Cases Of Femoral Shaft Fractures Research Articles

Titanium Elastic Nail outcomes in Children with Femur Fractures

Background: Titanium Elastic Nails are commonly used in children to heal diaphyseal and metaphyseal fractures. The age of the patient, as well as the nature and location of the fracture, determine if the TEN is required. The management of femoral diaphyseal fractures in children aged 5 to 14 years is still disputed. It is a successful and acceptable treatment option in some cases of femoral diaphyseal fractures. The TEN allows for the utilisation of elastically stable intramedullary nailing. Aim of the Study: The purpose of this study was to assess the effectiveness of Titanium Elastic Nails (TEN) in paediatric femoral fractures. Methods: This study was conducted in 250 Bedded General Hospital, Pabna, Bangladesh, from January 2020 to December 2020. The study included 65 paediatric patients aged 5 to 14 years who had femoral shaft fractures and were admitted to the study institution. All acquired data was entered into a Microsoft Excel Work Sheet and analysed in SPSS 11.5 using descriptive statistics. Results: The majority of the participants (84.62%) were male. Most of the participants (78.46%) were aged 5-10 years. Sports-related injuries caused fractures in 44.62% of the participants. The fracture began in the middle of the femur in 47.69% of the cases, the proximal region in 43.08% of the cases, and the distal region in 9.23% of the cases. In this study, 58.46% of participants were hospitalised for 7-14 days, while 33.85% were hospitalised for 14-21 days. Only 7.69% of the individuals had to spend more than 21 days in the hospital. The majority of participants in this study had no post-operative difficulties. At the 12-month follow-up, 81% of participants reported excellent patient satisfaction, 17% reported satisfactory patient satisfaction, and 2% reported poor patient satisfaction. Conclusion: Titanium elastic nailing is a successful and practical therapeutic alternative in certain cases of femoral shaft fractures in children aged 5 to 14. TENS is a safe .....

A novel pre-bending tool for elastic stable intramedullary nailing: An efficient and accurate study.

The elastic stable intramedullary nail has been recognized as an accepted technique for treating pediatric long bone fractures. The principle of the technique is "3-point support and fixation," and it should be followed to achieve the optimum outcome without implant failure and complications. However, tools have yet to be reported for pre-bending of the elastic stable intramedullary nail. This study aims to present a novel tool for pre-bending the elastic stable intramedullary nails and the results of using this tool by surgeons. A designed case of femoral shaft fracture was provided to the participants. All participants were divided into three groups according to their experience with the elastic stable intramedullary nail technique: resident, fellow, and attending groups. The time of completing the pre-bending and coronal plane deviation of the nails after pre-bending was recorded. Statistical analysis compared the data in a conventional way and with the new tools in each group. A total of 30 physicians were recruited in this study. The pre-bending duration with the new tool was significantly shorter than that of the conventional method for all physicians (p < 0.001). The coronal plane deviation of nails after pre-bending by the new tool was significantly smaller than that of the conventional method for all physicians (p < 0.001). This novel tool for elastic stable intramedullary nail pre-bending was convenient and easy to use in achieving the principal role of the elastic stable intramedullary nail technique. Physicians could reduce the coronal plane deviation when pre-bending elastic stable intramedullary nails, especially for physicians with less experience with the elastic stable intramedullary nail technique. IV.

Rare case of femoral shaft fracture in osteopetrosis

First described by Albert Schonberg in 1904 [1], osteopetrosis is a group of sclerosing bone dysplasias characterized by generalized skeletal densification due to decreased osteoclast mediated resorption [2].

