Femoral Shaft Fractures Research Articles

Accelerated fixation is associated with fewer pulmonary embolism in patients with isolated and unilateral femoral shaft fractures: A TQIP analysis

IntroductionThe optimal time to intramedullary internal fixation for patients with isolated and unilateral femoral shaft fractures was investigated by the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP). Material and methodsAdult patients from the TQIP between 2017 and 2019 were eligible for inclusion. The associations between time to fixation and target outcomes (pulmonary embolism [PE], deep vein thrombosis [DVT], acute respiratory distress syndrome [ARDS], and mortality) were assessed. Maximization of the sum of sensitivity and specificity was used to determine the optimal cut point. The patients were divided into three groups according to different time to fixation intervals. A multinomial propensity scores weighting using generalized boosted models was performed for all unbiased pre-treatment factors between the groups. Multivariate logistic regression was used to clarify the outcomes predictors. ResultsThe univariate and multivariate analysis before weighting showed that only PE was significantly associated with time to fixation (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.09; p = 0.012). The optimal cut point of time to fixation was 13.88 h. The patients were divided into accelerated (≤ 13.88 h), standard (> 13.88 and ≤ 24 h), and delayed (> 24 and < 36 h) groups. After weighting for all unbiased pre-treatment factors between the groups, multivariate logistic regression showed that standard group significantly increased the risk of PE compared with accelerated group (OR, 4.436; 95% CI, 1.844-10.672; p = 0.001). ConclusionAccelerated intramedullary internal fixation within 13.88 h was associated with a significantly decreased risk of PE compared with standard fixation in patients with isolated and unilateral femoral shaft fractures without additional mortality risks.

Predictors of nonunion for transverse femoral shaft fractures treated with intramedullary nailing: a SIGN database study.

Nonunion is a common postfracture complication resulting in decreased quality of life for patients in resource-limited settings. This study aims to determine how age, sex, injury mechanism, and surgical intervention affect the rate of nonunion in transverse femur fractures treated with a SIGN intramedullary nail (IMN). A retrospective study was conducted using the SIGN online surgical database. All patients older than 16 years with simple transverse (<30 degrees), open or closed, femur fractures treated using a SIGN IMN between 2007 and 2021 were included. Our primary outcome of nonunion was measured with the modified Radiographic Union Scale for Tibial fractures (mRUST); scores ≤9 of 16 defined nonunion. The secondary outcome was squat depth. Outcomes were evaluated at follow-up appointments between 240 and 365 days postoperatively. Univariate and multivariate analysis were used for statistical comparison. Inclusion criteria were met for 182 patients. The overall radiographic union rate was 61.0%, and a high proportion (84.4%) of patients could squat with their hips at or below the level of their knees. Older age, retrograde approach, and fracture distraction were associated with nonunion, but sex, injury mechanism, and other surgical variables were not. Poor reduction with fracture distraction was associated with a higher rate of nonunion. Loss of follow-up may have contributed to our overall union rate; however, we observed high rates of functional healing using the SIGN IMN. IV.

Comparison of Noncontact Plating with Conventional Methods and Osteosynthesis Techniques in the Treatment of Pediatric Femoral Fractures

Introduction: Studies on surgical options in pediatric femoral fractures have been continuing for many years. We aimed to compare the noncontact plating we applied with the other techniques.&#x0D; Material and Methods: Pediatric patients treated for femoral shaft fracture were included. The patients were evaluated in terms of fracture type, time until surgery, duration of surgery, time of union, complications, Flynn criteria, radiological findings. 21 were in the elastic nailing (group 1), 27 were in the conventional plating (group 2), 11 were in the noncontact plating (group 3). &#x0D; Results: The mean age was 8.3±1.4 (6-11) in group 1, 10.2±2.2 (7-15) in group 2, and 9.7±2.8 (7-15) in group 3. The time of union was 8.0±2.2 weeks (6-16) in group 1, 9.7±2.7 weeks (7-20) in group 2, and 7.1±1.0 weeks in group 3 (6 -9). In group 1, one patient had delayed union, two patients had a valgus deformity, two patients had minor wound site infection, and four patients had shortening of less than 2 cm. In group 2, three patients had a valgus deformity.Moreover, one patient underwent revision due to plate fracture. In group 3, no delayed union or deformity was observed in any patient.&#x0D; Conclusion: The fact that elastic nailing, which is the most frequently recommended method in pediatric femoral fractures. However, it is obvious that conditions such as the absence of splinting, better reduction, fewer deformity, early rehabilitation provide advantages over noncontact plating. While it is up to the surgeon's preference, noncontact plating can be applied safely and successfully.

