood loss had statistically significant difference between two groups (p < 0.05); however, the differences of the total length of incision, the length of preoperative hospitalization, postoperative ambulatory episode, and the length of stay between two groups were not statistically significant (p > 0.05). Both pTGN and pDHS internal fixation were effective on femoral intertrochanteric fracture, with pDHS internal fixation having better overall efficiency.

  6. [Stress reactions--stress fracture of the upper femoral neck in endurance sports].

    PubMed

    Schultz, W; Stinus, H; Schleicher, W; Hess, T

    1991-06-01

    Stress reactions of the musculoskeletal system may be interpreted as possible precursors of stress fractures. Biological material, in contrast to artificial products, can react in numerous and complex ways. This can not only lead to a continual weakening of the tissue, but also to adaptation phenomena in response to overuse. The causes of such stress reactions are still unclear in many respects. For example, it is unknown to what extent a predisposition to these stress symptoms is created by mechanical stress alone or whether other factors such as physical condition, nutrition or even hormone balance come into play. Early diagnosis considerably reduces the healing process and, the later the diagnosis of the stress reaction, the more drawn out is the healing process and the extent of the athlete's absence from training. In this connection may be discussed whether the stress reaction can be the represent as the precursor of the stress fracture. In light of the need for taking special care in obtaining anamnestic data and determining the predisposition of an athlete, it appears to be justified to perform whole body bone scanning in the initial stages and particularly after an innocuous radiological finding. To what extent more current methods (e. g. MRI) can be applied without exposing the athlete to undue radiation cannot be conclusively judged at present. The treatment of a stress reaction should, at least at the beginning, be the same as for a diagnosed stress fracture.

  7. Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study

    PubMed Central

    Metcalfe, David; Salim, Ali; Olufajo, Olubode; Gabbe, Belinda; Zogg, Cheryl; Harris, Mitchel B; Perry, Daniel C; Costa, Matthew L

    2016-01-01

    Objective To explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals. Design Population-based observational study. Setting All acute hospitals in California, USA. Participants All individuals aged ≥65 that underwent an operation for an isolated hip fracture in California between 2007 and 2011. Patients transferred between hospitals were excluded. Primary and secondary outcomes Quality indicators (time to surgery) and patient outcomes (length of stay, in-hospital mortality, unplanned 30-day readmission, and selected complications). Results 91 401 individuals satisfied the inclusion criteria. Time to operation and length of stay were significantly prolonged in low-volume hospitals, by 1.96 (95% CI 1.20 to 2.73) and 0.70 (0.38 to 1.03) days, respectively. However, there were no differences in clinical outcomes, including in-hospital mortality, 30-day re-admission, and rates of pneumonia, pressure ulcers, and venous thromboembolism. Conclusions These data suggest that there is no patient safety imperative to limit hip fracture care to high-volume hospitals. PMID:27056592

  8. [Disparities in hospital mortality after proximal femoral fractures in East Germany 1989].

    PubMed

    Wildner, M; Markuzzi, A; Casper, W; Bergmann, K

    1998-01-01

    The revised and pseudonymized data set of the hospital discharge diagnoses of East Germany (German Democratic Republic, GDR) for 1989 was analyzed regarding the in-hospital case fatality of closed hip fractures (ICD-9 820.0, 820.2, 820.8). The case fatality of 20.2% during an average hospital stay of 60 days including between-ward and between-hospital transfers is high when compared to international data and data for West Germany. Apart from the expected influence of age, fatality was reduced for cervical (intracapsular) fractures, female sex, and for a location of the treating hospital within East Berlin. This reduction of the case fatality within East Berlin by nearly two thirds after adjustment for age, sex, and type of fracture compared to other regions is most likely explained by better medical treatment facitilities within East Berlin, the former capital of the GDR. The regional disparities that were observed during our model analysis give a hint towards the influence that medical care can have on the fatality associated with this on a population level relevant disease.

  9. Mid term results of Furlong LOL uncemented hip hemiarthroplasty for fractures of the femoral neck.

    PubMed

    Chandran, Prakash; Azzabi, Mohammed; Burton, Dave J C; Andrews, Mark; Bradley, John G

    2006-08-01

    We report the mid-term results of hemiarthroplasty with the Furlong hydroxyapatite coated bipolar prosthesis for displaced (Garden type III and IV) intracapsular hip fracture in 480 patients operated between 1989 and 2000. Three hundred sixty eight (77%) patients were lost to follow-up due to death, dementia or movement away from the area. In the patients followed up there was an 8% reoperation rate for infection, aseptic loosening, periprosthetic fracture and acetabular erosion. One hundred and twelve patients with a mean follow-up of 4 years (3-14) were studied. Eighty eight percent had no or slight pain, 77% could mobilise outdoors and 89% needed either no aid or a single walking stick to mobilise. Radiographic assessment revealed a stable implant with visible osseointegration in 91%. We conclude that hemiarthroplasty with the hydroxyapatite coated bipolar Furlong LOL prosthesis for displaced intracapsular fracture of the neck of the femur gives good mid term results in elderly patients for return to mobility, use of mobility aids and freedom from pain. It avoids the need for cement and provides satisfactory incorporation into the host bone. The use of a modular head makes revision to total hip replacement easier.

  10. [Treatment of the femoral, tibia and humeral shaft fractures in children with the use of intramedullary nailing or external fixation, a long term study].

    PubMed

    Kołecka, Ewa; Niedzielski, Kryspin Ryszard; Lipczyk, Zbigniew; Flont, Paweł

    2009-01-01

    The treatment of long bones shaft fractures with intramedullary nailing and external fixation is gaining popularity nowadays. The aim of this study was to analyze operative methods of treatment of the long bones shafts fractures in children. We compared outcomes of surgical treatment with the use of external fixation and flexible nails. The study group consisted of 127 patients (4 to 18 years old) who were operated on in our hospital during the period 1990-2005: 90 patients with femoral shaft fractures, 31 with tibia fractures and 6 with humeral fractures. In 81 children we performed fixation with Wagner's tool and in 46 cases we used Prevot or Ender nails. The follow up (performed at least one year after treatment cessation) included clinical examination and X-ray imaging. Union in an almost anatomical position was obtained in 126 patients. There was one fracture-healing complication ( nonunion- due to to early hardware removal). The study showed many advantages of the surgical treatment: minimal invasiveness, short hospitalization period, early rehabilitation. In our group both methods of management were comparable. We recommend intramedullary nailing in closed, transverse fractures and external fixator in open, multifragmentary and possibly unstable fractures. PMID:19777945

  11. Association of Osteoporosis Self-Assessment Tool for Asians (OSTA) Score with Clinical Presentation and Expenditure in Hospitalized Trauma Patients with Femoral Fractures

    PubMed Central

    Chen, Chien-Chang; Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2016-01-01

    Background: A cross-sectional study to investigate the association of Osteoporosis Self-Assessment Tool for Asians (OSTA) score with clinical presentation and expenditure of hospitalized adult trauma patients with femoral fractures. Methods: According to the data retrieved from the Trauma Registry System between 1 January 2009 and 31 December 2015, a total of 2086 patients aged ≥40 years and hospitalized for treatment of traumatic femoral bone fracture were categorized as high-risk patients (OSTA < −4, n = 814), medium-risk patients (−1 ≥ OSTA ≥ −4, n = 634), and low-risk patients (OSTA > −1, n = 638). Two-sided Pearson’s, chi-squared, or Fisher’s exact tests were used to compare categorical data. Unpaired Student’s t-test and Mann-Whitney U-test were used to analyze normally and non-normally distributed continuous data, respectively. Propensity-score matching in a 1:1 ratio was performed using Number Crunching Statistical Software (NCSS) software (NCSS 10; NCSS Statistical Software, Kaysville, UT, USA), with adjusted covariates including mechanism and Glasgow Coma Scale (GCS); injuries were assessed based on the Abbreviated Injury Scale (AIS), and Injury Severity Score (ISS) was used to evaluate the effect of OSTA-related grouping on a patient’s outcome. Results: High-risk and medium-risk patients were predominantly female, presented with significantly older age and higher incidences of co-morbidity, and were injured in a fall accident more frequently than low-risk patients. High-risk patients and medium-risk patients had a different pattern of femoral fracture and a significantly lower ISS. Although high-risk and medium-risk patients had significantly shorter lengths hospital of stay (LOS) and less total expenditure than low-risk patients did, similar results were not found in the selected propensity score-matched patients, implying that the difference may be attributed to the associated injury severity of the patients with femoral fracture

  12. In vivo biomechanical evaluation of nail-plate fixation of femoral neck fractures of rehabilitated patients.

    PubMed

    Mizrahi, J; Kantarovski, A; Najenson, T; Susak, Z

    1985-01-01

    A major advantage of internal fixation of intertrochanteric fractures is that it can normally be followed by early and fast rehabilitation of the patient, finding expression in weight bearing and locomotion abilities of the patients. Complications which nevertheless occur, are mostly of mechanical origin. The purpose of our study was to evaluate the biomechanical performance of rehabilitated patients treated with four different types of nail-plates. Forty nine patients (12 men and 37 women) with walking ability, and with an average age of 70.5 years, were tested on a 10 m walkway, instrumented for the monitoring of the time distance parameters of the stride. This method of evaluation is especially suitable for pathological gait, free or supported, as it does not impose any constraints on the natural and individual walking trend of the patient. The average time elapsed between the actual fracture and the locomotor test was 764 days, implying that the investigated patients formed a homogeneous, well-rehabilitated group. The main average stride results were as follows: contact time 1.25 sec, double contact time 0.41 sec, stride length 68.2 cm, velocity 51.39 cm/sec and symmetry 0.51. No significant differences were found in these parameters between the subgroups of patients using different nail-plates. These results show that while the biomechanical performance of the patients with their implants was satisfactory (good walking symmetry) this group can be characterized by its smaller stride and slower gait, compared to those of a healthy population of the same age.

  13. Demineralized Bone Matrix Add-On for Acceleration of Bone Healing in Atypical Subtrochanteric Femoral Fracture: A Consecutive Case-Control Study

    PubMed Central

    Kulachote, Noratep; Sirisreetreerux, Norachart; Chanplakorn, Pongsthorn; Fuangfa, Praman; Suphachatwong, Chanyut; Wajanavisit, Wiwat

    2016-01-01

    Background. Delayed union and nonunion are common complications in atypical femoral fractures (AFFs) despite having good fracture fixation. Demineralized bone matrix (DBM) is a successfully proven method for enhancing fracture healing of the long bone fracture and nonunion and should be used in AFFs. This study aimed to compare the outcome after subtrochanteric AFFs (ST-AFFs) fixation with and without DBM. Materials and Methods. A prospective study was conducted on 9 ST-AFFs patients using DBM (DBM group) during 2013-2014 and compared with a retrospective consecutive case series of ST-AFFs patients treated without DBM (2010–2012) (NDBM group, 9 patients). All patients were treated with the same standard guideline and followed up until fractures completely united. Postoperative outcomes were then compared. Results. DBM group showed a significant shorter healing time than NDBM group (28.1 ± 14.4 versus 57.9 ± 36.8 weeks, p = 0.04). Delayed union was found in 4 patients (44%) in DBM group compared with 7 patients (78%) in NDBM group (p > 0.05). No statistical difference of nonunion was demonstrated between both groups (DBM = 1 and NDBM = 2, p > 0.05). Neither postoperative infection nor severe local tissue reaction was found. Conclusions. DBM is safe and effective for accelerating the fracture healing in ST-AFFx and possibly reduces nonunion after fracture fixation. Trial registration number is TCTR20151021001. PMID:27022610

  14. Knee megaprosthesis: a salvage solution for severe open and complex distal femoral fracture associated with an ipsilateral brachial plexus injury (a case report with literature review).

    PubMed

    Ennaciri, Badr; Vasile, Christian; Lebredonchel, Thierry; Berrada, Mohamed Saleh; Montbarbon, Eric; Beaudouin, Emmanuel

    2015-01-01

    Complex distal femoral fractures in the young patient often occur as a result of high velocity trauma. Timely recognition and treatment is everything in such a situation, and it needs a robust staged management pathway to optimize the chance of limb preservation. We report a case of a motorcyclist admitted to the department of orthopedics at Chambery hospital, France, with a complex comminuted and open distal femoral fracture of the left leg, associated with a brachial plexus injury to the ipsilateral upper limb. On arrival to the emergency department, damage control stabilization and surgery was commenced, debridement of contaminated non-viable tissue, abundant antiseptic lavage and application of external fixation coupled with the use of antibiotic spacer. Following normalization of inflammatory markers and ensuring no clinical signs of infection, subsequent management consisted of joint reconstruction to achieve a functional knee. The external fixator and femoral spacer was removed and a modular megaprosthesis was implanted with a lateral gastrocnemius flap to cover the exposed knee joint and reinforce the extensor apparatus. Nerve graft to the left brachial plexus injury was performed at University Hospital of Grenoble. Our patient entered an intensive rehabilitation program and at 1 year follow-up achieved good knee function and sensation to the left upper limb. PMID:26421102

  15. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation.

    PubMed

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    BACKGROUND The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. MATERIAL AND METHODS A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. RESULTS There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). CONCLUSIONS The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  16. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation

    PubMed Central

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Background The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. Material/Methods A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. Results There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). Conclusions The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  17. Bipolar cemented hip hemiarthroplasty in patients with femoral neck fracture who are on hemodialysis is associated with risk of stem migration

    PubMed Central

    Kolodziej, Robert; Karwanski, Marek

    2009-01-01

    Background and purpose Femoral neck fractures are considerably more common in patients on hemodialysis than in the general population. We determined the outcome of bipolar hemiarthroplasty for hip fracture in patients with long-term hemodialysis and compared it with that of a matched-paired group of patients with intact renal function. Methods We analyzed 26 bipolar hemiarthroplasties in 23 hemodialysed patients with a mean age of 56 (41–78) years who were followed for mean 3.6 (1–8) years. These cases were matched for age, sex, and BMI with 26 patients with femoral neck fractures and normal renal function. The mean follow-up time in the control group was 7 (5–10) years. As primary surgery for their femoral neck fracture, all patients had a bipolar hemiarthroplasty with a 28-mm metal-polyethylene internal articulation and a cemented stem. Results The mortality rate was 21% in the hemodialysed group and 4% in the control group (p = 0.005). The bipolar head migrated in 1 patient in the hemodialysed group but in none of the patients in the case-matched group. In the hemodialysed group, 8 stems migrated and 3 of these were revised, whereas in the control group 3 stems migrated and 2 were revised. The stem migration in the hemodialysed group was not preceded by the development of osteolysis or radiolucent lines at the bone-cement interface. The cumulative survival for prosthesis migration as endpoint was 44% at 5 years in the hemodialysed group and 96% in the control group (p = 0.03). Interpretation The main mode of failure of cemented bipolar hemiarthroplasties in hemodialysed patients is stem migration, due to failure of the bone-cement interface. PMID:19404798

  18. [Fracture of the femoral diaphysis in children. Ascending or descending centro-medullary nailing? A choice of principle or of necessity?].

    PubMed

    Bourdelat, D; Sanguina, M

    1991-01-01

    Over a period of 4 years, 40 children between the ages of 6 and 14 years (mean: 10 years) were treated for a fracture of the femoral shaft (39 closed fractures and 1 Cauchoix type I open fracture) by flexible medullary nailing, either ascending (5 cases) or descending (35 cases). Although it is classical to use the ascending route described by the Nancy team, the sub-trochanteric descending route was preferred for its simplicity; non-involvement of the knee by the insertion of the nail allows earlier autonomy in children. The results have been found to be satisfactory; no complications related to the method were observed. The biomechanical principles are also conserved. PMID:1669956

  19. 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.

    PubMed

    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.

  20. Nano-structural, compositional and micro-architectural signs of cortical bone fragility at the superolateral femoral neck in elderly hip fracture patients vs. healthy aged controls.

    PubMed

    Milovanovic, Petar; Rakocevic, Zlatko; Djonic, Danijela; Zivkovic, Vladimir; Hahn, Michael; Nikolic, Slobodan; Amling, Michael; Busse, Bjoern; Djuric, Marija

    2014-07-01

    To unravel the origins of decreased bone strength in the superolateral femoral neck, we assessed bone structural features across multiple length scales at this cortical fracture initiating region in postmenopausal women with hip fracture and in aged-matched controls. Our combined methodological approach encompassed atomic force microscopy (AFM) characterization of cortical bone nano-structure, assessment of mineral content/distribution via quantitative backscattered electron imaging (qBEI), measurement of bone material properties by reference point indentation, as well as evaluation of cortical micro-architecture and osteocyte lacunar density. Our findings revealed a wide range of differences between the fracture group and the controls, suggesting a number of detrimental changes at various levels of cortical bone hierarchical organization that may render bone fragile. Namely, mineral crystals at external cortical bone surfaces of the fracture group were larger (65.22nm±41.21nm vs. 36.75nm±18.49nm, p<0.001), and a shift to a higher mineral content and more homogenous mineralization profile as revealed via qBEI were found in the bone matrix of the fracture group. Fracture cases showed nearly 35% higher cortical porosity and showed significantly reduced osteocyte lacunar density compared to controls (226±27 vs. 247±32#/mm(2), p=0.05). Along with increased crystal size, a shift towards higher mineralization and a tendency to increased cortical porosity and reduced osteocyte lacunar number delineate that cortical bone of the superolateral femoral neck bears distinct signs of fragility at various levels of its structural organization. These results contribute to the understanding of hierarchical bone structure changes in age-related fragility.

  1. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions

    DOE PAGESBeta

    Zimmermann, Elizabeth A.; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N.; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; et al

    2016-02-16

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibrilmore » deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. We find the significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates.« less

  2. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions.

    PubMed

    Zimmermann, Elizabeth A; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; Tang, Simon; Amling, Michael; Ritchie, Robert O; Busse, Björn

    2016-02-16

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibril deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. The significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates.

  3. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions

    PubMed Central

    Zimmermann, Elizabeth A.; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N.; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; Tang, Simon; Amling, Michael; Ritchie, Robert O.; Busse, Björn

    2016-01-01

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibril deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. The significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates. PMID:26879146

  4. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions

    NASA Astrophysics Data System (ADS)

    Zimmermann, Elizabeth A.; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N.; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; Tang, Simon; Amling, Michael; Ritchie, Robert O.; Busse, Björn

    2016-02-01

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibril deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. The significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates.

  5. Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award.

    PubMed

    Macaulay, William; Nellans, Kate W; Garvin, Kevin L; Iorio, Richard; Healy, William L; Rosenwasser, Melvin P

    2008-09-01

    The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed "Up & Go" Test. Forty subjects were enrolled. At 24 months, THA patients had significantly less pain on the SF-36 subscale than hemiarthroplasty patients (54.8 +/- 7.9 vs 44.7 +/- 10.5, P = .04) and scored significantly better on the SF-36 mental health subscale (54.9 +/- 9.4 vs 40.9 +/- 10.3, P = .006). Total hip arthroplasty patients also had superior WOMAC function scores (81.8 +/- 10.2 vs 65.1 +/- 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.

  6. The biomechanics of plate fixation of periprosthetic femoral fractures near the tip of a total hip implant: cables, screws, or both?

    PubMed

    Shah, S; Kim, S Y R; Dubov, A; Schemitsch, E H; Bougherara, H; Zdero, R

    2011-09-01

    Femoral shaft fractures after total hip arthroplasty (THA) remain a serious problem, since there is no optimal surgical repair method. Virtually all studies that examined surgical repair methods have done so clinically or experimentally. The present study assessed injury patterns computationally by developing three-dimensional (3D) finite element (FE) models that were validated experimentally. The investigation evaluated three different constructs for the fixation of Vancouver B1 periprosthetic femoral shaft fractures following THA. Experimentally, three bone plate repair methods were applied to a synthetic femur with a 5 mm fracture gap near the tip of a total hip implant. Repair methods were identical distal to the fracture gap, but used cables only (construct A), screws only (construct B), or cables plus screws (construct C) proximal to the fracture gap. Specimens were oriented in 15 degrees adduction to simulate the single-legged stance phase of walking, subjected to 1000 N of axial force, and instrumented with strain gauges. Computationally, a linearly elastic and isotropic 3D FE model was developed to mimic experiments. Results showed excellent agreement between experimental and FE strains, yielding a Pearson linearity coefficient, R2, of 0.92 and a slope for the line of best data fit of 1.06. FE-computed axial stiffnesses were 768 N/mm (construct A), 1023 N/mm (construct B), and 1102 N/mm (construct C). FE surfaces stress maps for cortical bone showed Von Mises stresses, excluding peaks, of 0-8 MPa (construct A), 0-15 MPa (construct B), and 0-20 MPa (construct C). Cables absorbed the majority of load, followed by the plates and then the screws. Construct A yielded peak stress at one of the empty holes in the plate. Constructs B and C had similar bone stress patterns, and can achieve optimal fixation. PMID:22070022

  7. Bisphosphonate-associated osteonecrosis of the jaw, with healing after teriparatide: a review of the literature and a case report.

    PubMed

    Narongroeknawin, Pongthorn; Danila, Maria I; Humphreys, Lewis G; Barasch, Andrei; Curtis, Jeffrey R

    2010-01-01

    This paper reports the case history of a patient who had bisphosphonate-associated osteonecrosis of the jaw (ONJ) in which adjunctive treatment with teriparatide was used. The patient was treated for 5 years with alendronate for osteoporosis and developed ONJ after extraction of maxillary teeth. An implant was placed at the site of the extracted teeth. The pathology report confirmed the clinical diagnosis of ONJ; treatment was changed from alendronate to teriparatide and the ONJ resolved. To our knowledge, this is the third case history reported in the literature in which teriparatide was successfully used as adjunct therapy in ONJ because it has an anabolic effect and presumed role in accelerating bone healing. ONJ is a serious but infrequent condition that has been recently associated with nitrogen-containing bisphosphonate therapy. Teriparatide may be a useful adjunctive therapy when ONJ develops.

  8. Intravenous analgesia with opioids versus femoral nerve block with 0.2% ropivacaine as preemptive analgesic for fracture femur: A randomized comparative study

    PubMed Central

    Singh, Arvinder Pal; Kohli, Vaneet; Bajwa, Sukhminder Jit Singh

    2016-01-01

    Background and Objective: Femoral fractures are extremely painful and pain invariably worsens on any movement. Anesthesia for fracture femur surgery is usually provided by spinal block. This study was undertaken to compare the analgesic effects of femoral nerve block (FNB) using nerve stimulator with 0.2% ropivacaine (15 ml) and intravenous (I.V.) fentanyl before patient positioning for fracture femur surgery under spinal anesthesia. Materials and Methods: A prospective, randomized, double-blind, comparative study was conducted on 60 American Society of Anesthesiologists I and II patients (18–60 years) scheduled for femur surgery under combined spinal epidural anesthesia. Patients in Group I (n = 30), were administered FNB using nerve stimulator with 0.2% ropivacaine (15 ml) and in Group II patients (n = 30), I.V. fentanyl 0.5 μg/kg was given as preemptive analgesia. Parameters observed included time to spinal anesthesia, intra-operative and postoperative visual analog scale (VAS) for any pain and postoperative epidural top-ups dosages. Results: Demographic profile was comparable in both the groups. VAS at 2 min in Group I was 5.63 and in Group II it was 8.00. Satisfaction score was better in Group I as compared to Group II patients. Time to administer subarachnoid block was 17.80 min in patients of Group I as compared to 25.03 min in Group II patients. Postoperatively, VAS scores were lower in Group I than Group II patients. The frequency of epidural top-ups was higher in Group II than in Group I patients. Conclusions: FNB is comparatively better in comparison to I.V. fentanyl when used as preemptive and postoperative analgesic in patients being operated for fracture femur. PMID:27212771

  9. Treatment of Femoral Neck Fracture with a Minimal Invasive Surgical Approach for Hemiarthroplasty – Clinical and Radiological Results in 180 Geriatric Patients

    PubMed Central

    Unger, A.C; Dirksen, B; Renken, F. G; Wilde, E; Willkomm, M; Schulz, A.P

    2014-01-01

    Purpose : The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH. Materials and Methods : The data of 180 geriatric patients with medial femoral neck fractures were evaluated retrospectively. The general and surgical complications, mobilisation using the Timed Up and Go test (TUG), the social environment pre- and postoperative and the radiological results have been compared with established approaches for geriatric hip surgery. Results : After joint replacement, 18 (10%) patients were developed pneumonia, of which 3 (1.7%) died during hospitalisation. In 7 cases (4%), surgical revision had to be carried out: three times (1.7%) because of a seroma, three times (1.7%) because of subcutaneous infection, and one time (0.6%) because the BHH was removed, owing to deep wound infection. One dislocation (0.6%) occurred, as well as one femoral nerve lesion (0.6%) occured. 88.3% of patients were mobilised on walkers or crutches; the Timed Up and Go Test showed a significant improvement during inpatient rehabilitation. 83% were discharged to their usual social environment, 10% were transferred to a short-term care facility and 7% were relocated permanently to a nursing home. 3/4 of patients had a cemented stem alignment in the range between -5° and 5°, while 2/3 of patients had a maximum difference of 1 cm in leg length. Conclusion : Using the modified DAA, a high patient satisfaction is achieved after implantation of a BHH. The rate of major complications is just as low as in conventional approaches, and rapid mobilisation is possible. PMID:25136389

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

    PubMed

    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.

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

    PubMed

    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. PMID:26541215

  12. Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study

    PubMed Central

    Dong, Chenhui; Wang, Yunjiao; Wang, Ziming; Wang, Yu; Wu, Siyu; Du, Quanyin; Wang, Aimin

    2016-01-01

    Background Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients. Methods In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained. Results Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3–10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups. Conclusion In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events. PMID:27149117

  13. Energy-shunting external hip protector attenuates the peak femoral impact force below the theoretical fracture threshold: an in vitro biomechanical study under falling conditions of the elderly.

    PubMed

    Parkkari, J; Kannus, P; Heikkilä, J; Poutala, J; Sievänen, H; Vuori, I

    1995-10-01

    The first objective of this study was to design a hip protector that would effectively attenuate and shunt away from the greater trochanter the impact energies created in typical falls of the elderly. As the shock absorption material, the protector included the 12 mm-thick Plastazote, which was found to be the most efficient energy-absorbing material in our previous in vitro biomechanical tests. With an anatomically designed semiflexible outer shield of the protector (high density polyethylene), the impact surface was increased and the impact energy shunted away from the greater trochanter. In the second phase of the study, we determined the force attenuation capacity of this device in realistic (in vitro) falling conditions of the elderly. With the impact force of 6940 N used (a typical hip impact force measured in in vitro falling tests), the trochanteric soft tissue (25 mm-thick polyethylene foam) attenuated the peak femoral impact force to 5590 N and the tested protector to 1040 N. In the second series of this experiment, the peak femoral impact force was set to be so high (13,130 N) that the protector, if effective, should prevent the hip fracture in almost all cases. The trochanteric soft tissue attenuated this peak impact force to 10,400 N and the tested protector to 1810 N. Thus, the force received by the proximal femur still remained clearly below 4170 N, the average force required to fracture in vitro the proximal femur of the elderly in a fall loading configuration. In conclusion, our test results suggest that an anatomically designed energy-shunting and energy-absorbing hip protector can provide an effective impact force attenuation in typical falling conditions of the elderly. However, the efficacy of the protector in the prevention of hip fractures can only be evaluated in randomized clinical trials.

  14. Applying low-intensity pulsed ultrasounds (LIPUS) to a zoledronate-associated atypical femoral shaft fracture without cessation of zoledronate therapy for 3 years follow up: a case report

    PubMed Central

    Arakawa, Shoutaro; Saito, Mitsuru; Kubota, Makoto; Suzuki, Hidehiko; Tsuchida, Shigeki; Hashimoto, Kurando; Marumo, Keishi

    2015-01-01

    Summary Reports are increasing regarding atypical femoral fractures (AFFs) caused by minor trauma in patients using bisphosphonates (BPs) for long periods. Patients with malignant skeletal metastases potentially are at greater risk for these AFFs, especially considering the high dose and the duration of treatment with BPs. We evaluated a case of atypical femoral shaft fracture treated with an intramedullary nail in a patient treated for five years with zoledronate who had breast cancer with metastases to bone. Although bone union was achieved without cessation of zoledronate therapy by applying low-intensity pulsed ultrasounds (LIPUS), the remodeling phase of the fracture healing process was delayed. For BPs-associated AFFs, LIPUS is an alternative to parathyroid hormone (PTH) analogs such as teriparatide that are contraindicated in patients with malignant skeletal metastases. LIPUS is an effective treatment for fracture healing and may avoid the necessity to discontinue BP therapy. PMID:26811711

  15. A Case of Variegate Porphyria in Association With Coeliac Disease and Bisphosphonate Associated Dental Osteonecrosis

    PubMed Central

    Ogundipe, Olayinka A.

