Femoral Fracture Surgery Research Articles

Early surgery improves survival after femoral fractures in the elderly: A retrospective review of 502 fragility fractures

AimsFragility fractures are a growing global healthcare burden; fragility fractures of the femur have been shown to occur in a highly comorbid patient group, with parallels to hip fracture patients. This study aimed to investigate if early surgery for femoral fractures, distal to the hip, resulted in a reduction in mortality in patients over 65 years of age. MethodsA retrospective review of prospectively collected data for all consecutive femoral fractures in patients aged over 65 years who underwent surgical management between January 2000 and December 2018. Data was extracted from the Fracture Outcomes Research Database (FORD) and analysed to assess if early surgery, defined as occurring within 48 h of hospital admission with a fragility femur fracture, had an effect on 30 day and 1 year mortality. Results502 eligible patients were included; median follow up time was 57 months. 24 patients (4.7%) died within 30 days of surgery and 105 patients (20.9%) had died within 1 year of surgery. Patients who underwent surgery within 48 h of admission had a significantly reduced chance of mortality within 1 year of surgery compared to patients who had surgery more than 48 h after admission (OR = 0.401, 95% CI 0.25–0.65, p<0.001). Following Multivariate Cox Regression analysis the hazard ratio of 1 year mortality following early surgery remained significantly reduced (HR = 0.57, 95% CI 0.36–0.92, p = 0.020). ConclusionsThis study demonstrates that fragility femoral fracture patients represent a similar cohort to hip fracture patients, with high mortality rates. We recommend that hip fracture management principles are also employed for fragility femoral fractures in patients over 65 years, with rapid pre-operative optimisation to ensure these patients undergo early surgical intervention.

Dexmedetomidine and Bupivacaine Versus Bupivacaine Alone in Ultrasound Guided Fascia Iliaca Compartment Blockade for Femoral Fractures

Background: Pain control is one of the most important issues in femoral fractures. One of the most effective methods is the fascia iliaca compartment block. Objectives: The aim of this study was to compare the efficacy of the addition of dexmedetomidine to bupivacaine on the quality of ultrasound guided blockade of the fascia iliaca compartment in adults undergoing femoral shaft fracture surgery. Methods: This study was a double-blind clinical trial. We studied 60 adults who were hospitalized for a femoral shaft fracture. The patients were divided into two equal groups receiving either bupivacaine alone or bupivacaine and dexmedetomidine for compartment blockade of the iliac fascia. Group allocation was based on the method of randomization from concealed envelopes. Primary outcomes were pain intensity, sedation and analgesic consumption assessed at 1, 2, 6 and 24 hours after surgery in two groups. Data were analyzed using SPSS software. Results: Pain intensity was lower in the dexmedetomidine group 1, 2, 6 and 24 hours after surgery (p&lt;0.05). The sedation score was also higher in the dexmedetomidine group 6 and 24 hours after surgery (p&lt;0.05). The dose of analgesics used by the dexmedetomidine group was significantly lower 6 and 24 h after treatment. No hypotension, respiratory depressionand bradycardia occurred in the patients participating in this study. Conclusion: The addition of dexmedetomidine to bupivacaine during ultrasound-guided blockade of the fascia-iliac compartment is associated with reduced pain intensity and improved sedation in patients undergoing femoral fracture surgery.

Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries.