Assessment of knee pain and knee range of motion (ROM) in distal third femur shaft fractures managed with retrograde (RG) intramedullary locking nail: A Retrospective study.

Objective: To assess knee pain and ROM in distal third femoral Fracture managed with RG intramedullary nailing technique. Study Design: Retrospective study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: November 2020 to March 2021. Material &amp; Methods: 38 patients with extra-articular distal femoral Fracture were surgically treated in our center with an RG IM nail. The functional Outcome of the knee for knee pain and knee ROM was assessed using a modified Hospital for Special Surgery (HSS) Knee Score. Results: In this study, a total of 38 patients were diagnosed with distal third femur shaft fractures managed with retrograde (RG) intramedullary locking nail; among these, 31(81.6%) were males, and 7(18.4%) were females. The mean age of patients was 29.76±11.87, ranging from (16-50) years. In more than half of the cases, 30(78.9%) had a history of injury as RTA and 8(21.1%) sustained fall. The right side effected 65.8% of cases compared to the left side. 60.53% of cases had excellent functional Outcomes due to HSS sore between 85-100, 7.89% had good Outcomes because of scores ranging from 70-84, 26.32 had fair, and 5.285 had poor outcomes, respectively. There was no case with extension lag. Conclusion: Based on this study, RG IM nail fixation of distal extra-articular femur fracture can be safely performed, and improved knee function score can be anticipated with meticulous patient selection and adherence to proper postoperative physical therapy protocol.

Comparative Study of Paediatric Femur Shaft Fracture Treated With TENS and DCP

Introduction: Paediatric femoral shaft fractures are common injuries in the age group treated by an orthopaedic surgeon. These fractures typically occur either in the early childhood when weak woven bone is changing to the stronger lamellar bone or at adolescence when children are subject to high energy trauma from motor vehicle accidents or from sports [1]. Femoral shaft fractures represent around 2.2% of all bony injuries in children. There are varieties of approaches to treat femoral fractures in the field of medical science. The aim of this study is to compare the outcomes between TENS and DCP approach for paediatric femur shaft fracture. Methodology: This was a prospective comparative study conducted at the department of Orthopaedics Surgery in Dhaka Orthopaedics Hospital, Dhaka, Bangladesh during December, 2017 to November, 2019. The ethical clearance of this study was obtained from the ethics committee of the hospital and a total of 23 children were enrolled in this study. The children were divided into two groups, TENS group n=14), DCP group (n=9). The collected data were analyzed using Statistical Package for Social Sciences (SPSS), software, version-23.0. Results: A total of 23 children aged 6-18 were enrolled in this study. Among the children 78 % were male and 22% were female. The mean age of the children was 10.7 years. In TENS group 9(63%) children fall from height and followed by 4(28%) got road traffic accident, and 1(7%) blunt trauma whereas in DCP group, 6(66%) fall from height and followed by 2(22%) got road traffic accident, and 1(11%) blunt trauma. In TENS group, 2(14%) children had radiologically comminuted fracture and followed by 3(21%) oblique, 9(63%) transverse whereas, in DCP group,1(11%) children had comminuted radiological fracture and followed by 2(22%) oblique and 6(66%) transverse In TENS group, the mean duration of surgery was 53.00 ±9.20 minutes while the mean duration of surgery in DCP group was 60.00±16.52 minutes, which was .....