    2009-01-01

    This case describes an older patient with a rare diagnosis of variegate porphyria presenting with acute abdominal pains and bloating, intermittent loose stools and jaw pains following surgical repair of an osteoporotic hip fracture. She was noted to have acute hyponatraemia. All the abdominal symptoms and the hyponatraemia were initially attributed to an acute episode of variegate porphyria with an accompanying syndrome of inappropriate antidiuretic hormone secretion. However, following further evaluations necessitated by the incomplete resolution of the abdominal symptoms, it became apparent that some of the persisting symptoms were due to a concurrent and new presentation of serology positive coeliac disease. The jaw pains were established to be due to dental osteonecrosis in association with the use of bisphosphonate therapy for treatment of osteoporosis. The various symptoms and signs subsequently settled uneventfully following institution of appropriate management options for the various coexisting diagnoses. Keywords Abdominal pain; Abdominal bloating; Loose stools; Hyponatraemia; Variegate porphyria; Coeliac disease; Osteoporosis; Bisphosphonates; Osteonecrosis PMID:22481993

  16. Simultaneous bilateral femoral neck fracture and end-stage renal disease in a 76-year-old woman: a case report.

    PubMed

    Mazzola, Paolo; Anzuini, Alessandra; Picone, Domenico; De Filippi, Francesco; Dubner, Lauren; Bellelli, Giuseppe; Zatti, Giovanni; Pasinetti, Giulio M; Annoni, Giorgio

    2015-08-01

    Hip fracture is a common occurrence in the elderly. Due to the growing demand for the specific care of these patients, we established the Orthogeriatric Unit (OGU) at San Gerardo University Hospital (Italy) in 2007. However, simultaneous bilateral femoral neck fractures among the geriatric population (those aged ≥65 years) are rarely reported in the literature. Reporting the rare case of a frail 76-year-old woman admitted with bilateral hip fracture and end-stage renal disease, we explain the important role played by the OGU and its flexible multidisciplinary approach for providing comprehensive care to patients with multimorbidity and clinical complexity. The team of geriatricians, orthopedic surgeons, anesthesiologists, and, in this case, a nephrologist, helped in the careful planning and timing of the single-step surgical repair, decided the appropriate type of anesthesia, and optimized outcomes. After a prompt evaluation of the patient, the OGU approach can achieve clinical stabilization prior to intervention. Along with a strict follow-up in the postoperative phase, this could result in a significant reduction of complications and mortality rates and an early start to a tailored rehabilitation process. We strongly suggest employing facilities with multidisciplinary teams for cases involving complex patients at short-term high risk for poor clinical outcomes. Indeed, the usual single-specialist model of care is gradually being abandoned worldwide.

  17. Incidence and Future Projections of Periprosthetic Femoral Fracture Following Primary Total Hip Arthroplasty: An Analysis of International Registry Data.

    PubMed

    Pivec, Robert; Issa, Kimona; Kapadia, Bhaveen H; Cherian, Jeffery J; Maheshwari, Aditya V; Bonutti, Peter M; Mont, Michael A

    2015-01-01

    As the number of total hip arthroplasties (THA) increases, the number of fractures will increase as well. The purpose of this study was to determine the incidence and prevalence of intra- and post-operative periprosthetic fractures following THA based on national joint registry data and to create a projection model that estimates the future fracture burden. Registry data from multiple joint registries were analyzed. Data on the incidence and prevalence of intra- and post-operative periprosthetic fractures were extracted. The prevalences between individual countries were analyzed to determine the mean prevalence. Three quantitative models were then generated to predict the fracture burden in the United States based on future population trends between 2015 and 2060. The mean incidence of post-operative periprosthetic fractures requiring revision was 0.8% while the incidence of intraoperative fractures was 0.8%. When all revision arthroplasties were assessed, the mean proportion of hips revised due to periprosthetic fracture was 6.6%. Projection models demonstrated that the number of periprosthetic fractures is expected to rise by a mean 4.6% every decade over the next 30 years. Periprosthetic fractures represent a small but important proportion of the revision THA burden worldwide. The incidence of both intra- and post-operative fractures is low, but the number is likely to steadily increase along with the number of surgeries performed. The number of fractures may rise even further as the incidence may potentially be higher in elderly, osteoporotic patients who are likely to represent a greater proportion of the arthroplasty population, particularly. PMID:26852635

  18. A Prospective Observational Cohort Study on Orthopaedic and Anaesthetic Registrars Performing Femoral Nerve Block on Patients with an Acute Hip Fracture

    PubMed Central

    Thelaus, Åsa; Pettersson, Tobias; Gordon, Max

    2016-01-01

    We investigated if a femoral nerve block (FNB) for patients with a proximal femoral fracture (PFF) and administered by an orthopaedic registrar (OR) instead of an anaesthesiology registrar (AR) lowers the lead time to block and reduces the total amount of rescue analgesics during the preoperative phase. 205 patients were included in a prospective observational cohort study. The main outcome variable was rescue analgesics as total intravenous morphine prior to surgery. All results were adjusted for confounding using age, sex, cognitive dysfunction, and ASA classification. The OR group (n = 135) was over 2 hours faster in performing the block compared to the AR group (n = 70) but was nonetheless correlated with an increased amount of rescue analgesics during the study, 2.4 mg morphine (95% CI 0.0–4.9) more compared to the AR group. We found no difference between the groups in the risk of adverse events. We conclude that, for patients with an acute PFF and with morphine consumption as end point, how soon from arrival to hospital the patients receive a FNB is of lesser importance than who is administering it. Based on our results we recommend that emergency hospitals should have routines for anaesthesiologists performing FNB on this frail patient group. PMID:27704039

  19. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck.

    PubMed

    Filipov, Orlin

    2011-10-01

    The present work introduces a method of screw fixation of femoral neck fractures in the presence of osteoporosis, according to an original concept of the establishment of two supporting points for the implants and their biplane positioning in the femoral neck and head. The provision of two steady supporting points for the implants and the highly increased (obtuse) angle at which they are positioned allow the body weight to be transferred successfully from the head fragment onto the diaphysis, thanks to the strength of the screws, with the patient's bone quality being of least importance. The position of the screws allows them to slide under stress with a minimal risk of displacement. The method was developed in search of a solution for those patients for whom primary arthroplasty is contraindicated. The method has been analysed in relation to biomechanics and statics. For the first time, a new function is applied to a screw fixation-the implant is presented as a simple beam with an overhanging end.

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

    PubMed

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

    2016-08-01

    The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate. PMID:27537579

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

    PubMed

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

    2016-08-01

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

  2. Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate: nationwide cohort and nested case-control study

    PubMed Central

    Abrahamsen, Bo; Eiken, Pia; Eastell, Richard

    2016-01-01

    Objectives To determine the skeletal safety and efficacy of long term (≥10 years) alendronate use in patients with osteoporosis. Design Open register based cohort study containing two nested case control studies. Setting Nationwide study of population of Denmark. Participants 61 990 men and women aged 50-94 at the start of treatment, who had not previously taken alendronate, 1996-2007. Interventions Treatment with alendronate. Main outcome measures Incident fracture of the subtrochanteric femur or femoral shaft (ST/FS) or the hip. Non-fracture controls from the cohort were matched to fracture cases by sex, year of birth, and year of initiation of alendronate treatment. Conditional logistic regression models were fitted to calculate odds ratios with and without adjustment for comorbidity and comedications. Sensitivity analyses investigated subsequent treatment with other drugs for osteoporosis. Results 1428 participants sustained a ST/FS (incidence rate 3.4/1000 person years, 95% confidence interval 3.2 to 3.6), and 6784 sustained a hip fracture (16.2/1000 person years, 15.8 to 16.6). The risk of ST/FS was lower with high adherence to treatment with alendronate (medication possession ratio (MPR, a proxy for compliance) >80%) compared with poor adherence (MPR <50%; odds ratio 0.88, 0.77 to 0.99; P=0.05). Multivariable adjustment attenuated this association (adjusted odds ratio 0.88, 0.77 to 1.01; P=0.08). The risk was no higher in long term users (≥10 dose years; 0.70, 0.44 to 1.11; P=0.13) or in current compared with past users (0.91, 0.79 to 1.06; P=0.22). Similarly, MPR >80% was associated with a decreased risk of hip fracture (0.73, 0.68 to 0.78; P<0.001) as was longer term cumulative use for 5-10 dose years (0.74, 0.67 to 0.83; P<0.001) or ≥10 dose years (0.74, 0.56 to 0.97; P=0.03). Conclusions These findings support an acceptable balance between benefit and risk with treatment with alendronate in terms of fracture outcomes, even for over 10

  3. Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture

    PubMed Central

    Jiang-jun, Zhou; Min, Zhao; Ya-bo, Yan; Wei, Lei; Ren-fa, Lv; Zhi-yu, Zhu; Rong-jian, Chen; Wei-tao, Yu; Cheng-fei, Du

    2014-01-01

    Objective: Finite element analysis was used to compare preoperative and postoperative stress distribution of a bone healing model of femur fracture, to identify whether broken ends of fractured bone would break or not after fixation dislodgement one year after intramedullary nailing. Method s: Using fast, personalized imaging, bone healing models of femur fracture were constructed based on data from multi-slice spiral computed tomography using Mimics, Geomagic Studio, and Abaqus software packages. The intramedullary pin was removed by Boolean operations before fixation was dislodged. Loads were applied on each model to simulate a person standing on one leg. The von Mises stress distribution, maximum stress, and its location was observed. Results : According to 10 kinds of display groups based on material assignment, the nodes of maximum and minimum von Mises stress were the same before and after dislodgement, and all nodes of maximum von Mises stress were outside the fracture line. The maximum von Mises stress node was situated at the bottom quarter of the femur. The von Mises stress distribution was identical before and after surgery. Conclusion : Fast, personalized model establishment can simulate fixation dislodgement before operation, and personalized finite element analysis was performed to successfully predict whether nail dislodgement would disrupt femur fracture or not. PMID:24772140

  4. An Unusual Complication Seen in a Six-Year-Old Girl Treated with Open Reduction and Pemberton Osteotomy for Neglected Developmental Dysplasia of the Hip: A Femoral Neck Fracture Sustained during Passive Motion under General Anesthesia.

    PubMed

    Uruc, Vedat; Karabulut, Samet

    2014-01-01

    Despite the screening programs for newborn children with hip ultrasonography, neglected developmental dysplasia of the hip (DDH) is still continuing to be a problem in the east and southeast parts of our country. The main complications are redislocation, avascular necrosis, and joint stiffness. We present an unusual complication, femoral neck fracture during passive motion under general anesthesia, of a six-year-old girl with neglected DDH treated by open reduction and Pemberton osteotomy without femoral shortening. The fracture was treated by open reduction and internal fixation combined with proximal femoral shortening. After 5 years the patient had excellent clinical results, no avascular necrosis was seen, and the radiologic appearance was type IA according to modified Severin classification. In conclusion older children with neglected DDH are more likely to have joint stiffness after open reduction. If there is even a little doubt about joint stiffness after open reduction, one should not refrain from femoral shortening. Also passive motion under general anesthesia should be applied very carefully with fluoroscopic control. PMID:24971184

  5. Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures

    PubMed Central

    2014-01-01

    Background Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. Methods/Design FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. Discussion This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. Trial registration The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813). PMID:24965132

  6. Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation.

    PubMed

    Samiezadeh, Saeid; Fawaz, Zouheir; Bougherara, Habiba

    2016-03-01

    Intramedullary nails are the golden treatment option for diaphyseal fractures. However, their high stiffness can shield the surrounding bone from the natural physiologic load resulting in subsequent bone loss. Their stiff structure can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. Composite intramedullary nails have recently been introduced to address these drawbacks. The purpose of this study is to evaluate the mechanical properties of a previously developed composite IM nail made of carbon-fibre/epoxy whose structure was optimized based on fracture healing requirements using the selective stress shielding approach. Following manufacturing, the cross-section of the composite nail was examined under an optical microscope to find the porosity of the structure. Mechanical properties of the proposed composite intramedullary nail were determined using standard tension, compression, bending, and torsion tests. The failed specimens were then examined to obtain the modes of failure. The material showed high strength in tension (403.9±7.8MPa), compression (316.9±10.9MPa), bending (405.3±8.1MPa), and torsion (328.5±7.3MPa). Comparing the flexural modulus (41.1±0.9GPa) with the compressive modulus (10.0±0.2GPa) yielded that the material was significantly more flexible in compression than in bending. This customized flexibility along with the high torsional stiffness of the nail (70.7±2.0Nm(2)) has made it ideal as a fracture fixation device since this unique structure can stabilize the fracture while allowing for compression of fracture ends. Negligible moisture absorption (~0.5%) and low porosity of the laminate structure (< 3%) are other advantages of the proposed structure. The findings suggested that the carbon-fibre/epoxy intramedullary nail is flexible axially while being relatively rigid in bending and torsion and is strong enough in all types of physiologic loading, making it a potential

  7. Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation.

    PubMed

    Samiezadeh, Saeid; Fawaz, Zouheir; Bougherara, Habiba

    2016-03-01

    Intramedullary nails are the golden treatment option for diaphyseal fractures. However, their high stiffness can shield the surrounding bone from the natural physiologic load resulting in subsequent bone loss. Their stiff structure can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. Composite intramedullary nails have recently been introduced to address these drawbacks. The purpose of this study is to evaluate the mechanical properties of a previously developed composite IM nail made of carbon-fibre/epoxy whose structure was optimized based on fracture healing requirements using the selective stress shielding approach. Following manufacturing, the cross-section of the composite nail was examined under an optical microscope to find the porosity of the structure. Mechanical properties of the proposed composite intramedullary nail were determined using standard tension, compression, bending, and torsion tests. The failed specimens were then examined to obtain the modes of failure. The material showed high strength in tension (403.9±7.8MPa), compression (316.9±10.9MPa), bending (405.3±8.1MPa), and torsion (328.5±7.3MPa). Comparing the flexural modulus (41.1±0.9GPa) with the compressive modulus (10.0±0.2GPa) yielded that the material was significantly more flexible in compression than in bending. This customized flexibility along with the high torsional stiffness of the nail (70.7±2.0Nm(2)) has made it ideal as a fracture fixation device since this unique structure can stabilize the fracture while allowing for compression of fracture ends. Negligible moisture absorption (~0.5%) and low porosity of the laminate structure (< 3%) are other advantages of the proposed structure. The findings suggested that the carbon-fibre/epoxy intramedullary nail is flexible axially while being relatively rigid in bending and torsion and is strong enough in all types of physiologic loading, making it a potential

  8. Compression type stress fracture of femoral neck with equivocal X-ray features diagnosed on 99mTc-MDP SPECT/CT in a case of trivial hip pain

    PubMed Central

    Vitalkar, Saurabh; Manglunia, Ashmi S.; Kulkarni, Arvind; Puranik, Ameya D.

    2016-01-01

    Stress insufficiency fracture is usually diagnosed clinically and on the basis of routine X-ray imaging findings. However, the absence of any known predisposing factors and negative or occult radiographic findings pose diagnostic challenges. We report the case of an elderly male patient who presented with a chief complaint of trivial left hip pain and with equivocal radiographic findings. Triphasic 99mTc-methylene diphosphonate bone scan and single-photon emission computed tomography/computed tomography helped in arriving at the diagnosis of stress insufficiency fracture involving femoral neck. PMID:27385898

  9. [The characteristics of the technical instrumental support for the osteosynthesis of femoral neck fractures using the Seppo fixator].

    PubMed

    Mel'tser, R I; Oshukova, S M; Ivanova, I U; Dudanov, I P

    1997-01-01

    Operative treatment of fractures of the femur neck is the method of choice. The authors prefer the A. Seppo construction out of great number of fixtures but it is difficult to introduce and remove this fixture due to its complexity. To make the procedure of such interventions easier the authors propose a marking device, a screwdriver and a device allowing the fixture's curvature to be regulated. The modification of the technique and using a specially developed extractor is explained by difficulties in removing the fixture by common methods. The variant of the improved instrumental tooling proposed by the authors makes the operation more handy and practicable.

  10. Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty.

    PubMed

    Naqvi, Gohar A; Baig, Shakoor A; Awan, Nasir

    2012-06-01

    The Vancouver classification system of periprosthetic fractures has been revalidated in this study, using the radiographs of 45 patients. Three consultants and 3 trainees reviewed the radiographs independently, on 2 separate occasions, at least 2 weeks apart. Interobserver and intraobserver agreement and validity were analyzed, using weighted κ statistics. The mean κ value for interobserver agreement was found to be 0.69 (0.63-0.72) for consultants and 0.61 (0.56-0.65) for the trainees, both representing substantial agreement. Intraobserver κ values ranged from 0.74 to 0.90, showing substantial agreement. Validity analysis of 37 type B cases revealed 81% agreement within B1, B2, and B3 subgroups with a κ value of 0.68 (substantial agreement). This study has reconfirmed the reliability and validity of the Vancouver classification while it also emphasizes the intraoperative assessment of implant stability.

  11. [Surgical treatment of a displaced femoral head fracture with a cement-free dual-headed prosthesis using a minimally invasive approach. Clinical and radiographic outcome].

    PubMed

    Wick, M; Muhr, G; Rincon, R; Lester, D

    2005-03-01

    One hundred patients treated with a cementless bipolar prosthesis for a displaced subcapital hip fracture were prospectively evaluated for clinical and radiographic outcome. All patients were operated via a minimally invasive approach; in every case we implanted a Zweymuller stem. There were 77 women and 33 men with a mean age of 80 years (29-98 years). The mean duration of the operation was 29 min (20-95 min). Full weight bearing on crutches was allowed 1 day after the operation. The mean follow-up was 2.5 years (6 months to 7 years). Two years after the operation there were 40% of the remaining 65 patients who scored between 90 and 100 on the Harris hip score, 23% between 80 and 89, 20% between 70 and 79, and 17% below 70. No patient complained about thigh pain and up to now there has been no need for femoral revision due to loosening. There was no infection or nerve lesion. In three patients there was a luxation of the prosthesis which could be reduced by closed means. Radiographs from 81 patients showed stress shielding in 97.5% mainly in Gruen zones 1 and 7. Radiolucent lines in two or more Gruen zones were found in two patients. These findings suggest that the noncemented, pressfit, grit-blasted bipolar prosthesis demonstrated similar stability and radiographic results to cemented bipolar prostheses. Stress shielding was common but did not influence longevity of the implant. We did not find any signs of protrusion. Especially in older patients with a history of cardiac disease, the noncemented bipolar prosthesis is a rational alternative to avoid intra- and postoperative complications despite the higher costs for the implant. The minimally invasive approach helps to reduce operation time and intraoperative blood loss. PMID:15778832

  12. A laboratory investigation to assess the influence of cement augmentation of screw and plate fixation in a simulation of distal femoral fracture of osteoporotic and non-osteoporotic bone.

    PubMed

    Wähnert, D; Lange, J H; Schulze, M; Gehweiler, D; Kösters, C; Raschke, M J

    2013-10-01

    The augmentation of fixation with bone cement is increasingly being used in the treatment of severe osteoporotic fractures. We investigated the influence of bone quality on the mechanics of augmentation of plate fixation in a distal femoral fracture model (AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral models were randomly assigned to either an augmented or a non-augmented group. Fixation was performed using a locking compression plate. In the augmented group additionally 1 ml of bone cement was injected into the screw hole before insertion of the screw. Biomechanical testing was performed in axial sinusoidal loading. Augmentation significantly reduced the cut-out distance in the osteoporotic models by about 67% (non-augmented mean 0.30 mm (sd 0.08) vs augmented 0.13 mm (sd 0.06); p = 0.017). There was no statistical reduction in this distance following augmentation in the non-osteoporotic models (non-augmented mean 0.15 mm (sd 0.02) vs augmented 0.15 mm (sd 0.07); p = 0.915). In the osteoporotic models, augmentation significantly increased stability (p = 0.017). PMID:24078541

  13. Ultrasound-Guided Femoral and Sciatic Nerve Blocks for Repair of Tibia and Fibula Fractures in a Bennett's Wallaby (Macropus rufogriseus)

    PubMed Central

    Campoy, Luis; Adami, Chiara

    2016-01-01

    Locoregional anesthetic techniques may be a very useful tool for the anesthetic management of wallabies with injuries of the pelvic limbs and may help to prevent capture myopathies resulting from stress and systemic opioids' administration. This report describes the use of ultrasound-guided femoral and sciatic nerve blocks in Bennett's wallaby (Macropus rufogriseus) referred for orthopaedic surgery. Ultrasound-guided femoral and sciatic nerve blocks were attempted at the femoral triangle and proximal thigh level, respectively. Whilst the sciatic nerve could be easily visualised, the femoral nerve could not be readily identified. Only the sciatic nerve was therefore blocked with ropivacaine, and methadone was administered as rescue analgesic. The ultrasound images were stored and sent for external review. Anesthesia and recovery were uneventful and the wallaby was discharged two days postoperatively. At the time of writing, it is challenging to provide safe and effective analgesia to Macropods. Detailed knowledge of the anatomy of these species is at the basis of successful locoregional anesthesia. The development of novel analgesic techniques suitable for wallabies would represent an important step forward in this field and help the clinicians dealing with these species to improve their perianesthetic management. PMID:27803817

  14. Fractures

    PubMed Central

    Hall, Michael C.

    1963-01-01

    Recent studies on the epidemiology and repair of fractures are reviewed. The type and severity of the fracture bears a relation to the age, sex and occupation of the patient. Bone tissue after fracture shows a process of inflammation and repair common to all members of the connective tissue family, but it repairs with specific tissue. Cartilage forms when the oxygen supply is outgrown. After a fracture, the vascular bed enlarges. The major blood supply to healing tissue is from medullary vessels and destruction of them will cause necrosis of the inner two-thirds of the cortex. Callus rapidly mineralizes, but full mineralization is achieved slowly; increased mineral metabolism lasts several years after fracture. PMID:13952119

  15. Femoral nerve dysfunction

    MedlinePlus

    Neuropathy - femoral nerve; Femoral neuropathy ... Craig EJ, Clinchot DM. Femoral neuropathy. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation . 3rd ...

  16. Fractures

    MedlinePlus

    ... commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the ...

  17. Evolution of bisphosphonate-related atypical fracture retrospectively observed with DXA scanning.

    PubMed

    Ahlman, Mark A; Rissing, Michael S; Gordon, Leonie

    2012-02-01

    We present a case of a 61-year-old female with history of long-term bisphosphonate therapy for osteoporosis initially diagnosed by screening dual-energy X-ray absorptiometry (DXA). After 4 years of treatment with bisphosphonates, the patient presented to primary care with left hip pain. Diagnostic hip radiographs were interpreted as normal, and she continued to take bisphosphonates. Two months later, she experienced a complete transverse subtrochanteric left femur fracture after minimal trauma. The patient underwent open reduction and internal fixation. Review of the patient's postoperative films revealed lateral subtrochanteric cortical beaking at the fracture. This type of "atypical" fracture has been reported to be a result of chronic bisphosphonate-associated fractures with high specificity. In addition, the right femur also showed cortical beaking with a horizontal linear lucency in an identical location, suggesting an impending fracture. Longitudinal review of the both diagnostic radiographs as well as DXA images shows a stepwise development of these subtrochanteric abnormalities in both femurs. A current hypothesis regarding the pathophysiology of bisphosphonate-associated fracture is that the medication inhibits bone turnover and repair of microscopic trauma. A cycle of defective repair and continual microtrauma compounded over time gradually weakens the bone and creates an architectural conduit for transverse or "atypical" fracture. Standard practice is not to use DXA as a diagnostic "image." We present this case to show that a common location and classic appearance of subtrochanteric bisphosphonate-associated fractures may be clearly visualized on absorptiometry images long before fracture. This observation is important because the majority of patients taking bisphosphonate therapy also receive regular DXA imaging. Because of the chronicity of standard bone-density monitoring for these patients throughout their treatment regimen, DXA may find a role for

  18. Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture – a case report and literature review

    PubMed Central

    Dys, Krzysztof; Drelichowska-Durawa, Justyna; Dołega-Kozierowski, Bartosz; Lis, Michał; Sokratous, Kyriakos; Iwanowski, Wojciech; Drelichowski, Stanisław; Witkiewicz, Wojciech

    2013-01-01

    Summary Background: Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation. Case Report: A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow. Discussion: Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels. Conclusions: Frequency of angioplasty and

  19. Intramedullary locking femoral nails. Experience with the AO nail.

    PubMed Central

    Fogarty, A. B.; Yeates, H. A.

    1991-01-01

    The AO interlocking nail was introduced to the Ulster Hospital, Dundonald in 1988 and since then has been used in over 50 patients with femoral shaft fractures. We have reviewed 45 patients with 46 femoral shaft fractures treated between June 1988 and April 1990. These included four compound fractures and 13 comminuted fractures. The results compare favourably with other series. The union rate was 98% and there were no instances of deep infection. The alternative treatment methods available are discussed along with a review of the relevant literature. Images Fig 3 Fig 5 PMID:1785145

  20. Purtscher’s retinopathy after intramedullary nailing of a femoral shaft fracture in a 20-year old healthy female – report of a rare case and review of the literature

    PubMed Central

    2014-01-01

    Background Purtscher’s retinopathy is a sight threatening, occlusive microvasculopathy associated with trauma, it is rarely reported after long bone fractures. Case presentation A 20-year-old female sustained a femoral shaft fracture (AO 32-A2.3) in a ski accident colliding with a snowgun and was treated with intramedullary nailing one hour after the accident. 14 hours after surgery the patient complained of loss of vision in both eyes and was therefore referred to a neurologist, furthermore an MRI scan of the brain was performed. Neither showed any pathological findings. The patient was finally transferred to an ophthalmology department. After slit lamp examination and funduscopy Purtscher’s retinopathy was diagnosed. Treatment was started right after diagnosis and 5 days after the onset of symptoms. The patient was administered intravenous haemo-rheologic therapy for five days as well as low molecular heparine in therapeutic dose and Vasonit® 400 mg bid orally. At follow-up 4 weeks and 6 months later visual acuity had improved after 4 weeks before that exam. At final follow-up the symptoms had almost resolved completely and uncorrected visual acuity (UCVA) and best corrected visual acuity had improved from originally 0.25 decimal in both eyes to 0.8 decimal UCVA and BCVA in both eyes. Conclusions Patients suffering from perioperative loss of vision have to be referred for ophthalmological and neurological assessment as soon as possible. History of trauma and visual loss can point to the diagnosis of Purtscher’s retinopathy. PMID:24548655

  1. The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal Index, a solution to preventing intra-operative periprosthetic fracture.

    PubMed

    Chana, Rishi; Mansouri, Reza; Jack, Chris; Edwards, Max R; Singh, Ravi; Keller, Carmel; Khan, Farid

    2011-11-18

    This study will seek to identify a measurable radiographic index, the Metaphyseal-Diaphyseal Index (MDI) score to determine whether intra-operative fracture in osteoporotic bone can be predicted.A 5 year prospective cohort of 560 consecutive patients, undergoing hemiarthroplasty (cemented or uncemented), was evaluated. A nested case-control study to determine risk factors affecting intra-operative fracture was carried out. The Vancouver Classification was used to classify periprosthetic fracture. The MDI score was calculated using radiographs from the uncemented group. As a control (gold standard), Yeung et al's Canal Bone Ratio (CBR) score was also calculated. From this, a receiver operating characteristic (ROC) curve was formulated for both scores and area under the curve (AUC) compared. Intra and inter-observer correlations were determined. Cost analysis was also worked out for adverse outcomes. Four hundred and seven uncemented and one hundred and fifty-three cemented stems were implanted. The use of uncemented implants was the main risk factor for intra-operative periprosthetic fracture. Sixty-two periprosthetic fractures occurred in the uncemented group (15.2%), nine occurred in the cemented group (5.9%), P < 0.001. The revision rate for sustaining a periprosthetic fracture (uncemented group) was 17.7%, P < 0.001 and 90 day mortality 19.7%, P < 0.03. MDI's AUC was 0.985 compared to CBR's 0.948, P < 0.001. The MDI score cut-off to predict fracture was 21, sensitivity 98.3%, specificity 99.8%, positive predictive value 90.5% and negative predictive value 98%. Multivariate regression analysis ruled out any other confounding factors as being significant. The intra and inter-observer Pearson correlation scores were r = 0.99, P < 0.001. JRI uncemented hemiarthroplasty has a significantly higher intra-operative fracture rate. We recommend cemented arthroplasty for hip fractures. We propose a radiographic system that may allow surgeons to select patients who are good

  2. Femoral hernia repair

    MedlinePlus

    Femorocele repair; Herniorrhaphy; Hernioplasty - femoral ... During surgery to repair the hernia, the bulging tissue is pushed back in. The weakened area is sewn closed or strengthened. This repair ...

