Distal Femoral Shaft Research Articles

Understanding the variability of the proximal femoral canal: A computational modeling study.

Statistical shape modeling (SSM) offers the potential to describe the morphological differences in similar shapes using a compact number of variables. Its application in orthopedics is rapidly growing. In this study, an SSM of the intramedullary canal of the proximal femur was built, with the aim to better understanding the complexity of its shape which may, in turn, enhance the preoperative planning of total hip arthroplasty (THA). This includes the prediction of the prosthetic femoral version (PFV) which is known to be highly variable amongst patients who have undergone THA. The model was built on three dimensional (3D) models of 64 femoral canals which were generated from pelvic computed tomography images including the proximal femur in the field of view. Principal component analysis (PCA) was performed on the mean shape derived from the model and each segmented canal. Five prominent modes of variations representing approximately 84% of the total 3D variations in the population of shapes were found to capture variability in size, proximal torsion, intramedullary femoral anteversion, varus/valgus orientation, and distal femoral shaft twist/torsion, respectively. It was established that the intramedullary femoral canal is highly variable in its size, shape, and orientation between different subjects. PCA-driven SSM is beneficial for identifying patterns and extracting valuable features of the femoral canal.

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

PurposeFemoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach.Material and MethodsThis was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated.ResultsA total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57).ConclusionsBoth options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.

Flexible nailing: Pushing the indications for diametaphyseal lower-extremity fractures.

Elastic stable intramedullary nailing (ESIN) has been shown to be an effective form of surgical management for lower-extremity diametaphyseal fractures in pediatric patients, but studies are limited because ESIN treatment for these fractures is relatively uncommon. We sought to determine whether ESIN can be used effectively in the most distal or proximal short-segment forms of these fractures. We queried the electronic medical record system at Johns Hopkins Hospital using Current Procedural Terminology codes for femur and tibia fractures treated with ESIN in patients under 18 years old between January 2015 and October 2022. Preoperative and postoperative radiographs were subsequently reviewed to identify patients with a proximal or distal third femoral or tibial shaft fracture treated with ESIN and to define criteria for short-segment diametaphyseal fractures. We used Beaty radiological criteria to evaluate radiographic outcomes and Flynn titanium elastic nails (TENs) outcome scale to assess clinical recovery after radiographic evidence of union. There were 43 children who met the inclusion criteria. Among them, 10 patients had short-segment diametaphyseal fractures. There were 22 (51.2%) who sustained femur fractures and 21 (48.8%) who sustained tibia fractures. Using Beaty radiologic criteria, ESIN was associated with more satisfactory outcomes in patients with distal or proximal third shaft fractures (32/33) than in patients with short-segment diametaphyseal fractures (7/10) (P = .03). Using the TENs outcome scale, 21 (63.4%) patients with distal or proximal third shaft fractures had excellent results, 11 (33.3%) had satisfactory results, and 1 (3%) had a poor result. Among patients with short-segment diametaphyseal fractures, 4 (40%) had excellent results, 5 (50%) had satisfactory results, and 1 (10%) had a poor result. There were no differences in TENs outcomes between the groups (P = .24). Patients with short-segment lower-extremity diametaphyseal fractures treated with ESIN had worse radiographic outcomes but did no worse clinically than patients with distal or proximal third shaft fractures. Consequently, ESIN should be considered a safe and effective surgical management option for pediatric patients with even the most distal or proximal forms of these fractures.

Comparison of Results between Minimally Invasive Plate Fixation and Antegrade Intramedullary Nailing of Recon-Type in Low-Energy Injury Distal Femoral Shaft Fractures

Comparison of Results between Minimally Invasive Plate Fixation and Antegrade Intramedullary Nailing of Recon-Type in Low-Energy Injury Distal Femoral Shaft Fractures

