Femoral Fractures In Elderly Patients Research Articles

Distal femoral fractures treated by hinged total knee replacement in elderly patients

Although the use of constrained cemented arthroplasty to treat distal femoral fractures in elderly patients has some practical advantages over the use of techniques of fixation, concerns as to a high rate of loosening after implantation of these prostheses has raised doubts about their use. We evaluated the results of hinged total knee replacement in the treatment of 54 fractures in 52 patients with a mean age of 82 years (55 to 98), who were socially dependent and poorly mobile. Within the first year after implantation 22 of the 54 patients had died, six had undergone a further operation and two required a revision of the prosthesis. The subsequent rate of further surgery and revision was low. A constrained knee prosthesis offers a useful alternative treatment to internal fixation in selected elderly patients with these fractures, and has a high probability of surviving as long as the patient into whom it has been implanted.

Cruciate-Retaining Stemmed Total Knee Arthroplasty for Supracondylar-Intercondylar Femoral Fractures in Elderly Patients: A Report of Three Cases

The treatment of supracondylar or intercondylar femoral fractures in elderly patients with gonarthrosis is a difficult problem. Primary total knee arthroplasty (TKA) can be considered as a treatment modality for these patients, and several authors have reported acceptable results with this option. They have performed TKA using custom-made, hinged, or constrained components with long stem for fracture reduction and stabilization. But use of hinged or constrained total knee arthroplasties for dealing with supracondylar and intercondylar fractures may be unnecessary, and an alternative is to use a cruciate-retaining stemmed TKA. We report 3 elderly female patients who had supracondylar or intercondylar femoral fractures and coexisting gonarthrosis treated by primary TKA with use of a cruciate-retaining augmentable femoral component with stem extension. All patients improved their ambulatory status and showed good knee function. We believe that use of a cruciate-retaining type of component is a reasonable alternative to the use of a more constrained prosthesis in the treatment for this group of patients.

The retrograde nail for distal femoral fractures in the elderly: High failure rate of the condyle screw and nut

Displaced distal femoral fractures in elderly patients benefit from surgical fixation. We describe the use of a retrograde femoral nail to treat these fractures. The implant has a special condyle screw and nut that allows for manual compression of the fracture when there is an additional inter-condylar split. We present our results when using this implant to treat 16 patients over a 13-month period. The mean patient age was 78 years (range, 65-96 years). All 16 patients were available at the time of final follow up and proceeded to union at an average time of 11 weeks (range, 10-14 weeks). Twenty-six condyle screw and nuts were used. Ten out of 26 condyle screws in 10 out of 16 patients failed by disengaging at a mean time of 10 weeks (range, 8-12 weeks). Our union rate was unaffected by the nut and bolt disengaging. This would suggest that the condylar compression generated by the nut and bolt may not be critical for union.

Trochanteric Gamma Nail and Compression Hip Screw for Trochanteric Fractures

To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures. Prospective randomized. Level 1 trauma center. Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures. Treatment with a compression hip screw or a new design of the Trochanteric Gamma nail (180 mm in length with a mediolateral angle of 4 degrees and available only with a proximal diameter of 17 mm and distal diameter of 11 mm). Operative and fluoroscopy times, blood loss, functional outcome, complication rate, and failure of fixation. The Trochanteric Gamma nail was used in 104 patients and the compression hip screw in 106. The 2 groups were similar in terms of their preoperative data, with a median follow-up of 13.6 months (range 12-30). The results show no difference in operating time (P = 0.21), but the Trochanteric Gamma nail group had a significantly shorter fluoroscopy time (P = 0.006), and the number of patients transfused and the mean of units of blood transfused were significantly less in the Trochanteric Gamma nail group (P = 0.013, 0.046, respectively). Mortality within 12 months was similar in both groups (P = 0.83). All fractures were radiographically healed at the last visit. There was no difference in intraoperative and postoperative complications or rate of fixation failure between the 2 groups, and no case of secondary shaft fracture of the femur was encountered in this study. In the entire series, there was no difference in the functional outcome (P = 0.74), but the postoperative walking ability was better in those patients with unstable fractures who were treated with the Trochanteric Gamma nail (P = 0.017). The new Trochanteric Gamma nail is an effective method for the treatment of trochanteric femoral fractures in elderly patients. The indication for either Trochanteric Gamma nail or compression hip screw is similar in stable fractures, but we recommend the use of the Trochanteric Gamma nail for unstable trochanteric fractures.

A comparison of medical care for proximal femoral fracture in elderly patients now and 20 years ago

A comparison of medical care for proximal femoral fracture in elderly patients now and 20 years ago

Result of surgical treatment of proximal femoral fractures in elderly patients with severe risk factor for prognosis

Result of surgical treatment of proximal femoral fractures in elderly patients with severe risk factor for prognosis

Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods

The objective of this study is to present the results of surgical management of supracondylar fractures of the femur (types A and C according to the AO/ASIF classification) in elderly patients with the use of two different methods of fixation: the mini open dynamic condylar screw fixation (DCS) and the closed retrograde intramedullary nailing (RIN). Eighty patients with supracondylar fractures of the femur were treated from January 1994 to June 2000 and 72 of them followed up completely. There were 25 (34%) men and 47 (65%) women with a median age of 73.2 years (range 60-88 years). In patients with the same type of fracture, the chosen method was random, one after the other (alternately). RIN was used in 35 patients, and DCS was used in 37. The mean operative time for the DCS fixation group was 145 min (range 115-180 min), whereas for the RIN group it was 92 min (range 76-110 min) (p<0.001) with an average estimated blood loss of 310 cc (range 120-450 cc) and 118 cc (range 90-165 cc), respectively (p<0.001). The mean follow-up was 28 months (range 18-42 months). According to the criteria set by Schatzker and Lambert, excellent results were recorded in 18 (51%), good in 11 (31%), moderate in 3 (9%), poor in 3 (9%) patients with RIN and excellent in 19 (51%), good in 11 (30%), moderate in 4 (11%) and poor in 3 (8%) patients with DCS (p>0.05). The complications that occurred in the RIN group were 2 (6%) stiffness of the knee (mean flexion 80 degrees), 2 (6%) non-unions, 2 (6%) varus deformity and in the DCS group 2 (5%) haematomas, 4 (11%) stiffness of the knee (mean flexion 73 degrees) and 2 (5%) non-unions. Although the two methods appear to have the same percentage of excellent results and same time to bony union, RIN is preferable to DCS in terms of less blood loss and shorter operating time.

Primary total knee arthroplasty for complex distal femur fractures in elderly patients.

Fractures of the distal femur in the geriatric population are associated with a high incidence of postoperative complications and poor results. Nonunion, loss of fixation, and malunion of these fractures occur with all types of treatment. The postoperative treatment of these patients demands a lengthy period of limited weightbearing that can increase the rate of medical complications. Our experience with these challenging fractures caused us to consider the use of a primary distal femur replacement total knee arthroplasty with the goals of elimination of fracture healing issues, early mobilization, and immediate weightbearing. Twenty-four distal femoral replacement knee arthroplasties were done from July 1998 to January 1999. Reviewed with a mean followup of 11 months, 17 patients (71%) resumed their preoperative level of ambulation. Knee range of motion averaged 1 degree - 103 degrees. No major surgical or significant medical complications were experienced by these patients. Our experiences with this small number of patients have shown that an immediate arthroplasty offers many advantages over open reduction and internal fixation for geriatric patients with poor bone quality, preexisting degenerative joint disease, and medical problems.

EVOLUTION OF THE INTERNAL FIXATION OF LONG BONE FRACTURES

EVOLUTION OF THE INTERNAL FIXATION OF LONG BONE FRACTURES

大腿骨転子部骨折に対するＣＨＳ法とＧａｍｍａ ｎａｉｌ法との比較

We conducted a randomised prospective comparison of the Compression Hip Screw(CHS) and gamma nail for internal fixation of 60 intertrochanteric femoral fractures in elderly patients. The gamma nail group showed shorter convalescence and earlier full weight-bearing. There were however no significant differences in the operative time, blood loss, stay in hospital' and patien's mobility at the final review. Intra-operative lateral cortex fracture and post-operative cutting cut were recorded in the gamma nail group. Use of the gamma nail is thus not recommended for these complications considering the good results of CHS.

Primary knee arthroplasty for distal femoral fractures in elderly patients.

We discuss the role of primary knee arthroplasty in supracondylar and intercondylar fractures of the femur in elderly patients with reference to 13 cases. This method of treatment is shown to be effective and to have good results. It is recommended for all type C and some type A supracondylar fractures in old people.

The Partridge Nylon Cerclage: Its Use as a Supplementary Fixation of Difficult Femoral Fractures in the Elderly

We report on our early experience with the use of the Partridge nylon cerclage. This system was employed as a supplementary fixation in 18 femoral fractures in elderly patients (average age, 78 years). Indications of its use were reduction of comminuted fragments and enhancement of the grip of the main fixation device on osteoporotic femora or in femora with a prosthesis in situ. All fractures but one healed primarily. At an average follow-up time of 25 months, 15 of the 18 patients were ambulatory. Radiographic review showed that the cerclage did not cause cortical avascularity and that none of the straps used failed. We concluded that the internal fixation of difficult femoral fractures in the elderly can be easily and effectively strengthened by the use of this cerclage system.

Fractures of the proximal femur : Sikorski J. M., Davis N. J. and Senior J. (1985) The rapid transit system for patients with fractures of proximal femur. Br. Med. J.290, 439

ip fracture is among the most common injuries necessitating hospital admission. Fractures of the hip include fractures of the proximal femur and pelvic ring and may be classified as pathologic or nonpathologic. Regardless of the type of fracture, however, hip fractures can lead to substantial morbidity and mortality. This article discusses the epidemiology of fractures of the proximal femur and the evaluation and treatment of nonpathologic and osteoporotic pathologic proximal femoral fractures. The specific types of proximal femoral fracture discussed are intertrochanteric, femoral neck, subtrochanteric, and greater trochanteric fractures. A future article in this journal will discuss fractures of the pelvic ring, including sacral and acetabular injuries. EPIDEMIOLOGY OF PROXIMAL FEMORAL FRACTURES Between 220,000 and 250,000 proximal femoral fractures occur in the United States each year 1,2 ; 90% of these fractures occur in patients older than 50 years. 1,2 In younger patients, proximal femoral fractures are usually the result of high-energy physical trauma (eg, highspeed motor vehicle accidents) and usually occur in the absence of disease. Intertrochanteric and femoral neck fractures account for 90% of the proximal femoral fractures occurring in elderly patients. 1 Proximal femoral fractures in elderly patients are often pathologic, usually resulting from minimal-to-moderate physical trauma to areas of bone significantly affected by osteoporosis. However, pathologic fractures can occur at any age; typically, these fractures result from low-energy injuries and may be characterized by unusual fracture patterns. 3