Parallel Reconstruction of Vascularized Fibula Autograft for Treatment of Complications after Resection of Malignant Tumor from the Thigh.

The authors herein introduce a modification of parallel reconstruction with a vascularized fibula autograft (VFA) for cases of femur allograft complications. Conventional parallel reconstruction, in which the fibula with its vascular pedicle is placed on the medial side of the femur and allogeneic bone, may be an effective means to solve the allograft complications. However, the limited contact area between the fibula and femur/allogeneic bone can affect the bone healing ability. Furthermore, the rigid internal fixation method for the VFA may cause stress shielding and result in bone resorption. The authors propose the use of modified parallel reconstruction of the VFA with fibula expansion and titanium cable fixation for patients with allograft-host junction nonunion, allogeneic bone fracture, and femoral shaft fracture after surgical removal of a malignant tumor from the thigh. The modified parallel reconstruction has been performed on 5 patients (2 patients underwent fibular expansion). All 5 patients with 7 nonunions of the allograft-host junction or fracture were followed up for 33.2 months. The length of fibular graft was 10 to 20 cm, with an average of 15.0 cm. The union rate of allograft-host junction and fracture was 100% (7 of 7), and the union time was 15.9 months. This modified parallel reconstruction technique can achieve satisfactory union in treatment of the above complications.

Outcome of Plate and Screw Fixation in Femoral Shaft Fracture at Sanjiwani General Hospital Gianyar in 2021

Introduction: Fracture is a bone discontinuity followed by soft tissue damage such as blood vessels, muscles and nerves. One of the most common fractures is a femoral shaft fracture that reported the one year mortality rate post trauma is still high around 10-20%and it is a challenged in orthopedics. Surgical therapy in the orthopedic field hasbeen highly developed in the treatment of femoral shaft fractures. Method: Gold standard therapies that have been used for femoral shaft fractures is intramedullary nail but the ORIF PS method is still often used especially in hospitals that have inadequate health facilities byconsidering several risk factors and complications that can occur during the perioperative. This study is a retrosepctive descriptive study that aims to indentify the outcome of plate and screw fixation in femoral shaft fracture at Sanjiwani General Hospital Gianyar in 2021. Result: Medical record, surgical procedure, and outpatient control reports were reviewed to colect pre-, intra-, and postoperative details by identifying data on complications that occur in patients with open and closed femoral shaft fractures who had performed ORIF PS at Sanjiwani Hospital in January 2021 - December 2021. All obtained data analysed using SPSS statisics 22 software. A total of 12 patients were included in this study. Major complication were represented by perioperative bleeding (33%), redisual pain (8%), no complication of implant failure, deep infection, minor infection such as superficial infection and impaired wound healing in this study. Conclusion: In this study was concluded that the most common femoral shaft fracture complication that performed ORIF PS is perioperative bleeding.

Functional outcome of intramedullary nailing of the femoral shaft fracture

Background &amp; Objective: A common fracture is a femoral shaft fracture. The advantages of intramedullary interlocking nails make them the method of choice for treating femoral shaft fractures. These benefits include a small incision, minimal dissection, decreased rates of infection, nonunion, and malunion, shorter hospital stays and rehabilitation periods, excellent union, rotational stability and length maintenance, rapid recovery, and early weight-bearing. Therefore, the aim of this study was to analyze the functional findings from femoral shaft fracture intramedullary nailing. Material and Methods: This was a hospital- based, longitudinal, observational study. All patients with femoral shaft fractures admitted at UCMS-TH, Bhairahawa from the Emergency Department managed surgically from October 2019 to March 2020 were included in the study. Femoral shaft fractures with age ≥ 16 years were included while open fractures (Gustalio and Anderson type 2 and 3), pathological fractures,congenital anomaly of the affected limb, previous fracture of the affected limb were excluded. All the patients were managed surgically and followed for at least 6 months. The outcome was measured by the Thoresen scoring system at the end of 6 months. Results: In this study of 30 cases, the mean age was 30.47 years, male and female ratio of 2:1, the left side was affected in 18 cases, RTA was the most common mode of injury. Most of the cases were Winquist and Hansen type 2 and AO type 32B. In the majority of the cases, 27 cases (90%) had no complication while superficial infection in 2 cases and shortening was seen in 1 case. We found excellent results in 86.7% cases, good in 10% cases and fair in 3.3% cases. Conclusion: The excellent functional outcome in terms of alignment and range of motion obtained in this study in the majority of patients makes this technique more reliable. The method of choice for femoral shaft fracture in adults was due to its low complication rate, high incidence of union, shorter hospital stay and early mobility.

