Bilateral Femoral Shaft Research Articles

Delayed femoral artery injury caused by heterotopic ossification: a rare case report and review of the literature

BackgroundArterial injury caused by heterotopic ossification (HO) following fractures is rarely reported, yet it can have catastrophic consequences. This case report presents a unique instance of femoral artery injury and hematoma organization, occurring a decade after intramedullary nail fixation for a femoral shaft fracture complicated by HO.Case presentationA 56-year-old male presented with right femoral artery injury and organized hematoma, a decade after suffering bilateral femoral shaft fractures with mild head injury in a traffic accident. He had received intramedullary nailing for the right femoral shaft fracture and plate fixation for the left side in a local hospital. Physical examination revealed two firm, palpable masses with clear boundaries, limited mobility, and no tenderness. Peripheral arterial pulses were intact. Radiography demonstrated satisfactory fracture healing, while a continuous high-density shadow was evident along the inner and posterior aspect of the right thigh. Computed tomography angiography identified a large mixed-density mass (16.8 × 14.8 × 20.7 cm) on the right thigh’s medial side, featuring central calcification and multiple internal calcifications. The right deep femoral artery coursed within this mass, with a smaller lesion noted on the posterior thigh. Surgical consultation with a vascular surgeon led to planned intervention. The smaller mass was completely excised, but the larger one partially, as it encased the femoral artery. The inability to remove all HO was due to excessive bleeding. Postoperatively, the patient experienced no complications, and one-year follow-up revealed a favorable recovery with restoration of full right lower limb mobility.ConclusionThis case underscores the potential gravity of vascular injury associated with heterotopic ossification. Surgeons should remain vigilant regarding the risk of vascular injury during HO excision.

Two big bones, one big decision: When to fix bilateral femur fractures

PurposeFor polytrauma patients with bilateral femoral shaft fractures (BFSF), there is currently no consensus on the optimal timing of surgery. This study assesses the impact of early (≤ 24 h) versus delayed (>24 h) definitive fixation on clinical outcomes, especially focusing on concomitant versus staged repair. We hypothesized that early definitive fixation leads to lower mortality and morbidity rates. MethodsThe 2017–2020 Trauma Quality Improvement Program was used to identify patients aged ≥16 years with BFSF who underwent definitive fixation. Early definitive fixation (EDF) was defined as fixation of both femoral shaft fractures within 24 h, delayed definitive fixation (DDF) as fixation of both fractures after 24 h, and early staged fixation (ESF) as fixation of one femur within 24 h and the other femur after 24 h. Propensity score matching and multilevel mixed effects regression models were used to compare groups. Results1,118 patients were included, of which 62.8% underwent EDF. Following propensity score matching, 279 balanced pairs were formed. EDF was associated with decreased overall morbidity (12.9% vs 22.6%, p = 0.003), lower rate of deep venous thrombosis (2.2% vs 6.5%, p = 0.012), a shorter ICU LOS (5 vs 7 days, p < 0.001) and a shorter hospital LOS (10 vs 15 days, p < 0.001). When compared to DDF, early staged fixation (ESF) was associated with lower rates of ventilator acquired pneumonia (0.0% vs 4.9%, p = 0.007), but a longer ICU LOS (8 vs 6 days, p = 0.004). Using regression analysis, every 24-hour delay to definitive fixation increased the odds of developing complications by 1.05, postoperative LOS by 10 h and total hospital LOS by 27 h. ConclusionEarly definitive fixation (≤ 24 h) is preferred over delayed definitive fixation (>24 h) for patients with bilateral femur shaft fractures when accounting for age, sex, injury characteristics, additional fractures and interventions, and hospital level. Although mortality does not differ, overall morbidity and deep venous thrombosis rates, and length of hospital and intensive care unit stay are significantly lower. When early definitive fixation is not possible, early staged repair seems preferable over delayed definitive fixation.

Early intramedullary nailing of bilateral femur fractures: who might benefit most?