Effects of Moderate- to High-Impact Exercise Training on Bone Structure Across the Lifespan: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Moderate- to high-impact exercise improves bone mineral density (BMD) across the lifespan, but its effects on bone structure, which predicts fracture independent of areal BMD, are unclear. This systematic review and meta-analysis investigated effects of impact exercise on volumetric BMD (vBMD) and bone structure. Four databases (PubMed, Embase, SPORTDiscus, Web of Science) were searched up to March 2022 for randomized controlled trials (RCTs) investigating the effects of impact exercise, with ground reaction forces equal to or greater than running, compared with sham or habitual activity, on bone vBMD and structure. Bone variables were measured by quantitative computed tomography or magnetic resonance imaging at the tibia, radius, lumbar spine, and femur. Percentage changes in bone variables were compared among groups using mean differences (MD) and 95% confidence intervals (CI) calculated via random effects meta-analyses. Subgroup analyses were performed in children/adolescents (<18 years), adults (18-50 years), postmenopausal women, and older men. Twenty-eight RCTs (n = 2985) were included. Across all studies, impact exercise improved trabecular vBMD at the distal tibia (MD = 0.54% [95% CI 0.17, 0.90%]), total vBMD at the proximal femur (3.11% [1.07, 5.14%]), and cortical thickness at the mid/proximal radius (1.78% [0.21, 3.36%]). There was no effect on vBMD and bone structure at the distal radius, femoral shaft, or lumbar spine across all studies or in any subgroup. In adults, impact exercise decreased mid/proximal tibia cortical vBMD (-0.20% [-0.24, -0.15%]). In postmenopausal women, impact exercise improved distal tibia trabecular vBMD (0.79% [0.32, 1.25%]). There was no effect on bone parameters in children/adolescents in overall analyses, and there were insufficient studies in older men to perform meta-analyses. Impact exercise may have beneficial effects on bone structure and vBMD at various skeletal sites, but additional high-quality RCTs in different age and sex subgroups are needed to identify optimal exercise protocols for improving bone health across the lifespan. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Metabolic abnormalities underlying nonunion in the adult fracture patient

Introduction: The objective of this study is to comprehensively evaluate fracture type, category of nonunion, and metabolic profile to identify metabolic causes that may impact fracture union. Methods: A retrospective chart review of patients diagnosed with nonunion after fracture fixation was performed. Patient demographics, fracture characteristics, and metabolic profiles were assessed. Results: Data was collected from 94 patients with nonunion, with a mean age of 54.7 years, 50% men, 47.3% obese, and 60.8% current/former smokers. The most common nonunited bone was the femur (48%), tibia (22%), humerus (15%), ulna (5%), clavicle (3%), and fibula (2%). The distal femur, femoral shaft, and tibial shaft made up 50% of the nonunion. The intra-articular fracture was diagnosed in 13% and open injuries in 27%. The most common metabolic abnormalities were low hemoglobin (62.3%), elevated neutrophil percentage (61.9%), elevated erythrocyte sedimentation rate in women (51.8%), low testosterone (46.9%), and hypovitaminosis D (44.3%). Conclusion: The prevalence of metabolic abnormalities was documented across all nonunion types, suggesting this is not unique to atrophic nonunion. Given the high morbidity and cost of nonunion, and low cost of vitamin supplementation, future prospective studies are warranted to identify effective prevention and treatment.

Imaging of Parosteal Lipoma: A Case Report

Parosteal lipoma is an extremely rare benign tumor, accounting for 0.3% of all lipoma. They are often located in the lower limbs, contiguous to the periosteum, and associated with osseous changes. We present a case of a parosteal lipoma appearing in the distal femur with a bony excrescence in a 57-year-old female patient, presenting with a painless soft tissue mass that had been progressing for 10 years. Imaging showed a juxta cortical adipose mass, located in the mid and distal left femoral diaphysis, with adjacent cortical thickening, and osseous excrescences.