Surgical treatment for ipsilateral femoral neck and shaft fracture

To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications. From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus. All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair. Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

Delayed Onset Iatrogenic Femur fracture in a Child Primarily treated with Cerclage Wires: Unrecorded Complications of an Unconventional Treatment Method

Paediatric femur shaft fractures are common bony injuries in children. Although there are set protocol for these fractures, sometimes a deviation from standard methods may lead to unpredicted consequences. We report a case of femoral shaft fracture in a 8 years old boy which was primarily treated with 3 cerclage wires. The fracture healed over next few months but the child presented with refracture at the same site 11 months post first surgery. There was vascular compromise at the cerclage site which caused the fracture. This was treated with plate fixation and fracture finally healed. In this case report we highlight how not following the basic principles of treatment and management can lead to further complications. We also bring to light a previously unreported complication of one such unfavoured and rather unconventional method of fixation. Keywords: Pediatric Femur Fracture, Cerclage, Nonunion, iatrogenic

Artificial intelligence improves the accuracy of residents in the diagnosis of hip fractures: a multicenter study

BackgroundLess experienced clinicians sometimes make misdiagnosis of hip fractures. We developed computer-aided diagnosis (CAD) system for hip fractures on plain X-rays using a deep learning model trained on a large dataset. In this study, we examined whether the accuracy of the diagnosis of hip fracture of the residents could be improved by using this system.MethodsA deep convolutional neural network approach was used for machine learning. Pytorch 1.3 and Fast.ai 1.0 were applied as frameworks, and an EfficientNet-B4 model (a pre-trained ImageNet model) was used. We handled the 5295 X-rays from the patients with femoral neck fracture or femoral trochanteric fracture from 2009 to 2019. We excluded cases in which the bilateral hips were not included within an image range, and cases of femoral shaft fracture and periprosthetic fracture. Finally, we included 5242 AP pelvic X-rays from 4851 cases. We divided these 5242 images into two images per image, and prepared 5242 images including fracture site and 5242 images without fracture site. Thus, a total of 10,484 images were used for machine learning. The accuracy, sensitivity, specificity, F-value, and area under the curve (AUC) were assessed. Gradient-weighted class activation mapping (Grad-CAM) was used to conceptualize the basis for the diagnosis of the fracture by the deep learning algorithm. Secondly, we conducted a controlled experiment with clinicians. Thirty-one residents;young doctors within 2 years of graduation from medical school who rotate through various specialties, were tested using 300 hip fracture images that were randomly extracted from the dataset. We evaluated the diagnostic accuracy with and without the use of the CAD system for each of the 300 images.ResultsThe accuracy, sensitivity, specificity, F-value, and AUC were 96.1, 95.2, 96.9%, 0.961, and 0.99, respectively, with the correct diagnostic basis generated by Grad-CAM. In the controlled experiment, the diagnostic accuracy of the residents significantly improved when they used the CAD system.ConclusionsWe developed a newly CAD system with a deep learning algorithm from a relatively large dataset from multiple institutions. Our system achieved high diagnostic performance. Our system improved the diagnostic accuracy of residents for hip fractures.Level of evidenceLevel III, Foundational evidence, before-after study. Clinical relevance: high

A prospective study on functional outcome of fracture shaft of femur stabilised with reamed intramedullary nail

Background: The incidence of femoral shaft fractures is on raise because of fast and high speed transportation and modern lifestyles. Internal fixation is the mainstay of treatment. Conventional plating is associated with high risk of infection, pseudoarthrosis, malunion, decreased knee motion and loss of fixation. Interlocking techniques lead to fewer complications of nonunion/malunion, lesser soft tissue dissection, earlier fracture healing and lesser chances of infection. Fractures in any zone from the subtrochanteric to distal supracondylar part of the femur are accessible to nailing. This study conducted to analyse the results of fractures of femur treated by interlocking nail AO type. Methods: This was a prospective study of patients who underwent reamed intramedullary nailing for the fracture shaft of the femur. Postoperatively all patients were initiated on the rehabilitation protocol based on the fracture pattern. All patients were operated by the same surgeon and patients were followed up to six months period at regular intervals. Functional outcome is assessed by Thoresen’s criteria and lower extremity functional scoring system, radiological with fracture healing.Results: In our series of 78 cases of femoral shaft fractures treated by interlocking nail 57 patients had good outcome, 12 patients had moderate outcome, 5 had fair and 4 patients had poor outcome. Most of the patients in this series were younger age group; more than 80% were below 50 years.Conclusions: We confirm that the functional outcome after fracture shaft of femur stabilised by reamed intramedullary nail is good to moderate. Intramedullary nailing is effective treatment for the stabilisation of the fracture shaft of femur in view of subjective and objective perspective. From this sample study we concluded the femur interlocking nail is a good implant for the treatment of femoral shaft fractures because of its load sharing, close insertion, rotational stability, restoration of anatomic length alignment and early mobilization.