  3. Prediction of femoral head collapse in osteonecrosis.

    PubMed

    Volokh, K Y; Yoshida, H; Leali, A; Fetto, J F; Chao, E Y S

    2006-06-01

    The femoral head deteriorates in osteonecrosis. As a consequence of that, the cortical shell of the femoral head can buckle into the cancellous bone supporting it. In order to examine the buckling scenario we performed numerical analysis of a realistic femoral head model. The analysis included a solution of the hip contact problem, which provided the contact pressure distribution, and subsequent buckling simulation based on the given contact pressure. The contact problem was solved iteratively by approximating the cartilage by a discrete set of unilateral linear springs. The buckling calculations were based on a finite element mesh with brick elements for the cancellous bone and shell elements for the cortical shell. Results of 144 simulations for a variety of geometrical, material, and loading parameters strengthen the buckling scenario. They, particularly, show that the normal cancellous bone serves as a strong supporting foundation for the cortical shell and prevents it from buckling. However, under the development of osteonecrosis the deteriorating cancellous bone is unable to prevent the cortical shell from buckling and the critical pressure decreases with the decreasing Young modulus of the cancellous bone. The local buckling of the cortical shell seems to be the driving force of the progressive fracturing of the femoral head leading to its entire collapse. The buckling analysis provides an additional criterion of the femoral head collapse, the critical contact pressure. The buckling scenario also suggests a new argument in speculating on the femoral head reinforcement. If the entire collapse of the femoral head starts with the buckling of the cortical shell then it is reasonable to place the reinforcement as close to the cortical shell as possible.

  4. Updated Outcomes of Prophylactic Femoral Fixation.

    PubMed

    Kreul, Sarah M; Sorger, Joel I; Rajamanickam, Victoria P; Heiner, John P

    2016-01-01

    Despite an increasing number of patients with metastatic bone disease (MBD), minimal data exist regarding outcomes of patients undergoing prophylactic femoral fixation for MBD when compared with other frequently performed orthopedic operations, such as hemiarthroplasty of the femur. The authors performed a retrospective database review evaluating these procedures due to similar operative times and patient populations and also reviewed common comorbidities such as body mass index (BMI). The goal was to provide updated results of prophylactic femoral fixation and evaluate whether certain patient risk factors (eg, BMI) altered 30-day survival for patients with MBD. The authors reviewed 1849 patients with and without MBD treated by prophylactic fixation and hemiarthroplasty from 2006 to 2011 identified in the American College of Surgeons National Surgical Quality Improvement Program database. There were no significant differences in complications between patients undergoing surgical treatment for impending or actual femoral fracture. In addition, there were no differences between the 217 patients with MBD in either the hemiarthroplasty or prophylactic fixation groups because the rate of death within 30 days postoperatively was 5.56% and 3.30%, respectively (P=.526). When comparing BMI, obese patients had higher rates of wound infection, and underweight patients were more likely to develop pneumonia or die within 30 days postoperatively. Patients with impending femur fractures benefit from prophylactic fixation and perform as well in the short term as patients undergoing hemiarthroplasty. Certain BMI categories (underweight or obese) contributed to poorer outcomes. These findings provide updated information for discussing risks and benefits with surgical candidates.

  5. [Recent progress in orthopaedic managements of osteoporosis-related fractures].

    PubMed

    Yamamoto, Seizo

    2011-07-01

    Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the treatment of femoral neck fractures, impacted or nondisplaced type is treated by three cannulated cancellous pins. Displaced type of femoral neck fracture is treated by bipolar prosthesis. Results of femoral neck fractures are influenced by the complications of each patients. Osteoporotic spine fractures are commonly healed within 2 or 3 months. Spinal compression with paraparesis or paraplegia is unusual complication in burst type of spine fractures. Surgical decompression, bone grafting and stabilization with instrumentation can result in some correction of deformity and neurogenic recovery. Distal radius fractures are common fractures in the eldery. Recently advances includes external fixation and plate fixation for the comminuted fractures in the distal radius. Treatments of osteoporosis-related fractures are still difficult problems to be resolved. PMID:21774371

  6. Alternative reliable techniques in femoral torsion measurement.

    PubMed

    Delialioglu, M Onder; Tasbas, Bulent A; Bayrakci, Kenan; Daglar, Bulent; Kurt, Murat; Agar, Mustafa; Gunel, Ugur

    2006-01-01

    The clinical and conventional bi-planar determinations of femoral torsion were compared with the tomographic technique, the reliability of which was confirmed. Femoral torsions were measured with the trochanteric prominence angle test, the sinus-wave bi-planar conventional radiographic technique, the modified Hermann bi-planar conventional radiographic technique and the limited three-dimensional volumetric tomography technique in 34 femora of 17 patients. There was a strong correlation between the modified Hermann and the limited tomography techniques for 14 intact and 20 fractured femora. If limited three-dimensional volumetric tomography cannot be obtained, the modified Hermann bi-planar conventional radiographic technique must be used in patients who have scarring about the proximal femur and obesity. Otherwise use of the trochanteric prominence angle test is much more cost-effective and is as accurate as the limited three-dimensional volumetric tomography technique.

  7. Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty

    PubMed Central

    Lee, Ju Hong

    2015-01-01

    Background We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system. Methods We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups. Results The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 ± 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 ± 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups

  8. Fractures of the femur in newborn calves

    PubMed Central

    Ferguson, James G.; Dehghani, Seifola; Petrali, Elena H.

    1990-01-01

    A retrospective study of femoral fractures in 77 calves revealed that most occurred in the femoral shaft or in the proximal physis, with thin cortices and periosteal stripping significant problems in fractures of the femoral shaft. Most cases were related to forced extraction, with more left femurs being affected than right. The existence of concurrent disease reduced the success rate by 50% and, when significant additional trauma was present, no calves survived. When all cases were considered regardless of condition, the “longterm” success rate was 43%. PMID:17423560

  9. [Treatment of hip fractures in elderly patients].

    PubMed

    Hack, Juliana; Bliemel, Christopher; Ruchholtz, Steffen; Bücking, Benjamin

    2015-04-01

    Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program.

  10. Total femoral replacement.

    PubMed

    Nerubay, J; Katznelson, A; Tichler, T; Rubinstein, Z; Morag, B; Bubis, J J

    1988-04-01

    Between 1973 and 1983, 19 patients with sarcoma of the femur were treated by adjuvant chemotherapy, excision of the entire femur, and replacement by a total femoral prosthesis. Five patients had excellent and nine had good functional results. Twelve patients died an average of 23 months after the procedure and seven are at present disease free. This limb-saving procedure permits rapid rehabilitation, prevents severe psychological problems, and improves the quality of life.

  11. A Case of Late Femoral Pseudoaneurysm Caused by Stent Disconnection

    SciTech Connect

    Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele Tozzi, Matteo; Carrafiello, Gianpaolo

    2010-10-15

    We present the case of a late superficial femoral artery stent disconnection causing an asymptomatic pseudoaneurysm successfully treated with a stent-graft. A 67-year-old female was referred to our department for evaluation of claudication of the left lower limb and was diagnosed to have a total occlusion of the superficial femoral artery. Three nitinol stents were used to revascularize this artery. At 48 months, duplex-ultrasonography control revealed the presence of a 45-mm saccular femoral dilatation; X-rays and CT angiography showed fractures of the proximal stents and the presence of a pseudoaneurysm at the site of the distal stents disconnection. The pseudoaneurysm was excluded using two stent-grafts. We conclude that patients and surgeons should be aware of structural complications with all stents. Rigorous follow-up controls should be mandatory. Endovascular repair proved to be feasible and durable to manage a previous endovascular procedure.

  12. Biomechanical analyses of static and dynamic fixation techniques of retrograde interlocking femoral nailing using nonlinear finite element methods.

    PubMed

    Shih, Kao-Shang; Hsu, Ching-Chi; Hsu, Tzu-Pin; Hou, Sheng-Mou; Liaw, Chen-Kun

    2014-02-01

    Femoral shaft fractures can be treated using retrograde interlocking nailing systems; however, fracture nonunion still occurs. Dynamic fixation techniques, which remove either the proximal or distal locking screws, have been used to solve the problem of nonunion. In addition, a surgical rule for dynamic fixation techniques has been defined based on past clinical reports. However, the biomechanical performance of the retrograde interlocking nailing systems with either the traditional static fixation technique or the dynamic fixation techniques has not been investigated by using nonlinear numerical modeling. Three-dimensional nonlinear finite element models were developed, and the implant strength, fixation stability, and contact area of the fracture surfaces were evaluated. Three types of femoral shaft fractures (a proximal femoral shaft fracture, a middle femoral shaft fracture, and a distal femoral shaft fracture) fixed by three fixation techniques (insertion of all the locking screws, removal of the proximal locking screws, or removal of the distal locking screws) were analyzed. The results showed that the static fixation technique resulted in sufficient fixation stability and that the dynamic fixation techniques decreased the failure risk of the implant and produced a larger contact area of the fracture surfaces. The outcomes of the current study could assist orthopedic surgeons in comprehending the biomechanical performances of both static and dynamic fixation techniques. In addition, the surgeons could also select a fixation technique based on the specific patient situation using the numerical outcomes of this study.

  13. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report.

    PubMed

    Jain, Sumit Kumar; Jadaan, Mutaz; Rahall, Elias

    2015-02-01

    Hoffa's fracture is a coronal fracture of the posterior femoral condyle and is an unusual injury. It can be easily missed on plain radiographs. There is no dearth of literature on Hoffa's fracture, its various presentations, management and rehabilitation principles. The intra-articular nature of the fracture, vulnerable blood supply of the posterior femoral condyle, involvement of the weight bearing articular surface of the knee and the unstable fracture pattern necessitate the surgical management. We encountered an unusual case of Hoffa's fracture where the lateral meniscus was blocking the reduction of fractured fragments. The patient required mini arthrotomy to remove the meniscus from in between the bone fragments. The fracture was fixed with two anteroposterior screws and knee was immobilised in extension. A gentle knee range of movements was commenced after the wound had healed but weight bearing was delayed for 12 weeks. PMID:25554423

  14. Finite element analysis of femoral neck stress in relation to pelvic width.

    PubMed

    Schwarzkopf, Ran; Dong, Nick N G; Fetto, Joseph F

    2011-01-01

    Hip resurfacing arthroplasty has been developed as an alternative to traditional total hip arthroplasty, in an effort to minimize the loss of native bone in young patients with symptomatic hip osteoarthritis. Femoral neck fracture following hip resurfacing is a unique complication; several risk factors are associated with this complication, including female gender. In the present study, we used finite element models of the proximal femur to simulate stresses across the femoral neck in pelvis models with varying widths. This analysis demonstrated an increase in hip reaction forces as the width of the pelvis increases, a condition that simulates a resurfacing condition in a female pelvis. This difference in peak stress on the femoral neck may explain the increased incidence of femoral neck fractures seen in female patients following hip resurfacing.

  15. Bisphosphonate-associated osteonecrosis of the jaws.

    PubMed

    Agarwal, Pankaj; Rao, Nirmala N

    2012-01-01

    Bisphosphonates constitute a group of drugs capable of modulating bone turnover and reduce its remodeling when an excessive resorption occurs. This is why they are indicated in a large group of bone diseases like postmenopausal osteoporosis or osteolysis associated with breast cancer or multiple myeloma. Over the last few years and due to their extensive use, many cases of complications associated with their use have been published. Among the most important possible adverse effects are the oral ones, with the appearance of ulcerations and, especially, osteonecrosis of the jaws associated with this therapy. In this paper, we have analyzed the general characteristics of these drugs and their mechanisms of action as well as the described adverse effects, especially oral and maxillofacial, have been made special reference, regarding the prevention of osteonecrosis of the jaws, heightened by cases described in the medical and odontological literature. The preventive protocol backs up the fundamental role of the odontologist in the effective prevention of this process before, during and after the treatment. PMID:22842261

  16. Short-term Results of Muscle-Pedicle Bone Grafting with Tensor Fascia Lata for Delayed Femoral Neck Fractures; Case Series and Literature Review

    PubMed Central

    Salgotra, Kuldip; Kohli, Sarabjeet; Vishwakarma, Nilesh

    2016-01-01

    Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft) and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG) using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7%) men and 1 (14.3%) women among the patients. Overall 5 (71.5%) patients had transcervical and 2 (28.5%) had subcapital fractures. At the end of 6 months, 6 (85.7%) patients were pain free and on plain radiographs fracture union was noted. One (14.3%) patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures. PMID:27331067

  17. Nose fracture

    MedlinePlus

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It ... with other fractures of the face. Sometimes a blunt injury can ...

  18. Computer assisted measurement of femoral cortex thickening on radiographs

    NASA Astrophysics Data System (ADS)

    Yao, Jianhua; Liu, Yixun; Chen, Foster; Summers, Ronald M.; Bhattacharyya, Timothy

    2013-03-01

    Radiographic features such as femoral cortex thickening have been frequently observed with atypical subtrochanteric fractures. These features may be a valuable finding to help prevent fractures before they happen. The current practice of manual measurement is often subjective and inconsistent. We developed a semi-automatic tool to consistently measure and monitor the progress of femoral cortex thickening on radiographs. By placing two seed points on each side of the femur, the program automatically extracts the periosteal and endosteal layers of the cortical shell by active contour models and B-spline fitting. Several measurements are taken along the femur shaft, including shaft diameter, cortical thickness, and integral area for medial and lateral cortex. The experiment was conducted on 52 patient datasets. The semi-automatic measurements were validated against manual measurements on 52 patients and demonstrated great improvement in consistency and accuracy (p<0.001).

  19. Effects of Hip Geometry on Fracture Patterns of Proximal Femur

    PubMed Central

    Kazemi, Seyyed Morteza; Qoreishy, Mohamad; Keipourfard, Ali; Sajjadi, Mohammadreza Minator; Shokraneh, Shahram

    2016-01-01

    Background: Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF), intertrochanteric (ITF) and Subtrochanteric (STF) fractures. Methods: In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group). Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL), diameter of femoral head (FHD), diameter of femoral neck (FND), femoral head neck offset (FHNO), neck-shaft angle (alpha), femoral neck anteversion (beta) were measured and compared in all three groups. Results: Amount of FNL was significantly higher in STF group compared to FNF (0.011) while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference. Conclusion: Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men. PMID:27517071

  20. The management of fractures of the hip.

    PubMed

    Wicker, P

    Proximal femoral fractures are a common reason for admission to orthopaedic units, and one which may become even more regular as the population ages. Despite this, newcomers to the orthopaedic arena, such as nursing students, may be confused when faced by different hip fractures and the treatments which may be offered. This article seeks to clarify some of these points by outlining the anatomy of the proximal femoral region, various common fractures, the treatments available to the surgeon and aspects of nursing care associated with the pre and post operative phases of the patient's care.

  1. Femoral neck non-union treatment by valgus intertrochanteric osteotomy

    PubMed Central

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT OBJECTIVE : The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union. METHODS : Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS : Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis). CONCLUSIONS : Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study. PMID:27057146

  2. [Risk of infection in centro-medullary locking nailing of open fractures of the femur and tibia].

    PubMed

    Jenny, J Y; Jenny, G; Gaudias, J; Kempf, I

    1995-01-01

    Intramedullary reamed locking nail of open fractures remains controversial because of the risk of infection. 1,474 closed reamed locked nailings were performed between 1974 and 1989 for femoral (744 cases) or tibial (730 cases) fractures. 349 fractures were open: 100 femoral fractures (51 Gustilo and Anderson Grade I and 49 Grade II) and 249 tibial fractures (140 Grade I, 99 Grade II et 10 Grade III). 24 femoral (3.2%) and 46 tibial (6.3%) nails were followed by infection. This difference is significant (p < 0.01). Reoperations for infection occur more frequently for femoral than tibial fractures (p < 0.05). There is no difference between the results of infection treatment between femoral or tibial fractures. Traumatic opening of the femoral fracture site does not affect the occurrence of an infection, its severity or the results of its treatment. Traumatic opening of the tibial fracture site significantly increases the infection rate (p < 0.001), and the incidence of infection increases with the severity of the soft tissue lesions; but the severity of the infection and the results of its treatment are not modified. Acute closed reamed intramedullary locking nail is the best treatment for open femoral or tibial fractures with respect to the bone healing and infection rate for Grade I and II fractures. For Grade III fractures, nailing must be followed by a coverage flap. PMID:8623602

  3. Biomechanical Consequences of Anterior Femoral Notching in Cruciate-Retaining Versus Posterior-Stabilized Total Knee Arthroplasty.

    PubMed

    Jethanandani, Rishabh; Patwary, Mahbubul B; Shellito, Adam D; Meehan, John P; Amanatullah, Derek F

    2016-01-01

    Anterior femoral notching during total knee arthroplasty is a potential risk factor for periprosthetic supracondylar femur fracture. We conducted a study to determine if the design of the femoral implant changes the risk for periprosthetic supracondylar femur fractures after anterior cortical notching. An anterior cortical defect was created in 12 femoral polyurethane models. Six femora were instrumented with cruciate-retaining implants and 6 with posterior-stabilized implants. Each femur was loaded in external rotation along the anatomical axis. Notch depth and distance from anterior cortical notch to implant were recorded before loading, and fracture pattern was recorded after failure. There were no statistically significant differences in notch depth, distance from notch to implant, torsional stiffness, torque at failure, final torque, or fracture pattern between cruciate-retaining and posterior-stabilized femoral component designs. Periprosthetic fracture after anterior femoral notching is independent of the bone removed from the intercondylar notch. After notching, there likely is no significant difference in femoral strength in torsion between cruciate-retaining and posterior-stabilized designs.

  4. Biomechanical Consequences of Anterior Femoral Notching in Cruciate-Retaining Versus Posterior-Stabilized Total Knee Arthroplasty.

    PubMed

    Jethanandani, Rishabh; Patwary, Mahbubul B; Shellito, Adam D; Meehan, John P; Amanatullah, Derek F

    2016-01-01

    Anterior femoral notching during total knee arthroplasty is a potential risk factor for periprosthetic supracondylar femur fracture. We conducted a study to determine if the design of the femoral implant changes the risk for periprosthetic supracondylar femur fractures after anterior cortical notching. An anterior cortical defect was created in 12 femoral polyurethane models. Six femora were instrumented with cruciate-retaining implants and 6 with posterior-stabilized implants. Each femur was loaded in external rotation along the anatomical axis. Notch depth and distance from anterior cortical notch to implant were recorded before loading, and fracture pattern was recorded after failure. There were no statistically significant differences in notch depth, distance from notch to implant, torsional stiffness, torque at failure, final torque, or fracture pattern between cruciate-retaining and posterior-stabilized femoral component designs. Periprosthetic fracture after anterior femoral notching is independent of the bone removed from the intercondylar notch. After notching, there likely is no significant difference in femoral strength in torsion between cruciate-retaining and posterior-stabilized designs. PMID:27552464

  5. Femoral approach to lead extraction.

    PubMed

    Mulpuru, Siva K; Hayes, David L; Osborn, Michael J; Asirvatham, Samuel J

    2015-03-01

    Laser and radiofrequency energy-assisted lead extraction has greatly facilitated this complex procedure. Although success rates are high, in some instances alternate methods of extraction are required. In this review, we discuss techniques for femoral extraction of implanted leads and retained fragments. The major tools available, including commonly used snares and delivery tools, are discussed. We briefly describe combined internal jugular and femoral venous extraction approaches, as well as complimentary utilization of more than one technique via the femoral vein. Animated and procedural sequences are included to help the reader visualize the key components of these techniques. PMID:25311643

  6. Spontaneous modular femoral head dissociation complicating total hip arthroplasty.

    PubMed

    Talmo, Carl T; Sharp, Kinzie G; Malinowska, Magdalena; Bono, James V; Ward, Daniel M; LaReau, Justin

    2014-06-01

    Modular femoral heads have been used successfully for many years in total hip arthroplasty. Few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. Although there has always been some concern over the potential for fretting, corrosion, and generation of particulate debris at the modular junction, this was not considered a significant clinical problem. More recently, concern has increased because fretting and corrosive debris have resulted in rare cases of pain, adverse local tissue reaction, pseudotumor, and osteolysis. Larger femoral heads, which have gained popularity in total hip arthroplasty, are suspected to increase the potential for local and systemic complications of fretting, corrosion, and generation of metal ions because of greater torque at the modular junction. A less common complication is dissociation of the modular femoral heads. Morse taper dissociation has been reported in the literature, mainly in association with a traumatic event, such as closed reduction of a dislocation or fatigue fracture of the femoral neck of a prosthesis. This report describes 3 cases of spontaneous dissociation of the modular prosthetic femoral head from the trunnion of the same tapered titanium stem because of fretting and wear of the Morse taper in a metal-on-polyethylene bearing. Continued clinical and scientific research on Morse taper junctions is warranted to identify and prioritize implant and surgical factors that lead to this and other types of trunnion failure to minimize complications associated with Morse taper junctions as hip implants and surgical techniques continue to evolve.

  7. Mechanical properties of femoral diaphysis and femoral neck of female rats chronically exposed to various levels of cadmium.

    PubMed

    Brzóska, M M; Majewska, K; Moniuszko-Jakoniuk, J

    2005-04-01

    The effect of chronic exposure to cadmium (Cd) on the mechanical properties of femoral diaphysis and femoral neck was investigated on a rat model of human exposure. Three-week-old female Wistar rats were exposed to Cd in drinking water at concentrations of 1, 5, 50, or 100 mg/L for 12 months. Biomechanical properties of the femoral diaphysis were evaluated in a three-point bending test and those of the femoral neck in a bending test with vertical loading of the head. Bone mineral content (BMC) and bone mineral density (BMD) at the whole femur, and BMD at the diaphysis and proximal femur (head and neck region) of the Cd-treated rats decreased in a dose-dependent manner, except for the diaphyseal BMD at a Cd concentration of 1 mg/L. Exposure to Cd concentrations of 1 and 5 mg/L had only little effect on the diaphyseal mechanical properties (decreased yield load with unchanged bending strength, stiffness, yield stress, ultimate stress, and Young modulus), whereas the bending strength and stiffness of the neck decreased and the yield load clearly tended to decline or declined. The effect of Cd at the two locations was more marked in the 50 and 100 mg/L groups, and changes in the bone geometry were observed in these animals. The results clearly revealed that chronic, even low-level, exposure to Cd results in demineralization and weakening of the femur. The femoral neck seems to be more vulnerable than the diaphysis to failure from Cd. We conclude that environmental exposure to Cd may be an important risk factor for femoral neck fracture.

  8. Uncemented custom femoral components in hip arthroplasty

    PubMed Central

    2010-01-01

    Background and purpose We have developed an individually designed, uncemented femoral component for achievement of improved strain distribution and fixation to the bone, to make uncemented stems more applicable in femurs of abnormal size and shape, and to improve the joint mechanics. Here we describe the design of the implant and present the results of a prospective clinical study with at least 7 years of follow-up. Patients and methods The prostheses are produced by CAD-CAM technique. The design of the stem is based on CT information, and the neck design is based on the surgeon's planning of the center of rotation, femoral head offset, and leg length correction. The first-generation stem produced before 2001 had a proximal HA coating and a sand-blasted distal part that was down-scaled to avoid contact with compact bone. The second-generation stem had a porous coating beneath the HA layer and the distal part of the stem was polished. The implant was used in 762 hips (614 patients) from 1995 until 2009. 191 of these hips were followed for 7 years and 83 others were followed for 10 years, and these hips are included in the present study. Mean age at surgery was 48 (20–65) years. Congenital dysplasia of the hip was the reason for osteoarthritis in 46% and 57% of the hips in respective groups. Merle d'Aubigné score was recorded in 152 and 75 hips in the two groups. Prostheses followed for 10 years, and almost all in the 7-year group, were first-generation stems. Results The 7- and 10-year cumulative revision rates were 1.1% and 2.4%, respectively, with stem revision for any reason as endpoint. The clinical results were similar at 7 and 10 years, with Merle d'Aubigné scores of 17. Intraoperative trochanteric fissures occurred in 2 of the 191 operations (1.0%); both healed after wiring. In hips followed for 7 years, 2 periprosthetic fractures occurred; exchange of the stem was necessary in both. One additional fracture occurred between 7 and 10 years, and it was

  9. [Severe fractures while driving a Segway personal transporter].

    PubMed

    Heiselberg, Svend Erik; Brink, Ole

    2014-07-21

    We present two cases of patients who sustained severe fractures while driving a Segway in an amusement park. The first, a 59-year-old man, had a displaced femoral neck fracture operated with three screws. After two and a half months he had a total hip replacement. After three weeks he had another re-placement due to infection. The second, a 26-year-old male, had a displaced femoral neck fracture operated with three screws. The fracture healed uneventfully. The Segway's legal position, in Denmark, is like bicycles. For statistics, we have specific codes for trauma with a Segway.

  10. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement

    PubMed Central

    Fantry, Amanda J.; Elia, Gregory; Vopat, Bryan G.; Daniels, Alan H.

    2015-01-01

    While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization. PMID:25874066

  11. Pain management: setting up a nurse-led femoral nerve block service.

    PubMed

    Layzell, Mandy

    Managing pain following a fractured neck of femur is challenging for a number of reasons. This group of patients are typically older people and frail with multiple co-morbidities and are often on numerous medications. In addition to a hip fracture, they commonly present with acute medical problems. Fractures cause significant pain, which can be difficult to manage safely and effectively with the traditional analgesics. A femoral nerve block has been shown to be a safe and effective preoperative intervention for managing pain in this patient group while they wait for surgery. This article describes how an acute pain team have developed protocols and training to establish a nurse-led service for providing preoperative femoral nerve blocks to patients with fractured neck of femur. PMID:17851357

  12. Acute compartment syndrome of the thigh secondary to isolated common femoral vessel injury: an unusual etiology.

    PubMed

    Davaine, Jean-Michel; Lintz, François; Cappelli, Marc; Chaillou, Philippe; Gouin, François; Patra, Philippe; Gouëffic, Yann

    2013-08-01

    We report a case of acute compartment syndrome of the thigh secondary to common femoral vessel injury. The lesion was associated with common femoral artery dissection and common femoral vein rupture. Emergency surgical treatment consisted of resection-anastomosis of the arterial dissection, vein ligature, and fasciotomies. The patient is symptom-free after 15 months of follow-up. Isolated vascular injury is an unusual cause of acute compartment syndrome of the thigh. This case serves to increase awareness that isolated vascular injury, without femoral fracture or multiple injury, can result in thigh compartment syndrome. Early recognition and treatment of vascular involvement contributes to better functional outcome of this rare condition, but treatment modalities remain subject to discussion.

  13. Femoral Condyles Tangential Views: An Effective Method to Detect the Screw Penetration of Femoral Condyles After Retrograde Nailing

    PubMed Central

    Zheng, Zhan-Le; Yu, Xian; Chen, Wei; Liu, Yue-Ju; Yu, Kun-Lun; Wu, Tao; Zhang, Ying-Ze

    2015-01-01

    Background: Postoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior (A-P) view in detecting distal locking screw penetrations during retrograde femoral nailing. Methods: The angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography (CT) images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were left 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not. Results: According to the results of CT scan, the lateral condyle view was 20.88 ± 0.98° and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% (lateral condyle screw) and 25.0% (medial condyle screw) at 4 mm, and 41.7% (lateral condyle screw) and 58.3% (medial condyle screw) at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 mm. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 mm. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths (2, 4, and 6 mm) compared with the A-P view (P < 0.05). Conclusions: The femoral condyles tangential

  14. Open reduction of a lateral femoral notch associated with an acute anterior cruciate ligament tear.

    PubMed

    Garth, W P; Wilson, T

    2001-10-01

    The lateral notch is a radiographic sign that describes a depression in the lateral femoral condyle near the terminal sulcus. The sign was first described in association with chronic instability in an anterior cruciate ligament-deficient knee. Recently, the senior author, after a prospective study, reported that these lateral notches might occur acutely at the time of anterior cruciate ligament injury. We report such a case in which the lateral femoral condylar depression fracture resulted in symptoms of lateral compartment incongruity. Open reduction and internal fixation were required. Anterior cruciate ligament reconstruction was performed as a staged procedure 2 months after fracture reduction. The postoperative result has been excellent for over 5 years. This case is an example that lateral femoral notches may be acute and a source of symptoms. In some cases, reduction and fixation of significant depressions in association with ligament reconstruction can alleviate these symptoms and may improve the patient's long-term result.

  15. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

    PubMed Central

    Hwang, Jin-Ho; Garg, Anant Kumar; Oh, Jong-Keon; Oh, Chang-Wug; Lee, Sung-Jae; Myung-Rae, Cho; Kim, Min-Keun; Kim, Hyun

    2012-01-01

    Objective: Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA). The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center) of the helical blade in the femoral head in unstable trochanteric fractures. Materials and Methods: Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C) group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C) group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failure Results: Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship. Conclusion: The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres. PMID:23325963

  16. Stress Fractures of the Pelvis and Legs in Athletes

    PubMed Central

    Behrens, Steve B.; Deren, Matthew E.; Matson, Andrew; Fadale, Paul D.; Monchik, Keith O.