E029 Erdheim-Chester disease: a rare multisystem disorder

Abstract Background/Aims Erdheim-Chester disease is a rare non-Langerhans cell histiocytosis with multiorgan involvement. Otherwise known as polyostotic sclerosing histiocytosis it is characterised by proliferation and infiltration of lipid laden macrophages into bone marrow. Extraskeletal involvement is commonly seen involving heart, CNS, skin, lung, kidney, and retroperitoneum resulting in a variety of presenting features. Methods Case: 75-year-old male referred to rheumatology connective tissue disease clinic by respiratory team with dyspnoea and unintentional weight loss of 20kg in one year. CT had shown pleural effusions and interstitial markings in mid zones felt to be due to cardiac failure. PMH - IHD, CABG. Mildly elevated dsDNA of 10. He denied cough, sputum or haemoptysis. No mouth ulceration, alopecia, sicca symptoms, Raynaud's, rashes, fevers, myalgia, or joint swelling. No family history of rheumatic disease. On examination reduced air entry to lung bases, no synovitis, no nail bed changes, no lymphadenopathy. Results Further investigations showed persistent mildly elevated dsDNA, crithidia negative, negative ANA on HEp2, Hb 136, WCC 13.8, PLT 329, complement levels normal, Igs normal, IgG4 normal, NTproBNP raised 3196, ESR 27, CRP 28. Further CT CAP - bilateral pleural effusions, thickened enhancement of pleura bilaterally without focal mass, increased interstitial markings lung mid zones, significant thick pericardial enhancement and pericardial effusion, thickening around distal oesophagus and a rind of inflammatory thickening around distal thoracic aorta. Transthoracic echocardiogram - small pericardial effusion without haemodynamic compromise, normal left and right ventricular function. NM whole body - marked increased uptake in diametaphyseal regions of tibial bones and distal aspect of femora. MRI femurs - significant symmetrical abnormality in distal femoral shaft and metaphyseal region of both femora, endosteitis with extensive linear and patchy reduction T1 signal intensity and increase in STIR intensity within medullary cavity of distal femur. CT guided biopsy of distal femur identified foamy histiocytic infiltration with fibrosis. BRAF mutation testing of plasma showed strong positive result confirming molecular diagnosis of Erdheim-Chester disease. Cardiac MRI had been requested and MRI of brain was normal. He was treated initially with 40mg prednisolone, weaned to 15mg, and weekly PEG interferon with improvement in dyspnoea and weight loss. However, he deteriorated slowly over the next year and died of cardiac failure. Conclusion Histiocytic disorders such as Erdheim-Chester disease do rarely present to rheumatology given multisystem involvement and diagnostic uncertainty. This patient had skeletal, cardiac, lung, and gastrointestinal involvement resulting in his dyspnoea and weight loss. Initial treatment involves corticosteroid and interferon. Approximately 50% of patients have BRAF mutation and may respond to vemurafenib therapy. Our patient unfortunately deteriorated prior to being considered for this treatment. Prognosis is poor with a 3-year survival of 50%. Disclosure G. Starritt: None. D. McCormick: None.

A RETROSPECTIVE AUDIT INVESTIGATING THE MDT CARE PROVIDED FOR FRAGILITY NON-HIP FEMORAL FRACTURES WITHIN A MAJOR TRAUMA CENTRE

There has been extensive research into neck of femur fractures in the elderly. Fragility non-hip femoral fractures share many of the same challenges [1]. Surgical management is complex, patients are frail and mortality rates have been reported as high as 38% [2]. Despite this, relatively little data is available evaluating the level of MDT care provided to non-hip femoral fractures.This audit aimed to evaluate the standard of MDT care provided for patients with non-hip femoral fractures according to the NHFD key performance indicators. The following fractures were included in the dataset: distal femoral, femoral shaft and peri-prosthetic femoral. Patients under 65 were excluded. Data was retrospectively collected using post-operative and medical documentation. Performance was assessed according to five key performance indicators:Did orthogeriatrics review the patient within 72-hours?Was surgery performed within 36-hours?Was the patient weight bearing post-operatively?Was a confusion assessment completed?Was the patient discharged home?38 patients met the inclusion criteria. 84% of patients were seen by orthogeriatrics within 72 hours of admission. 32% of patients were operated on within 36-hours of admission, with time to theatre exceeding 36-hours in 92% of peri-prosthetic fractures. 37% of patients were not advised to full weight bear post operatively. 84% of patients received a confusion assessment whilst 61% of patients were discharged to their prior place of living.Our results suggest that non-hip femoral fractures do not receive the same standard of MDT care as neck of femur fractures. Greater prioritisation of resources should be given to this patient subset so that care is equivalent to hip-fracture patients. Time to surgery is a particular area for improvement, particularly in peri-prosthetic fractures, a trend that is mirrored nationally. Greater emphasis should be placed on encouraging full-weight bearing post-operatively to prevent post-surgical complications.