Application of self-made fine-tuning device in distal locking process of femoral interlocking intramedullary nail

To evaluate the curative efficacy of self-made fine-tuning setting in the process of femoral distal implantation of intramedullary nail. From October 2015 to October 2017, 66 cases of femoral shaft fracture were treated with anterograde interlocking intramedullary nail including 45 males and 21 females with a mean age of(37.21±11.18) years old. Among them, 36 cases were treated with the manufacture's aiming device and self-made fine-tuning setting (research group), other 30 cases were treated with the manufacture's aiming device(control group). The mean operation time, the times of C-arm scan in surgery, the post-operation complications and the fracture union were observed and compared in two groups. Sixty-two cases acquired 8 to 15 months with a mean time of 12.4 months follow-up visit. The post-operation complications and the fracture union between the two groups had no significant difference(P>0.05), the mean operation time and the times of C-arm scan in surgery had statistically significant difference(P<0.05). Self-made fine-tuning setting in the process of femoral interblocking intramedullary nail could shorten operation time and reduce the the times of C-arm scan.

A prospective study on functional outcome of fracture shaft of femur stabilised with reamed intramedullary nail

The incidence of femoral shaft fractures is on rise because of fast, high speed transportation and modern lifestyles. Internal fixation is the mainstay of treatment. Conventional plating is associated with high risk of infection, pseudoarthrosis, malunion, decreased knee motion and loss of fixation. Interlocking techniques lead to fewer complications of nonunion/malunion, lesser soft tissue dissection, earlier fracture healing and lesser chances of infection. Fractures in any zone from the subtrochanteric to distal supracondylar part of the femur are accessible to nailing.Materials and Methods: This was a prospective study of patients who underwent reamed intramedullary nailing for the fracture shaft of the femur. All patients were operated by the same surgeon and patients were followed up to six months period at regular intervals. Functional outcome is assessed by Thoresen’s criteria and lower extremity functional scoring system. The study shall be of two and half years duration with effect from May 2015 to October 2017. Post operative evaluation was done at 1 month, 3 months and 6 months following surgery. Results: In our series of 78 cases of femoral shaft fractures treated by interlocking nail 57 patients had good outcome, 12 patients had moderate outcome, 5 had fair and 4 patients had poor outcome. Most of the patients in this series were younger age group; more than 80% were below 50 years. Conclusion: We confirm that the functional outcome after fracture shaft of femur stabilised by reamed intramedullary nail is good to moderate. Intramedullary nailing is effective treatment for the stabilisation of the fracture shaft of femur in view of subjective and objective perspective. Femur interlocking nail is a good implant for the treatment of femoral shaft fractures because of its load sharing, closed insertion, rotational stability, restoration of anatomic length alignment and early mobilization.

Association Between Alendronate Use and Hip Fracture Risk in Older Patients Using Oral Prednisolone