    2013-01-01

    Context: Stress fractures are common injuries in athletes, often difficult to diagnose. A stress fracture is a fatigue-induced fracture of bone caused by repeated applications of stress over time. Evidence Acquisition: PubMed articles published from 1974 to January 2012. Results: Intrinsic and extrinsic factors may predict the risk of stress fractures in athletes, including bone health, training, nutrition, and biomechanical factors. Based on their location, stress fractures may be categorized as low- or high-risk, depending on the likelihood of the injury developing into a complete fracture. Treatment for these injuries varies substantially and must account for the risk level of the fractured bone, the stage of fracture development, and the needs of the patient. High-risk fractures include the anterior tibia, lateral femoral neck, patella, medial malleolus, and femoral head. Low-risk fractures include the posteromedial tibia, fibula, medial femoral shaft, and pelvis. Magnetic resonance is the imaging test of choice for diagnosis. Conclusions: These injuries can lead to substantial lost time from participation. Treatment will vary by fracture location, but most stress fractures will heal with rest and modified weightbearing. Some may require more aggressive intervention, such as prolonged nonweightbearing movement or surgery. Contributing factors should also be addressed prior to return to sports. PMID:24427386

  17. Arthroscopically confirmed femoral button deployment.

    PubMed

    Sonnery-Cottet, Bertrand; Rezende, Fernando C; Martins Neto, Ayrton; Fayard, Jean M; Thaunat, Mathieu; Kader, Deiary F

    2014-06-01

    The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means "one size fits all," thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications. PMID:25126492

  18. Arthroscopically confirmed femoral button deployment.

    PubMed

    Sonnery-Cottet, Bertrand; Rezende, Fernando C; Martins Neto, Ayrton; Fayard, Jean M; Thaunat, Mathieu; Kader, Deiary F

    2014-06-01

    The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means "one size fits all," thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications.

  19. Removal of well-fixed fixed femoral stems.

    PubMed

    Laffosse, J-M

    2016-02-01

    The removal of a well-fixed prosthetic stem raises technical challenges. The objective is not only to remove the material, but also to prepare the implantation of a new prosthesis. Cemented stems are only very rarely unremovable; extraction of the cement mantle and plug raises the greatest difficulties. The main risk is cortex perforation, and a radiograph should be obtained at the slightest doubt. The removal of cementless stems carries a higher risk of fracture. Difficulties should be anticipated based on thorough familiarity with the implant design and on evaluations of implant fixation and bone stock. The intramedullary approach is usually sufficient to extract a cemented or cementless, well fixed, standard stem. Routine use of a transfemoral approach is warranted only in the following situations: revision surgery for infection, S-shaped stem, long stem, curvature or angulation of the femoral shaft, or unfeasible hip dislocation. However, the possibility that the intramedullary approach may need to be converted to a transfemoral approach should be anticipated. Thus, preoperative planning must include determination of the optimal length of a femoral osteotomy or femoral flap, should one be needed, and the surgeon must have access to all the revision implants and tools that might be needed for re-implantation. Experience with the various techniques is indispensable, as a well-performed extensive approach is associated with less morbidity than a fracture or trajectory error. There are three main techniques, which are described here: intramedullary extraction of a cementless stem, intramedullary extraction of a cemented stem, and transfemoral extraction through an extended trochanterotomy. The patients should receive detailed information on the difficulties of femoral stem removal and on the available solutions. PMID:26797009

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

    PubMed

    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. Differences in Femoral Geometry and Structure Due to Immobilization

    NASA Technical Reports Server (NTRS)

    Kiratli, Beatrice Jenny; Yamada, M.; Smith, A.; Marcus, R. M.; Arnaud, S.; vanderMeulen, M. C. H.; Hargens, Alan R. (Technical Monitor)

    1996-01-01

    Reduction in bone mass of the lower extremity is well documented in individuals with paralysis resulting from spinal cord injury (SCI). The consequent osteopenia leads to elevated fracture risk with fractures occurring more commonly in the femoral shaft and supracondylar regions than the hip. A model has recently been described to estimate geometry and structure of the femoral midshaft from whole body scans by dual X-ray absorptiometry (DXA). Increases in femoral geometric and structural properties during growth were primarily related to mechanical loading as reflected by body mass. In this study, we investigate the relationship between body mass and femoral geometry and structure in adults with normal habitual mechanical loading patterns and those with severely reduced loading. The subjects were 78 ambulatory men (aged 20-72 yrs) and 113 men with complete paralysis from SCI of more than 4 years duration (aged 21 73 yrs). Subregional analysis was performed on DXA whole body scans to obtain bone mineral content (BMC, g), cortical thickness (cm), crosssectional moment of inertia (CSMI, cm4), and section modulus (cm3) of the femoral midshaft. All measured bone variables were significantly lower in SCI compared with ambulatory subjects: -29% (BMC), -33% (cortical thickness), -23% (CSMI), and -22% (section modulus) while body mass was not significantly different. However, the associations between body mass and bone properties were notably different; r2 values were higher for ambulatory than SCI subjects in regressions of body mass on BMC (0.48 vs 0.20), CSMI (0.59 vs 0.32), and section modulus (0.59 vs 0.31). No association was seen between body mass and cortical thickness for either group. The greatest difference between groups is in the femoral cortex, consistent with reduced bone mass via endosteal expansion. The relatively lesser difference in geometric and structural properties implies that there is less effect on mechanical integrity than would be expected from

  2. Use of the F-Tool for the removal of a bent intramedullary femoral nail with a sagittal plane deformity.

    PubMed

    Heffernan, Michael J; Leclair, Walter; Li, Xinning

    2012-03-01

    Locked intramedullary nailing is the current standard of treatment for femoral shaft fractures and has low complication rates. Bent femoral intramedullary nails resulting from secondary trauma are rare and technically challenging. This article describes a case of a 36-year-old man who presented with a bent femoral intramedullary nail following a motorcross accident. The patient had a previous femoral shaft fracture treated with an intramedullary nail. Previous reports outlined methods to remove bent femoral nails through the fracture site and proximally; however, this article describes a novel technique combining the use of a Midas Rex MR7 high-speed burr (Medtronic, Minneapolis, Minnesota) and the F-Tool (Synthes, West Chester, Pennsylvania) to facilitate nail extraction.The patient was placed in the lateral decubitus position. After limited exposure at the fracture site, the intramedullary nail was weakened at the apex of the deformity with a Midas Rex MR7 high-speed burr. We then used the F-Tool to straighten the nail to facilitate removal through the original proximal insertion site. The F-Tool allows forces to be concentrated at the apex of the deformity and minimizes soft tissue damage. Additional advantages of our technique include limited exposure and the ability to remove the nail in 1 piece.

  3. Longitudinal stress fracture of the femur: A rare presentation

    PubMed Central

    Bilreiro, Carlos; Bahia, Carla; Castro, Miguel Oliveira e

    2016-01-01

    We present the case of an 80 year old woman with hip pain, caused by a longitudinal femoral insufficiency stress fracture, depicted with radiographs, CT and MR. This type of fracture is very rare, with only a few cases reported. We conducted a literature review and compared the findings with the present case. PMID:27069976

  4. Which Fractures Are Most Attributable to Osteoporosis?

    PubMed Central

    Warriner, Amy H.; Patkar, Nivedita M.; Curtis, Jeffrey R.; Delzell, Elizabeth; Gary, Lisa; Kilgore, Meredith; Saag, Kenneth G.

    2014-01-01

    Background Determining anatomic sites and circumstances under which a fracture may be a consequence of osteoporosis is a topic of ongoing debate and controversy that is important to both clinicians and researchers. Methods We conducted a systematic literature review and generated an evidence report on fracture risk based on specific anatomic bone sites as well as fracture diagnosis codes. Using the RAND/UCLA appropriateness process, we convened a multi-disciplinary panel of 11 experts who rated fractures according to their likelihood of being due to osteoporosis based on the evidence report. Fracture sites (as determined by ICD-CM codes) were stratified by four clinical risk factor categories based on age, sex, race/ethnicity (African- American and Caucasian) and presence or absence of trauma. Results Consistent with current clinical experience, the fractures rated most likely due to osteoporosis were the femoral neck, pathologic fractures of the vertebrae, and lumbar and thoracic vertebral fractures. The fractures rated least likely due to osteoporosis were open proximal humerus fractures, skull, and facial bones. The expert panel rated open fractures of the arm (except proximal humerus) and fractures of the tibia/fibula, patella, ribs, and sacrum as being highly likely due to osteoporosis in older Caucasian women but a lower likelihood in younger African American men. Conclusion Osteoporosis attribution scores for all fracture sites were determined by a multidisciplinary expert panel to provide an evidence-based continuum of the likelihood of a fracture being associated with osteoporosis. PMID:21130353

  5. The influence of hip rotation on femoral offset in plain radiographs

    PubMed Central

    Frink, Michael; Gulati, Aashish; Murray, David; Renkawitz, Tobias; Bücking, Benjamin; Ruchholtz, Steffen; Boese, Christoph Kolja

    2014-01-01

    Background and purpose Adequate restoration of femoral offset (FO) is critical for successful outcome after hip arthroplasty or fixation of hip fracture. Previous studies have identified that hip rotation influences the projected femoral offset (FOP) on plain anteroposterior (AP) radiographs, but the precise effect of rotation is unknown. Patients and methods We developed a novel method of assessing rotation-corrected femoral offset (FORC), tested its clinical application in 222 AP hip radiographs following proximal femoral nailing, and validated it in 25 cases with corresponding computed tomography (CT) scans. Results The mean FORC was 57 (29–93) mm, which differed significantly (p < 0.001) from the mean FOP 49 (22–65) mm and from the mean femoral offset determined by the standard method: 49 (23–66) mm. FORC correlated closely with femoral offset assessed by CT (FOCT); the Spearman correlation coefficient was 0.94 (95% CI: 0.88–0.97). The intraclass correlation coefficient for the assessment of FORC by AP hip radiographs correlating the repeated measurements of 1 observer and of 2 independent blinded observers was 1.0 and 1.0, respectively. Interpretation Hip rotation affects the FOP on plain AP radiographs of the hip in a predictable way and should be adequately accounted for. PMID:24954484

  6. Slipped Distal Femoral Epiphysis in Congenital Insensitivity to Pain

    PubMed Central

    Shaikh, M Javed; Rex, C; Vignesh, R; Chavan, Madhav

    2016-01-01

    Introduction: Congenital insensitivity to pain (CIP) is a rare disorder, and often presents to an orthopaedic surgeon as recurrent fractures, dislocations, pseudoarthrosis, osteomyelitis etc. Here, we report a case of congenital insensitivity to pain presenting with distal femoral physeal separation in a child. Case Report: A 12-year-old girl child came with complaints of limp while walking and swelling in the left knee for past 5 weeks. Mother gave a history that the girl is a known case of congenital insensitivity to pain with clear history of no pain on intramuscular injection since birth. She was born of consanguineous marriage and had no significant trauma, fever, other joint involvement or any features of rheumatism. On local examination, she had no bony tenderness, mild warmth, and moderate knee effusion with restricted range of movement. Plain radiograph showed epiphysiolysis of distal femur with widening of physis. Examination under anaesthesia demonstrated gross movement indicating lower femoral physeal separation. This unstable distal femoral epiphysis was treated under general anaesthesia with closed reduction, percutaneous cross pinning and above knee plaster cast. Conclusion: Congenital insensitivity to pain (CIP) is a rare disorder to diagnose. Emphasis is given on early diagnosis of orthopaedic problems and prompt treatment, educating parents and prevention of accidents. Physeal separation without significant trauma must prompt an orthopaedic surgeon to think about congenital insensitivity to pain as a differential diagnosis. PMID:27703943

  7. Aneurysmal femoral neck cyst: Report of a paediatric case and review of literature

    PubMed Central

    Ndour, Oumar; Boseba, Rodia; Damipi, Jacque Barre; Nibagora, Juvenal; Fall, Aimée Lakh Faye; Ngom, Gabriel; Ndoye, Mamadou

    2016-01-01

    The aneurysmal bone cyst (ABC) is a benign tumour of children and young adults. It represents approximately 1-2% of all bone tumours. The ABC may develop on all skeletal bones, but the proximal end of the femur is the most common location. The authors report a ABC femoral neck in a child of 13 years. This location is pretty special. Indeed, the fragility of the femoral neck due partly to the pathology itself and secondarily curettage requires a judicious attitude surgical (excisional curettage + bone graft + screw) to prevent the risk of high local recurrence and pathological fracture. PMID:27251662

  8. [Osteoporosis and fracture in rheumatoid arthritis].

    PubMed

    Norimatsu, H

    2001-05-01

    Patients with rheumatoid arthritis often have periarticular and generalized osteoporosis. Bone resorption develops through increased productions of cytokines and prostaglandines by synovium and bone. Important risk factors of osteoporosis are functional impairment, postmenopausal state, and corticosteroids usage. Osteoporotic fracture occurs at the spinal body, femoral neck, distal radius, and periprosthetic bone.

  9. Bilateral femur fractures associated with short-term bisphosphonate use.

    PubMed

    Rifai, Aiman; Pourtaheri, Sina; Carbone, Andrew; Callaghan, John J; Stadler, Chris M; Record, Nicole; Issa, Kimona

    2015-02-01

    Bisphosphonates are the most commonly prescribed drugs to treat osteoporosis because they have been proposed to prevent bone loss. Nevertheless, in up to 0.1% of patients, long-term use may cause atypical stress or insufficiency femoral fractures. Bilateral femoral shaft fractures have been reported after long-term use of bisphosphonates; however, there is limited evidence of the effect of short-term use. The current study reports a case of bilateral femoral fractures after a low-energy fall in a 56-year-old woman and provides a review of the literature on bilateral femoral shaft fractures after long-term use of bisphosphonates. Patients should be educated about the potential for stress fractures with the use of this treatment. In patients with thigh pain, a thorough history and physical examination, including the contralateral thigh, may be beneficial to detect bilateral traumatic or atypical stress fracture patterns. More studies with larger sample sizes are necessary to better identify patients who may be at risk for fracture, including histomorphometric evidence of low bone turnover in patients with unfortunate bilateral cases.

  10. Rotational osteoplasty and bioabsorbable polylactate pin fixation in Pipkin type 2 fracture with acute osteochondral defect: a case report.

    PubMed

    Maluta, Tommaso; Micheloni, Gian Mario; Sandri, Andrea; Regis, Dario; Costanzo, Alessandro; Magnan, Bruno

    2016-01-01

    Pipkin fractures are relative rare high-energy lesions characterized by an intra-articular fracture of the femoral head after posterior hip dislocation. Early anatomic reduction and stable fixation are the main goals of treatment. This case evaluates the outcome of managing Pipkin type 2 fracture with acute osteochondral defect of the femoral head using "rotational osteoplasty" and bioabsorbable polylactate pin fixation. 24-year-old male patient was involved in a motorcycle accident, suffering from a left hip fracture-dislocation, and pelvic Computed Tomography revealed a Pipkin type 2 lesion. An open urgent treatment was performed. After  anatomic reduction of the femoral head fragment a large osteochondral defect in the anterior-superior weight bearing surface was evident. The pattern of the fracture allowed us to perform a "rotational osteoplasty" including rotation of the femoral head fragment, to obtain an osteochondral cartilage congruence of the anterior-superior surface. Stable fixation was obtained by three bioabsorbable polylactate pins. At four-year follow up the patient had an excellent outcome and Magnetic Resonance Imaging (MRI) showed fracture healing, minimal signs of arthritis, excluding osteonecrosis of the femoral head. The reported case confirms that Pipkin fractures are very insidious surgical urgencies. In selected cases, "rotational osteoplasty" may be an alternative to osteochondral transplant for acute osteochondral defect of the femoral head. Bioabsorbable polylactate pin fixation allowed us to have a stable fixation evaluating the bone healing process and vitality of femoral head by MRI. PMID:27104330

  11. Association of ABO blood group with fracture pattern and mortality in hip fracture patients

    PubMed Central

    Smith, RP; Khan, A; Aghedo, D; Venkatesan, M

    2014-01-01

    Introduction The mechanism of falling has been proposed as the exclusive explanation for hip fracture pattern. Evidence exists that other genetic factors also influence proximal femoral fracture configuration. The ABO blood group serotype has been associated with other pathologies but any role in hip fracture has yet to be definitively characterised. Methods Our National Hip Fracture Database was interrogated over a four-year period. All patients had their blood group retrieved, and this was compared with hip fracture pattern and mortality rates. Confounding factors were accounted for using logistic regression and the Cox proportional hazards model. Results A total of 2,987 consecutive patients presented to our institution. Those with blood group A were significantly more likely to sustain intracapsular fractures than ‘non-A’ individuals (p=0.009). The blood group distribution of patients with intracapsular fractures was identical to that of the national population of England. However, blood group A was less common in patients with intertrochanteric fractures than in the general population (p=0.0002). Even after correction for age and sex, blood group A was associated with a decrease in the odds of suffering an intertrochanteric fracture to 80% (p=0.002). Blood group A had inferior survivorship correcting for age, sex and hip fracture pattern (hazard ratio: 1.14, p=0.035). This may be due to associated increased prevalence of co-morbid disease in this cohort. Conclusions Blood group is an independent predictor of hip fracture pattern, with group A patients more likely to sustain an intracapsular fracture and non-A individuals more likely to sustain an intertrochanteric fracture. The determinants of fracture pattern are likely to be related to complex interactions at a molecular level based on genetic susceptibility. The mechanism of fall may not be the only aetiological determinant of proximal femoral fracture configuration. PMID:25198976

  12. Arthroplasty in Femoral Head Osteonecrosis

    PubMed Central

    Nam, Dong Cheol; Jung, Kwangyoung

    2014-01-01

    Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head. PMID:27536561

  13. Evaluation of radiation resistance of the bacterial contaminants from femoral heads processed for allogeneic transplantation

    NASA Astrophysics Data System (ADS)

    Singh, Rita; Singh, Durgeshwer

    2009-09-01

    Femoral heads excised during surgery were obtained from patients who had a fractured neck of the femur and were processed as bone allograft. The bacterial contaminants were isolated from femoral heads at different stages of processing and identified based on morphological characteristics and biochemical tests. Bacterial contaminants on bone were mainly Gram-positive bacilli and cocci (58.3%). Twenty-four isolates from bone samples were screened for resistance to radiation. The D10 values for Gram-negative bacteria isolated from femoral heads ranged from 0.17 to 0.65 kGy. Higher D10 values 0.56-1.04 kGy were observed for Gram-positive bacterial isolates.

  14. Survivorship and Complications of Revision Total Hip Arthroplasty with a Mid-Modular Femoral Stem.

    PubMed

    Riesgo, Aldo M; Hochfelder, Jason P; Adler, Edward M; Slover, James D; Specht, Lawrence M; Iorio, Richard

    2015-12-01

    We retrospectively reviewed 161 revision THAs with diaphyseal fitting, mid-modular femoral components performed by ten surgeons at two academic medical centers. The average follow-up was 6.1 years. At final follow-up, 4 patients required re-revision for failure of the femoral component; 3 (2%) for aseptic loosening and 1 for mechanical failure of stem in setting of periprosthetic fracture. There were a total of 24 (14.9%) revisions for any reason, with the most common reason being septic failure (10 of 24). To our knowledge, this is the largest reported series of mid-term survivorship and complications of revision THA with mid-modular femoral components. Our results show that these stems have a low rate of aseptic loosening, subsidence, and mechanical failure.

  15. The importance of previous fracture site on osteoporosis diagnosis and incident fractures in women.

    PubMed

    Morin, Suzanne N; Lix, Lisa M; Leslie, William D

    2014-07-01

    Previous fracture increases the risk of subsequent fractures regardless of the site of the initial fracture. Fracture risk assessment tools have been developed to guide clinical management; however, no discrimination is made as to the site of the prior fracture. Our objective was to determine which sites of previous nontraumatic fractures are most strongly associated with a diagnosis of osteoporosis, defined by a bone mineral density (BMD) T-score of ≤ -2.5 at the femoral neck, and an incident major osteoporotic fracture. Using administrative health databases, we conducted a retrospective historical cohort study of 39,991 women age 45 years and older who had BMD testing with dual-energy X-ray absorptiometry (DXA). Logistic regression and Cox proportional multivariate models were used to test the association of previous fracture site with risk of osteoporosis and incident fractures. Clinical fractures at the following sites were strongly and independently associated with higher risk of an osteoporotic femoral neck T-score after adjustment for age: hip (odds ratio [OR], 3.58; 95% confidence interval [CI], 3.04-4.21), pelvis (OR, 2.23; 95% CI, 1.66-3.0), spine (OR, 2.16; 95% CI, 1.77-2.62), and humerus (OR, 1.74; 95% CI, 1.49-2.02). Cox proportional hazards models, with adjustment for age and femoral neck BMD, showed the greatest increase in risk for a major osteoporotic fracture for women who had sustained previous fractures of the spine (hazard ratio [HR], 2.08; 95% CI, 1.72-2.53), humerus (HR, 1.70; 95% CI, 1.44-2.01), patella (HR, 1.54; 95% CI, 1.10-2.18), and pelvis (HR, 1.45; 95% CI, 1.04-2.02). In summary, our results confirm that nontraumatic fractures in women are associated with osteoporosis at the femoral neck and that the site of previous fracture impacts on future osteoporotic fracture risk, independent of BMD.

  16. Prevalence of exclusively and concomitant pelvic fractures at magnetic resonance imaging of suspect and occult hip fractures.

    PubMed

    Collin, David; Geijer, Mats; Göthlin, Jan H

    2016-02-01

    Pelvic fractures may occur together with hip fractures as a result of low energy trauma. It is unclear whether they do require special attention. There are conflicting results in the literature about the prevalence of both concomitant hip and pelvic fractures as well as exclusive pelvic fractures. It has been reported that hip fractures and obturator ring fractures are mutually exclusive. To retrospectively analyze the prevalence of exclusively pelvic as well as concomitant hip and pelvic fractures in patients examined with MRI after low-energy trauma in elderly. During 9 years, 316 elderly patients had been examined with MRI for suspected or occult hip fracture after a fall. A fracture was diagnosed when MRI showed focal signal abnormalities in the subcortical bone marrow, with or without disruption of adjacent cortices. One observer reviewed all studies. A second observer verified all studies with hip fractures. Follow-up was available for all but two patients that died prior to hip surgery. The prevalence of concomitant pelvic and femoral neck or trochanteric fractures was statistically compared using chi-squared test for categorical variables. Hip fractures were found in 161 (51 %) patients of which 29 (9 %) had concomitant pelvic fractures. There were exclusively pelvic fractures in 82 (26 %) patients of which 65 (79 %) were on the traumatized side only. In 73 patients, there were no fractures. Occult or suspected hip fractures are not infrequently associated with pelvic fractures. Exclusively pelvic fractures are not uncommon.

  17. In vivo discrimination of hip fracture with quantitative computed tomography: results from the prospective European Femur Fracture Study (EFFECT).

    PubMed

    Bousson, Valérie Danielle; Adams, Judith; Engelke, Klaus; Aout, Mounir; Cohen-Solal, Martine; Bergot, Catherine; Haguenauer, Didier; Goldberg, Daniele; Champion, Karine; Aksouh, Redha; Vicaut, Eric; Laredo, Jean-Denis

    2011-04-01

    In assessing osteoporotic fractures of the proximal femur, the main objective of this in vivo case-control study was to evaluate the performance of quantitative computed tomography (QCT) and a dedicated 3D image analysis tool [Medical Image Analysis Framework--Femur option (MIAF-Femur)] in differentiating hip fracture and non-hip fracture subjects. One-hundred and seven women were recruited in the study, 47 women (mean age 81.6 years) with low-energy hip fractures and 60 female non-hip fracture control subjects (mean age 73.4 years). Bone mineral density (BMD) and geometric variables of cortical and trabecular bone in the femoral head and neck, trochanteric, and intertrochanteric regions and proximal shaft were assessed using QCT and MIAF-Femur. Areal BMD (aBMD) was assessed using dual-energy X-ray absorptiometry (DXA) in 96 (37 hip fracture and 59 non-hip fracture subjects) of the 107 patients. Logistic regressions were computed to extract the best discriminates of hip fracture, and area under the receiver characteristic operating curve (AUC) was calculated. Three logistic models that discriminated the occurrence of hip fracture with QCT variables were obtained (AUC = 0.84). All three models combined one densitometric variable--a trabecular BMD (measured in the femoral head or in the trochanteric region)--and one geometric variable--a cortical thickness value (measured in the femoral neck or proximal shaft). The best discriminant using DXA variables was obtained with total femur aBMD (AUC = 0.80, p = .003). Results highlight a synergistic contribution of trabecular and cortical components in hip fracture risk and the utility of assessing QCT BMD of the femoral head for improved understanding and possible insights into prevention of hip fractures.

  18. Outcomes following surgical treatment of periprosthetic femur fractures: a single centre series

    PubMed Central

    Holder, Natasha; Papp, Steve; Gofton, Wade; Beaulé, Paul E.

    2014-01-01

    Background Periprosthetic femoral fracture after total hip arthroplasty (THA) is an increasing clinical problem and a challenging complication to treat surgically. The aim of this retrospective study was to review the treatment of periprosthetic fractures and the complication rate associated with treatment at our institution. Methods We reviewed the cases of patients with periprosthetic femoral fractures treated between January 2004 and June 2009. We used the Vancouver classification to assess fracture types, and we identified the surgical interventions used for these fracture types and the associated complications. Results We treated 45 patients with periprosthetic femoral fractures during the study period (15 men, 30 women, mean age 78 yr). Based on Vancouver classification, 2 patients had AL fractures, 9 had AG, 15 had B1, 24 had B2, 2 had B3 and 4 had C fractures. Overall, 82% of fractures united with a mean time to union of 15 (range 2–64) months. Fourteen patients (31%) had complications; 11 of them had a reoperation: 6 to treat an infection, 6 for nonunion and 2 for aseptic femoral component loosening. Conclusion Periprosthetic fractures are difficult to manage. Careful preoperative planning and appropriate intraoperative management in the hands of experienced surgeons may increase the chances of successful treatment. However, patients should be counselled on the high risk of complications when presenting with this problem. PMID:24869614

  19. Intraoperative cone-beam CT for correction of periaxial malrotation of the femoral shaft: A surface-matching approach

    SciTech Connect

    Khoury, Amal; Whyne, Cari M.; Daly, Michael; Moseley, Douglas; Bootsma, Greg; Skrinskas, Tomas; Siewerdsen, Jeffrey; Jaffray, David

    2007-04-15

    Limb length, alignment and rotation can be difficult to determine in femoral shaft fractures. Shaft axis rotation is particularly difficult to assess intraoperatively. Femoral malpositioning can cause deformity, pain and secondary degenerative joint damage. The aim of this study is to develop an intraoperative method based on cone-beam computed tomography (CBCT) to guide alignment of femoral shaft fractures. We hypothesize that bone surface matching can predict malrotation even with severe comminution. A cadaveric femur was imaged at 16 femoral periaxial malrotations (-51.2 deg. to 60.1 deg.). The images were processed resulting in an unwrapped bone surface plot consisting of a pattern of ridges and valleys. Fracture gaps were simulated by removing midline CT slices. The gaps were reconstituted by extrapolating the existing proximal and distal fragments to the midline of the fracture. The two bone surfaces were then shifted to align bony features. Periaxial malrotation was accurately assessed using surface matching (r{sup 2}=0.99, slope 1.0). The largest mean error was 2.20 deg. and the average difference between repeated measurements was 0.49 deg. CBCT can provide intraoperative high-resolution images with a large field of view. This quality of imaging enables surface matching algorithms to be utilized even with large areas of comminution.

  20. Radiohumeral synostosis, femoral bowing, other skeletal anomalies and anal atresia, a variant example of Antley-Bixler syndrome?

    PubMed

    Antich, J; Iriondo, M; Lizarraga, I; Manzanares, R; Cusi, V

    1993-01-01

    We report a newborn with radiohumeral synostosis, femoral bowing, anal atresia, a prominent nose (pear shaped nose), slender ribs, long tapering fingers with distal camptodactyly, genital hypoplasia and a neonatal humeral fracture. Among the possible differential diagnoses a variant example of Antley-Bixler syndrome is considered to be the most likely final diagnosis.

  1. Repairing Femoral Fractures: A Model Lesson in Biomaterial Science

    ERIC Educational Resources Information Center

    Sakakeeny, Jarred

    2006-01-01

    Biomaterial science is a rapidly growing field that has scientists and doctors searching for new ways to repair the body. A merger between medicine and engineering, biomaterials can be complex subject matter, and it can certainly capture the minds of middle school students. In the lesson described in this article, seventh graders generally learn…

  2. [A femoral neck fracture and a kidney transplantation in Egypt].

    PubMed

    Barnard, H

    1999-11-01

    The mother of an Egyptian friend of the author is admitted to Asyut University Hospital after breaking her hip. A number of direct relatives spend the night in her hospital room and discuss the situation with the surgeon the next day. They are subsequently sent out to buy an artificial joint, and to bring the fee for the operation. The 2000 Egyptian Pounds which is claimed for this is later, during the operation, increased by 500 Egyptian Pounds, equivalent to about 150 US dollars. This is relatively cheap compared with the kidney transplant of another relative, which amounted to 40,000 Egyptian Pounds. Most of this money was used to pay the donor, since Egyptian law only allows the transplantation of organs from living donors.

