Cases Of Femoral Shaft Fractures Research Articles

The Treatment of Reverse Obliquity Intertrochanteric Fractures With the Intramedullary Hip Nail

Reverse obliquity intertrochanteric fractures have been recognized as having unique anatomic and mechanical characteristics. Even though some clinical reports regarding intramedullary hip nailing for reverse obliquity intertrochanteric fracture show favorable results, there has been no clinical report of intramedullary hip nailing regarding the clinical significance of the lesser trochanteric fragment which differentiates Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A3.3 from A3.1 and A3.2. We retrospectively reviewed the clinical results of 46 cases of reverse obliquity or transverse intertrochanteric fracture treated with intramedullary hip nails. Twenty-five fractures were fixed with proximal femoral nail (PFN), and 21 fractures were fixed with intertrochanteric subtrochanteric nail. Among 40 patients, followed up for more than 6 months, 22 31-A3.3 fractures (84.6%) out of 26 and all 14 A3.1 or A3.2 fractures were healed after the first operation. The complications were four cases of fixation failure and one case of femoral shaft fracture after fall. They occurred in the A3.3 type fracture, which were fixed with the PFN. The mean union time was longer in the A3.3 group (5.98 months, range 3-17 months) compared with that in the A3.1 or A3.2 group (4.65 months, range 3-9 months) (p = 0.048). Two cases of reciprocal migration of two screws (Z-effect) required exchange of the femoral neck screw to a shorter one in the PFN group. The amount of sliding of the femoral neck screw of the PFN (6.8 mm, range 0.3 mm-16.5 mm) was greater than that of the intertrochanteric subtrochanteric nail lag screw (1.89 mm, range: 0.2 mm-4.6 mm) (p = 0.012). Statistical analysis showed that the type of implant PFN, fracture subtype (31-A3.3), and old ages (more than 65 years old) significantly prolonged the union time (p < 0.05). The lesser trochanteric fragment and posteromedial defect in 31-A3.3 fracture seems to play an important role in the stability after intramedullary hip nailing. The causes of fixation failure in the PFN group were associated with excessive sliding of femoral neck screw, which was aggravated by toggling motion in the 31-A3.3 fractures.

Evaluation of the Stryker S2™ IM Nail Distal Targeting Device for reduction of radiation exposure: A case series study

Distal locking is one challenging step during intramedullary nailing of femoral shaft fractures that can lead to an increase of radiation exposure. In the present study, the authors describe a technique for the distal locking of femoral nails, implementing a new targeting device in an attempt to reduce radiation exposure and operational time. Over a 2-year period, 127 consecutive cases of femoral shaft fractures were included in the study. All cases were treated with nailing of femoral shaft fractures with an unslotted reamed antegrade femoral nail and distal locking was performed with the use of a proximally mounted aiming device. Mean duration of the procedure was 63.5 18.1 min while the duration for distal locking was 6.6 +/- 2.6 min. In all successful cases, exposure from intraoperative fluoroscopy was 17.2 +/- 7.4 s for the whole operative procedure, and for distal locking was 2 shots, 1.35 s (range, 0.9-2.2 s) and 1.9 mGy (range, 1.1-2.9 mGy). Five cases (3.9%) were unsuccessful, but overall no intraoperative complications were encountered from the application of this technique. The ability of the device to correspond to the level of nail deformation and to properly identify the distal holes, reduced exposure to radiation compared to other published reports, and should be considered as a valuable tool for distal locking of femoral fractures.

Treatment of ipsilateral femoral neck and shaft fractures

To investigate the clinical characteristics, treatment options and causes of misdiagnosis of ipsilateral femoral neck and shaft fractures. Among 20 patients with ipsilateral femoral neck and shaft fractures, 19 were treated operatively and 1 was treated conservatively. Sixteen cases of femoral shaft fractures were treated by open reduction and internal fixation with compressive plate, and 2 cases were treated with interlocking intramedullary nailing. Eighteen femoral neck fractures were treated with cannulated screws. Another patient was treated with proximal femoral nail to fix both the neck and shaft. Delayed diagnosis for femoral neck fractures occurred in 2 cases preoperatively. A total of 19 patients were followed up. The follow up period ranged from 5 to 48 months with an average of 15 months. All the fractures were healed. For case of femoral shaft fracture caused by high energy injury, an AP pelvic film should be routinely taken. Once the femoral neck fracture is recognized, operative reduction and fixation should be performed in time. Femoral neck and shaft fractures should be fixed separately.

Antegrade Versus Retrograde Locked Intramedullary Nailing for Femoral Fractures: Which Is Better?

Locked intramedullary nailing or interlocking nailing (ILN) is a proven mode of treatment for femoral shaft fractures. It can be inserted via the antegrade or retrograde approach. Retrograde approach is technically less demanding especially if the patient is overweight. But there are concerns with regard to the violation of the knee and its effect on subsequent knee function. We studied consecutive cases of femoral shaft fractures treated with locked intramedullary nailing at the Penang General Hospital, from 1st June 2004 to 1st June 2005. We looked at radiological and clinical union rates, union of fractures, alignment of the operated limb, and the knee function, using the Thoresen scoring system. There were a total of 77 cases of femoral interlocking nails during the study period. Forty-two cases were antegrade nails and 35 cases were retrograde nails. Both groups of patients eventually achieved union of the fracture and retrograde nailing group showed significantly earlier union rate (p = 0.032). There is no significant difference between both groups, in regards to knee pain, swelling, and range of motion as well as postnailing femoral alignment. Both methods of nailing achieved excellent union rates with good alignment of the limb. Contrary to popular belief, we found that retrograde nailing does not give rise to a higher rate of knee complications. Therefore, we strongly recommend this approach of nailing as it is technically less demanding.