Oral glucocorticoid treatment increases fracture risk, and evidence is lacking regarding the efficacy of alendronate to protect against hip fracture in older patients using glucocorticoids. To investigate whether alendronate treatment in older patients using oral prednisolone is associated with decreased hip fracture risk and adverse effects. Retrospective cohort study using a national database (N = 433 195) of patients aged 65 years or older undergoing a health evaluation (baseline) at Swedish health care facilities; 1802 patients who were prescribed alendronate after at least 3 months of oral prednisolone treatment (≥5 mg/d) were identified. Propensity score matching was used to select 1802 patients without alendronate use from 6076 patients taking prednisolone with the same dose and treatment time criteria. Follow-up occurred between January 2008 and December 2014. Alendronate vs no alendronate use; no patients had previously taken alendronate at the time of prednisolone initiation. The primary outcome was incident hip fracture. Of the 3604 included patients, the mean age was 79.9 (SD, 7.5) years, and 2524 (70%) were women. After a median follow-up of 1.32 years (interquartile range, 0.57-2.34 years), there were 27 hip fractures in the alendronate group and 73 in the no-alendronate group, corresponding to incidence rates of 9.5 (95% CI, 6.5-13.9) and 27.2 (95% CI, 21.6-34.2) fractures per 1000 person-years, with an absolute rate difference of -17.6 (95% CI, -24.8 to -10.4). The use of alendronate was associated with a lower risk of hip fracture in a multivariable-adjusted Cox model (hazard ratio, 0.35; 95% CI, 0.22-0.54). Alendronate treatment was not associated with increased risk of mild upper gastrointestinal tract symptoms (alendronate vs no alendronate, 15.6 [95% CI, 11.6-21.0] vs 12.9 [95% CI, 9.3-18.0] per 1000 person-years; P = .40) or peptic ulcers (10.9 [95% CI, 7.7-15.5] vs 11.4 [95% CI, 8.0-16.2] per 1000 person-years; P = .86). There were no cases of incident drug-induced osteonecrosis and only 1 case of femoral shaft fracture in each group. Among older patients using medium to high doses of prednisolone, alendronate treatment was associated with a significantly lower risk of hip fracture over a median of 1.32 years. Although the findings are limited by the observational study design and the small number of events, these results support the use of alendronate in this patient group.

Value of the ultrasonography in guiding closed reduction and intramedullary nail fixation for femoral shaft fractures

Objective To study the ultrasonic image characteristics of the displaced femoral shaft fracture before and post reduction, and to explore its clinical significance in guiding the closed reduction and intramedullary nail fixation. Methods Ultrasonic imaging features of 21 cases of femoral shaft fractures were observed.Closed reduction was completed under ultrasound monitoring, and the characteristics of ultrasonic imaging after fracture reduction were observed. Fixation of femoral fractures with intramedullary nails after closed reduction was completed. Results On the long axis of the femoral shaft, the ultrasonograms displayed a gap between two hyperechoic bands(step sign). On the cross section, two short arc hyperechoic bands can be seen(double short arc sign). After the completion of closed reduction, the step sign and double short arc sign disappeared. In the front and rear of the femoral shaft, there were 2 echo lines connected to a straight line. The line in front of the femoral parallel to the rear(continuous parallel sign). Continuous parallel sign indicated that reduction was achieved, the intramedullary nail guide pin could be successfully inserted into the femoral shaft, to complete the intramedullary nail fixation. Conclusions Ultrasound imaging shows step sign and double short arc syndrome when femoral shaft fracture displaced. Post fracture reduction, the imaging shows continuous parallel sign. Observing ultrasonic image characteristics of the displaced femoral shaft fracture is effective in assisting closed reduction and intramedullary nailing for femoral shaft fractures. Key words: Ultrasonography; Femoral fractures; Reduction; Fracture fixation, internal

Outcomes of retrograde nailing of distal femoral fractures in Indian population: a prospective study