Identifying which patients can receive immediate intramedullary nailing (IMN) after bilateral femoral shaft fracture may improve health-related quality of life outcomes and decrease healthcare costs. This retrospective study evaluated the perioperative factors that guided emergency department transfer of patients to the operating room (OR) where IMN or temporizing external fixation (TEF) was performed, to the intensive care unit (ICU), or to the orthopedic ward. The hypothesis was that patients referred initially to the OR or to the ICU had more serious co-morbidities, complications, or orthopedic polytrauma, increasing the likelihood that they would benefit from "damage control orthopedics" and TEF use. A Level I Trauma Center database (2010-2020) review identified the records of 23 patients that met study inclusion and exclusion criteria. Most sustained their injury in a motor vehicle accident (87%) and were not wearing a seatbelt. Patients transferred to the operating room had a greater body mass index and shorter times between admission and surgery. Those transferred to the OR or ICU had higher injury severity scores (ISS), higher arterial blood O2 partial pressure (paO2) values on the first post-surgical day, and had more red blood cell unit (RBCU) transfusions during hospitalization. Patients transferred to the ICU more often underwent TEF and had shorter initial surgical procedure duration. Those with pneumothorax, rib fractures, or with other orthopedic comorbidities were more often transferred to the OR or ICU and those with acute complications requiring exploratory laparotomy were transferred to the OR. Patients with higher BMI, ISS, greater RBCU transfusion needs, with pneumothorax, rib fractures, or acute complications requiring exploratory laparotomy were more likely to be initially transferred to the OR or ICU. Patients transferred to the orthopedic ward represented a more heterogenous group with greater possibility for benefitting from earlier definitive IMN.

Fat Embolism Syndrome Complicated by Acute Pulmonary Thromboembolism after Bilateral Femoral Shaft Fractures: Two Nightmares in The Same Patient

Fat embolism syndrome (FES) is an uncommon but fatal complication usually in orthopedic trauma especially after a long bone fracture. A high level of suspicion should be kept in mind when a patient of long bone fracture develops hypoxia, confusion or rash in the absence of infection and other causes of respiratory failure. Concomitant FES and pulmonary thromboembolism (PTE) is a more rarer entity in comparison to FES and pulmonary thromboembolism as separate entities. There are few cases reported in literature wherein patients developed concomitant FES and pulmonary embolism. Almost in all cases fat embolism syndrome and pulmonary embolism occurred either simultaneously or pulmonary thromboembolism was complicated by FES. We report a case wherein patient initially developed FES pre-operatively which was later on complicated by acute pulmonary thromboembolism in the post-operative period.

A Comparison of the Prevalence of, Demographics of, and Effects on Outcomes of Bilateral Versus Unilateral Femoral Shaft Fractures: A Retrospective Cohort Analysis From the National Trauma Data Bank.

To document the prevalence of, and the effect on outcomes, operatively treated bilateral femur fractures treated using contemporary treatments. A retrospective cohort using data from the National Trauma Data Bank. In total, 119,213 patients in the National Trauma Data Bank between the years 2007 and 2015 who had operatively treated femoral shaft fractures. Complication rates, hospital length of stay (LOS), days in the intensive care unit (ICU LOS), days on a ventilator, and mortality rates. Patients with bilateral femur fractures had increased overall complications (0.74 vs. 0.50, P < 0.0001), a longer LOS (14.3 vs. 9.2, P < 0.0001), an increased ICU LOS (5.3 vs. 2.4, P < 0.0001), and more days on a ventilator (3.1 vs. 1.3, P < 0.0001), when compared with unilateral fractures. Bilateral femoral shaft fractures were independently associated with worse outcomes in all primary domains when adjusted by Injury Severity Score (P < 0.0001), apart from mortality rates. Age-adjusted bilateral injuries were independently associated with worse outcomes in all primary domains (P < 0.0001) except for the overall complication rate. A delay in fracture fixation beyond 24 hours was associated with increased mortality (P < 0.0001) and worse outcomes for all other primary measures (P < 0.0001 to P = 0.0278) for all patients. Bilateral femoral shaft fractures are an independent marker for increased hospital and ICU LOS, number of days on a ventilator, and increased complication rates, when compared with unilateral injuries and adjusted for age and Injury Severity Score. Timely definitive fixation, in a physiologically appropriate patient, is critical because a delay is associated with worse inpatient outcome measures and higher mortality rates. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review.