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.

Retrograde Intramedullary Interlocking Nailing in Fractures of the Distal Femur: A Review of 20 Cases with an Average Follow-Up of One Year

Objectives: In patients with distal femur fractures, we studied the role of retrograde locked intramedullary nails. Methods: Retrograde locked intramedullary nailing was used to treat the distal femur fractures of 20 patients (15 males, 5 females; mean age 47 years; range 25 to 69 years). Two patients had fracture of the distal femur and shaft. The fractures were classified as A1 (n=12), A2 (n=6), A3 (n=2), by the AO classification. There were two Grade I open fractures and 18 closed fractures. Three fractures were managed with percutaneous technique. At the mean first follow-up time of 18 months (range 15-48 months and mean second follow up at 27 months (range 12 to 68 months), the concluding functional results were assessed by using the modified Hospital for Special Surgery (HSS) knee assessment scale. Results: The average time to achieve union was 24.2 weeks (range 14 to 42 weeks). One patient had a delayed union (44 weeks). Five knees (25%) had normal joint range of motion, ten knees (50%) were having range of motion from 100° to 110°, three knees (15%) were having range of motion of 80°, and two knees (10%) were having range of motion below the 80°. According to the modified HSS knee scale, the results were excellent in eleven cases (55%), good in six (30%), moderate in two (10%), and poor in one case (5%). In two patients (10%), the postoperative radiographic examination revealed varus angulation (10°), healing took place with severe distortion in one subject. None of the patient had any deep infection or wound issues. Conclusion: Retrograde femoral nailing is an effective method for treating distal femoral shaft fractures. The healing rate of femoral shaft fractures fixed with a retrograde nail is the same regardless of fracture location, patient age, gender, or degree of comminution. For good results surgical treatment, post-surgery immediate knee mobilisation and avoiding nail tip prominence in the knee are essential.

Retrogradni intramedularni klinovi naspram distalnih ploča za zaključavanje u lečenju ekstraartikularnih preloma distalne femoralne osovine

Introduction: Distal femoral shaft fractures are characterized by their increasing incidence and complexity, presenting a significant challenge in management. The objective of this retrospective study was to compare the clinical and radiological results of patients with extra-articular distal third femoral shaft fractures treated using either retrograde Talon Distal Fix nail or a distal femur locking plate. Material and Method: The study comprised 40 patients aged &gt; 18 years who presented at our hospital with a distal third femoral shaft fracture between January 2017 and January 2023. The patients were divided into two groups: Group TDN, treated with retrograde Talon Distal Fix nailing (n = 18), and Group DLP, treated with a distal locking plate (n = 22). Demographic data, follow-up period, operating time, time to union, range of motion (ROM), mechanism of injury (traffic accident, fall from height, workplace accident, gunshot injury), fracture type, complications, and surgical method were retrospectively recorded. Clinical evaluation included deformity, knee ROM, pain, and the knee total score (KSS) for walking and knee stability. Results: The mean age of the patients was 48.03 ± 12.31 (min-max: 23-69) years, and the mean follow up time for all patients was 15.88 ± 2.32 (12-21) months. The mean time to union was 25.55 ± 1.86 (22-30) weeks. Delayed union and non-union rates were similar between the research groups (P = 1.000, P = 0.673, respectively). Union time (weeks) and mean ROM were not significantly different between the groups (P = 0.881, P = 0.892, respectively). The mean operation time of the TDF group (48.78 ± 3.94 minutes) was significantly lower than that of the DLP group (62.45 ± 3.33 minutes) (P &lt; 0.001). The mean blood loss values of the TDF group (267.5 ± 32.4) were significantly lower than those of the DLP group (324.1 ± 20.2) (P &lt; 0.001). Conclusion: This study demonstrated that both retrograde talon nails and locking plates provided satisfactory clinical and radiological results in the management of distal third femoral shaft fractures. Moreover, the retrograde talon nail offered the advantages of a shorter operating time and less intraoperative blood loss.