Plate fixation versus flexible intramedullary nails for management of closed femoral shaft fractures in the pediatric population: A systematic review and meta-analysis of the adverse outcomes.

Fractures of the femoral diaphysis are associated with a risk of morbidity in children. Various fixation methods have been developed, but with only limited evidence to support their use. This systematic review assesses the evidence regarding clinical outcomes of closed femoral diaphyseal fractures in children treated with plate fixation or flexible intramedullary nails. A PROSPERO-registered, PRISMA-compliant systematic review and meta-analysis were conducted. MEDLINE, Embase, and Web of Science (WoS) databases were searched from inception to February 2023. Inclusion criteria included clinical studies reporting adverse outcomes following surgical treatment of pediatric closed femoral diaphyseal fractures using plate fixation and flexible intramedullary nails. The ROBINS-I and RoB 2 tools evaluated the risk of bias. Thirteen papers (2 prospective randomized controlled trials and 11 retrospective cohorts) reported 805 closed diaphyseal femoral fractures in 801 children (559 males, 242 females). There were 360 plate fixations and 445 flexible intramedullary nails. Two cases of osteomyelitis and one nonunion were reported. Meta-analysis showed that plate fixation had a lower risk of soft tissue infection (relative risk 0.26 (95% confidence interval 0.07-0.92)). There was no difference in the following outcomes: malunion (relative risk 0.68 (95% confidence interval 0.32-1.44)); unplanned reoperation (relative risk 0.59 (95% confidence interval 0.31-1.14)), and leg-length difference (relative risk 1.58 (95% confidence interval 0.66-3.77)). The risk of bias was high in all studies. An analysis of 805 fractures with minimal differences in meta-analyses is considered high quality even when the quality of the evidence is low. The findings are limited by important flaws in the methodology in the published literature. Well-designed multicentre prospective studies using standardized core outcomes are required to advise treatment recommendations. III.

Intramedullary Nailing versus Dynamic Screw and Plate for Treatment of Trochanteric Fractures of the Femur