  3. Epidemiology of fractures in people with severe and profound developmental disabilities

    USGS Publications Warehouse

    Glick, N.R.; Fischer, M.H.; Heisey, D.M.; Leverson, G.E.; Mann, D.C.

    2005-01-01

    Fractures are more prevalent among people with severe and profound developmental disabilities than in the general population. In order to characterize the tendency of these people to fracture, and to identify features that may guide the development of preventive strategies, we analyzed fracture epidemiology in people with severe and profound developmental disabilities who lived in a stable environment. Data from a 23-year longitudinal cohort registry of 1434 people with severe and profound developmental disabilities were analyzed to determine the effects of age, gender, mobility, bone fractured, month of fracture, and fracture history upon fracture rates. Eighty-five percent of all fractures involved the extremities. The overall fracture rate increased as mobility increased. In contrast, femoral shaft fracture risk was substantially higher in the least mobile [relative risk (RR), 10.36; 95% confidence interval (CI), 3.29-32.66] compared with the most mobile group. Although the overall fracture rate was not associated with age, the femoral shaft fractures decreased but hand/foot fractures increased with age. Overall fracture risk declined in August and September (RR, 0.70; 95% CI, 0.55-0.89), being especially prominent for tibial/fibular fractures (RR, 0.31; 95% CI, 0.13-0.70). Gender was not a factor in fracture risk. Two primary fracture mechanisms are apparent: one, largely associated with lack of weight-bearing in people with the least mobility, is exemplified by femoral fractures during non-traumatic events as simple as diapering or transfers; the other, probably due to movement- or fall-related trauma, is exemplified by hand/foot fractures in people who ambulate. The fracture experience of people with severe and profound developmental disabilities is unique and, because it differs qualitatively from postmenopausal osteoporosis, may require population-specific methods for assessing risk, for improving bone integrity, and for reduction of falls and accidents

  4. [Aseptic necrosis of the femoral head in young adults].

    PubMed

    Vasey, H M

    1984-01-01

    their advocates. After fracture of the subchondral bone plate has occurred, there is evidence that grafts are unable to restore the strength of the necrotic area. Intertrochanteric osteotomy brings under the main load-bearing zone a vital part of the femoral head. Varus osteotomy can be successful if necrosis has spared sufficient of the lateral portion of the head. Rotation osteotomies, as proposed by Sugioka, are more radical and difficult operations. The published results are promising. Revascularisation of the weight-bearing area by pedicle grafts has been attempted, alone or in addition to osteotomy.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6386708

  5. The femoral sulcus in total knee arthroplasty.

    PubMed

    Lingaraj, Krishna; Bartlett, John

    2009-05-01

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

  6. Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients§

    PubMed Central

    Kumar, G.N. Kiran; Sharma, Gaurav; Khatri, Kavin; Farooque, Kamran; Lakhotia, Devendra; Sharma, Vijay; Meena, Sanjay

    2015-01-01

    Introduction: Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures. Materials and Methods: We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35 -90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement. Results: The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain. Conclusion: We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications. PMID:27468839

  7. FRACTURE PROPAGATION PROPENSITY OF CERAMIC LINERS DURING IMPINGEMENT-SUBLUXATION

    PubMed Central

    Elkins, Jacob M.; Pedersen, Douglas R.; Callaghan, John J.; Brown, Thomas D.

    2011-01-01

    Although improvements in materials engineering have greatly reduced fracture rates in ceramic femoral heads, concerns still exist for liners. Ceramics are vulnerable fracture due to impact, and from stress concentrations (point and line loading) such as those associated with impingement-subluxation. Thus, ceramic cup fracture propensity is presumably very sensitive to surgical cup positioning. A novel fracture mechanics finite element formulation was developed to identify cup orientations most susceptible to liner fracture propagation, for several impingement-prone patient maneuvers. Other factors being equal, increased cup inclination and increased anteversion were found to elevate fracture risk. Squatting, stooping and leaning shoe-tie maneuvers were associated with highest fracture risk. These results suggest that fracture risk can be reduced by surgeons’ decreasing cup abduction and by patients’ avoiding of specific activities. PMID:21855277

  8. Can martial arts techniques reduce fall severity? An in vivo study of femoral loading configurations in sideways falls.

    PubMed

    van der Zijden, A M; Groen, B E; Tanck, E; Nienhuis, B; Verdonschot, N; Weerdesteyn, V

    2012-06-01

    Sideways falls onto the hip are a major cause of femoral fractures in the elderly. Martial arts (MA) fall techniques decrease hip impact forces in sideways falls. The femoral fracture risk, however, also depends on the femoral loading configuration (direction and point of application of the force). The purpose of this study was to determine the effect of fall techniques, landing surface and fall height on the impact force and the loading configuration in sideways falls. Twelve experienced judokas performed sideways MA and Block ('natural') falls on a force plate, both with and without a judo mat on top. Kinematic and force data were analysed to determine the hip impact force and the loading configuration. In falls from a kneeling position, the MA technique reduced the impact force by 27%, but did not change the loading configuration. The use of the mat did not change the loading configuration. Falling from a standing changed the force direction. In all conditions, the point of application was distal and posterior to the greater trochanter, but it was less distal and more posterior in falls from standing than from kneeling position. The present decrease in hip impact force with an unchanged loading configuration indicates the potential protective effect of the MA technique on the femoral fracture risk. The change in loading configuration with an increased fall height warrant further studies to examine the effect of MA techniques on fall severity under more natural fall circumstances.

  9. Genetic Contribution of Femoral Neck Bone Geometry to the Risk of Developing Osteoporosis: A Family-Based Study

    PubMed Central

    Malouf, Jorge; Laiz, Ana; Marin, Ana; Herrera, Silvia; Farrerons, Jordi; Soria, Jose Manuel; Casademont, Jordi

    2016-01-01

    Femoral neck geometry parameters are believed to be as good as bone mineral density as independent factors in predicting hip fracture risk. This study was conducted to analyze the roles of genetic and environmental factors in femoral properties measured in a sample of Spanish families with osteoporotic fractures and extended genealogy. The “Genetic Analysis of Osteoporosis (GAO) Project” involved 11 extended families with a total number of 376 individuals. We studied three categorical phenotypes of particular clinical interest and we used a Hip structural analysis based on DXA to analyze 17 strength and geometrical phenotypes of the hip. All the femoral properties had highly significant heritability, ranging from 0.252 to 0.586. The most significant correlations were observed at the genetic level (ρG). Osteoporotic fracture status (Affected 2) and, particularly, low bone mass and osteoporotic condition (Affected 3) had the highest number of significant genetic correlations with diverse femoral properties. In conclusion, our findings suggest that a relatively simple and easy to use method based on DXA studies can provide useful data on properties of the Hip in clinical practice. Furthermore, our results provide a strong motivation for further studies in order to improve the understanding of the pathophysiological mechanism underlying bone architecture and the genetics of osteoporosis. PMID:27163365

  10. Genetic Contribution of Femoral Neck Bone Geometry to the Risk of Developing Osteoporosis: A Family-Based Study.

    PubMed

    Hernandez-de Sosa, Nerea; Athanasiadis, Georgios; Malouf, Jorge; Laiz, Ana; Marin, Ana; Herrera, Silvia; Farrerons, Jordi; Soria, Jose Manuel; Casademont, Jordi

    2016-01-01

    Femoral neck geometry parameters are believed to be as good as bone mineral density as independent factors in predicting hip fracture risk. This study was conducted to analyze the roles of genetic and environmental factors in femoral properties measured in a sample of Spanish families with osteoporotic fractures and extended genealogy. The "Genetic Analysis of Osteoporosis (GAO) Project" involved 11 extended families with a total number of 376 individuals. We studied three categorical phenotypes of particular clinical interest and we used a Hip structural analysis based on DXA to analyze 17 strength and geometrical phenotypes of the hip. All the femoral properties had highly significant heritability, ranging from 0.252 to 0.586. The most significant correlations were observed at the genetic level (ρG). Osteoporotic fracture status (Affected 2) and, particularly, low bone mass and osteoporotic condition (Affected 3) had the highest number of significant genetic correlations with diverse femoral properties. In conclusion, our findings suggest that a relatively simple and easy to use method based on DXA studies can provide useful data on properties of the Hip in clinical practice. Furthermore, our results provide a strong motivation for further studies in order to improve the understanding of the pathophysiological mechanism underlying bone architecture and the genetics of osteoporosis. PMID:27163365

  11. Bilateral Femoral Nutrient Foraminal Cement Penetration during Total Hip Arthroplasty

    PubMed Central

    Coomber, Ross; Bhumbra, Rej S; Marston, Robert

    2012-01-01

    Introduction: Cement pressurisation is important for the insertion of both the acetabular and femoral components during Total Hip Arthroplasty (THA). Secondary to pressurization the rare phenomenon of unilateral cement incursion into the nutrient foramen has previously been reported. No bilateral case has been reported to date. This has implications both for misdiagnosis of periprosthetic fractures and for medico-legal consequences due to a presumed adverse intra-operative event. Case Report: We present a case report of a 59 year old, caucasian female who underwent staged bilateral cemented Stanmore THA. The post-operative radiographs demonstrate evidence of bilateral nutrient foramen penetration intra-operatively by standard viscosity cement. The patient suffered no adverse consequences. Conclusions: In summary, cement extravasation into the nutrient foramen is an important differential to be considered in presence of posterior-medial cement in the diaphysis of femur following THA. This requires no further intervention and has no effect on the outcome.

  12. Unilateral Isolated Proximal Femoral Focal Deficiency

    PubMed Central

    Doğer, Emek; Köpük, Şule Y.; Çakıroğlu, Yiğit; Çakır, Özgür; Yücesoy, Gülseren

    2013-01-01

    Objective. To discuss a patient with a prenatal diagnosis of unilateral isolated femoral focal deficiency. Case. Antenatal diagnosis of unilateral isolated femoral focal deficiency was made at 20 weeks of gestation. The length of left femur was shorter than the right, and fetal femur length was below the fifth percentile. Proximal femoral focal deficiency was diagnosed. After delivery, the diagnosis was confirmed with skeletal radiographs and magnetic resonance imaging. In prenatal ultrasonographic examination, the early recognition and exclusion of skeletal dysplasias is important; moreover, treatment plans should be initiated, and valuable information should be provided to the family. PMID:23984135

  13. Total hip arthroplasty for acute acetabular fractures: a review of the literature.

    PubMed

    Jauregui, Julio J; Clayton, Adrian; Kapadia, Bhaveen H; Cherian, Jeffrey J; Issa, Kimona; Mont, Michael A

    2015-05-01

    There have been many advances in the treatment of acetabular fractures; however, the role of total hip arthroplasty (THA) as part of acute fracture management is not well-defined. The indications to acutely manage an acetabular fracture with THA include patients who were older than 65 years of age, who had extensive intra-articular comminution, impaction of the acetabular dome, a displaced-impacted femoral neck fracture, presented with severe osteopenia or osteoporosis, or preexisting osteoarthritis. Implant survivorship and clinical outcomes were favorable with low complications when managing an acetabular fracture with THA. THA may be an effective option for treating acetabular fractures in appropriately selected patients.

  14. Meralgia Paresthetica and Femoral Acetabular Impingement: A Possible Association

    PubMed Central

    Ahmed, Aiesha

    2010-01-01

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Keywords Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies PMID:22043261

  15. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options.

    PubMed

    Matcuk, George R; Mahanty, Scott R; Skalski, Matthew R; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J

    2016-08-01

    Stress fracture, in its most inclusive description, includes both fatigue and insufficiency fracture. Fatigue fractures, sometimes equated with the term "stress fractures," are most common in runners and other athletes and typically occur in the lower extremities. These fractures are the result of abnormal, cyclical loading on normal bone leading to local cortical resorption and fracture. Insufficiency fractures are common in elderly populations, secondary to osteoporosis, and are typically located in and around the pelvis. They are a result of normal or traumatic loading on abnormal bone. Subchondral insufficiency fractures of the hip or knee may cause acute pain that may present in the emergency setting. Medial tibial stress syndrome is a type of stress injury of the tibia related to activity and is a clinical syndrome encompassing a range of injuries from stress edema to frank-displaced fracture. Atypical subtrochanteric femoral fracture associated with long-term bisphosphonate therapy is also a recently discovered entity that needs early recognition to prevent progression to a complete fracture. Imaging recommendations for evaluation of stress fractures include initial plain radiographs followed, if necessary, by magnetic resonance imaging (MRI), which is preferred over computed tomography (CT) and bone scintigraphy. Radiographs are the first-line modality and may reveal linear sclerosis and periosteal reaction prior to the development of a frank fracture. MRI is highly sensitive with findings ranging from periosteal edema to bone marrow and intracortical signal abnormality. Additionally, a brief description of relevant clinical management of stress fractures is included.

  16. Flows In Model Human Femoral Arteries

    NASA Technical Reports Server (NTRS)

    Back, Lloyd H.; Kwack, Eug Y.; Crawford, Donald W.

    1990-01-01

    Flow is visualized with dye traces, and pressure measurements made. Report describes experimental study of flow in models of human femoral artery. Conducted to examine effect of slight curvature of artery on flow paths and distribution of pressure.

  17. Neonatal skeletal fractures. Birth trauma or child abuse?

    PubMed

    Cumming, W A

    1979-03-01

    When a fracture is discovered in a newborn infant, it is important to decide whether it occurred at birth or after birth. Calcification around the fracture site gives a useful estimate of the age of the fracture. We reviewed films of 23 patients with fractures resulting from delivery. The fractures occurred at three different sites: the clavicle, the humerus, and the femur. Calcification could be seen as early as seven days after birth and was absent for as long as 11 days after birth. Six of seven femoral fractures occurred in infants with neuromuscular problems. Fracture at an unusual site or absence of calcification after 11 days should alert the radiologist to the possibility of abuse.

  18. Femoral Bone Plug in Total Knee Replacement.

    PubMed

    Vulcano, Ettore; Regazzola, Gianmarco M V; Murena, Luigi; Ronga, Mario; Cherubino, Paolo; Surace, Michele F

    2015-10-01

    The intramedullary alignment guides used in total knee replacement disrupt the intramedullary vessels, resulting in greater postoperative blood loss. The use of an autologous bone plug to seal the intramedullary femoral canal has been shown to be effective in reducing postoperative bleeding. The authors present a simple technique to create a bone plug from the anterior chamfer femoral cut to perfectly seal the intramedullary canal of the femur. PMID:26488774

  19. Investigation of a fatigue failure in a stainless steel femoral plate.

    PubMed

    Marcomini, J B; Baptista, C A R P; Pascon, J P; Teixeira, R L; Reis, F P

    2014-10-01

    Surgical implants are exposed to severe working conditions and therefore a wide range of failure mechanisms may occur, including fatigue, corrosion, wear, fretting and combinations of them. The mechanical failures of metallic implants may also be influenced by several other factors, including the design, material, manufacturing, installation, postoperative complications and misuse. An 83-year-old patient suffered an oblique femoral shaft fracture due to a fall at home. A stainless steel locking compression plate (LCP) employed in the fracture reduction failed after four months and was sent back to the producer. A second LCP of the same type was implanted and also failed after six months. A failure analysis of the second femoral LCP is performed in this paper. The results demonstrate that poor material quality was decisive to the failure. The chemical analysis revealed a high P content in the steel, which is not in accordance to the standards. A combination of factors lead to LCP fracture and these include: brittle crack initiation due to phosphorus, segregation at grain boundaries, crack propagation due to cyclic loading and final fast fracture favored by the loss of ductility due to cold work. PMID:25023519

  20. Role of Fracture and Repair Type on Pain and Opioid Use After Hip Fracture in the Elderly

    PubMed Central

    Strike, Sophia A.; Sieber, Frederick E.; Gottschalk, Allan; Mears, Simon C.

    2013-01-01

    Background and Purpose: Pain after hip fracture repair is related to worse functional outcomes and higher fracture care costs than that for patients with no or less pain. However, to our knowledge, few studies have examined the roles of hip fracture type or surgical procedure as factors influencing postoperative pain or opioid analgesic requirements. Our goal was to determine whether the type of hip fracture or hip fracture repair affects postoperative pain or opioid analgesic requirements in the elderly patient. Methods: We conducted a retrospective review of 231 patients ≥65 years old admitted to a hip fracture center for surgical repair. Fracture patterns were classified into femoral neck (FN) versus intertrochanteric (IT), stable versus unstable, and type of surgical repair. Demographic and intraoperative variables, postoperative pain scores, and opioid analgesic use data were collected and analyzed according to the type of hip fracture and type of surgical repair. Results: There were no differences in postoperative pain when comparing FN versus IT fractures, stable versus unstable fractures, or type of surgical repair. Patients with FN fractures had higher analgesic requirements on postoperative days 1, 2, and 3. There was no difference in postoperative analgesic requirements among patients with stable versus unstable fractures or type of surgical repair. Otherwise, there were no differences in postoperative pain or opioid analgesic use based on the surgical repair or fracture type. Overall, patients with hip fracture experienced low levels of pain. PMID:24600530

  1. Elbow Fractures

    MedlinePlus

    ... and held together with pins and wires or plates and screws. Fractures of the distal humerus (see ... doctor. These fractures usually require surgical repair with plates and/or screw, unless they are stable. SIGNS ...

  2. The use of femoral struts and impacted cancellous bone allograft in patients with severe femoral bone loss who undergo revision total hip replacement: a three- to nine-year follow-up.

    PubMed

    Buttaro, M A; Costantini, J; Comba, F; Piccaluga, F

    2012-02-01

    We determined the midterm survival, incidence of peri-prosthetic fracture and the enhancement of the width of the femur when combining struts and impacted bone allografts in 24 patients (25 hips) with severe femoral bone loss who underwent revision hip surgery. The pre-operative diagnosis was aseptic loosening in 16 hips, second-stage reconstruction in seven, peri-prosthetic fracture in one and stem fracture in one hip. A total of 14 hips presented with an Endoklinik grade 4 defect and 11 hips a grade 3 defect. The mean pre-operative Merle D'Aubigné and Postel score was 5.5 points (1 to 8). The survivorship was 96% (95% confidence interval 72 to 98) at a mean of 54.5 months (36 to 109). The mean functional score was 17.3 points (16 to 18). One patient in which the strut did not completely bypass the femoral defect was further revised using a long cemented stem due to peri-prosthetic fracture at six months post-operatively. The mean subsidence of the stem was 1.6 mm (1 to 3). There was no evidence of osteolysis, resorption or radiolucencies during follow-up in any hip. Femoral width was enhanced by a mean of 41% (19% to 82%). A total of 24 hips had partial or complete bridging of the strut allografts. This combined biological method was associated with a favourable survivorship, a low incidence of peri-prosthetic fracture and enhancement of the width of the femur in revision total hip replacement in patients with severe proximal femoral bone loss.

  3. The epidemiology and treatment of femur fractures at a northern tanzanian referral centre

    PubMed Central

    Hollis, Alexander Conor; Ebbs, Samuel Robert; Mandari, Faiton Ndesanjo

    2015-01-01

    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 records in the orthopaedic department at Kilimanjaro Christian Medical Centre (KCMC) was performed. Patient demographics, aetiology of fractures, diagnosis and treatment were all recorded. Results A total of 540 consecutive patient admission records were reviewed over a 9 month period. Of these 540 cases, 213 (39%) were diagnosed with a femoral fracture. The 21-30 age group were the most commonly affected by femur fractures (20% n = 42). Within this group, motor traffic accidents (MTA) were the cause of 71% of injuries (n = 30). For males, MTA's caused 59% of all femur fractures (n = 80), while falls were the most common cause of femur fractures in females (70%; n = 49). 80% of the fractures in the 51-100 age group were caused by falls (n = 52). In both the male and female groups the most common fracture seen was mid shaft femoral fracture (males 33% (n = 48), females 25% (n = 18)). The most common treatment was skeletal traction used in 40% (n = 85) of patients. Conclusion Femur fracture most commonly presented in males under age 30. Femur fracture was most commonly cause by MTAs in males and by falls in females. The most common diagnosis was mid shaft of femur fracture. Skeletal traction was the most frequent treatment. PMID:26977245

  4. Atraumatic bilateral femur fracture in long-term bisphosphonate use.

    PubMed

    Goddard, Maria S; Reid, Kristoff R; Johnston, James C; Khanuja, Harpal S

    2009-08-01

    Postmenopausal women with osteoporosis are commonly treated with the bisphosphonate class of medications, one of the most frequently prescribed medications in the United States. In the past 4 years, reports have been published implying that long-term bisphosphonate therapy could be linked to atraumatic femoral diaphyseal fractures. This article presents a case of a 67-year-old woman who presented with an atraumatic right femur fracture. She had a medical history notable for use of the bisphosphonate alendronate for 16 years before being switched to ibandronate for 1 year before presentation. She had sustained a similar fracture on the contralateral side 3 years previously. This case report, in addition to a review of the literature, shows that use of the bisphosphonate class of medications for an extended period of time may result in an increased susceptibility to atraumatic femoral diaphyseal fractures. Some studies have suggested that the reason may be the mechanism of action of bisphosphonates, resulting in decreased bone turnover and remodeling. Studies have not shown if the entire class of medications produce a similar result, but patients who have been treated with any bisphosphonate for an extended period of time should be considered at risk. In patients who have already sustained a femoral diaphyseal fracture, imaging of the contralateral side should be performed to identify cortical thickening as an early sign of fracture risk. Patients should also be questioned about thigh pain.

  5. Epidemiology of hip fractures in Okinawa, Japan.

    PubMed

    Arakaki, Harumi; Owan, Ichiro; Kudoh, Hirohisa; Horizono, Hidehiro; Arakaki, Kaoru; Ikema, Yasunari; Shinjo, Hirotaka; Hayashi, Kaori; Kanaya, Fuminori

    2011-05-01

    This study investigated the current incidence of hip fractures in Okinawa prefecture and compared the data with those obtained in our previous study, which was conducted using similar methods in 1987/1988. All patients, aged 50 years or older and residing in Okinawa, admitted to Okinawa hospitals in 2004 for a fresh hip fracture were identified from hospital registries. Details were obtained from the medical records and radiographs of all patients and classified according to fracture type (cervical or trochanteric), age, sex, and fracture location. Subtrochanteric fractures and pathological fractures were excluded. A total of 1,349 patients (242 men and 1,107 women) were admitted for a fresh hip fracture in 2004. Their average age was 76.9 years for men and 82.4 years for women. There were 671 cervical fractures, 654 trochanteric fractures, and 24 unclassified proximal femoral fractures. Comparing the data from 1987/1988 to those from 2004, the total number of hip fractures increased by 188%, from 469 to 1,349. The age-adjusted incidence rates per 100,000, standardized to the 2000 US population, were 75.7 and 296.1 in 1987/1988 and 123.6 and 420 in 2004 for men and women, respectively. The incidence rates in all age groups (at 5-year intervals) were higher in 2004 than in 1987/1988, indicating that people 50 years of age or older became more susceptible to hip fractures. Accordingly, the accretion of the hip fracture incidence rate was greater than that which could be explained purely by changes in population size and structure.

  6. Facial fractures.

    PubMed Central

    Carr, M. M.; Freiberg, A.; Martin, R. D.

    1994-01-01

    Emergency room physicians frequently see facial fractures that can have serious consequences for patients if mismanaged. This article reviews the signs, symptoms, imaging techniques, and general modes of treatment of common facial fractures. It focuses on fractures of the mandible, zygomaticomaxillary region, orbital floor, and nose. Images p520-a p522-a PMID:8199509

  7. Atypical Fractures are Mainly Subtrochanteric in Singapore and Diaphyseal in Sweden: A Cross-Sectional Study.

    PubMed

    Schilcher, Jörg; Howe, Tet Sen; Png, Meng Ai; Aspenberg, Per; Koh, Joyce S B

    2015-11-01

    We have previously noted a dichotomy in the location of atypical fractures along the femoral shaft in Swedish patients, and a mainly subtrochanteric location of atypical fractures in descriptions of patients from Singapore. These unexpected differences were now investigated by testing the following hypotheses in a cross-sectional study: first, that there is a dichotomy also in Singapore; second, that the relation between subtrochanteric and diaphyseal location is different between the two countries; third, that the location is related to femoral bow. The previously published Swedish sample (n = 151) was re-measured, and a new Singaporean sample (n = 75) was established. Both samples were based on radiographic classification of all femoral fractures in women above 55 years of age. The distance between the fracture line and the lesser trochanter was measured. Femoral bow was classified as present or absent on frontal radiographs. Frequency distribution of the measured distances was analyzed using the Bayesian information criterion to choose the best description of the observed variable distribution in terms of a compilation of normally distributed subgroups. The analysis showed a clear dichotomy of the fracture location: either subtrochanteric or diaphyseal. Subtrochanteric fractures comprised 48% of all fractures in Singapore, and 17% in Sweden (p = 0.0001). In Singapore, femoral bow was associated with more fractures in the diaphyseal subgroup (p = 0.0001). This was not seen in Sweden. A dichotomous location of atypical fractures was confirmed, because it was found also in Singapore. The fractures showed a different localization pattern in the two countries. This difference may be linked to anatomical variations, but might also be related to cultural differences between the two populations that influence physical activity.

  8. [Bilateral acetabulum fracture after suffering sport trauma].

    PubMed

    Trost, P; Kollersbeck, C; Pelitz, M; Walcher, T; Genelin, F

    2013-07-01

    This case study describes a 37-year-old male who suffered a bilateral transverse acetabulum fracture with a fracture of the posterior wall and a double-sided dorsal hip dislocation in combination with a left-sided femoral head fracture (Pipkin IV) while skiing in a "fun park". The accurate diagnosis and presurgical planning was made by means of a computed tomography (CT) scan and a subsequent 3D reconstruction. After a primarily executed shielded repositioning of the bilateral hip dislocationearly secondary and anatomical reconstruction of the double-sided acetabulum fracture was possible using the Kocher-Langenbeck approach. A consistent physiotherapy as well as rehabilitation finally led to a positive clinical result for the patient.

  9. Patellar fractures following total knee arthroplasty: a review.

    PubMed

    Sayeed, Siraj A; Naziri, Qais; Patel, Yashika D; Boylan, Matthew R; Issa, Kimona; Mont, Michael A

    2013-01-01

    There are several periprosthetic complications associated with total knee arthroplasty, with femoral fracture as the most common and patellar fractures as the second most common. Patellar fractures are challenging complications that occur almost exclusively on the resurfaced patellae, although unresurfaced patellar fractures have been reported in literature. The purpose of this study is to describe the anatomy of the patella, the etiology of patellar fractures, and strategies to treat and manage these fractures following knee arthroplasty. The vascular supply to the patella may be compromised during total knee arthroplasty and special care must be taken to preserve it. Vessel injury may result in further complications, most notably avascular necrosis with subsequent fracture. Other patient-, surgical-, and prosthetic-related factors can contribute to increased risk of patellar fracture. Patellar fractures are classified into three types. Type I fractures have an intact extensor mechanism with a stable implant. Type II fractures have a complete disruption of the extensor mechanism with or without a stable implant. Type III fractures, which are further subclassified into types IIIa and IIIb, have an intact extensor mechanism but a loose patellar component. While type IIIa fractures have reasonable remaining bone stock, type IIIb fractures have poor bone stock. Type I patellar fractures may be best managed nonoperatively, but types II and III patellar fractures often necessitate surgical intervention. Patellectomy should be reserved for comminuted fractures, as well as fractures in patients with poor bone stock. Larger prospective randomized studies are necessary to better evaluate the treatment algorithm for patellar fractures following total knee arthroplasty.

  10. A fracture risk assessment model of the femur in children with osteogenesis imperfecta (OI) during gait.

    PubMed

    Fritz, Jessica M; Guan, Yabo; Wang, Mei; Smith, Peter A; Harris, Gerald F

    2009-11-01

    Osteogenesis imperfecta (OI) is a heritable bone fragility disorder characterized by skeletal deformities and increased bone fragility. There is currently no established clinical method for quantifying fracture risk in OI patients. This study begins the development of a patient-specific model for femur fracture risk assessment and prediction based on individuals' gait analysis data, bone geometry from imaging and material properties from nanoindentation (Young's modulus=19 GPa, Poisson's ratio=0.3). Finite element models of the femur were developed to assess fracture risk of the femur in a pediatric patient with OI type I. Kinetic data from clinical gait analysis was used to prescribe loading conditions on the femoral head and condyles along with muscle forces on the bone's surface. von Mises stresses were analyzed against a fracture strength of 115 MPa. The patient with OI whose femur was modeled showed no risk of femoral fracture during normal gait. The highest stress levels occurred during the mid-stance and loading responses phases of gait. The location of high stress migrated throughout the femoral diaphysis across the gait cycle. Maximum femoral stress levels occurred during the gait cycle phases associated with the highest loading. The fracture risk (fracture strength/von Mises stress), however, was low. This study provides a relevant method for combining functional activity, material property and analytical methods to improve patient monitoring.