Functional Outcome of Intramedullary Tibial Nail in Distal Femur Shaft Fractures

Objective: Assessment of the functionality in patients with supracondylar fracture of femur managed with intermedullary tibial nails. Study Design: Case Series Study. Place and Duration of Study: We conducted a prospective cohort study for 6 months, from September 2021 to February 2022. Materials and Methods: 25 adult patients presented in the accidents and emergency department of Railway General Hospital, Rawalpindi. They were managed using tibial nail and their functionalities after the operations were managed using the Tegner-Lysholm Criteria measured at 2 weeks, 6 weeks, and 12 weeks till union achieved. Results: Five of our patients were females and twenty males. Average healing time was calculated at 15 weeks and 6 days approximately (2.646 SD) 24% (n=6) showed excellent healing, 48% (n=12) had good results and 28% (n=7) had fair results. We did not observe any complications. Conclusion: Tibial nails are convenient and effective to manage the patients with supracondylar fracture of ffemur and show good functional outcomes.

Severe Quadriceps Heterotopic Ossification after Knee Revision Arthroplasty in a 42-Year-Old Suffering from Rheumatoid Arthritis: A Case Report

Background: Heterotopic Ossification (HO) of the knee is most commonly formed anteriorly to the distal femoral shaft in the quadriceps expansion. Although the incidence of severe HO with large dimensions affecting the knee and resulting in severe consequences is extremely rare, these cases are extremely difficult to prevent and have severe clinical limitations for the patient. Aim: The purpose of this study was to present and explore HO formation after Total Knee Arthroplasty (TKA). Conclusions: It is crucial to perform a stratification of patients for the risk of HO formation after TKA and to gain a better understanding of the fundamental role of post-operative treatments. In severe HO, surgery should be considered following appropriate investigations and should only be considered when the HO has fully matured. In comparison to Total Hip Arthroplasty (THA), HO formation after TKA is less frequent and underexplored. Therefore, further studies are required. This case report can represent a protocol for the treatment of clinically relevant HO in the knee after TKA.

Derotational Plate Augmentation with Retention of Intramedullary Interlocking Nail in Resistant Nonunion at Distal Femur Shaft

Background: Non-union in femur shaft after satisfactory treatment with closed intramedullary interlocking nail is not very common. This nonunion is always a challenging condition for surgeon. These nonunion are usually treated by dynamization, close exchange nail with larger diameter, retention of nail and onlay bone graft, removal of nail and fixed with plates and bone graft, removal of nail and application of cast brace and sometimes removal of nail and applications of external fixators. But no treatment is’ gold standard’ the rotational instability is blamed to be one of the most common reason of nonunion. Aim: To control rotational instability, we did plate augmentation with or without bone grafts without removing the nail to treat this nonunion. Methods: Total patients were 16. Proximal and distal interlocking screws were removed, nonunion site was opened, compression at nonunion site was done, and broad DCP was applied as de rotation plate with or without bone grating. We excluded fracture less than one-year duration and fracture with infective nonunion. Results: In 12 patients bone grafting was done where there was less callus or there was suspicion of atrophic non-union. We got union in all patients. 6.25 months were average time of union. 13 months was average time between the primary and secondary surgery. 71 minutes was means surgical time. Complications or implant failure were not noted. 0.9 cm was average residual limb shortening and 115 degrees was average range of motion at knee joint. Conclusion: Nonunion in distal femur shaft fracture with interlocking nail in situ is reliable and effective procedure Keywords: Distal femur, plate, External fixator. Bone grafting

Incidental Findings in Low-Dose Full-Body Imaging Taken for Total Hip and Knee Arthroplasty