Background Trochanteric and intertrochanteric femur fractures are extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter. Trochanteric fractures in adults mostly affect elderly subjects. Frequency is increasing with population aging despite the development of treatments for osteoporosis. The two most widely used types of internal fixation are intramedullary nailing and screw-plate fixation, often performed by trainee surgeons due to their frequency and reputed simplicity. Aim of the Work The aim of the study is to conduct a systematic review of literature and metaanalysis comparing between intramedullary nailing and dynamic plate and screw in treatment of trochanteric fractures of the femur according to: Length of mean operation time, time of radiation exposure (fluoroscopy time), Intraoperative blood loss, reoperation rate, fracture non-union and postoperative wound infection wither superficial or deep infection. Patients and Methods We followed the PRISMA statement guidelines during this study preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane, and Web of Science, Embase, and Science Direct in June 2021 and updated the search in July 2021 using relevant Keywords. The eligibility inclusion criteria for studies inclusion were the following: (1) Adult patients above 18 years old (2) Double arm designs (3) Studies designs are limited to randomized control trial (RCT) (4) English studies (5) Any outcome is acceptable. The risk of bias was evaluated by the Cochrane handbook of systematic reviews of interventions 5.1.0. Regarding the data extraction, we obtained data from text, tables, figures (using graph grabber version 2.0), and supplementary data. We conducted this metaanalysis by using Review Manager software (RevMan version 5.4). Results Compared to the control group (Dynamic hip screw and plate technique), Intramedullary nailing (IMN) showed a significant improvement in length of operation time (MD = −9.27; 95% CI: [-18.07, -0.47]; P = 0.04) and perioperative blood loss(MD = -120; 95% CI: [-164.05, -77.89]; P &amp;lt; 0.00001) than dynamic hip screw with plate fixation technique. However, in the term of intraoperative radiation exposure time (Fluoroscopy time), dynamic hip screw (DHS) with plate fixation showed a significant lesser fluoroscopy time than IMN(MD = 0.61; 95% CI: [0.23, 0.99]; P = 0.002). Regarding the postoperative patient satisfaction (assessed by visual analogue scale), postoperative Fracture non-union, perioperative wound infection, femur shaft fracture, and hip prosthetic instability, they showed no significant difference between IMN and dynamic hip screw with plate fixation. Reoperation rate also showed no significant difference between IMN and DHS with plate fixation. Conclusion DHS with plate is not the preferred implant for stable intertrochanteric femur fractures. IMN showed a better result than DHS. We believe that the IMN is biologically superior to DHS for fixation of unstable inter-trochanteric fractures as it provides stable intramedullary fixation resistant to varus collapse and fixation failure, with relatively less operation time, and blood loss.

Effect of a New Antibiotic Protocol Adopted by ASU Hospitals on Patients with Intra-Medullary Nailing of Femoral and Tibial Diaphyseal Fractures as Regard Post-Operative Infection

Background This study postulated that systemic antibiotic prophylaxis delivered preoperatively in intramedullary nailing of femur and tibia procedures significantly reduces the incidence of infection. Prophylactic antibiotics should be taken IV before skin incision by 30-60 minutes and no need for antibiotics more than 24 hours after operation. This protocol of antibiotics has multiple benefits such as saving a lot of money, decrease the risk of surgical site infection and decrease antibiotic resistance. Aim of the Work To assess the effect of antibiotic choice, duration on prevalence of surgical site infection among patients with intramedullary nailing of femoral and tibial fractures, and identify risk factors. Patients and Methods This study conducted on 50 cases of femoral and tibial fractures admitted from Al-Demerdash University Hospital in the period from June 2019 to December 2020 with age ranged from 18 to 56 years and with mean ± SD of 28.14 ± 10.14. This study was based on the antibiotic protocol adopted by Ain Shams University Hospitals that we give first generation cephalosporin (zinol) for all patient undergoing intramedullary nailing of femur and tibia, 30 – 60 minutes before skin incision and for 24 hours post-operative. Results The results of this study showed 1 case infected postoperative from 50 cases with a percentage of 2%, by this result we found that by studying the risk factors for infection there was no specific risk factor for infection except for obesity and diabetes. By studying of the results of application of our new antibiotic prophylaxis protocol in our hospital (Ain Shams University Hospitals) from the period from 6-2019 to 12-2020 the new protocol have the benefits of the following: Decrease of the total percentage of infection in all orthopedic surgeries in our department to less than 2%, Presence of fixed, known and effective prophylactic antibiotic protocol in our hospital unlike before every surgeon has his opinion about type and dose of antibiotics causing less controversy and confusion among surgeons in the practice of postoperative antibiotic use. Conclusion This study postulated that systemic antibiotic prophylaxis delivered preoperatively in intramedullary nailing of femur and tibia procedures significantly reduces the incidence of infection.

Application of bridge-link type combined fixation system in the treatment of trifocal femoral fractures.