To evaluate rates of complications in patients with bilateral femur fractures treated with intramedullary nailing (IMN) during either 1 single procedure or 2 separate procedures. A multicenter retrospective review of patients sustaining bilateral femur fractures, treated with IMN in single or 2-stage procedure, from 1998 to 2018 was performed at 10 Level-1 trauma centers. Ten Level-1 trauma centers. Two hundred forty-six patients with bilateral femur fractures. Intramedullary nailing. Incidence of complications. A total of 246 patients were included, with 188 single-stage and 58 two-stage patients. Gender, age, injury severity score, abbreviated injury score, secondary injuries, Glasgow coma scale, and proportion of open fractures were similar between both groups. Acute respiratory distress syndrome (ARDS) occurred at higher rates in the 2-stage group (13.8% vs. 5.9%; P value = 0.05). When further adjusted for age, gender, injury severity score, abbreviated injury score, Glasgow coma scale, and admission lactate, the single-stage group had a 78% reduced risk for ARDS. In-hospital mortality was higher in the single-stage cohort (2.7% compared with 0%), although this did not meet statistical significance (P = 0.22). This is the largest multicenter study to date evaluating the outcomes between single- and 2-stage IMN fixation for bilateral femoral shaft fractures. Single-stage bilateral femur IMN may decrease rates of ARDS in polytrauma patients who are able to undergo simultaneous definitive fixation. However, a future prospective study with standardized protocols in place will be required to discern whether single- versus 2-stage fixation has an effect on mortality and to identify those individuals at risk. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Acute Lumbosacral Plexopathy Following Femoral Fracture: An Unusual Association

Background: Post traumatic lumbosacral plexopathy (LSP) is a well-known condition following pelvic fracture or abdominal trauma and surgery. A rare condition of LSP has been reported in the literature following femoral shaft fractures. Case Report: Two cases of LSP after bilateral femoral shaft fracture presented to our center. In both cases, the mechanism of injury was a high energy trauma without any signs or symptoms of pelvic or spinal injury. Electrodiagnostic studies confirmed acute plexopathy and spontaneous recovery occurred in both. Conclusion: LSP can be seen in association with fractures or traumas far from anatomical location of the plexus. Multidisciplinary approach and complete accurate examination are mandatory for diagnosis management of the condition.

Factors influencing management of bilateral femur fractures: A multicenter retrospective cohort of early versus delayed definitive Fixation

IntroductionThe purpose of our study was to evaluate the factors that influence the timing of definitive fixation in the management of bilateral femoral shaft fractures and the outcomes for patients with these injuries. MethodsPatients with bilateral femur fractures treated between 1998 to 2019 at ten level-1 trauma centers were retrospectively reviewed. Patients were grouped into early or delayed fixation, which was defined as definitive fixation of both femurs within or greater than 24 hours from injury, respectively. Statistical analysis included reversed logistic odds regression to predict which variable(s) was most likely to determine timing to definitive fixation. The outcomes included age, sex, high-volume institution, ISS, GCS, admission lactate, and admission base deficit. ResultsThree hundred twenty-eight patients were included; 164 patients were included in the early fixation group and 164 patients in the delayed fixation group. Patients managed with delayed fixation had a higher Injury Severity Score (26.8 vs 22.4; p<0.01), higher admission lactate (4.4 and 3.0; p<0.01), and a lower Glasgow Coma Scale (10.7 vs 13; p<0.01). High-volume institution was the most reliable influencer for time to definitive fixation, successfully determining 78.6% of patients, followed by admission lactate, 64.4%. When all variables were evaluated in conjunction, high-volume institution remained the strongest contributor (X2 statistic: institution: 45.6, ISS: 8.83, lactate: 6.77, GCS: 0.94). ConclusionIn this study, high-volume institution was the strongest predictor of timing to definitive fixation in patients with bilateral femur fractures. This study demonstrates an opportunity to create a standardized care pathway for patients with these injuries. Level of EvidenceLevel III

Bilateral femoral shaft fracture in polytrauma patients: Can intramedullary nailing be done on an emergency basis?