Doctors are bound to obtain informed written consent prior to any form of surgical procedure on a patient. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidance on what constitutes valid consent. Failure to obtain valid and adequate consent can have legal ramifications. All relevant material risks associated with the surgery must be discussed with the patient during the consenting process. This was a retrospective cross-sectional study of the consenting practices for neck of femur fracture surgeries, covering a period of three months, from the 15thof April to the 15thof July 2023. We evaluated the consent forms of 100 patients, of which 63 were consent form-1 and were included in the study. The British Orthopaedics Association (BOA)-endorsed consent forms, together with the RCS and GMC guidance on consent, which were used as the standard for the audit. The majority of the consents were obtained by senior house officers (SHO) and core surgical trainees who did not have prior formal orthopaedic training (52.4%). The risks that were most frequently documented were infection, blood clots (deep vein thrombosis and pulmonary embolism), and bleeding, with documentation rates of over 90%. Prosthetic joint dislocation following hemiarthroplasty or total hip replacement was not mentioned in 22.2% of the forms. Neurovascular injury was not documented in 20.6% of the consent forms. Less than 75% documentation rates were observed for postoperative pain (74.6%), anesthetic complications (73%), failure (malunion/non-union/loosening of prosthesis) (68.3%), leg length discrepancy (60.3%), bone damage/fracture (50.8%), death (49.2%), wound-related complications/scars (42.9%), and hip stiffness (14.3%). None of the patients had been advised about the probable need for catheterization following surgery. We also noted that 22.2% (n=14) of the consent forms did not contain the diagnosis or the indication for surgery, 12.7% (n=8) did not mention the intended benefits, and 28.6% (n=18) of the consent forms had no mention of the responsible consultant.We also noted that in 25.4% (n=16) of the cases, the possible requirement of a blood transfusion had not been mentioned. The audit revealed several deficiencies in the consenting of patients for neck and femur fracture surgeries. There were poor documentation rates for risks associated with surgery, especially the less common and rare ones. We also identified several deficiencies in the remaining aspects of the consent forms that were not in keeping with the GMC and RCS guidance on consent. The lack of orthopaedic training and knowledge among the senior house officers and core trainees may be a contributing factor.

Femoral metastatic pathological fractures, impending and actual fractures – A patient survival study

IntroductionThe skeleton is a common site for metastases. Prostate, breast, lung, renal and thyroid carcinomas account for 80 % of the original cancers, with the femur being the most affected long bone. With improved oncological treatments, prolonged patient survival leads to an increased prevalence of osseous metastases. This study examines the impact of preventive surgery for impending femoral pathological fracture (IFF), versus treatment of pathological femur fracture (PFF) on patient mortality and morbidity. MethodsRetrospective cohort of 174 patients undergoing surgery due to femoral metastases (2004–2015). Eighty-two patients were with PFF, and 92 were with IFF based on the Mirels' score. The followed-up period was until 2016. Demographic data, oncological, pathological, radiation, surgical reports, outpatient clinical records, and imaging studies were examined. Exclusion criteria included primary tumours and Multiple Myeloma. ResultsThe mean age was 64.8 ± 13.3 and 60.2 ± 11.9 years (p = 0.02) in the PFF and the IFF cohorts, with 62.1 % women and 57 % men. The breast was the most common source of femoral metastases. The average Mirels' score was 10 ± 1.2. There was an association between tumour origin and survival. Carcinoma of the lung had the worst survival, while the prostate had the most prolonged survival. Survival rates differed between IFF and PFF (p = 0.03). Postoperative complications occurred in 26 % of the patient, with no difference between IFF & PFF. ConclusionBreast and lung are the most common tumours to metastasize the femur. Our study revalidates that pathological femoral fractures impede patient survival compared to impending fractures and should undergo preventive surgery. Postoperative complications do not differ between IFF and PFF but remain relatively high. Overall, patients with proximal femoral metastatic disease survive longer than previously published, probably due to improved treatment modalities.

Ultrasound-guided pericapsular nerve group (PENG) block versus femoral nerve block for positioning during spinal anaesthesia in proximal femur fractures: A randomised comparative study.

Femoral nerve block is a widely used analgesia technique for positioning before spinal anaesthesia for proximal femur fracture surgeries. Pericapsular nerve group (PENG) block is a newer technique with motor-sparing characteristics. We compared the analgesic efficacy of these blocks for patient positioning for spinal anaesthesia. In this study, 60 patients were randomised to either the PENG group (n = 30) or the femoral group (n = 30). After performing the block, the pain was assessed every 10 min using a visual analogue scale (VAS) score for 30 min. The primary objective was the median [interquartile range (IQR)] reduction in pain (dynamic VAS with 15-degree passive limb elevation) at 30 min. Secondary objectives were ease of spinal position score (EOSP), angle obtained during positioning, duration of postoperative analgesia and quadriceps weakness. The demographics were comparable in both groups. After 30 min, the median (IQR) VAS was 6 (5-7) in the PENG group and 5 (5-6) in the femoral group (P = 0.004). Secondary outcomes such as EOSP score and angle obtained by patients were comparable. In the postoperative period, patients had significantly lower pain in the PENG group compared to the femoral group. The duration of analgesia was prolonged with PENG block. Quadriceps weakness was significantly low with PENG block (P < 0.001). PENG block provides better analgesia than a femoral block before spinal anaesthesia for proximal femur fracture surgery. The postoperative duration of analgesia was also longer.