Ipsilateral combined fractures of the proximal femur, femoral shaft, and distal femur, though uncommon, present significant treatment challenges for orthopaedic surgeons. This retrospective study aims to investigate the intraoperative and long-term postoperative outcomes of this combination fracture when treated using a bridge-link type combined fixation system (BCFS). Four individuals received treatment at a level 1 trauma centre between January 2013 and December 2017 for combined fractures of the proximal femur, femoral shaft, and distal femur. The medical records of these patients were retrospectively examined. In addition to minimally invasive percutaneous plate osteosynthesis (MIO), all patients underwent BCFS. The median follow-up period for each patient was 28.5 months. The median duration of the surgical procedure was 176.0 min, with intraoperative haemorrhage measured at 470.0 ml. Among the cases, three patients showed firm union of the femoral shaft fractures. However, one patient experienced nonunion 12 months after the procedure, while another patient suffered from refracture of the femoral shaft and postoperative avascular necrosis of the femoral head. At the time of the last follow-up, the Friedman-Wyman functional scores were excellent in one case, good in two cases, and fair in one case. Trifocal femoral fractures lack a widely approved therapeutic strategy. Nonetheless, BCFS may present itself as a viable alternative for treating this type of fracture, offering positive clinical outcomes.

Clinical outcome of femoral diaphyseal fractures in adults treated with open verses closed interlocking nail

BACKGROUND &amp; OBJECTIVE: There are different methods for treatment of the long bone fractures, including femoral diaphyseal fractures, ranging from closed intramedullary nail, open intramedullary nail to flexible nail, plating, and external fixator in open type 3 B and 3C fractures. The aim of this study was to compare the functional outcome of open versus closed techniques in treating femoral diaphyseal fractures in skeletally mature adults.&#x0D; METHODOLOGY: A simple observational study was conducted at the Department of Orthopedics, Allied Hospital Faisalabad, from January 2018 to January 2020 with a total of 60 skeletally mature patients with mean age 38.4+1.2 who fulfilled the inclusion criteria were operated, and five patients lost in follow-up. Group A consisted of 27 patients (18 males and 9 females) who were operated with closed interlocking technique. Group B consisted of 28 patients (12 males and 16 females) who were operated with open technique. Both groups were followed prospectively for two years to evaluate the outcome. T-test was used for statistical analysis.&#x0D; RESULTS: The rate of union in group A was better than in group B. Patients in group A had a reunion 1.99±0.86 weeks earlier than group B a significant difference between the two groups with p&lt;0.001. Nonunion occurred in 02(7.40%) patients of group A and 03(10.71%) patients of group B. Only 01 (3.7%) patient from group A and 02 (7.40%) patient of group B suffered from deep infections.&#x0D; CONCLUSION: Closed interlocking for femoral diaphyseal fractures provides earlier reunion of the bone and should be considered the treatment of choice. In case of lack of technical availabilities, open interlocking should be considered as a suitable option.

Comparison of titanium elastic nailing and spica casting outcomes in preschool children following femoral diaphyseal fractures

BACKGROUND &amp; OBJECTIVE: Pediatric femoral diaphyseal fractures are common fractures in preschool children. The titanium elastic nailing technique is becoming prevalent in developed and developing countries. To compare the frequency of efficacy, safety and mean surgical fixation outcomes among patients who underwent titanium elastic nailing versus spica casting in diaphyseal femur fractures&#x0D; METHODOLOGY: A prospective study was conducted at department of orthopedics, Pakistan Ordinance Factory (POF) hospital. The study duration was 2 years (March 2018-March 2020). A sample size of 42 children was calculated using WHO calculator. Children selection was made on the basis of non-probability (consecutive) sampling. Group TEN underwent titanium elastic nailing, while group SPICA underwent hip spica casting. Patients were followed for six months. We used SPSS version 24 for the analysis of data. Fisher exacts and independent T-test were applied for measuring associations and comparisons of two groups. P-value ≤0.05 was considered significant.&#x0D; RESULTS: Total of 42 patients were included in the study. The mean age of patients was 3.4 years±1.4SD. The TEN group showed satisfactory results in malalignment (p=0.000) and complications (p=0.000). SPICA group showed significantly high assisted weight bearing duration (p=0.000), full weight bearing duration (p=0.000), greater operative time (p=0.000), lower range of motion (p=0.000) and less patient satisfaction (p=0.000) as compared to TEN group.&#x0D; CONCLUSION: Titanium elastic nailing is safe, effective, and allows faster recovery in pediatric patients with diaphyseal femoral fractures. We recommend titanium elastic nailing as a valid treatment option for femur fractures in preschool children.