Background: Distal femur fractures are tough to handle, and the choice of implant for internal fixation remains controversial. One of the therapeutic principles that can be employed for the treatment of distal femoral fractures is retrograde intramedullary nailing, which follows the principle of biological osteosynthesis. Objective: To investigate in a retrospective manner the results of retrograde nailing in distal femoral fractures and selected cases of femoral shaft fractures. Emphasis was posed on long-term functional outcome, especially in daily activities. Materials and Methods: Retrograde femoral nailing was used from January 2010 to October 2015 in level 1 trauma center for the treatment of various types of femoral fractures (AO/ASIF-type 32/33) in 20 patients with 21 fractures. Patients were followed up till fracture healing and invited to a functional follow-up using Neer’s knee scoring system. Result: Osseous healing occurred in shaft fractures in 18.33 weeks on an average when compared with 15.25 weeks in supracondylar fractures. Stiffness was seen as only late postoperative complication in five of 19 (26.31%) patients beyond 1 year of postoperation. Two patients with pathological fracture died on follow-up owing to metastasis. After a mean 20.4 month follow-up, the mean scores were 85 in shaft and 74 in distal femoral fractures (I/A and E/A). Motion was better in shaft fractures (arc of motion—mean: 116.67°) than in distal femoral fractures (arc of motion—mean: 102.18°). Conclusion: Retrograde nailing represents a reliable fixation method for extra-articular (33A) and intra-articular (33C) fractures of the supracondylar area. In femoral shaft fractures, retrograde inserted nails offer a valuable alternative, especially when the proximal femoral approach is obstructed. There is a need of methodologically sound clinical trials to generate high quality evidence for efficacy of retrograde nailing.

Pediatric femoral shaft fractures treated by flexible intramedullary nailing

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

Design and clinical application of a new distraction reduction device for closed reduction and internal fixation of femoral shaft fracture

Objective To evaluate a new self-designed device to assist closed reduction of femoral shaft fracture. Methods From January 2012 to June 2014, 18 cases of femoral shaft fracture received closed reduction and internal fixation with anterograde intramedullary nails on a popular fluoroscopic orthopedic table. The new self-designed distraction reduction device was used during the operation. The patients contained 14 males and 4 females, aged from 21 to 48 years (mean, 33.6 years). Fracture AO classification was type 32A2 in 8 cases, 32A3 in 5 cases, 32B1 in 3 cases and 32B2 in 2 cases. Mean pre-operation time was 5.5 days (range, 3-10 days). Results Operation time ranged from 85 to 130 minutes (mean, 96 minutes). Intraoperative bleeding ranged from 120 to 180 ml (mean, 150 ml). X-ray fluoroscopy time ranged from 20 to 40 seconds (mean, 25 seconds). Frequency of nailing into the distal fracture end was 1 to 3 times (mean, 1.5 times). One case had additional small incision for open reduction. Fourteen cases experienced external rotational deformity of the femur from 2° to 6° (mean, 3.6°) after surgery, and four cases were free of rotational deformity. All patients were followed up for 6 to 20 months (mean, 12.8 months). All patients had fracture healing in a period of 4.5 to 8.5 months (mean, 5.5 months). No iatrogenic fracture, infections, nail breakage or other complications occurred. At the final follow-up, knee score according to the system of hospital for special surgery (HSS) was found to be excellent in 12 cases, good in 4, and fair in 2, giving an excellent-to-good rate of 89%. Conclusion The new self-designed distraction device is an easy-to-operate instrument that is useful in assisting distraction and reduction of the femoral shaft fracture difficult to be fixed with routine methods as well as intramedullary nailing just on a popular fluoroscopic orthopedic table. Key words: Femoral fractures; Fracture fixation, intramedullary; Bone nails; Surgical instruments

Long-Term Effectiveness of Total Hip Replacement with the Collum Femoris Preserving Prosthesis

The objective of this study was to follow-up long term (5-12 years) patients with total hip arthroplasty with the collum femoris preserving prosthesis to evaluate clinical outcome and potential complications. Forty-six of 152 patients who underwent this procedure between September 2000 and September 2012 were followed up. The average follow-up time was 7.6 years, and assessed were radiographs, Harris score, limb length, hip function, and complications. Six patients had perioperative complications including five cases of femoral shaft fracture and one case of dislocation 1 week after the operation. No infections of the surgical site, no deep venous thrombosis or pulmonary embolism were observed. The last recorded Harris hip score improved from a preoperative average of 41.2 (range 17-60) to an average of 82.3 (74-96), with the score >80 in 38 patients, 70-80 in six patients, and <70 in two patients. Radiolucent lines were found on radiographs in two patients with acetabular prosthesis and one patient with femoral prosthesis. The remainder of patients had satisfactory positions of acetabular and femoral stem prostheses with no loosening or subsidence, and a good condition of femoral neck. Total hip arthroplasty with the collum femoris preserving prosthesis is a good option for younger patients who need prosthesis revision. This arthroplasty achieves satisfactory long-term effectiveness.