AbstractDetection of incidental findings (IFs) in preoperative imaging for total joint arthroplasty (TJA) patients may lead to additional testing, cost, and surgical delay. The purpose of this study is to identify the incidence and clinical significance of IFs on preoperative low-dose full-body imaging (LFI) in the total joint population. Furthermore, we aim to determine whether these findings lead to additional imaging, delay, or cancelation in TJA cases. A retrospective review of 2,183 patients planned for total hip arthroplasty or total knee arthroplasty, who had preoperative LFI imaging obtained from 2013 to 2020 was conducted. LFI radiographic reports were reviewed to identify any flagged radiographs. Flagged IFs were divided into thoracic, spinal, lower limb, and abdominal IFs. Charts were reviewed to identify if any additional imaging was completed, the case was delayed or canceled, or a new pathology requiring continued follow-up or treatment was discovered. Of the 2,183 LFI images taken prior to TJA, 41 cases qualified as having IF (1.9%, 41/2,183), 18 thoracic, 11 spinal, 11 lower limb, and 1 abdominal. Overall, 15 (0.7%, 15/2,183) IF cases were clinically determined to require at least one additional form of imaging. Two had a significant finding; a schwannoma near the distal femoral shaft and a squamous cell carcinoma of the lung. Three TJA cases were delayed, and no cases were cancelled due to the IFs. The possible increase in IF detection by preoperative LFI does not greatly impact TJA case completion. Though rare, providers should pay close attention as clinically significant IFs can be discovered and lead to early treatment. This was a retrospective cohort study with level III evidence.

Evaluation of Clinical Outcome of Subtrochanteric &amp; Proximal Femur Fracture treated by Interlocking Intramedullary Nail with Side plate

Fractures of the subtrochanteric region and proximal femur can be especially challenging to manage, and they warrant special consideration to obtain consistently satisfactory results. The subtrochanteric zone of the femur is generally considered to include the area extending 5 cm distally from the inferior border of the lesser trochanter, or the junction of the proximal one third and middle third of the femoral shaft. Fractures that have their major displacement in this area are considered subtrochanteric fractures despite the possibility that some of them may extend into the trochanteric area proximally or the distal femoral shaft. The management of fractures of the subtrochanteric region and proximal femur has always held a particular interest for orthopedic surgeons. Biomechanically, the subtrochanteric area of the proximal femur is an area of high stress concentration, which has led to high rates of implant failures in the treatment of these fractures. Current evidence suggested that interlocking intramedullary nail with side plate offer better outcome.&#x0D; Objectives: To evaluate the operative efficacy and clinical outcome of interlocking intramedullary nail with side plate in the treatment of subtrochanteric &amp; proximal femur fracture.&#x0D; Methods: This prospective cross sectional study was conducted in Cumilla General Hospital and private Clinics, Cumilla, from April 2018 to November 2019 among the 62 cases of subtrochanteric femur fractures. Objective of this study was to find out a safe, effective management of fracture, early mobility of patient, functional joint motion and short stay in hospital. All patients were treated by interlocking intramedullary nail with side plate. Routine follow up was carried out and outcomes were assessed. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system.&#x0D; Result: In this study, the mean age was 49.3±8.5 years. Among 62 cases 52 cases (83.9%) were male and 10 cases (16.1%) were female. The male and female ratio was 5.2:1. Regarding the causes of injury, out of 62 patients 50 (81%) had a history of fall from height. In 12 (19%) cases, motor vehicle accident was the cause of fracture. Average time of healing was 18 weeks. According to Harris hip score findings, 46 cases were considered as excellent in functional recovery, 11 good, 4 fair and 1 poor. The proportion of the patients with excellent and good recovery was 91.8%.&#x0D; Conclusion: Study showed interlocking intramedullary nail with side plate provides better functional outcome with early mobility of patients, and fracture unites without joint stiffness and less complication.&#x0D; Central Medical College Journal Vol 5 No 2 Jul 2021 PP 88-93

MicroRNA-148a-3p is a candidate mediator of increased bone marrow adiposity and bone loss following spinal cord injury.

Spinal cord injury is often followed by osteoporosis characterized by rapid and severe bone loss. This leads to an increased risk of osteoporotic fracture in people with spinal cord injury, resulting in increased healthcare costs, morbidity, and mortality. Though it is common, the mechanisms underlying this osteoporosis are not completely understood and treatment options are limited. No biomarkers have been identified for predicting fracture risk. In this study, we sought to investigate microRNA mediated mechanisms relating to osteoporosis following spinal cord injury. We studied subjects with acute SCI (n=12), chronic SCI (n=18), and controls with no SCI (n=23). Plasma samples from all subjects underwent transcriptomic analysis to quantify microRNA expression, after which miR-148a-3p was selected for further study. We performed CT scans of the knee on all subjects with SCI and analyzed these scans to quantify bone marrow adipose tissue volume. MiR-148a-3p was upregulated in subjects with acute SCI vs chronic SCI, as well as in acute SCI vs no SCI. Subjects with chronic SCI had greater levels of marrow adiposity in the distal femoral diaphysis compared to subjects with acute SCI. MiR-148a-3p levels were negatively associated with distal femoral diaphysis marrow adiposity. A multivariable model showed that miR-148a-3p and BMI explained 24% of variation in marrow adiposity. A literature search revealed that miR-148a-3p has multiple bone and fat metabolism related targets. Our findings suggest that miR-148a-3p is a mediator of osteoporosis following spinal cord injury and a potential future therapeutic target.