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.

Holistic pedestrian safety assessment for average males and females.

An integrated assessment framework that enables holistic safety evaluations addressing vulnerable road users (VRU) is introduced and applied in the current study. The developed method enables consideration of both active and passive safety measures and distributions of real-world crash scenario parameters. The likelihood of a specific virtual testing scenario occurring in real life has been derived from accident databases scaled to European level. Based on pre-crash simulations, it is determined how likely it is that scenarios could be avoided by a specific Autonomous Emergency Braking (AEB) system. For the unavoidable cases, probabilities for specific collision scenarios are determined, and the injury risk for these is determined, subsequently, from in-crash simulations with the VIVA+ Human Body Models combined with the created metamodel for an average male and female model. The integrated assessment framework was applied for the holistic assessment of car-related pedestrian protection using a generic car model to assess the safety benefits of a generic AEB system combined with current passive safety structures. In total, 61,914 virtual testing scenarios have been derived from the different car-pedestrian cases based on real-world crash scenario parameters. Considering the occurrence probability of the virtual testing scenarios, by implementing an AEB, a total crash risk reduction of 81.70% was achieved based on pre-crash simulations. It was shown that 50 in-crash simulations per load case are sufficient to create a metamodel for injury prediction. For the in-crash simulations with the generic vehicle, it was also shown that the injury risk can be reduced by implementing an AEB, as compared to the baseline scenarios. Moreover, as seen in the unavoidable cases, the injury risk for the average male and female is the same for brain injuries and femoral shaft fractures. The average male has a higher risk of skull fractures and fractures of more than three ribs compared to the average female. The average female has a higher risk of proximal femoral fractures than the average male. A novel methodology was developed which allows for movement away from the exclusive use of standard-load case assessments, thus helping to bridge the gap between active and passive safety evaluations.

Risk factors, classification, and operative choices of femur fractures at a Tertiary Hospital: first report from Somalia

A traumatic femur fracture is a significant cause of morbidity, affecting one to three million individuals annually. The present is the first study investigated the epidemiological characteristics, risk factors, classification, mechanisms of injury, and early management of femoral fractures in Somalia. This retrospective epidemiological study included all patients with a femur fracture who were admitted for four years between November 2018 and December 2022 to the orthopedic and trauma surgery department. We reviewed patient demographic characteristics, including age and gender, the mechanism of injury, injury characteristics, and the type of fixation performed. We reviewed the radiographs and classified the fracture using the AO/OTA classification system. During the study period, a total of 402 patients were treated for femur fractures; 256 (64%) were males, and 144 (36%) were females. The mean patient age was 47.7 ± 8.5 years. Regarding the anatomical location of femur fractures, the proximal (31A, 31B) was the most common, accounting for 50% of the patients. Femur neck fracture (31B) was the most common in the proximal femur fractures. Gunshot 82 (59.42%) was the leading cause of femur shaft fractures. Most patients with femur shaft fractures were males; 150 (86.20%) and 152 (64.47%) were young patients between 19 and 40 years old. Almost half of the patients (86) with femur shaft fractures had open fractures. The distribution of the mechanism of injury significantly differed according to age (p < 0.001). Younger patients (< 40 years) were predominantly injured due to gunshot injuries compared to elderly cases (> 60 years), where falls from standing height were the primary mechanism of injuries. There was a statistically significant difference between the mechanism of injury and gender categories (p < 0.001). Male patients were injured mainly by gunshots in about 40%, while 80% of fractures in female patients were due to falls from standing height. Female fractures occurred primarily in the proximal, while the males had an equal fracture rate for proximal and shaft fractures. Femur fracture causes significant morbidity and mortality. The study findings revealed that the most common femur fracture type was femur neck fracture, and low-energy injuries were the most common mode of injury in the elderly. Proximal femur fractures occur in older age and mainly in females. Gunshots were the most common cause of femur shaft fractures in Somalia, a country that has struggled with wars for over 30 years.