  11. Femoral tunnel malposition in ACL revision reconstruction.

    PubMed

    Morgan, Joseph A; Dahm, Diane; Levy, Bruce; Stuart, Michael J

    2012-11-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific "technical cause of failure." Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons.

  12. Femoral Tunnel Malposition in ACL Revision Reconstruction

    PubMed Central

    Morgan, Joseph A.; Dahm, Diane; Levy, Bruce; Stuart, Michael J.

    2013-01-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific “technical cause of failure.” Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. PMID:23150344

  13. Metatarsal fractures.

    PubMed

    Rammelt, Stefan; Heineck, Jan; Zwipp, Hans

    2004-09-01

    Metatarsal fractures are relatively common and if malunited, a frequent source of pain and disability. Nondisplaced fractures and fractures of the second to fourth metatarsal with displacement in the horizontal plane can be treated conservatively with protected weight bearing in a cast shoe for 4-6 weeks. In most displaced fractures, closed reduction can be achieved but maintenance of the reduction needs internal fixation. Percutaneous pinning is suitable for most fractures of the lesser metatarsals. Fractures with joint involvement and multiple fragments frequently require open reduction and plate fixation. Transverse fractures at the metaphyseal-diaphyseal junction of the fifth metatarsal ("Jones fractures") require an individualized approach tailored to the level of activity and time to union. Avulsion fractures of the fifth metatarsal bone are treated by open reduction and tension-band wiring or screw fixation if displaced more than 2 mm or with more that 30% of the joint involved. The metatarsals are the most common site of stress fractures, most of which are treated nonoperatively. Symptomatic posttraumatic deformities need adequate correction, in most cases by osteotomy across the former fracture site.

  14. Total knee arthroplasty with concurrent femoral and tibial osteotomies in osteogenesis imperfecta.

    PubMed

    Wagner, Russell; Luedke, Colten

    2014-01-01

    Three total knee arthroplasties (TKA) with concurrent femoral and/or tibial osteotomies in 2 patients with osteogenesis imperfecta were performed from 2004 to 2009. The 2 patients were followed for a mean of 6 years. One patient with concurrent TKA, and femoral and tibial osteotomies developed a nonunion of the tibial site that responded to open reduction and internal fixation with iliac crest bone graft. The second patient underwent right TKA with bi-level tibial osteotomies, which healed uneventfully, allowing pain free, unassisted ambulation. The same patient then elected to undergo left TKA with bi-level tibial osteotomies. Intraoperatively he sustained a minor tibial plateau fracture requiring the use of a stemmed component and postoperatively, he developed a nonunion at the proximal site and valgus malunion of the distal site. Revision of fixation was performed at both osteotomy sites, and both healed within 3 months. Both patients are now pain free and ambulate without assistance.

  15. Femoral lipectomy increases postprandial lipemia in women.

    PubMed

    Hernandez, Teri L; Bessesen, Daniel H; Cox-York, Kimberly A; Erickson, Christopher B; Law, Christopher K; Anderson, Molly K; Wang, Hong; Jackman, Matthew R; Van Pelt, Rachael E

    2015-07-01

    Femoral subcutaneous adipose tissue (SAT) appears to be cardioprotective compared with abdominal SAT, possibly through better triglyceride (TG) sequestration. We hypothesized that removal of femoral SAT would increase postprandial TG through a reduction in dietary fatty acid (FA) storage. Normal-weight (means ± SD; BMI 23.9 ± 2.6 kg/m(2)) women (n = 29; age 45 ± 6 yr) were randomized to femoral lipectomy (LIPO) or control (CON) and followed for 1 yr. Regional adiposity was measured by DEXA and CT. A liquid meal labeled with [(14)C]oleic acid was used to trace the appearance of dietary FA in plasma (6-h postprandial TG), breath (24-h oxidation), and SAT (24-h [(14)C]TG storage). Fasting LPL activity was measured in abdominal and femoral SAT. DEXA leg fat mass was reduced after LIPO vs. CON (Δ-1.4 ± 0.7 vs. 0.1 ± 0.5 kg, P < 0.001) and remained reduced at 1 yr (-1.1 ± 1.4 vs. -0.2 ± 0.5 kg, P < 0.05), as did CT thigh subcutaneous fat area (-39.6 ± 36.6 vs. 4.7 ± 14.6 cm(2), P < 0.05); DEXA trunk fat mass and CT visceral fat area were unchanged. Postprandial TG increased (5.9 ± 7.7 vs. -0.6 ± 5.3 × 10(3) mg/dl, P < 0.05) and femoral SAT LPL activity decreased (-21.9 ± 22.3 vs. 10.5 ± 26.5 nmol·min(-1)·g(-1), P < 0.05) 1 yr following LIPO vs. CON. There were no group differences in (14)C-labeled TG appearing in abdominal and femoral SAT or elsewhere. In conclusion, femoral fat remained reduced 1 yr following lipectomy and was accompanied by increased postprandial TG and reduced femoral SAT LPL activity. There were no changes in storage of meal-derived FA or visceral fat. Our data support a protective role for femoral adiposity on circulating TG independent of dietary FA storage and visceral adiposity.

  16. Femoral lipectomy increases postprandial lipemia in women

    PubMed Central

    Hernandez, Teri L.; Bessesen, Daniel H.; Cox-York, Kimberly A.; Erickson, Christopher B.; Law, Christopher K.; Anderson, Molly K.; Wang, Hong; Jackman, Matthew R.

    2015-01-01

    Femoral subcutaneous adipose tissue (SAT) appears to be cardioprotective compared with abdominal SAT, possibly through better triglyceride (TG) sequestration. We hypothesized that removal of femoral SAT would increase postprandial TG through a reduction in dietary fatty acid (FA) storage. Normal-weight (means ± SD; BMI 23.9 ± 2.6 kg/m2) women (n = 29; age 45 ± 6 yr) were randomized to femoral lipectomy (LIPO) or control (CON) and followed for 1 yr. Regional adiposity was measured by DEXA and CT. A liquid meal labeled with [14C]oleic acid was used to trace the appearance of dietary FA in plasma (6-h postprandial TG), breath (24-h oxidation), and SAT (24-h [14C]TG storage). Fasting LPL activity was measured in abdominal and femoral SAT. DEXA leg fat mass was reduced after LIPO vs. CON (Δ−1.4 ± 0.7 vs. 0.1 ± 0.5 kg, P < 0.001) and remained reduced at 1 yr (−1.1 ± 1.4 vs. −0.2 ± 0.5 kg, P < 0.05), as did CT thigh subcutaneous fat area (−39.6 ± 36.6 vs. 4.7 ± 14.6 cm2, P < 0.05); DEXA trunk fat mass and CT visceral fat area were unchanged. Postprandial TG increased (5.9 ± 7.7 vs. −0.6 ± 5.3 × 103 mg/dl, P < 0.05) and femoral SAT LPL activity decreased (−21.9 ± 22.3 vs. 10.5 ± 26.5 nmol·min−1·g−1, P < 0.05) 1 yr following LIPO vs. CON. There were no group differences in 14C-labeled TG appearing in abdominal and femoral SAT or elsewhere. In conclusion, femoral fat remained reduced 1 yr following lipectomy and was accompanied by increased postprandial TG and reduced femoral SAT LPL activity. There were no changes in storage of meal-derived FA or visceral fat. Our data support a protective role for femoral adiposity on circulating TG independent of dietary FA storage and visceral adiposity. PMID:25968576

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

    PubMed

    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 cases, this article presents a forensic evidence-based approach to differentiate between accidental and non-accidental causes of femoral fractures. We describe three cases of young children who were presented to the emergency department because of a suspected femur fracture. Although in all cases, the fracture had a similar location and appearance, the clinical history and developmental stage of the child led to three different conclusions. In the first two cases, an accidental mechanism was a plausible conclusion, although in the second case, neglect of parental supervision was the cause for concern. In the third case, a non-accidental injury was diagnosed and appropriate legal prosecution followed. Any doctor treating children should always be aware of the possibility of child abuse and neglect in children with injuries, especially in young and non-mobile children presenting with an unknown trauma mechanism. If a suspicion of child abuse or neglect arises, a thorough diagnostic work-up should be performed, including a full skeletal survey according to the guidelines of the Royal College of Radiologists and the Royal College of Paediatrics and Child Health. In order to make a good assessment, the radiologist reviewing the skeletal survey needs access to all relevant clinical and social information.

  18. Pharmacogenetics of Bisphosphonate-associated Osteonecrosis of the Jaw.

    PubMed

    Fung, P L; Nicoletti, P; Shen, Y; Porter, S; Fedele, S

    2015-11-01

    Osteonecrosis of the jaws (ONJ) is a potentially severe disorder that develops in a subgroup of individuals who have used bisphosphonate (BP) medications. Several clinical risk factors have been associated with the risk of ONJ development, but evidence is limited and in most instances ONJ remains an unpredictable adverse drug reaction. Interindividual genetic variability can contribute to explaining ONJ development in a subset of BP users and the discovery of relevant associated gene variants could lead to the identification of individuals at higher risk. No genetic variant has been found to be robustly associated with susceptibility to ONJ.

  19. A novel surgical tool for the revision hip arthroplasty due to neck stem's fracture.

    PubMed

    Grivas, T B; Magnissalis, E; Papadakis, S

    2015-01-01

    During revision surgery of total hip arthroplasties, surgeons may come across the challenging complication of a proximally fractured femoral stem, which however maintains sufficient distal fixation. Such cases, although rare, are extremely demanding due to lack of available attachments that would assist surgical explantation of the broken implant. It is herein presented a metal sterilisable surgical tool designed for the removal of the femoral stem broken at the level of the "neck". Hippokratia 2015; 19 (4): 352-355. PMID:27688701

  20. A novel surgical tool for the revision hip arthroplasty due to neck stem’s fracture

    PubMed Central

    Grivas, TB; Magnissalis, E; Papadakis, S

    2015-01-01

    During revision surgery of total hip arthroplasties, surgeons may come across the challenging complication of a proximally fractured femoral stem, which however maintains sufficient distal fixation. Such cases, although rare, are extremely demanding due to lack of available attachments that would assist surgical explantation of the broken implant. It is herein presented a metal sterilisable surgical tool designed for the removal of the femoral stem broken at the level of the “neck”. Hippokratia 2015; 19 (4): 352-355.

  1. Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur.

    PubMed

    Choi, Hyung Suk; Nho, Jae Hwi; Kim, Chung Hyun; Kwon, Sai Won; Park, Jong Seok; Suh, You Sung

    2016-11-01

    Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips. PMID:27593884

  2. Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur

    PubMed Central

    Choi, Hyung-Suk; Kim, Chung-Hyun; Kwon, Sai-Won; Park, Jong-Seok; Suh, You-Sung

    2016-01-01

    Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips. PMID:27593884

  3. Micromotion of cemented and uncemented femoral components.

    PubMed

    Burke, D W; O'Connor, D O; Zalenski, E B; Jasty, M; Harris, W H

    1991-01-01

    We evaluated the initial stability of cemented and uncemented femoral components within the femoral canals of cadaver femurs during simulated single limb stance and stair climbing. Both types were very stable in simulated single limb stance (maximum micromotion of 42 microns for cemented and 30 microns for uncemented components). However, in simulated stair climbing, the cemented components were much more stable than the uncemented components (76 microns as against 280 microns). There was also greater variation in the stability of uncemented components in simulated stair climbing, with two of the seven components moving 200 microns or more. Future implant designs should aim to improve the initial stability of cementless femoral components under torsional loads; this should improve the chances of bony ingrowth. PMID:1991771

  4. Emergency intravenous access through the femoral vein.

    PubMed

    Swanson, R S; Uhlig, P N; Gross, P L; McCabe, C J

    1984-04-01

    A study was undertaken to assess the efficacy and safety of femoral venous catheterization for resuscitation of critically ill patients in the emergency department setting. From May 1982 to April 1983, 100 attempts were made at percutaneous insertion of a large-bore catheter into the femoral veins of patients presenting to our emergency department in cardiac arrest or requiring rapid fluid resuscitation. Eighty-nine attempts were successful. Insertion was generally considered easy, and flow rates were excellent. The only noted complications were four arterial punctures and one minor groin hematoma. This study suggests that short-term percutaneous catheterization of the femoral vein provides rapid, safe, and effective intravenous access. PMID:6703430

  5. The potential application of functionally graded material for proximal femoral nail antirotation device.

    PubMed

    Gong, He; Wang, Lizhen; Zheng, Dong; Fan, Yubo

    2012-09-01

    Proximal femoral nail antirotation (PFNA) device is an intramedullary nail system designing for the treatment of trochanteric fractures. It is composed of a helical neck blade, a nail and a distal locking bolt. There were some reports of femoral shaft fractures even after the fractures were healed. The stress shielding effects of the PFNA device made of stiff titanium alloy on the bone-remodeling behavior of the host femur and the uneven distribution of interface shear stress may contribute to this complication. Recently, a new class of composite called functionally graded material (FGM) was developed, that consisted a gradual pattern of material composition and/or microstructures, and was introduced in dental implant and cementless hip stem. Accordingly, in this paper, we hypothesized that FGM might be used as the material of the nail in PFNA device with the material composition of the nail gradually shifting from more stiff at the proximal side of the femur to more flexible 'iso-elastic' towards the distal side. This hypothesis can be evaluated from the long-term remodeling behavior of host femur and the stress distributions in the PFNA device and bone.

  6. Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures

    PubMed Central

    2014-01-01

    Objective The purpose of this study is to compare the clinical effects of our self-designed rotary self-locking intramedullary nail (RSIN) and interlocking intramedullary nail (IIN) for long bone fractures. Methods A retrospective study was performed in 1,704 patients who suffered bone fractures and underwent RSIN or IIN operation in our hospital between March 1999 and March 2013, including 494 with femoral fractures, 572 with humeral fractures, and 638 with tibial fractures. Among them, 634 patients were followed up for more than 1 year. The operative time, intraoperative blood loss, postoperative complications, healing rate, and the excellent and good rate of functional recovery were compared between two groups. Results Compared with IIN group, RSIN group exhibited significantly shorter operative time and less intraoperative blood loss no matter for humeral, femoral, or tibial fractures (all p < 0.001). The healing rate in patients with more than 1 year follow-up was significantly higher in RSIN group for femoral and tibial fractures (both p < 0.05). In RSIN group, no nail breakage or loosening occurred, but radial nerve injury and incision infection were respectively observed in one patient with humeral fracture. In IIN group, nail breakage or loosening occurred in 7 patients with femoral fractures and 16 patients with tibial fractures, radial nerve injury was observed in 8 patients with humeral fractures, and incision infection was present in 2 patients with humeral fractures and 1 patient with femoral fracture. The complication rate of IIN group was significantly higher than that of RSIN group (p < 0.05). However, there were no significant differences in the excellent and good rate of shoulder, elbow, knee, and ankle joint functional recovery between RSIN group and IIN group. Conclusion RSIN may be a reliable and practical alternative method for the treatment of long bone fractures. PMID:25047454

  7. Blood flow interpretation in femoral pseudoaneurysm

    NASA Astrophysics Data System (ADS)

    Suh, Sang-Ho; Choi, Young Ho; Kim, Hyoung-Ho; Jeon, Min-Gyu; Doh, Deog-Hee

    2013-06-01

    A femoral artery pseudoaneurysm is one complication of vascular intervention, and the incidence is increasing. Early management is then needed to avoid potential dangers from it. It differs from a true aneurysm in that it doesn't include any component of the vascular wall, and is not studied as much as a true aneurysm. Here, a model of a femoral pseudoaneurysm was made and a Computational Fluid Dynamics(CFD) simulation was verified with PIV experiment. Afterwards, a CFD simulation with two different models was performed to look for any findings which may help in developing new treatment methods.

  8. Management of femoral head osteonecrosis: Current concepts

    PubMed Central

    Tripathy, Sujit Kumar; Goyal, Tarun; Sen, Ramesh Kumar

    2015-01-01

    Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill-defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made. PMID:25593355

  9. Distal femoral derotational osteotomy with external fixation for correction of excessive femoral anteversion in patients with cerebral palsy.

    PubMed

    Skiak, Eyad; Karakasli, Ahmet; Basci, Onur; Satoglu, Ismail S; Ertem, Fatih; Havitcioglu, Hasan

    2015-09-01

    16-year-old female who had sustained a knee flexion contracture of 30° because of a delay in the physiotherapy program. One 13-year-old female patient with a bilateral osteotomy had a nondisplaced fracture in her right femur after a direct trauma 2 weeks after removal of an external fixator, and was treated by a cast. Another 17-year-old male patient developed a nonunion because of loosening of two pins and achieved solid union after revision by dynamic compression plate plating. Besides four cases with superficial pin-tract infection, no other complications were documented. Minimally invasive supracondylar femoral derotational osteotomy fixed with a unilateral external fixators crossing the knee joint is a reliable procedure in CP patients. Most patients can be treated with early postoperative full weight-bearing. However, removal of the knee joint crossing fixator should be performed as early as possible to achieve a full range of motion. PMID:25794115

  10. Periprosthetic fractures of the femur after total hip arthroplasty: etiology and outcome.

    PubMed

    Blacha, Jan; Gagała, Jacek

    2004-10-30

    Background. This article reports on our experience in the management of periprosthetic fractures of the femur. Materials and methods. We studied 44 patients (39 women and 5 men) with periprosthetic fractures of the femur after total hip replacement (THR). The average age of the patients at the time of surgery was 68 (range 33-82). Femoral fractures had occurred 1-20 years after THR in 27 hips. Revision hip arthroplasty was associated with periprosthetic fracture in 14 hips. Three patients had primary THR complicated by intraoperative femoral periprosthetic fracture. The outcome measures were bone union, delayed union or any revision intervention. Results. Bone union was achieved in 42 cases (95%). Thirty-five patients were satisfied with the surgical results, seven were moderately satisfied. Two patients had non-union of the femoral shaft, necessitating another intervention. The mean Harris Hip Score after bone union was 84 points (range 58-97). Deviation of the femoral axis was observed in 4 cases, due to subsiding of polished cemented stems. There were no deep infections. Conclusions. Internal stabilization with plate and cables is the best option in the treatment of fractured femur around a stable stem. Ineffective stabilization due to the use of a plate that was not long enough resulted in union with angulation. Long polished stems tended to subside within the cement mantle.

  11. HIF-1α change in serum and callus during fracture healing in ovariectomized mice

    PubMed Central

    Li, Wenliang; Wang, Kejie; Liu, Zhiwei; Ding, Wenge

    2015-01-01

    The purpose was to detect the effects of ovariectomy (OVX) on femoral fracture healing through different angiogenesis and HIF-1α expression in mice. Thirty-six young female C57 mice were randomized into two groups: OVX and age-matched intact control (CON). The femoral fracture was generated at 3 weeks after OVX or CON. At 2 or 4 weeks after fracture, the femoral fracture area was evaluated healing status by bone mineral density (BMD), callus formation and mineralization and neovascularization in callus, biomechanical analysis, and HIF-1α tests. OVX mice showed lower BMD as compared with CON mice. Callus geometric microstructural parameters of the femora in OVX mice were significantly lower than CON mice. OVX induced significant changes of biomechanical parameters in the femoral fracture healing area. The callus forming, callus neovascularization and HIF-1α tests in OVX mice were significantly lower than in CON mice. HIF-1α results have the positive proportion with osteoporotic fracture healing. PMID:25755698

  12. Beneficial effect of zinc supplementation on biomechanical properties of femoral distal end and femoral diaphysis of male rats chronically exposed to cadmium.

    PubMed

    Brzóska, Malgorzata M; Galazyn-Sidorczuk, Malgorzata; Rogalska, Joanna; Roszczenko, Alicja; Jurczuk, Maria; Majewska, Katarzyna; Moniuszko-Jakoniuk, Janina

    2008-02-15

    The present study was aimed at estimate, based on the rat model of human moderate and relatively high chronic exposure to cadmium (Cd), whether zinc (Zn) supplementation may prevent Cd-induced weakening in the bone biomechanical properties. For this purpose, male Wistar rats were administered Cd (5 or 50 mg/l) or/and Zn (30 or 60 mg/l) in drinking water for 6 and 12 months. Bone mineral density (BMD) and biomechanical properties (yield load, ultimate load, post-yield load, displacement at yield and at ultimate, stiffness, work to fracture, yield stress, ultimate stress and Young modulus of elasticity) of the femoral distal end and femoral diaphysis were examined. Biomechanical properties of the distal femur were estimated in a compression test, whereas those of the femoral diaphysis -- in a three-point bending test. Exposure to Cd, in a dose and duration dependent manner, decreased the BMD and weakened the biomechanical properties of the femur at its distal end and diaphysis. Zn supplementation during Cd exposure partly, but importantly, prevented the weakening in the bone biomechanical properties. The favorable Zn influence seemed to result from an independent action of this bioelement and its interaction with Cd. However, Zn supply at the exposure to Cd had no statistically significant influence on the BMD at the distal end and diaphysis of the femur. The results of the present paper suggest that Zn supplementation during exposure to Cd may have a protective influence on the bone tissue biomechanical properties, and in this way it can, at least partly, decrease the risk of bone fractures. The findings seem to indicate that enhanced dietary Zn intake may be beneficial for the skeleton in subjects chronically exposed to Cd.

  13. Open Calcaneus Fractures and Associated Injuries.

    PubMed

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  14. Open Calcaneus Fractures and Associated Injuries.

    PubMed

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  15. Impaired Fracture Healing after Hemorrhagic Shock

    PubMed Central

    Kobbe, Philipp; Pfeifer, Roman; Campbell, Graeme C.; Tohidnezhad, Mersedeh; Bergmann, Christian; Kadyrov, Mamed; Fischer, Horst; Glüer, Christian C.; Pape, Hans-Christoph; Pufe, Thomas

    2015-01-01

    Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP) of 35 mmHg for 90 minutes). Serum cytokines (IL-6, KC, MCP-1, and TNF-α) were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing. PMID:26106256

  16. Outcome of uncemented primary femoral stems for treatment of femoral head osteonecrosis.

    PubMed

    Hungerford, Marc W; Hungerford, David S; Jones, Lynne C

    2009-04-01

    Cementless total hip replacement has been advocated for patients with osteonecrosis of the femoral head. This study examined the outcome of the femoral stem of four generations of an uncemented, proximally porous-coated, chrome-cobalt total hip prosthesis. There were 158 cases in 141 osteonecrosis patients (74 men, 67 women) who had a mean age of 46 years (range, 17-83 years). The mean follow-up was 103 months (range, 20-235 months). The femoral components of 144 cases were not revised and had a mean Harris hip score of 84 (+/-15) at final follow-up. Of the 14 revisions (8.9%), the primary reasons for revision were loosening or significant osteolysis. There were one infection and one chronic dislocation. Proximally porous-coated, anatomic, press-fit stems provide excellent long-term results in patients with osteonecrosis of the femoral head.

  17. Risk factors for osteoporotic fractures in elderly men.

    PubMed

    Nguyen, T V; Eisman, J A; Kelly, P J; Sambrook, P N

    1996-08-01

    Osteoporosis is recognized as an important cause of morbidity and mortality in aging women, but there have been few epidemiologic studies in men. Potential risk factors for osteoporotic fractures were assessed in 220 elderly men aged 60 years or above in the city of Dubbo (Australia). During the follow-up period of 1989-1994, the overall incidence of fractures (determined from x-ray reports) was 220 fractures per 10,000 person-years. Higher risk of fracture was associated with lower femoral neck bone mineral density (BMD), quadriceps weakness, higher body sway, falls in the preceding 12 months, a history of fractures in the previous 5 years, lower body weight, and shorter current height. Use of thiazide diuretics, higher physical activity, and moderate alcohol intake were protective against fracture. In multivariate analysis (Cox's proportional hazards model), femoral neck BMD (odd ratio (OR) = 1.47, 95% confidence interval (CI) 1.25-1.73 per 0.12 g/cm2), quadriceps strength (OR = 1.43, 95% CI 1.18-1.73 per 10 kg), and body sway (OR = 1.25, 95% CI 1.07-1.45 per 5.15 cm2) were independent risk factors. Preventive measures for bone loss and maintaining a physically active, healthy life-style and modification of risk factors for falls in the elderly could yield beneficial effects in the reduction of the incidence of osteoporotic fracture and hence improve the survival among men.

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

    PubMed Central

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

    2015-01-01

    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. PMID:26501331

  19. Femoral Neck Version Affects Medial Femorotibial Loading

    PubMed Central

    Papaioannou, T. A.; Digas, Georgios; Bikos, Ch.; Karamoulas, V.; Magnissalis, E. A.

    2013-01-01

    The aim of this study was to provide a preliminary evaluation of the possible effect that femoral version may have on the bearing equilibrium conditions developed on the medial tibiofemoral compartment. A digital 3D solid model of the left physiological adult femur was used to create morphological variations of different neck-shaft angles (varus 115, normal 125, and valgus 135 degrees) and version angles (−10, 0, and +10 degrees). By means of finite element modeling and analysis techniques (FEM-FEA), a virtual experiment was executed with the femoral models aligned in a neutral upright position, distally supported on a fully congruent tibial tray and proximally loaded with a vertical only hip joint load of 2800 N. Equivalent stresses and their distribution on the medial compartment were computed and comparatively evaluated. Within our context, the neck-shaft angle proved to be of rather indifferent influence. Reduction of femoral version, however, appeared as the most influencing parameter regarding the tendency of the medial compartment to establish its bearing equilibrium towards posteromedial directions, as a consequence of the corresponding anteroposterior changes of the hip centre over the horizontal tibiofemoral plane. We found a correlation between femoral anteversion and medial tibiofemoral compartment contact pressure. Our findings will be further elucidated by more sophisticated FEM-FEA and by clinical studies that are currently planned. PMID:24959355

  20. Fatigue Fractures

    PubMed Central

    Morris, James M.

    1968-01-01

    Fatigue (or stress) fracture of bone in military recruits has been recognized for many years. Most often it is a metatarsal bone that is involved but the tarsal bones, calcaneus, tibia, fibula, femur, and pelvis are occasionally affected. Reports of such fractures in the ribs, ulna and vertebral bodies may be found in the literature. In recent years, there has been increasing awareness of the occurrence of fatigue fractures in the civilian population. Weekend sportsmen, athletes in an early phase of training, and persons engaged in unaccustomed, repetitive, vigorous activity are potential victims of such a fracture. The signs and symptoms, roentgenographic findings, treatment and etiology of fatigue fractures are dealt with in this presentation. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6. PMID:5652745

  1. Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component.

    PubMed

    Takasago, Tomoya; Goto, Tomohiro; Wada, Keizo; Hamada, Daisuke; Iwame, Toshiyuki; Matsuura, Tetsuya; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis. PMID:27648325

  2. Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component

    PubMed Central

    Hamada, Daisuke; Iwame, Toshiyuki; Sairyo, Koichi

    2016-01-01

    The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis. PMID:27648325

  3. Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component

    PubMed Central

    Hamada, Daisuke; Iwame, Toshiyuki; Sairyo, Koichi

    2016-01-01

    The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis.

  4. Treatment Options for Distal Femur Fractures.

    PubMed

    von Keudell, Arvind; Shoji, Kristin; Nasr, Michael; Lucas, Robert; Dolan, Robert; Weaver, Michael J

    2016-08-01

    Despite advances in implant design, the management of distal femur fractures remains challenging. Fracture comminution and intra-articular extension can make it difficult to obtain an adequate reduction while preserving the soft tissue attachments to bone fragments to allow for bone healing. Many implant manufacturers have developed optimal anatomically contoured, distal femoral locking plates with percutaneous guides. This environment allows for the application of lateral locked plates in a biologically friendly manner. Although initial reports had high success rates, more recently a high rate of nonunion has been found, particularly in elderly patients. Limited literature is available for the treatment of patients with osteoporotic bone and associated ipsilateral total knee replacement and hip replacement. We present a patient with a distal femur fracture with significant comminution in the setting of an ipsilateral total hip replacement. PMID:27441931

  5. Comparing the In Vitro Stiffness of Straight-DCP, Wave-DCP, and LCP Bone Plates for Femoral Osteosynthesis.

    PubMed

    Mariolani, José Ricardo Lenzi; Belangero, William Dias

    2013-01-01

    The objective of this study was to compare the Locking Compression Plate (LCP) with the more cost-effective straight-dynamic compression plate (DCP) and wave-DCPs by testing in vitro the effects of plate stiffness on different types of diaphyseal femur fractures (A, B, and C, according to AO classification). The bending structural stiffness of each plate was obtained from four-point bending tests according to ASTM F382-99(2008). The plate systems were tested by applying compression/bending in different osteosynthesis simulation models using wooden rods to simulate the fractured bone fragments. Kruskal-Wallis test showed no significant difference in the bending structural stiffness between the three plate models. Rank-transformed two-way ANOVA showed significant influence of plate type, fracture type, and interaction plate versus fracture on the stiffness of the montages. The straight-DCP produced the most stable model for types B and C fractures, which makes its use advantageous for complex nonosteoporotic fractures that require minimizing focal mobility, whereas no difference was found for type A fracture. Our results indicated that DCPs, in straight or wave form, can provide adequate biomechanical properties for fixing diaphyseal femoral fractures in cases where more modern osteosynthesis systems are cost restrictive.