IntroductionWhether damage control orthopedics (DCO) or early total care (ETC) is the best way to treat polytrauma patients who have suffered a bilateral femoral shaft fracture remains unanswered. The aim of this study was to evaluate the morbidity of bilateral femur fractures treated by simultaneous intramedullary (IM) nailing according to ETC principles. Materials and methodsThis retrospective single-centre study included all polytrauma patients who had suffered a femoral shaft fracture and were treated at our level I trauma centre. Demographic data, associated lesions, injury severity score (ISS) and occurrence of acute respiratory distress syndrome (ARDS) were collected prospectively in our trauma database. Unilateral fractures (UF) were compared to bilateral fractures (BF). The risk of ARDS was evaluated by multivariate logistic regression. ResultsBetween 2010 and 2019, 176 UF (88%) and 25 BF (12%) were included. Patients with BF had a higher ISS (36 vs. 25, p<0.001) and more brain injuries (44% vs. 15%, p=0.001) than patients with a UF. More blood transfusions were done in BF than UF (4.0 vs. 1.6 units, p=0.002). The incidence of ARDS was higher in BF patients than UF (36% vs. 4%) with longer stay in intensive care (18 vs. 12 days, p=0.02) and in the hospital (32 vs. 23 days, p=0.006). There were no deaths in either group. The risk of ARDS was correlated to ISS, but not to bilaterality. DiscussionStudies on DCO and ETC report similar mortality and ARDS rates for BF. ISS appears to determine the postoperative morbidity irrespective of how the patients are managed. In contrast with DCO, perioperative intensive care has a predominant role in ETC, allowing early definitive fixation of fractures, even in severely injured patients. ConclusionBilateral femoral shaft fractures are a sign of severe trauma leading to high postoperative morbidity. The patient is likely to have concomitant severe injuries. Simultaneous ECM can be done emergently providing appropriate perioperative intensive care management. Level of evidenceIV; retrospective study.

Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures

The treatment of children between 5 and 12 years of age suffering from subtrochanteric femoral fracture is challenging. The optimal choice of internal fixation for these patients is controversial. The purpose of this study is to compare the outcomes and complications of titanium elastic nail and open reduction with plate fixation of subtrochanteric femur fractures in school-aged children.A total of 67 children aged 5 to 12 years with subtrochanteric femur fractures treated with titanium elastic nails or open plating were identified at our institution from January 2007 to December 2017. We retrospectively compared 39 children treated with titanium elastic nails with 28 children treated with open reduction and plate fixation. The data included age, sex, body weight, fracture pattern, operation time, blood loss, and length of hospitalization. The follow-up investigations included radiograph of pelvis, bilateral hip range of motion, bilateral femoral neck shaft angle, and length of lower extremity. The outcomes were classified according to Flynn classification as excellent, satisfactory, or poor. All the demographic characteristics were compared with statistical analyses.All 67 fractures united properly. No major postoperative complications were noted in both groups. No significant difference was found between the titanium elastic nail and open plating groups in terms of sex, fracture pattern, and length of hospitalization. We noted a significant difference between 2 groups in terms of age, weight, operation time, and blood loss. In total, we observed 24 excellent and 15 satisfactory results in the titanium elastic nail group, and 19 excellent results and 9 satisfactory results in the open plating group. There was no significant statistical difference between involved and uninvolved side of hip regarding range of motion and femoral neck shaft angle in both groups.Titanium elastic nail and pediatric hip plate fixation represent safe and effective methods in the treatment of subtrochanteric fractures in school-aged children. Titanium elastic nail internal fixation is a minimal invasive and simpler technique and suitable for young children of lower body weight. Open plate fixation is a more rigid fixation associated with a lower complication rate.

Integration of computer-assisted fracture reduction system and a hybrid 3-DOF-RPS mechanism for assisting the orthopedic surgery

In this paper, we present study to integrate virtual fracture bone reduction simulation tool with a novel hybrid 3-DOF-RPS external fixator to relocate back bone fragments into their anatomically original position. A 3D model of fractured bone was reconstructed and manipulated using 3D design and modeling software, PhysiGuide. The virtual reduction system was applied to reduce a bilateral femoral shaft fracture type 32-A3. Measurement data from fracture reduction and fixation stages were implemented to manipulate the manipulator pose in patient’s clinical case. The experimental result presents that by merging both of those techniques will give more possibilities to reduce virtual bone reduction time, improve facial and shortest healing treatment.