Comparison of Functional Outcome of closed Retrograde Nailing and Mippo (Minimally Invasive Percutaneous Plate Osteshnthesis) Distal Femoral Locking Plate Fixation for Distal Femoral Fractures

Objective: The purpose of our study is to compare the safety and efficacy of MIPPO distal femoral locking plate versus retrograde nailing in distal locking plate fixation among patients suffering from distal femoral fractures. Study Design: Quasi Experimental study Place and Duration: Nishtar Hospital Multan. August 2021-May 2022 Methods: There were 112 patients of both genders with ages 15-48 years had distal femoral fractures and underwent for surgery were included in this study. After obtaining informed written consent, demographically detailed of enrolled cases were recorded. Causes of distal femoral fractures were assessed. Patients were equally categorized in two group. 56 patients in group O received MIPPO DFLP and in group P 56 cases received retrograde nailing. All patients were radiographed and categorized according on the criteria established by the AO/OTA categorization system.[13] Outcomes among both groups were assessed and compared in terms surgery duration, efficacy and complications. HSS score was used to describe effectiveness of both groups. SPSS 24.0 was used to analyze all data. Results: We found that males were higher in numbers 80 (71.4%) than females (32 (28.6%). Mean age of the included patients were 29.5±9.81 years and had mean BMI 24.8±11.44 kg/m2. Most common cause of fracture was road traffic accident (RTA) in 51 (45.5%) cases, followed by falling in 35 (31.3%) cases, sports in 17 (15.2%) cases and violence in 9 (8.04%). Most common affected side was right. As per AO classification, numbers were higher in Type 43A1 classification found in 65 (58.04%) cases. Mean union time in group O was lower 2.5±4.87 months as compared to group P 3.9±6.54 significantly with p value &lt;0.005. We found significantly higher number of excellent results in MIPPO DFLP group found in 29 (51.8%) cases as compared to retrograde nailing group in 14 (25%) cases with p value &lt;0.003. Complications (delayed union, non-union, deformity, bone stiffness) were found higher in group P. Conclusion: We concluded in this study that use of MIPPO DFLP for the treatment of distal third femoral shaft fractures is highly effective and useful as compared to retrograde nailing with p value &lt;0.04 in terms of less unions time, higher excellent results and lower number of complications. Keywords: Retrograde Nailing, Distal Femoral Fractures, MIPPO DFLP, Efficacy, Complications

Minimal invasive plating osteosynthesis (MIPO) for distal femur fractures functional outcome.

Objective: To determine the functional outcome of minimally invasive plating osteosynthesis (MIPO) for distal femur fractures. Study Design: Description Study. Setting: Orthopedic Department of Allied Hospital, Faisalabad. Period: August 2020 to February 2021. Material &amp; Methods: 115 patients of both gender with age ranging from 18 to 50 years and having lower 1/3 femur shaft fractures. Patients having nerve, vascular injury and opened fracture were excluded. All patients were treated with minimally invasive plating osteosynthesis (MIPO). Criteria for bone union was bridging callus formation across the fracture site in antero-posterior and lateral knees x-rays without evidence of loosening breakage and migration of the implants with painless weight bearing on that lower limb. IKDC score at 12 weeks after the procedure was used to assess the functional &amp; clinical outcome. Results: These were excellent function result seen in 65 (56.51%) patients, good in 32 (27.83%), fair in 11 (9.57%) and poor out come in 07 (6.09%). 105 (91.30%) patients with distal 1/3 femur shaft fracture had achieved the union. Conclusion: Our study concluded minimally invasive plating osteosynthesis (MIPO) is an excellent method for the treatment of distal femoral shaft fractures.