  6. Assessment of femoral bone quality using co-occurrence matrices and adaptive regions of interest

    NASA Astrophysics Data System (ADS)

    Fritscher, Karl David; Schuler, Benedikt; Grünerbl, Agnes; Hänni, Markus; Schwieger, Karsten; Suhm, Norbert; Schubert, Rainer

    2007-03-01

    The surgical treatment of femur fractures, which often result from osteoporosis, is highly dependent on the quality of the femoral bone. Unsatisfying results of surgical interventions like early loosening of implants may be one result of altered bone quality. However, clinical diagnostic techniques to quantify local bone quality are limited and often highly observer dependent. Therefore, the development of tools, which automatically and reproducibly place regions of interest (ROI) and asses the local quality of the femoral bone in these ROIs would be of great help for clinicians. For this purpose, a method to position and deform ROIs automatically and reproducibly depending on the size and shape of the femur will be presented. Moreover, an approach to asses the femur quality, which is based on calculating texture features using co-occurrence matrices and these adaptive regions, will be proposed. For testing purposes, 15 CT-datasets of anatomical specimen of human femora are used. The correlation between the texture features and biomechanical properties of the proximal femoral bone is calculated. First results are very promising and show high correlation between the calculated features and biomechanical properties. Testing the method on a larger data pool and refining the algorithms to further increase its sensitivity for altered bone quality will be the next steps in this project.

  7. Age trends in remodeling of the femoral midshaft differ between the sexes.

    PubMed

    Feik, S A; Thomas, C D; Clement, J G

    1996-07-01

    Cross-sectional area properties of the femoral midshaft from 203 individuals of known height and weight. 1-97 years of age, from a modern Australian population were quantified using automatic video image analysis. The aim of this study, taking height and weight into account, was to determine whether (a) age trends in remodeling differ between the sexes, (b) men are better able to compensate for bone loss with age, and (c) this protective mechanism is carried through into old age. Our findings indicated that during adulthood there are distinct gender differences in femoral remodeling. From around the third to the seventh decade, men showed a fairly uniform increase in subperiosteal area, polar moment of inertia, and medullary area. Women displayed two distinct phases during this period: relative stability until around the menopause and then a marked increase in all of the above variables. In old age, gender differences diminished, both sexes showing reduced periosteal apposition and increased endosteal resorption. The resultant decline in cortical area of approximately 4% in men and 15% in women from the third to the eighth decade was significant only in women. For a given height, men had larger, stiffer femoral shafts with a greater cortical width and area and maintained this advantage into old age. Diaphyseal bone was not immune from age-related changes affecting other skeletal sites: however, due to compensatory remodeling, which was particularly evident in men, this was not reflected in increased fracture rates.

  8. Investigation of elemental distribution in human femoral head by PIXE and SRXRF microprobe

    NASA Astrophysics Data System (ADS)

    Zhang, Y. X.; Wang, Y. S.; Zhang, Y. P.; Zhang, G. L.; Huang, Y. Y.; He, W.

    2007-07-01

    In order to study the distribution and possible degenerative processes inducing the loss of inorganic substances in bone and to provide a scientific basis for the prevention and therapy of osteoporosis, proton induced X-ray emission (PIXE) method is used for the determination of elemental concentrations in femoral heads from five autopsies and seven patients with femoral neck fractures. Synchrotron radiation X-ray fluorescence (SRXRF) microprobe analysis technique is used to scan a slice of the femoral head from its periphery to its center, via cartilage, compact and spongy zones. The specimen preparation and experiment procedure are described in detail. The results show that the concentrations of P, Ca, Fe, Cu, Sr in the control group are higher than those in the patient group, but the concentrations of S, K, Zn, Mn are not significantly different. The quantitative results of elemental distribution, such as Ca, P, K, Fe, Zn, Sr and Pb in bone slice tissue including cartilage, substantial compact and substantial spongy, are investigated. The data obtained show that the concentrations of Ca, P, K, (the major elements of bone composition), are obviously low in both spongy and cartilage zones in the patient group, but there are no remarkable differences in the compact zone. Combined with the correlations between P, K, Zn, Sr and Ca, the loss mechanism of minerals and the physiological functions of some metal elements in bone are also discussed.

  9. Pelvic, acetabular and hip fractures: What the surgeon should expect from the radiologist.

    PubMed

    Molière, S; Dosch, J-C; Bierry, G

    2016-01-01

    Pelvic ring fractures when caused by trauma, either violent or in demineralized bone, generally consist of injuries in both the anterior (pubic symphysis and rami) and posterior (iliac wing, sacrum, sacroiliac joint) portions. Injury classifications are based on injury mechanism and pelvic stability, and are used to determine treatment. Acetabular fractures, associated or not to pelvic ring disruption, are classified on the basis of fracture line, into elementary fractures of the acetabular walls, columns and roof, and into complex fractures. Fractures of the proximal end of the femur occur often on demineralized bone following low-energy trauma. The fractures are categorized by anatomic location (neck, trochanter and subtrochanteric region) and degree of displacement. These variables determine the risk of osteonecrosis of the femoral head, which is the main complication of such fractures.

  10. Endovascular Treatment of In-Stent Occlusion: New Technique for Recanalization of Long Superficial Femoral Artery Occlusion (Direct Stent Puncture Technique)

    SciTech Connect

    Palena, Luis Mariano Cester, Giacomo; Manzi, Marco

    2012-04-15

    In-stent reocclusion is a frequent complication of endovascular treatment and stenting, especially in the superficial femoral artery. Neointimal hyperplasia is the main cause of this problem, but in many cases, it occurs as a result of the presence of stent strut fractures. The two treatment options are endovascular and surgical intervention. The effectiveness of endovascular interventions in patients with critical limb ischemia has been well established, but in some cases, crossing the occluded stent is difficult. We describe a new technique to recanalize long in-stent superficial femoral artery occlusions characterized by direct stent puncture, followed by retrograde-antegrade recanalization after antegrade failures.

  11. The effects of body mass index and age on cross-sectional properties of the femoral neck.

    PubMed

    Wheeler, Rachel L; Hampton, Aaron D; Langley, Natalie R

    2015-11-01

    Research on the relationship between body mass index (BMI) and cross-sectional geometry of long bone diaphyses demonstrates that strength properties are significantly greater in obese versus normal BMI individuals. However, articular dimensions do not differ appreciably. If femoral head size remains constant, we hypothesize that the femoral neck remodels to accommodate greater loads associated with increased BMI. High-resolution CT scans (n = 170 males) were divided into three BMI groups (normal, overweight, and obese) and two age groups (21-50 and >50). OsiriX software was used to obtain a cross-sectional slice at the waist of the femoral neck. Cortical area (CA), total cross-sectional area (TA), percent cortical area (%CA), circularity index (Imax /Imin ), section modulus (Zpol ), and second moment of area (J) were measured with ImageJ software. The effects of age and BMI were evaluated statistically. Pairwise comparisons in the younger group only detected significant differences between normal and obese males in the circularity index (P = 0.022). The older cohort showed significant differences in CA (P < 0.001), %CA (P = 0.004), Zpol (P = 0.007), and J (P < 0.001) between normal and obese groups. This study shows that the effects of obesity on the cross-sectional geometry of the femoral neck are more pronounced in older males relative to younger males. Older males with increased BMI have greater cortical area and bone strength in the femoral neck relative to younger males, thus making the femoral neck less susceptible to fractures in obese individuals.

  12. Loosening of the femoral component of total hip replacement after plugging the femoral canal.

    PubMed

    Harris, W H; McCarthy, J C; O'Neill, D A

    1982-01-01

    A roentgen follow-up study was done of 171 total hip replacements at an average of 3.3 years (range 2 to 5 years) after insertion to assess the loosening rate in older adult patients (average age 60 years) in whom the medullary canal was plugged. The cement (Simplex P) was introduced using a cement gun. The femoral components used were CAD and HD-2 in design, made of chrome cobalt alloy. Evaluation was made according to three categories of loosening: definite (requiring evidence of migration of the component or the cement), probable (requiring a continuous radiolucent zone around the cement mantle in one or more radiographic views), or possible (requiring a radiolucent zone that occupied 50% or more of the cement-bone interface in one or more views but was not continuous). One hip was revised for a loose femoral component. Another patient has asymptomatic subsidence of the femoral component. Thus the total incidence of definitely loose femoral components was 1.1%. No hip was classified as probably loose. Seven hips (4%) were rated as possibly loose. Compared to four other reported series of similar groups of patients followed for like duration, this incidence of definitely loose components is statistically significantly less than in nonplugged canals. The other differences among the series compared, such as stem design, type of cement introduction, modulus of elasticity of the metal used, presence or absence of a collar, and dates during which the surgery was done, are also discussed. Plugging the femoral canal; introducing the cement with a cement gun; using a femoral stem that largely fills the medullary canal, has a collar, and has a rounded rectangular cross section with no medial stress risers made of a superalloy with a modulus of elasticity of about 200 GPa--all these factors were associated with a low (1.1%) incidence of femoral component loosening at 3 years. PMID:7166501

  13. Stress fractures in rheumatological practice: clinical significance and localizations.

    PubMed

    Peris, Pilar

    2002-06-01

    The objective of this study was to analyze the clinical characteristics, associated disorders, and the most common sites of stress fractures in rheumatological patients. Over a 3-year period, 35 patients with 44 stress fractures were prospectively recruited from an outpatient rheumatological department (32 postmenopausal women and three men aged 47 to 86 years, mean 70+/-10.6 years). Clinical diagnosis was established by compatible clinical and radiological data. In addition, previous skeletal fractures were recorded in all patients. Bone mass assessment was performed in 23 patients and spinal X-ray in 21. The diagnosis of osteoporosis was defined by the presence of atraumatic vertebral fractures and/or densitometric criteria (lumbar or femoral bone mass <-2.5 T score). The most frequent stress fractures were: pelvic ring (13 sacrum and eight pubic) and metatarsal (11 fractures), followed by tibia (seven fractures), calcaneus (three fractures), femur (one), and tarsal (one). Nine patients (26%) presented simultaneous stress fractures. Twenty-four patients (69%) suffered previous osteoporotic fractures, vertebral and Colles' fractures being the most frequent. Most of the evaluated patients (25 out of 30) had osteoporosis (83%). Six patients had associated disorders (glucocorticoids use in three patients, neurologic disorders in two, and rheumatoid arthritis in one). Except for the patient with a femur fracture which required internal fixation, no other clinical complications were observed after conservative treatment. In conclusion, fractures of the pelvic ring, especially sacrum, and metatarsal are the most frequent stress fractures in rheumatological practice. The association with osteoporosis and the history of prior low-trauma fractures are common in these patients.

  14. Fracture Management

    MedlinePlus

    ... to hold the fracture in the correct position. • Fiberglass casting is lighter and stronger and the exterior ... with your physician if this occurs. • When a fiberglass cast is used in conjunction with a GORE- ...

  15. Lisfranc fractures.

    PubMed

    Wright, Amanda; Gerhart, Ann E

    2009-01-01

    Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.

  16. The impact of race and fractures on mortality in a postmenopausal Medicaid population.

    PubMed

    Kotzan, J A; Martin, B C; Reeves, J H; Wade, W

    1999-11-01

    The purpose of this study was to model fractures and survival by age and race in a large postmenopausal Medicaid population. All Georgia Medicaid claims were abstracted for the years 1992, 1993, and 1994. Claims for postmenopausal women (> or =50 years of age) were retained, and patients with fractures were identified by International Classification of Diseases, Ninth Revision codes for fracture. A survival analysis was conducted using Kaplan-Meier estimators to evaluate the effect of fracture, age, and race on 3-year survival. A total of 159,400 white and black postmenopausal women were identified. The cohort with fracture totaled 5933 patients, with femoral fractures constituting 46% of all fractures. Discounting those with fracture before the study, the fracture incidence was approximately 1.2% in this postmenopausal female cohort. The survival analysis suggested that after age was accounted for, black postmenopausal women had a 42% increased risk of death within 3 years of fracture, compared with 13% for white women. However, postmenopausal black women were approximately 50% less likely to experience a fracture, and postmenopausal black women without fracture had better survival rates than comparable white women. Mortality crossover and the diminished likelihood of fracture mask the true nature of fracture survival in postmenopausal black women. Postmenopausal black women with fracture are at greater risk of dying than their white counterparts.

  17. Fat emboli syndrome in isolated fractures of the tibia and femur.

    PubMed

    Ganong, R B

    1993-06-01

    The fat emboli syndrome (FES) was studied in otherwise healthy young skiers with isolated fractures of the tibia and femur treated from 1980 until 1991. During the first year, 13 of 56 tibial and femoral fractures developed FES. The overall incidence of FES was 23%: 19% among fractured tibiae and 75% among fractured femora. Thirty-three percent of displaced transverse tibial fractures developed FES. During the next ten year, only those tibial or femoral fractures that developed FES were studied. There were 44 such cases. Symptoms included a mean PO2 of 45 mm Hg and a fever of 39 degrees. In addition, 40% of the patients had petechiae. The mean patient age was 26 years. None of the patients had other significant injuries or illnesses, 75% received oxygen, and 9% received steroids. None of the patients received mechanical ventilation. All cases had developed by the third day of hospitalization, and the duration of the syndrome was less than four days in 86% of the patients. The mortality rate was 0%. In 50% of the patients, hospitalization was prolonged because of FES; otherwise, there were no complications. This study of isolated femoral and tibial fractures in healthy young skiers demonstrates that FES occurs more commonly than previously thought, is not associated with mortality, and causes little morbidity. Treatment should consist of supportive care only, with specific care directed toward the underlying injury.

  18. Bivariate Genome-Wide Linkage Analysis of Femoral Bone Traits and Leg Lean Mass: Framingham Study

    PubMed Central

    Karasik, David; Zhou, Yanhua; Cupples, L Adrienne; Hannan, Marian T; Kiel, Douglas P; Demissie, Serkalem

    2009-01-01

    The risk of osteoporotic fracture is a function of both applied muscle mass and bone tissue distribution. Leg lean mass (LLM) and femoral bone geometry are both known to have substantial genetic components. Therefore, we estimated shared heritability (h2) and performed linkage analysis to identify chromosomal regions governing both LLM and bone geometry. A genome-wide scan (using 636 microsatellite markers) for linkage analyses was performed on 1346 adults from 327 extended families of the Framingham study. DXA measures were LLM, femoral neck length, neck-shaft angle (NSA), subperiosteal width, cross-sectional area (CSA), and section modulus (Z) at the femoral narrow neck and shaft (S) regions. Variance component linkage analysis was performed on normalized residuals (adjusted for age, height, BMI, and estrogen status in women). The results indicated substantial h2 for LLM (0.42 ± 0.07) that was comparable to bone geometry traits. Phenotypic correlations between LLM and bone geometry phenotypes ranged from 0.033 with NSA (p > 0.05) to 0.251 with S_Z (p < 0.001); genetic correlations ranged from 0.087 (NSA, p > 0.05) to 0.454 (S_Z, p < 0.001). Univariate linkage analysis of covariate-adjusted LLM identified no chromosomal regions with LOD scores ≥2.0; however, bivariate analysis identified two loci with LOD scores >3.0, shared by LLM with S_CSA on chromosome 12p12.3–12p13.2, and with NSA, on 14q21.3–22.1. In conclusion, we identified chromosomal regions potentially linked to both LLM and femoral bone geometry. Identification and subsequent characterization of these shared loci may further elucidate the genetic contributions to both osteoporosis and sarcopenia. PMID:19063671

  19. The Short-term Clinical Outcome of Total Hip Arthroplasty Using Short Metaphyseal Loading Femoral Stem

    PubMed Central

    Choi, Yoo Wang

    2016-01-01

    Purpose The purpose of this study was to retrospectively evaluate the short-term clinical and radiological outcomes of total hip arthroplasty (THA) with short metaphyseal loading femoral stem. Materials and Methods We retrospectively reviewed the records of 56 cases in 47 patients who had undergone THA with short metaphyseal loading femoral stem from April 2010 to December 2011. There were 20 males and 27 females. The mean age was 54 years (range, 26-77 years). The average follow up period was 4.6 years. Clinical results were evaluated by Harris hip scores (HHS) before the operation and at the last follow-up. Radiographic analysis was done by evaluating osteolysis, loosening, stress shielding, and alignement. Results The mean HHS significantly improved from 45 (range, 15-58) preoperatively to 98 (range, 85-100) at the last follow-up. In radiographic analyses, there was no evidence of osteolysis or loosening around the stems and the acetabuluar components. All cases showed rounding off of the calcar, grade 1 bone resorption of the proximal femur. With regard to implant alignment, 51 femoral component (91.1%) were in neutral position, and 5 (8.9%) were in varus position. There was 1 intraoperative fracture treated by cerclage wiring and no case was revised during follow-up period. Conclusion Although longer follow-up is needed to confirm the durability of the short metaphyseal loading femoral stem, this short stem might provide stable fixation without diaphyseal fixation and demonstrated good clinical result at mean 4.6 year short term follow-up. PMID:27536649

  20. Femoral taperosis: an accident waiting to happen?

    PubMed

    Wassef, A J; Schmalzried, T P

    2013-11-01

    A modular femoral head-neck junction has practical advantages in total hip replacement. Taper fretting and corrosion have so far been an infrequent cause of revision. The role of design and manufacturing variables continues to be debated. Over the past decade several changes in technology and clinical practice might result in an increase in clinically significant taper fretting and corrosion. Those factors include an increased usage of large diameter (36 mm) heads, reduced femoral neck and taper dimensions, greater variability in taper assembly with smaller incision surgery, and higher taper stresses due to increased patient weight and/or physical activity. Additional studies are needed to determine the role of taper assembly compared with design, manufacturing and other implant variables.

  1. Microwave sterilization of femoral head allograft.

    PubMed

    Dunsmuir, Robert A; Gallacher, Grace

    2003-10-01

    The potential shortage of allograft bone has led to the need to investigate other sources of bone for allografts. Some allograft bone donated from primary total hip arthroplasty recipients must be discarded or treated to become usable as a result of bacterial contamination. Femoral head allografts were contaminated with Staphylococcus aureus and Bacillus subtilis. A domestic microwave oven was used. The contaminated bone was exposed to microwave irradiation for different time periods. The samples were then cultured to attempt to grow the two bacterial species. The contaminated bone samples failed to grow any organisms after 2 min of exposure to microwave irradiation. This study shows that sterilization of femoral head allografts contaminated with S. aureus and B. subtilis can be achieved with microwave irradiation in a domestic microwave oven. This method of sterilization of bone allografts is cheap, easily used, and an effective way to process contaminated bone. PMID:14532216

  2. ABNORMAL IMAGING FINDINGS OF THE FEMORAL THIRD TROCHANTER IN 20 HORSES.

    PubMed

    Shields, Georgette E; Whitcomb, Mary Beth; Vaughan, Betsy; Wisner, Erik R

    2015-01-01

    Injuries involving the femoral third trochanter are an uncommon but important source of equine lameness; however, clinical localization can be challenging. The purpose of this retrospective study was to describe ultrasonographic and scintigraphic findings in a group of horses with presumed third trochanter injury. Medical records of an equine referral hospital were searched from 2004-2014, and 20 horses met the inclusion criteria. Lesions consistent with third trochanter fracture were identified with ultrasound in 14/20 horses. Onset of lameness was acute (11), insidious (2), or unknown (1). All but one horse was lame at presentation, ranging from Grade 2-4/5. Ultrasound was the primary diagnostic modality in 5/14 horses with fragmentation, while scintigraphic findings of intense (3), moderate (5), and mild (1) increased radiopharmaceutical uptake (IRU) prompted ultrasonographic examinations in 9/14 fractured horses. A nondisplaced fracture was suspected in an additional horse with intense IRU and negative ultrasound findings. In the remaining five horses, imaging findings included only mild IRU. Lameness was localized to other regions in these cases. Six of 12 fractured horses with available outcome data were returned to function after a prolonged rehabilitation of 8-18 months. Scintigraphic findings helped to direct focused ultrasound exams in the majority of fracture cases. Horses with evidence of third trochanter fracture had similar clinical characteristics to that reported for pelvic fractures and authors therefore recommend ultrasonographic examination of both regions, especially when scintigraphy is unavailable. Prognosis for return to function in horses of the current study was less favorable than previously reported.

  3. Endo medullary extractability of cementless full HA coated femoral stem: Results from 19 cases.

    PubMed

    Lecuire, François; Melere, Gilles; Martres, Sébastien

    2015-03-01

    The Aura cementless full HA coated stem is an anatomical femoral component with a different surface treatment in the metaphyseal and diaphyseal areas. We have studied the feasibility of isolated endo-medullar extraction of the stem. 19 patients (6 infections, 6 neck fractures, 3 stems with risk of fracture, 3 head fractures, and 1 recurrent dislocation) were subjected to the removal of a stable and bone integrated implant at a mean of 4.5 years after surgery. The 19 cases represent the entire population of Aura cementless integrated stem requiring revision during the period of 2003 through 2011, excluding periprosthetic bone fracture cases. The technique consisted of a careful release of the metaphyseal part of the implant with thin osteotomes, followed by the use of a highly efficient extractor. The re-implanted procedure always utilised standard stems: 17 cementless stems full HA coated (13 had the same size as the removed implant, 4 cases had larger sizes) and two received cemented stems. The 19 stems were extracted by simple endo-medullary approach, without the need for additional action. Several complications were encountered, 1 intraoperative diaphyseal fracture, requiring a wiring, 1 fracture of the lesser trochanter at 15 days post-surgery, requiring a revision and 2 postoperative dislocations. Except for the early revision due to fracture, no other stem was revised. There was no recurrence of infection and the functional results were satisfactory (PMA 15-18). 3 patients showed metaphyseal lucent lines on X-Ray leading us to advise the use of a standard stem with larger size after distal reaming, combined with preventive circulate of the calcar. The use of dedicated instrumentation allows successful extraction of full HA coated short stem by endomedullary approach. PMID:26280859

  4. The role of imaging in diagnosis and management of femoral head avascular necrosis

    PubMed Central

    Manenti, Guglielmo; Altobelli, Simone; Pugliese, Luca; Tarantino, Umberto

    2015-01-01

    Summary The aim of this paper is to critically review the literature documenting the imaging approach in adult Femoral Head Avascular Necrosis (FHAVN). For this purpose we described and evaluated different radiological techniques, such as X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Nuclear Medicine. Plain films are considered the first line imaging technique due to its ability to depict femoral head morphological changes, to its low costs and high availability. CT is not a routinely performed technique, but is useful to rule out the presence of a subchondral fracture when MRI is doubtful or contraindicated. MRI is unanimously considered the gold standard technique in the early stages, being capable to detect bone marrow changes such as edema and sclerosis. It may be useful also to guide treatment and, as CT, it is a validated technique in follow-up of patients with FHAVN. Nuclear medicine imaging is mostly applied in post-operative period to detect graft viability or infective complications. More advanced techniques may be useful in particular conditions but still need to be validated; thus new research trials are desirable. In conclusion, X-ray examination is the first line approach, but lacks of sensitivity in early stage whereas MRI is indicated. CT easily depicts late stage deformation and may decrease MRI false positive results in detecting the subchondral fracture. However, the role of both Nuclear Medicine Imaging and advanced MR techniques in FHAVN still need to be investigated. PMID:27134630

  5. [Use of the anatomical cemented femoral stem SAS I: mid-term results].

    PubMed

    Mikláš, M; Pink, M; Valoušek, T

    2015-01-01

    PURPOSE OF THE STUDY In view of increasing interest in a relationship between the surface of an implant and its behaviour and longevity in total hip arthroplasty (THA), the aim of this study is to present the clinical and radiographic results, as well as complications, of hip replacement surgery using the cemented femoral stem SAS I. MATERIAL AND METHODS A total of 298 cemented femoral stems SAS I were implanted in 275 patients at our department between 1996 and 2005. The patient average age was 72.1 years, with the range from 64 to 92 years. The pre-operative diagnoses were as follows: primary osteoarthritis in 179 (30.1%); post-dysplastic osteoarthritis in 41 (13.7%); femoral neck fracture in 44 (14.8%); avascular necrosis of the femoral head in 23 (7.7%); rheumatoid arthritis in nine (3%) and other causes in two (0.7%) patients. Of the 275 patients who had the surgery, 186 (204 THAs) underwent clinical and X-ray examination at an average follow-up of 11.5 years (range, 8 to 17 years). The clinical results were used to calculate the Harris hip score and radiographic evaluation was based on antero-posterior views. RESULTS The group of 186 assessed patients (204 THAs) comprised 106 women and 80 men, who were on average 85.4 years old on evaluation (range, 72 to 92 years). Of the remaining patients, 62 patients (64 THAs) died from causes unrelated to the surgery and 27 patients (30 THAs) were lost to follow-up. The functional outcome of surgery assessed by the Harris hip score was excellent in 61 (32.8%), good in 94 (50.5%), satisfactory in 26 (14%) and poor in five (2.7%) patients. The 93.1% SAS I stem longevity was recorded in relation to aseptic loosening; reimplantation for this indication was performed in 14 THAs. No revision surgery for failure due to valgus/varus deviations of the stem was carried out. Of the 204 hips, 188 had femoral stems aligned in neutral, 12 (5.9%) in valgus and four (2%) in varus positions. DISCUSSION The anatomical femoral stem SAS I

  6. [Use of the anatomical cemented femoral stem SAS I: mid-term results].

    PubMed

    Mikláš, M; Pink, M; Valoušek, T

    2015-01-01

    PURPOSE OF THE STUDY In view of increasing interest in a relationship between the surface of an implant and its behaviour and longevity in total hip arthroplasty (THA), the aim of this study is to present the clinical and radiographic results, as well as complications, of hip replacement surgery using the cemented femoral stem SAS I. MATERIAL AND METHODS A total of 298 cemented femoral stems SAS I were implanted in 275 patients at our department between 1996 and 2005. The patient average age was 72.1 years, with the range from 64 to 92 years. The pre-operative diagnoses were as follows: primary osteoarthritis in 179 (30.1%); post-dysplastic osteoarthritis in 41 (13.7%); femoral neck fracture in 44 (14.8%); avascular necrosis of the femoral head in 23 (7.7%); rheumatoid arthritis in nine (3%) and other causes in two (0.7%) patients. Of the 275 patients who had the surgery, 186 (204 THAs) underwent clinical and X-ray examination at an average follow-up of 11.5 years (range, 8 to 17 years). The clinical results were used to calculate the Harris hip score and radiographic evaluation was based on antero-posterior views. RESULTS The group of 186 assessed patients (204 THAs) comprised 106 women and 80 men, who were on average 85.4 years old on evaluation (range, 72 to 92 years). Of the remaining patients, 62 patients (64 THAs) died from causes unrelated to the surgery and 27 patients (30 THAs) were lost to follow-up. The functional outcome of surgery assessed by the Harris hip score was excellent in 61 (32.8%), good in 94 (50.5%), satisfactory in 26 (14%) and poor in five (2.7%) patients. The 93.1% SAS I stem longevity was recorded in relation to aseptic loosening; reimplantation for this indication was performed in 14 THAs. No revision surgery for failure due to valgus/varus deviations of the stem was carried out. Of the 204 hips, 188 had femoral stems aligned in neutral, 12 (5.9%) in valgus and four (2%) in varus positions. DISCUSSION The anatomical femoral stem SAS I

  7. Internal fixation after fracture or osteotomy of the femur in young children with polyostotic fibrous dysplasia.

    PubMed

    Benedetti Valentini, Matteo; Ippolito, Ernesto; Catellani, Francesco; Farsetti, Pasquale

    2015-07-01

    Children from 4 to 7 years of age with polyostotic fibrous dysplasia (PFD) may need internal fixation of the femur for either fracture or osteotomy. At that age, the small size of the femur allows only the use of small intramedullary nails. However, titanium elastic nails and rigid intramedullary pediatric interlocking femoral nails - good for fracture or osteotomy fixation in the normal femur - are not indicated in PFD. From 2009 to 2011, we treated eight cases of PFD femoral fracture and deformity by internal fixation with a custom-modified adult humeral nail to which a spiral blade was connected. The 7-mm thick nail fit properly into the small femoral shaft and the spiral blade conferred ideal mechanical support to the femoral neck. Three cases had replacement of the humeral nail with a more appropriate adult femoral nail 3 years after the index procedure when the femur had reached an adequate size. In the maximum follow-up period of 4 years, few complications were observed.