LES PERFORATIONS DIGESTIVES DU NOUVEAU-NĖ : A PROPOS DE 4 CAS

The isolated digestive perforation in the newborn at term is rare and raises a real diagnostic problem. That is at the origin of a not inconsiderable morbidity and mortality. We report our experience about 4 cases brought together between 2008 and 2016 in the department of Pediatric Surgery of Albert ROYER Children’s Hospital. The purpose of our work is to run from these clinical observations and try to release the elements of answers on the idiopathic or secondary character of that entity. It is a retrospective and prospective study including three girls and one boy respectively aged one, five, twelve and thirty-eight days. The clinical symptoms were dominated by vomiting accompanied with an abdominal sensibility in day 1 of birth for one case and day five of birth in another one. In the two other cases the abdominal picture appeared twelve days after surgery of left hydrocele was performed in a 26-day-old on one hand, on the other hand, it occurred at day 12 of birth following a bilateral obstetrical femoral shaft fractures in a girl. The radiography of the belly without preparation realized in every case allowed us to objectify a pneumoperitoneum and air-fluid levels. A fast resuscitation consisting of urinary catheter and nasogastric probe implementation with the use of crystalloid fluid was led at any rate. The laparotomy findings in any cases were gastric perforation, gastric tearing or colonic perforation. The surgical treatment performed was temporary colostomy, gastric suture or colonic suture with postoperative death registered in one case. Question: is digestive perforation spontaneous or provoked ? Authors think that trauma is constant and real. Keywords: newborn ; digestive perforation; obstetric trauma; idiopathic.

Bilateral Atypical Femoral Shaft Fractures and Bisphosphonate Therapy; A Case Report

Bilateral Atypical Femoral Shaft Fractures and Bisphosphonate Therapy; A Case Report

Study to evaluate the outcomes of surgical stabilization of distal 1/3rd fracture shaft femur with retrograde nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Distal femur is a complex fractures and most of times a personalized approach is needed for these fractures. Over a period of time variety of approaches and implants have been used for these fractures. The use of retrograde femur nail for fixing femur fracture, using entry from inter-condylar notch of femur, is a known method of treatment, but most surgeons are apprehensive of making an entry from the knee joint because of possible complications like knee pain, arthro-fibrosis, infections etc .The aim of this study was to investigate its effectiveness in fixation of distal 1/3&lt;sup&gt;rd &lt;/sup&gt;fracture of femur with special emphasis on the outcome and inherent surgical challenges&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study of 40 patients with fracture femur diaphysial distal one third were treated by retrograde nailing, from July 2010 to January 2016, after obtaining required approval from the Institutional ethical &amp;amp; research committee. All the patients were followed till fracture union and evaluated on the basis of demography, duration of healing, complications and surgical challenges.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We observed that mean age of patients was 35.8 years (18 years to 62 years) where 87.5% were male and 12.5% were female. Average duration of healing was 17.75 weeks (ranging from 10 weeks to 36 weeks) with 100% healing achieved. Mean knee range of motion was 124.5 degree (70 to 140 degree), rate of knee pain 10% (4/40), re-operation rate 5% (2/40), infection rate 2.5% (1/40), and fat embolism 2.5% (1/40)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Retrograde femoral nailing is a reliable alternative to antegrade nailing or plate fixation for diaphyseal fracture distal one third femur, and may be in some situations even advantageous when antegrade nail entry is challenging like ipsilateral hip fractures, previous implant in hip &amp;amp; proximal femur, ipsilateral pelvi-acetabular injury, bilateral femoral shaft fracture, floating Knee injuries, poly-trauma and obese patients&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

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

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

Bilateral Femur Fractures Associated With Short-term Bisphosphonate Use

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.

Bilateral Femoral Neck Fractures in A Young Patient Suffering from Hypophosphatasia, Due to A First Time Epileptic Seizure.

Introduction:We report a case of an adolescent sustaining bilateral femoral neck fractures due to a first time epileptic seizure, as a result of expansion of his known syrinx.Case Report:A 19-year-old patient suffering from hypophosphatasia (HPP), Arnold-Chiari malformation, and a ventriculoperitoneal shunt sustained a trivial fall with profound pain and an inability to mobilize. Radiographs demonstrated a right-sided Garden-4 femoral neck and left-sided multi-fragmentary intracapsular/extracapsular fractures. The patient had previously suffered bilateral proximal femoral shaft fractures, treated with intramedullary unlocked nail fixation that was still in situ. Operative treatment with an exchange to Synthes Adolescent Lateral Recon nail was performed on the right with two Recon screws inserted into the femoral head. On the left, the existing Pedinail was preserved with an additional single screw inserted into the femoral head. In addition, 3 months of non-mobilization was required for adequate bone healing. After 1-year from time of injury, there is no avascular necrosis on radiographs and the patient is mobilizing pain-free.Conclusion:Patients with hypophosphatasia have delayed bone healing. We recommend surgical fixation with an intramedullary device and periods of non-mobilization until there is radiographical evidence of adequate bone healing.