Analysis of Nonunion in Intramedullary Interlocking Nailing in Fracture Shaft of Femur

Analysis of Nonunion in Intramedullary Interlocking Nailing in Fracture Shaft of Femur

Acute minimally invasive bone grafting of long bone fractures to reduce the incidence of fracture non-union

Diaphyseal fractures of the femur and tibia are a frequent consequence of trauma and are most often managed with intramedullary nailing. Although outcomes from these fractures are generally perceived as good, it is estimated that 7 to 14% of people with tibial and femoral shaft fractures progress to non-union and an even greater proportion suffer delayed union, which causes substantial health and economic burdens both for patients and health services. Compared to those whose fractures unite within the normal timeframe, patients suffering delayed union or non-union suffer more pain, worse functional outcomes, greater psychological disability and longer amounts of time off work. In response to non-union, invasive and costly secondary procedures such as exchange nailing, supplementary fixation and/or bone grafting are commonly required. We hypothesise that performing acute autologous bone grafting at the time of the primary intramedullary nailing procedure would reduce the incidence of fracture delayed union and non-union for tibial and femoral shaft fractures. The autologous cancellous bone retrieved during reaming with intramedullary nailing is usually discarded. We propose a minimally invasive surgical technique to transplant the retrieved intramedullary reamings to the fracture site during the primary fracture fixation. Autologous cancellous bone grafting is the gold standard for management of fracture non-union, and works by providing osteoprogenitor cells, an osteoconductive scaffold, and growth factors to the fracture site, where they are crucial for fracture healing. Proprietary biological products have also been developed that aim to replicate the results from bone grafting. Although autologous cancellous bone grafting is a proven and robust technique for the treatment of atrophic fracture non-union, it has not been widely studied in the acute management of femoral and tibial shaft fractures. The proposed hypothesis is amenable to testing in randomized clinical trials. If found to be effective in reducing rates of delayed union and non-union with minimal adverse events, this method could be adopted on a large scale, potentially transforming acute management of long bone fractures, and improving patient outcomes from these injuries.

Bone Growth After Fracture of the Femoral Shaft in Children

Background Overgrowth after femoral diaphyseal fractures in children has been well-known. The process and degree of overgrowth vary among patients, making it difficult to predict the length of the fractured femur at growth arrest. Materials and Methods 3 cases aged 4-7 years (2 boys and 1 girl) with femoral diaphyseal fractures were subjected. Observation period was 6-12 years. Leg length was assessed by taking a simple X-ray of the entire lower extremities in a standing position. Results 2 cases underwent anatomical reduction and external fixation. After the fracture had healed, there was overgrowth of the fractured femur, resulting in leg length discrepancy. Both cases were treated with an 8-plate temporal epiphysiodesis. 1 case was treated conservatively with skeletal traction, and fracture was healed with overriding of bone fragments. Overgrowth occurred and resulted in a fractured femur that became longer than opposite side. However, leg length discrepancy was gradually self-corrected and was eventually eliminated. Conclusions Overgrowth after femoral diaphyseal fracture was seen in all patients. Overgrowth tended to occur rapidly after the fracture and then slow down. Leg length discrepancy caused by overgrowth may be corrected during growth to some degree, and it should be decided whether patient need additional treatment.