  8. Prophylactic pinning for slipped capital femoral epiphysis: does it affect proximal femoral morphology?

    PubMed

    Cousins, Gerard R; Campbell, Donald M; Wilson, Neil I L; Maclean, Jamie G B

    2016-05-01

    This study was designed to determine whether prophylactic pinning of the unaffected hip in unilateral slipped capital femoral epiphysis affects the proximal femoral morphology. Twenty-four hips prophylactically pinned were compared with 26 cases observed. The articulotrochanteric distance (ATD) and the trochanteric-trochanteric distance (TTD) were measured. Postoperative radiographs were compared with final follow-up radiographs. The final TTD : ATD ratio was higher (P=0.048) in the pinned group, suggesting relative coxa vara/breva. There was a smaller difference between the two hips in the prophylactically pinned group (0.7) as opposed to those observed (1.47). Prophylactic pinning does not cause growth to stop immediately but alters the proximal femoral morphology.

  9. Predicting Hip Fracture Type With Cortical Bone Mapping (CBM) in the Osteoporotic Fractures in Men (MrOS) Study.

    PubMed

    Treece, Graham M; Gee, Andrew H; Tonkin, Carol; Ewing, Susan K; Cawthon, Peggy M; Black, Dennis M; Poole, Kenneth E S

    2015-11-01

    Hip fracture risk is known to be related to material properties of the proximal femur, but fracture prediction studies adding richer quantitative computed tomography (QCT) measures to dual-energy X-ray (DXA)-based methods have shown limited improvement. Fracture types have distinct relationships to predictors, but few studies have subdivided fracture into types, because this necessitates regional measurements and more fracture cases. This work makes use of cortical bone mapping (CBM) to accurately assess, with no prior anatomical presumptions, the distribution of properties related to fracture type. CBM uses QCT data to measure the cortical and trabecular properties, accurate even for thin cortices below the imaging resolution. The Osteoporotic Fractures in Men (MrOS) study is a predictive case-cohort study of men over 65 years old: we analyze 99 fracture cases (44 trochanteric and 55 femoral neck) compared to a cohort of 308, randomly selected from 5994. To our knowledge, this is the largest QCT-based predictive hip fracture study to date, and the first to incorporate CBM analysis into fracture prediction. We show that both cortical mass surface density and endocortical trabecular BMD are significantly different in fracture cases versus cohort, in regions appropriate to fracture type. We incorporate these regions into predictive models using Cox proportional hazards regression to estimate hazard ratios, and logistic regression to estimate area under the receiver operating characteristic curve (AUC). Adding CBM to DXA-based BMD leads to a small but significant (p < 0.005) improvement in model prediction for any fracture, with AUC increasing from 0.78 to 0.79, assessed using leave-one-out cross-validation. For specific fracture types, the improvement is more significant (p < 0.0001), with AUC increasing from 0.71 to 0.77 for trochanteric fractures and 0.76 to 0.82 for femoral neck fractures. In contrast, adding DXA-based BMD to a CBM-based predictive model

  10. Femoral neck structure and function in early hominins.

    PubMed

    Ruff, Christopher B; Higgins, Ryan

    2013-04-01

    All early (Pliocene-Early Pleistocene) hominins exhibit some differences in proximal femoral morphology from modern humans, including a long femoral neck and a low neck-shaft angle. In addition, australopiths (Au. afarensis, Au. africanus, Au. boisei, Paranthropus boisei), but not early Homo, have an "anteroposteriorly compressed" femoral neck and a small femoral head relative to femoral shaft breadth. Superoinferior asymmetry of cortical bone in the femoral neck has been claimed to be human-like in australopiths. In this study, we measured superior and inferior cortical thicknesses at the middle and base of the femoral neck using computed tomography in six Au. africanus and two P. robustus specimens. Cortical asymmetry in the fossils is closer overall to that of modern humans than to apes, although many values are intermediate between humans and apes, or even more ape-like in the midneck. Comparisons of external femoral neck and head dimensions were carried out for a more comprehensive sample of South and East African australopiths (n = 17) and two early Homo specimens. These show that compared with modern humans, femoral neck superoinferior, but not anteroposterior breadth, is larger relative to femoral head breadth in australopiths, but not in early Homo. Both internal and external characteristics of the australopith femoral neck indicate adaptation to relatively increased superoinferior bending loads, compared with both modern humans and early Homo. These observations, and a relatively small femoral head, are consistent with a slightly altered gait pattern in australopiths, involving more lateral deviation of the body center of mass over the stance limb. PMID:23341246

  11. [Slipped capital femoral epiphysis associated with hyperparathyroidism. A case report].

    PubMed

    Khiari, Karima; Cherif, Lotfi; Ben Abdallah, Nejib; Maazoun, Imen; Hadj Ali, Insaf; Bentaarit, Chokri; Turki, Sami; Ben Maïz, Hedi

    2003-12-01

    Slippage of the upper femoral epiphysis can occur in association with multiple endocrine imbalances. A case of slipped femoral epiphysis with primary hyperparathyroidism is reported. The patient was an adolescent, 16 Years of age, who presented bilateral slipped epiphysis. Investigation showed that he had hypercalcemia (3.1 mmol/l) related to primary hyperparathyroidism. A parathyroid adenoma was removed. Outcome was favorable and the slipped femoral epiphyses did not require a specific treatment.

  12. Galeazzi fracture.

    PubMed

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  13. Osteosynthesis of fractures of the femur with flexible metallic intramedullary nails.

    PubMed

    Firica, A; Troianescu, O; Petre, M

    1978-04-01

    The authors discuss their use of Ender's method in the treatment of fractures of the femur. The diameter and length of the nails depends on the type of fracture. 1) Three nails of 4 mm diameter are introduced in parallel from the medial condyle in fractures of the femoral neck; 2) 5 mm nails are used, in similar fashion, for the fixation of intertrochanteric and subtrochanteric fractures; 3) 5 mm nails are used for diaphyseal, supracondylar and intercondylar fractures, introduced in crossed fashion ("Eiffel Tower" technique) from both medial and lateral condyles. This method of fixation has proved to be extremely stable. The operation itself is quick, with no blood loss or shock. The patient can resume partial weight bearing after a week in stabilised intertrochanteric and shaft fractures, after a month in less stable types, and after three to four months in fractures of the neck of the femur. This report is based on the first 250 cases treated by this method.

  14. [Isolated true aneurysm of the deep femoral artery].

    PubMed

    Salomon du Mont, L; Holzer, T; Kazandjian, C; Saucy, F; Corpataux, J M; Rinckenbach, S; Déglise, S

    2016-07-01

    Aneurysms of the deep femoral artery, accounting for 5% of all femoral aneurysms, are uncommon. There is a serious risk of rupture. We report the case of an 83-year-old patient with a painless pulsatile mass in the right groin due to an aneurysm of the deep femoral artery. History taking revealed no cardiovascular risk factors and no other aneurysms at other localizations. The etiology remained unclear because no recent history of local trauma or puncture was found. ACT angiography was performed, revealing a true isolated aneurysm of the deep femoral artery with a diameter of 90mm, beginning 1cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient underwent open surgery, with exclusion of the aneurysm and interposition of an 8-mm Dacron graft to preserve deep femoral artery flow. Due to their localization, the diagnosis and the management of aneurysms of the deep femoral artery can be difficult. Options are surgical exclusion or an endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, aneurysms of the deep femoral artery should be treated without any delay.

  15. Hip Structural Changes and Fracture Risk in Osteopenia and Osteoporosis

    PubMed Central

    Esenyel, Meltem; Ozen, Aynur; Esenyel, Cem Zeki; Rezvani, Aylin; Sariyildiz, Mustafa Akif; Ergin, Onder

    2011-01-01

    Objective: Although bone mineral density (BMD) is an important predictor of hip fracture, there is a large overlap of BMD values between those who fracture their hips and those who do not. The aim of this study was to evaluate differences in the structural parameters of the hip in patients with osteopenia and osteoporosis in the hip region and to assess their relationship with osteoporotic fracture risk, age and gender. Materials and Methods: In this observational retrospective study, 150 patients with osteopenia (100 postmenopausal women and 50 men ≥50 years of age) and 125 patients with osteoporosis in the hip (100 postmenopaussal women and 25 men ≥50 years of age) were included. In addition to densitometry measurements by DEXA (Dual Energy X-ray Absorbimetry), structural variables were determined using the Hip Strength Analysis program (HSA). Results: In logistic regression analyses, the femoral neck BMD (odds ratio (OR), 2.6; 95% Confidence Interval (CI) 1.8–3.8), age (OR per 10 years 1.4; 95% CI, 1.1–1.9), femoral neck shaft angle (NSA) (OR 1.5; 95% CI, 1.2–2.1), Femur Strength Index (FSI) (OR 1.6; 95% CI 1.3–2.2), and Cross sectional area (CSA) (OR 1.6; 95% CI 1.2–2.1) were all associated with osteoporotic fractures in women and men. Osteopenic patients had smaller femoral neck-shaft angles (NSA) compared to osteoporotic patients (p<0.05). This angle was larger in women (p<0.05); and women had decreased (FSI) (p<0.001) and CSA (p<0.05), which cause increased fracture risk. Conclusion: Spatial distribution of bone tissue is a useful determinant of fracture risk. PMID:25610167

  16. Pediatric Thighbone (Femur) Fracture

    MedlinePlus

    ... fractures in infants under 1 year old is child abuse. Child abuse is also a leading cause of thighbone fracture ... contact sports • Being in a motor vehicle accident • Child abuse Types of Femur Fractures (Classification) Femur fractures vary ...

  17. Vertebral fracture assessment in acromegaly.

    PubMed

    Madeira, Miguel; Neto, Leonardo Vieira; Torres, Carolina Hammes; de Mendonça, Laura Maria Carvalho; Gadelha, Mônica Roberto; de Farias, Maria Lúcia Fleiuss

    2013-01-01

    Most vertebral fractures (VFs) are asymptomatic and incidentally found on X-rays. The effects of acromegaly on bone mineral density (BMD) are still controversial, and the prevalence of VFs in this specific population remains uncertain. The objective of this study was to assess VFs in acromegaly through vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA). Seventy-five acromegalic patients from the same center (53 female; age: 48.9±14.5yr) were enrolled in this study. None of them referred previous fragility fracture. They were divided according to the presence or absence of moderate or severe VFs on VFA, a densitometric spine imaging. Age, gender, estimated duration of disease, insulin-like growth factor I levels, disease control and gonadal status, as well as BMD and body composition (analyzed by DXA) were compared between these 2 groups. A prevalence of 10.6% of clinically unapparent VFs was observed. Eight patients had 13 moderate or severe VFs, and only one of them had osteoporosis at densitometry. There was a trend to longer duration of acromegaly before diagnosis, higher prevalence of hypogonadism, and higher BMD Z-score at lumbar spine and femoral neck in fractured patients, without reaching statistical significance. There is a significant prevalence of moderate and severe VFs in acromegalic patients, independently of BMD. More longitudinal and controlled studies are needed to recommend the use of VFA in all acromegalic patients submitted to DXA scan. VFA is simple, practical, uses low radiation, and may provide important information in the management of acromegaly.

  18. Mechanical failures after fixation with proximal femoral nail and risk factors

    PubMed Central

    Koyuncu, Şemmi; Altay, Taşkın; Kayalı, Cemil; Ozan, Fırat; Yamak, Kamil

    2015-01-01

    Background This study aims at assessing the clinical results, radiographic findings, and associated complications after osteosynthesis of trochanteric hip fractures with proximal femoral nail (PFN). Methods A total of 152 patients with hip fractures who underwent osteosynthesis with PFN were included. The hip fracture types in the patients included in the study were classified according to the American Orthopedic/Orthopedic Trauma Association (AO/OTA). AO/OTA A1, A2, and A3 type fractures were found in 24 (15.8%), 107 (70.4%), and 21 (13.8%) patients, respectively. The Baumgaertner scale was used to assess the degree of postoperative reduction. The Salvati–Wilson hip function (SWS) scoring system was used to evaluate functional results. After a follow-up period, clinical and radiographic results were evaluated and complications were assessed. The relationship between the complications and SWS score, age, sex, fracture type, reduction quality, and time from the fracture to surgery was evaluated. Results Eighty-five (55.9%) female patients and 67 (44.1%) male patients were enrolled in the study. Seventy-nine (51.9%) patients had left hip fractures, and 73 (48.1%) had right hip fractures. The mean age was 76 (range 21–93) years, and the mean follow-up duration was 23.6 (range 7–49) months. Postoperatively, one patient (0.6%) had a poor reduction, 16 patients (10.5%) had an acceptable reduction, and 135 patients (88.9%) had a good reduction according to the above criteria. The SWS scores were excellent, good, moderate, and poor in 91 (59.8%), 45 (29.6%), 15 (9.8%), and one (0.6%) patients, respectively. Late postoperative complications were seen in 27 patients (17.7%). A total of 14 patients (9.2%) underwent a revision procedure for mechanical complications. Conclusion The study results suggest that the quality of fracture reduction is an important factor that affects the revision rate and SWS score in patients with mechanical complications after osteosynthesis

  19. Fuzzy logic structure analysis of trabecular bone of the calcaneus to estimate proximal femur fracture load and discriminate subjects with and without vertebral fractures using high-resolution magnetic resonance imaging at 1.5 T and 3 T.

    PubMed

    Patel, Priyesh V; Eckstein, Felix; Carballido-Gamio, Julio; Phan, Catherine; Matsuura, Maiko; Lochmüller, Eva-Maria; Majumdar, Sharmila; Link, Thomas M

    2007-10-01

    Newly developed fuzzy logic-derived structural parameters were used to characterize trabecular bone architecture in high-resolution magnetic resonance imaging (HR-MRI) of human cadaver calcaneus specimens. These parameters were compared to standard histomorphological structural measures and analyzed concerning performance in discriminating vertebral fracture status and estimating proximal femur fracture load. Sets of 60 sagittal 1.5 T and 3.0 T HR-MRI images of the calcaneus were obtained in 39 cadavers using a fast gradient recalled echo sequence. Structural parameters equivalent to bone histomorphometry and fuzzy logic-derived parameters were calculated using two chosen regions of interest. Calcaneal, spine, and hip bone mineral density (BMD) measurements were also obtained. Fracture status of the thoracic and lumbar spine was assessed on lateral radiographs. Finally, mechanical strength testing of the proximal femur was performed. Diagnostic performance in discriminating vertebral fracture status and estimating femoral fracture load was calculated using regression analyses, two-tailed t-tests of significance, and receiver operating characteristic (ROC) analyses. Significant correlations were obtained at both field strengths between all structural and fuzzy logic parameters (r up to 0.92). Correlations between histomorphological or fuzzy logic parameters and calcaneal BMD were mostly significant (r up to 0.78). ROC analyses demonstrated that standard structural parameters were able to differentiate persons with and without vertebral fractures (area under the curve [A(Z)] up to 0.73). However, none of the parameters obtained in the 1.5-T images and none of the fuzzy logic parameters discriminated persons with and without vertebral fractures. Significant correlations were found between fuzzy or structural parameters and femoral fracture load. Using multiple regression analysis, none of the structural or fuzzy parameters were found to add discriminative value to BMD

  20. Zickel nail: a retrospective study of subtrochanteric fractures.

    PubMed

    Beaver, R H; Bach, P J

    1978-02-01

    Nineteen subtrochanteric fractures were treated at Charlotte Memorial Hospital and Medical Center between March 1973 and March 1976 by open reduction and internal fixation using the Zickel nail. Postoperative roentgenograms showed the cross-nail exiting the femoral neck in three of the cases, but this later proved not to be significant. Of the 16 patients available for follow-up all were ambulatory unassisted or with a walker within two months of surgery. Radiographically evident healing averaged 4.1 months. There were no non-unions and no infections. Our data support the use of the Zickel nail in the treatment of subtrochanteric fractures.

  1. Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study

    PubMed Central

    2014-01-01

    Background The growing utilization of total joint replacement will increase the frequency of its complications, including periprosthetic fracture. The prevalence and risk factors of periprosthetic fracture require further study, particularly over the course of long-term follow-up. The objective of this study was to estimate the prevalence and risk factors for periprosthetic fractures occurring in recipients of total hip replacement. Methods We identified Medicare beneficiaries who had elective primary total hip replacement (THR) for non-fracture diagnoses between July 1995 and June 1996. We followed them using Medicare Part A claims data through 2008. We used ICD-9 codes to identify periprosthetic femoral fractures occurring from 2006–2008. We used the incidence density method to calculate the annual incidence of these fractures and Cox proportional hazards models to identify risk factors for periprosthetic fracture. We also calculated the risk of hospitalization over the subsequent year. Results Of 58,521 Medicare beneficiaries who had elective primary THR between July 1995 and June 1996, 32,463 (55%) survived until January 2006. Of these, 215 (0.7%) developed a periprosthetic femoral fracture between 2006 and 2008. The annual incidence of periprosthetic fracture among these individuals was 26 per 10,000 person-years. In the Cox model, a greater risk of periprosthetic fracture was associated with having had a total knee replacement (HR 1.82, 95% CI 1.30, 2.55) or a revision total hip replacement (HR1.40, 95% CI 0.95, 2.07) between the primary THR and 2006. Compared to those without fractures, THR recipients who sustained periprosthetic femoral fracture had three-fold higher risk of hospitalization in the subsequent year (89% vs. 27%, p < 0.0001). Conclusion A decade after primary THR, periprosthetic fractures occur annually in 26 per 10,000 persons and are especially frequent in those with prior total knee or revision total hip replacements. PMID:24885707

  2. Changing trends in the management of children's fractures.

    PubMed

    Kosuge, D; Barry, M

    2015-04-01

    The management of children's fractures has evolved as a result of better health education, changes in lifestyle, improved implant technology and the changing expectations of society. This review focuses on the changes seen in paediatric fractures, including epidemiology, the increasing problems of obesity, the mechanisms of injury, non-accidental injuries and litigation. We also examine the changes in the management of fractures at three specific sites: the supracondylar humerus, femoral shaft and forearm. There has been an increasing trend towards surgical stabilisation of these fractures. The reasons for this are multifactorial, including societal expectations of a perfect result and reduced hospital stay. Reduced hospital stay is beneficial to the social, educational and psychological needs of the child and beneficial to society as a whole, due to reduced costs. PMID:25820880

  3. Eosinophilic granuloma of the capital femoral epiphysis.

    PubMed

    Goto, Takahiro; Nemoto, Tetsuo; Ogura, Koichi; Imanishi, Jungo; Hozumi, Takahiro; Funata, Nobuaki

    2011-05-01

    Eosinophilic granuloma occurs almost exclusively in the diaphysis or metaphysis, when tubular bones are affected. The investigators present an extremely rare case of eosinophilic granuloma arising at the epiphysis of the femoral head in an 8-year-old boy. Plain radiographs and computed tomography showed a well-circumscribed radiolucent lesion, suggesting chondroblastoma or Brodie's abscess. However, the findings on magnetic resonance images were different from typical features of chondroblastoma or Brodie's abscess. The lesion was curetted. Histological diagnosis was eosinophilic granuloma. Differential diagnoses of a radiolucent lesion at the epiphysis in a child should include, though quite rare, eosinophilic granuloma.

  4. Arcuate Fractures

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site]

    In the upper left corner of this VIS image are a series of fractures. Where the fractures are exposed on the surface it is impossible to tell the plane of the fracture; however where the fractures are visible in the cliff wall it is possible to see that the fractures dip to the north. This image shows part of the caldera of Tharsis Tholus.

    Image information: VIS instrument. Latitude 1.7, Longitude 176.5 East (183.5 West). 19 meter/pixel resolution.

    Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time.

    NASA's Jet Propulsion Laboratory manages the 2001 Mars Odyssey mission for NASA's Office of Space Science, Washington, D.C. The Thermal Emission Imaging System (THEMIS) was developed by Arizona State University, Tempe, in collaboration with Raytheon Santa Barbara Remote Sensing. The THEMIS investigation is led by Dr. Philip Christensen at Arizona State University. Lockheed Martin Astronautics, Denver, is the prime contractor for the Odyssey project, and developed and built the orbiter. Mission operations are conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  5. Conjoint bicondylar Hoffa fracture in an adult

    PubMed Central

    Ul Haq, Rehan; Modi, Prashant; Dhammi, IK; Jain, Anil K; Mishra, Puneet

    2013-01-01

    Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed. PMID:23798763

  6. Tension band wiring for proximal femoral varus osteotomy fixation in children.

    PubMed

    Maranho, Daniel Augusto; Pagnano, Rodrigo Gonçalves; Volpon, José Batista

    2014-08-01

    For proximal varus osteotomy of the femur in children, a stable fixation, is a concern regarding the safety and the protection of the surgery. The methods of fixation are mostly represented by plating systems; however, the tension band wiring is a simple and eligible option for fixation of proximal femur osteotomy. The purpose of this retrospective case series study is to evaluate outcomes and bone remodelation after using the tension band wiring technique to fixate proximal femoral varus osteotomies in children.The study enrolled 20 patients who underwent femoral varus osteotomy to treat Legg-Calvé-Perthes disease and other causes of necrosis of the femoral head. The mean patient age at the time of surgery was 7.4 ± 2.3 years (range, 4.3-13.8 y), and the follow-up period averaged 10 ± 4.3 years (range, 4.7-20.8 y). To assess the effects of the osteotomy at the neck-shaft angle and its evolution over time, radiographs obtained preoperatively and during the follow-up were analyzed. The neck-shaft angle was measured independently by 2 observers, and intraclass correlation coefficients (ICCs) were assessed for reliability.The ICC analysis showed good reliability. There was a significant reduction in the neck-shaft angle (P < 0.001) between the preoperative and the immediate postoperative periods, with an estimated difference of 14.3°. Between the immediate and the early postoperative periods, the estimated difference was 2.1°, which indicated a significant increase in the neck-shaft angle (P = 0.003). Between the early postoperative period and the final evaluation, there was a significant increase (P < 0.001), with an estimated difference of 7.0°. No implant failures or other complications were observed, but 1 case of peri-implant femoral fracture occurred >17 years postsurgery.The tension band wiring technique proved to be a simple and effective method for fixating proximal femoral varus osteotomy in children.The level IV is appropriated for our study (case

  7. A Case of Distal Femur Medial Condyle Hoffa Type II(C) Fracture Treated with Headless Screws

    PubMed Central

    Merh, Aditya; Shah, Malkesh; Golwala, Paresh

    2016-01-01

    Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures. They were described by Hoffa in 1904 and are known as Hoffa fractures (AO type B3). They are isolated fractures of the femoral condyle and rare in occurrence. The objective in the treatment of these fractures is to achieve anatomical reduction of the articular surface and a stable fixation to prevent joint damage in future and prevent post-traumatic arthritis of the joint. We report the case of a young male patient who had a rare type of medial Hoffa fracture which was treated by open reduction and internal fixation using headless Herbert screws using a posterior approach. The fracture was united in eight weeks, and the patient had a full range of knee movement. We advocate this approach and modality of treatment for Hoffa type II(C) fractures.

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

    PubMed

    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 cases, this article presents a forensic evidence-based approach to differentiate between accidental and non-accidental causes of femoral fractures. We describe three cases of young children who were presented to the emergency department because of a suspected femur fracture. Although in all cases, the fracture had a similar location and appearance, the clinical history and developmental stage of the child led to three different conclusions. In the first two cases, an accidental mechanism was a plausible conclusion, although in the second case, neglect of parental supervision was the cause for concern. In the third case, a non-accidental injury was diagnosed and appropriate legal prosecution followed. Any doctor treating children should always be aware of the possibility of child abuse and neglect in children with injuries, especially in young and non-mobile children presenting with an unknown trauma mechanism. If a suspicion of child abuse or neglect arises, a thorough diagnostic work-up should be performed, including a full skeletal survey according to the guidelines of the Royal College of Radiologists and the Royal College of Paediatrics and Child Health. In order to make a good assessment, the radiologist reviewing the skeletal survey needs access to all relevant clinical and social information. PMID:26642309

  9. Preliminary study report: topological texture features extracted from standard radiographs of the heel bone are correlated with femoral bone mineral density

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

    With the growing number of eldery patients in industrialized nations the incidence of geriatric, i.e. osteoporotic fractures is steadily on the rise. It is of great importance to understand the characteristics of hip fractures and to provide diagnostic tests for the assessment of an individual's fracture-risk that allow to take preventive action and give therapeutic advice. At present, bone-mineral-density (BMD) obtained from DXA (dual-energy x-ray-absorptiometry) is the clinical standard of reference for diagnosis and follow-up of osteoporosis. Since availability of DXA - other than that of clinical X-ray imaging - is usually restricted to specialized medical centers it is worth trying to implement alternative methods to estimate an individual's BMD. Radiographs of the peripheral skeleton, e.g. the ankle, range among the most ordered diagnostic procedures in surgery for exclusion or confirmation of fracture. It would be highly beneficial if - as a by-product of conventional imaging - one could obtain a quantitative parameter that is closely correlated with femoral BMD in addition to the original diagnostic information, e.g. fracture status at the peripheral site. Previous studies could demonstrate a correlation between calcaneal BMD and osteoporosis. The objective of our study was to test the hypothesis that topological analysis of calcaneal bone texture depicted by a lateral x-ray projection of the ankle allows to estimate femoral BMD. Our analysis on 34 post-menopausal patients indicate that texture properties based on graylevel topology in calcaneal x-ray-films are closely correlated with BMD at the hip and may qualify as a substitute indicator of femoral fracture risk.

  10. Substantially higher prevalence of postoperative peri­prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

    PubMed Central

    Mukka, Sebastian; Mellner, Carl; Knutsson, Björn; Sayed-Noor, Arkan; Sköldenberg, Olof

    2016-01-01

    Background and purpose Recent studies have demonstrated a high incidence of postoperative periprosthetic femoral fracture (PPF) in elderly patients treated with 2 commonly used cemented, polished tapered stems. We compared the prevalence and incidence rate of PPF in a consecutive cohort of octagenerians with femoral neck fractures (FNFs) treated with either a collarless, polished tapered (CPT) stem or an anatomic matte stem (Lubinus SP2). Patients and methods In a multicenter, prospective cohort study, we included 979 hips in patients aged 80 years and above (72% females, median age 86 (80–102) years) with a femoral neck fracture as indication for surgery. 69% of the patients were classified as ASA class 3 or 4. Hip-related complications and repeat surgery were assessed at a median follow-up of 20 (0–24) months postoperatively. Results 22 hips (2.2%) sustained a PPF at a median of 7 (0–22) months postoperatively; 14 (64%) were Vancouver B2 fractures. 7 of the 22 surgically treated fractures required revision surgery, mainly due to deep infection. The cumulative incidence of PPFs was 3.8% in the CPT group, as compared with 0.2% in the SP2 group (p < 0.001). The risk ratio (RR) was 16 (95% CI: 2–120) using the SP2 group as denominator. Interpretation The CPT stem was associated with a higher risk of PPF than the SP2 stem. We suggest that the tapered CPT stem should not be used for the treatment of femoral neck fractures in patients over 80 years. PMID:27045318

  11. Current concepts in total femoral replacement

    PubMed Central

    Ramanathan, Deepak; Siqueira, Marcelo BP; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K; Joyce, Michael J

    2015-01-01

    Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20th century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure. PMID:26716087

  12. Risks of all-cause and site-specific fractures among hospitalized patients with COPD

    PubMed Central

    Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

    2016-01-01

    Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted utilizing the Taiwan Longitudinal Health Insurance Database. Patients with COPD were defined as those who were hospitalized with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 490 to 492 or 496 between 2001 and 2011. The index date was set as the date of discharge. The study patients were followed from the index date to the date when they sought care for any type of fracture, date of death, date of health insurance policy termination, or the last day of 2013. The types of fracture analyzed in this study included vertebral, rib, humeral, radial and ulnar/wrist, pelvic, femoral, and tibial and fibular fractures. The cohort consisted of 11,312 patients with COPD. Among these patients, 1944 experienced fractures. The most common site-specific fractures were vertebral, femoral, rib, and forearm fractures (radius, ulna, and wrist) at 32.4%, 31%, 12%, and 11.8%, respectively. The adjusted hazard ratios of fracture were 1.71 [95% confidence interval (95% CI) = 1.56–1.87] for female patient with COPD and 1.50 (95% CI = 1.39–1.52) for patients with osteoporosis after covariate adjustment. Vertebral and hip fractures are common among patients with COPD, especially among males with COPD. Many comorbidities contribute to the high risk of fracture among patients with COPD. PMID:27749576

  13. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

    PubMed Central

    Miettinen, Simo S A; Mäkinen, Tatu J; Kostensalo, Inari; Mäkelä, Keijo; Huhtala, Heini; Kettunen, Jukka S; Remes, Ville

    2016-01-01

    Background and purpose — Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of—and risk factors for—intraoperative calcar fracture, and assessed its influence on the risk of revision. Patients and methods — This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8–8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture. Results — The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9–17) and 3.4% (CI: 1.3–8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner. Interpretation — Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices. PMID:26541230

  14. Epidemiology of proximal humerus fractures managed in a trauma center.

    PubMed

    Roux, A; Decroocq, L; El Batti, S; Bonnevialle, N; Moineau, G; Trojani, C; Boileau, P; de Peretti, F

    2012-10-01

    Proximal humerus fractures (PHF) are osteoporotic fractures that affect women over 70 years of age. Like fractures of the femoral neck they have become a public health concern. As the population ages there is an increase i