Spontaneous Knee Dislocation Subsequent to Intramedullary Nailing of Femoral Shaft Fracture

Knee dislocation is a rare and devastating injury, may cause limb-threatening sequelae if damage to nerves and blood vessels. We describe a case of femoral shaft fracture without initial knee dislocation followed by stabilization with intramedullary nailing. When the patient postoperatively regained consciousness from anesthesia, he had restless agitation that caused an obvious knee dislocation. Emergency physicians need to keep in mind that spontaneous dislocation or relocation of the knee can occur at any point in time after trauma.

Birth-related femoral fracture in newborns: Risk factors and management

Femoral shaft fracture following birth in newborns is a very rare injury. However, the risk factors for, mechanism of and management of these injuries remain a matter of debate. We describe our observations in a tertiary centre. Ten cases of femoral shaft fracture encountered during a study period from January 2005 to December 2009 were evaluated. The demographic details, risk factors during birth, systemic illness, mode of delivery, type of fracture and management used were documented, and an analysis was performed. Mean gestational age was 37.2weeks. Mean time to diagnose was 4days. Two patients had subtrochanteric fracture, and eight patients had mid-shaft fracture. Most patients had breech presentation and had been born by Caesarean section. All patients showed complete union at the end of 4weeks. No residual angulation or limb length discrepancy was noted after mean follow-up of 5years. Thorough clinical examination and proper orthopaedic consult in the event of doubtful presentation help in early diagnosis and management. These fractures have good prognosis at long-term follow-up.

Reverse oblique intertrochanteric femoral fractures treated with the Intramedullary Hip Screw (IMHS)

Aims: Reverse oblique intertrochanteric fractures (OTA/ AO 31-A3) have unique biomechanical properties that confer difficulties in obtaining stable fixation with the conventional sliding dynamic condylar screw. Recent studies have recommended the use of cephalocondylic intramedullary devices for these unstable fractures. Both the Proximal Femoral Nail (PFN) and the Gamma Nail (GN) have shown good outcome results but the results of treatment with the IMHS have not been reported in the literature. Methods: Between 1999–2008 6724 consecutive hip fractures were treated at our institute. There were 2586 extracapsular fractures and 307 subtrochanteric fractures. 115 of the extracapsular fractures had a reverse oblique pattern and 63 of these were treated with the IMHS. We retrospectively reviewed clinical and radiological records for the reverse oblique intertrochanteric fractures treated with the IMHS. Follow-up duration ranged from 8 months to 6 years. Results: Among the 63 patients treated with the IMHS, 56 (88%) fractures were reduced satisfactorily with only one poorly positioned hip screw in the femoral head. There were no cases of femoral shaft fracture, screw cut-out or collapse at the fracture site. The orthopaedic complications were two cases of mal-rotation, two cases of non-union, two cases of distal locking bolts backing out, and one cracked nail. 30 day mortality was 6.5%. Conclusion: Cephalo-medullary nailing devices have been recommended for the treatment of reverse oblique intertrochanteric femoral fractures. Our clinical and radiological outcomes with the IMHS compare favourably to the results in reports where other cephalo-medullary devices have been used. Therefore we consider the IMHS a good option for the treatment of these unstable fractures.

Two Cases of Femoral Shaft Fractures after THR in RA Patients

Two Cases of Femoral Shaft Fractures after THR in RA Patients

Two cases of femoral shaft fractures in children with minimally invasive surgery

Two cases of femoral shaft fractures in children with minimally invasive surgery