Realization of the operative treatment for 35 cases of femoral shaft fractures with ipsilateral femoral neck or intertrochanteric fractures

目的 观察动力髁螺钉(DCS)、近端股骨髓内钉(PFN)治疗股骨干骨折合并同侧股骨颈及转子间骨折的临床疗效.方法采用内固定方式治疗35例股骨干骨折合并同侧股骨颈或转子间骨折,其中股骨干合并同侧股骨颈骨折10例,合并转子间骨折25例,使用DCS固定9例,使用PFN固定26例.结果随访时间6～30个月,平均18个月,33例骨折愈合、患肢关节功能优良,2例出现股骨头坏死,愈合率为94%,不愈合率为6%.结论对于股骨干骨折合并同侧股骨颈或转子间的复杂骨折,选择采用DCS或PFN治疗,DCS适用于较稳定的骨折,PFN有手术时间短,组织损伤小的优点.两者均具有在骨折愈合、功能恢复和早期活动方面均较满意的效果。

An analysis of failure factors in treatment of femoral shaft fracture with interlocking intramedullary nailing

To analyze the failure factors treating femoral shaft fracture with interlocking intramedullary nailing, and to offer the measures for prevention. From April 1999 to September 2002, among the 213 cases of femoral shaft fracture treated by interlocking intramedullary nailing, 18 were failure. The data of these cases were analyzed. The failure cases were divided into 6 types: 3 cases with nail break-down, 7 with distal screw backing out, 3 with proximal screw backing out, 3 with fibrous ankylosis of knee, 2 with late infection. Failure relative factors were regarded to operation technique, incorrect rehabilitation choice of operative indication, quality of interlocking intramedullary nailing. An appropriate indication should be chosen as using interlocking intramedullary nailing for femoral shaft fracture. The skills should be mastered well. The suitable materials should be chosen carefully. And the rehabilitation exercises should be directed properly. All these are important measures for prevention.

大腿骨頚部骨折術後に大腿骨骨幹部骨折を来たした症例

We report four cases of femoral shaft fracture after operative treatment for femoral neck fracture. All cases were women aged 68 to 91 years. They were studied from January 1999 to June 2001. Three femoral shaft fractures occurred three months after operation for femoral neck fracture and were treated using the long gamma nail. One femoral shaft fracture occurred four months after operation and was treated using the intramedullary nail. Two cases were treated using the gamma nail without distal locking screw for the femoral neck fracture, one using the gamma nail with distal locking screw, and the remaining one using the compression hip screw and canulated cancellous hip screw.In all cases, postoperative femur shaft fracture occurred in an early stage. Treatment for this fracture needs to be selected in consideration of union of the femur neck fracture. The long gamma nail and intramedullary nail were found to be useful for secondary femoral shaft fracture.

高齢者の大腿骨骨幹部骨折に対するＭｅｎｎｅｎプレートの使用経験

In many cases of femoral shaft fractures in the aged, choosing the internal fixation material may be difficult due to the advanced bow of the femoral shaft or osteoporosis.In these cases, we fixed four fractures in the middle third of the femoral shaft in patients 75 years old and over by applying a Mennen plate using an anterolateral approach.CPM began one week postoperatively, and a functional brace was applied in order to start rehabilitation two weeks postoperatively.In all four cases, good bone union was achieved, and ADL returned to the normal level (before fracture) in about two months.

Ipsilateral Fractures of Femoral Neck and Shaft

Thirteen cases of ipsilateral intracapsular femoral neck and shaft fractures were seen. All cases occurred in young adults, with the mechanism of injury in all instances being high-energy trauma. The diagnosis of the femoral neck fracture was missed initially in four cases. The patients were divided into four groups according to treatment protocol: group 1 (two cases), both fractures treated nonoperatively; group 2 (four cases), femoral neck fracture treated nonoperatively, open reduction and internal fixation of femoral shaft fracture; group 3 (three cases), McMurray's osteotomy for femoral neck fracture and internal fixation for the femoral shaft fracture; and group 4 (four cases), open reduction and internal fixation of both fractures. The follow-up period ranged from 6 months to 10.1 years. There was a nonunion of one femoral neck fracture, while all shaft fractures united. The best results were seen in group 4 cases. It is also recommended that routine high-quality X-ray films of the hip should be done in all cases of femoral shaft fracture to decrease the high incidence of missed femoral neck fractures in ipsilateral injuries of the femur.

Fractures of the femural shaft following trepanation of the corticalis and how to avoid it. At the same time an article on changing hip endoprothesis (author's transl)

The problem of trepanation of the corticalis is investigated in 2 cases of femoral shaft fractures following a lateral trepanation of the femur, which can very often not be avoided in performing a necessary change of the hip prothesis. It can be demonstrated that because of the stress on the femur and its mechanical characteristics (material distribution, density distribution, breaking strength, "structure" strength and the histological structure), a lateral trepanation of the femoral corticalis is weakening the bone in its mechanically most stressed part whereas an anterior fenestration is mechanically much better. Considering the distribution of the strain in differently formed notches with rapid increase of strain with local rigidity in a pointed notch a mechanically much better rounding of the notch is suggested.

Clinical Observation on 60 Cases of Femoral Shaft Fractures in Adulat

Clinical Observation on 60 Cases of Femoral Shaft Fractures in Adulat

Fractures of the femur treated by the automatic ambulatory method of Roger Anderson

Twenty-two cases of femoral shaft fractures of all types have been treated by the Roger Anderson automatic ambulatory splint and the statistics analyzed. In spite of the apparently complicated procedure necessary to proper reduction, the results fully justify the use of the method in properly selected cases.