Early clinical protocols for traumatic bilateral femoral shaft fracture

Objective To investigate the mechanism,injury characteristics,and early interventions of bilateral femoral shaft fracture.Methods Twenty-five cases of bilateral femoral shaft fracture treated between December 2009 and June 2012 were enrolled in the study.Eighteen patients were males and 7 were females with mean age of 31.2 years (range,17-40 years).Nineteen cases were injured due to traffic accidents and 6 due to the hit by heavy objects.There were 47 sides with closed fracture and 3 sides with open fracture.Intramedullary nailing was performed at 32 sides and plate fixation was used at 18 sides.ISS,blood routine,some blood biochemical items,blood or plasma use,and hospitalization days were measured.Results ISS was (14.6 ± 5.2) points.Preoperative readiness time and hospital stay were (10.1 ± 3.7) days and (28.9 ± 8.4) days respectively.After hospitalization,measured values were (3.0 ± 0.4) × l012/L for red blood cells,(86.0 ± 13.5) g/L for hemogIobin,(47.0 ± 10.6) g/L for total protein,(31.4 ± 6.5) g/L for albumin,(124.1 ± 95.1) U/L for aspartate aminotransferase,(114.2 ± 107.1) U/L for alanine aminotransferase,and (1 848.7 ± 1 044.8) U/L for creatine kinase with significant differences from the reference ranges (P ＜ 0.05 or 0.01).Amount of blood transfused for 23 cases was (1 444.4 t 726.5) ml and plasma transfused for 19 cases was (305.6 ± 98.3) ml before operation.Volume of intra-and post-operative blood transfusion was (2 005.7 ± 1 153.1) ml.Conclusions Stabilization of vital signs predominates the early treatment of bilateral femoral shaft fracture.After the condition is stable,intramedulary nailing or plating can be performed concurrently. Key words: Femoral fractures ; Fracture fixation, internal; Early diagnosis

English

Even though there are recent reports showing strong association between long term bisphosphonate therapy and atypical femoral shaft fractures, there are no well-defined guidelines regarding screening of these fractures and also regarding prevention of the same in a patient with bilateral sequential atypical femoral shaft fractures. We report our experience with two cases of bilateral, sequential, atypical femoral shaft fractures helpful in formulating guidelines for screening and management of these fractures. We also believe that prophylactic femoral intramedullary nailing with continuation of bisphosphonate therapy as a potential option for preventing the propagation of incomplete bilateral simultaneous/sequential atypical femoral shaft fractures into complete fracture.

Dehydroepiandrosterone modulates the inflammatory response in a bilateral femoral shaft fracture model.

BackgroundDehydroepiandrosterone (DHEA) has been shown to have immunomodulatory effects after hemorrhage and sepsis. The present study analyzes whether DHEA is also involved in the mediation of inflammatory stimuli induced by bilateral femoral shaft fracture.MethodsMale C57/BL6 mice (6 per group) were subjected to closed bilateral femoral shaft fracture with intramedullary nailing followed by administration of either 25 mg/kg/24 h DHEA diluted in saline with 0.1% ethanol or saline with 0.1% ethanol. The sham group was treated by isolated intramedullary nailing without fracture. Animals were sacrificed after 6, 24, or 72 h. Serum TNFα, IL-1β, IL-6, IL-10, MCP-1, and KC concentrations were measured by Bio-Plex ProTm analysis. Acute pulmonary inflammation was assessed by histology, pulmonary myeloperoxidase (MPO) activity, and pulmonary IL-6 concentration.ResultsDHEA was associated with a decrease in the systemic inflammatory response induced by bilateral femoral fracture, especially systemic IL-6 (322.2 vs. 62.5 pg/mL; P = 0.01), IL-1β (1,422.6 vs. 754.1 pg/mL; P = 0.05), and MCP-1 (219.4 vs. 44.1 pg/mL; P >0.01) levels. No changes in pulmonary inflammation were measured.ConclusionWe conclude that DHEA may be a treatment option to reduce systemic inflammation following musculoskeletal injuries although the pulmonary inflammatory reaction was not affected.