COMPARATIVE STUDY OF ERECTOR SPINAE PLANE BLOCK VERSUS SYSTEMIC ANALGESIA FOR INTERLOCKING NAIL IN INTERTROCHANTERIC FRACTURE OF FEMUR: A RANDOMIZED CONTROLLED INTERVENTIONAL STUDY

Objective: The geriatric population is prone to multiple comorbidities, and their fragile bones and unsteadiness make them susceptible to fractures, commonly observed in the wrist and proximal end of the femur. Internal fixation of fractures under central neuraxial block allows for early mobilization. However, the presence of comorbidities in elderly patients puts them at higher risk for anesthesia and surgery.&#x0D; Methods: To manage postoperative pain following surgery for proximal femur fracture, opioid-sparing multimodal analgesia techniques are employed. Regional anesthesia techniques such as fascia iliaca block, femoral nerve block, and quadratuslumborum block are utilized as part of a multimodal approach. Pain is subjective, and the inability to communicate does not negate the need for appropriate pain relief.&#x0D; Results: Postoperative pain, if poorly managed, can result in complications, prolonged recovery, and chronic pain with reduced quality of life. Effective pain relief enhances patient satisfaction, reduces hospital stays and costs. Inadequate pain control activates the sympathetic nervous system, increases hormonal response, and contributes to adverse events. Opioids, though common, pose risks and adverse effects.&#x0D; Conclusion: The erector spinae plane block (ESPB) is a safe and easy-to-perform technique for postoperative pain management. It involves ultrasound-guided deposition of local anesthetic, allowing effective spread. Previous studies have shown its effectiveness for thoracic pain relief. This study evaluated lumbar ESPB and compared it with systemic analgesics in terms of ease of positioning and postoperative pain control.

The inter-prefectural regional disparity of healthcare resources and representative surgical procedures in orthopaedics and general surgery: a nationwide study in Japan during 2015–2019

BackgroundFew reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan.MethodsThe number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015–2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables.ResultsThe annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p < 0.001), 0.63 for hospitals (p < 0.001), and 0.62 for the ageing rate (p < 0.001); those by the incidence of cholecystectomy were 0.60 for general surgeon specialists (p < 0.001) and 0.59 for hospitals (p < 0.001). The number/incidence of orthopaedic surgeon specialists, hospitals, femur fracture surgery, and cholecystectomy, as well as the ageing rate, were significantly higher in rural prefectures than in urban prefectures (p < 0.05).ConclusionsInter-prefectural regional disparity was small, although certain items were unevenly distributed in the rural prefectures, which is contrary to our expectations. Higher prevalence was recognised in rural prefectures due to the higher ageing rate; however, supply and demand are balanced. This study provides basic data for healthcare policy development in a medium-sized community.Level of evidenceIII.

Predictive factors for home discharge after femoral fracture surgery: a prospective cohort study.

Femoral fractures require protracted hospitalization and often preclude return to pre-fracture levels of mobility, function and prior residential status following hospital discharge. Early prediction of rehabilitation and discharge potential in patients with femoral fracture would optimize discharge planning. To identify predictive factors of discharge destination during the early phase of femoral fracture rehabilitation. Prospective cohort design. Acute and postoperative rehabilitation hospital settings. Data from 109 participants (65 women [59.6%]) admitted for unilateral femoral fracture were included. Sociodemographic information, hip pain severity during gait (Numeric Pain Rating Scale), mobility (Elderly Mobility Scale), activities of daily living (Modified Barthel Index), cognition (Mini-Mental State Examination [MMSE]), exercise self-efficacy (Self-Efficacy for Exercise Scale), amount of physiotherapy received, and caregiver availability were assessed pre- and/or postoperatively. Discharge destination was assessed via telephone interviews 6 weeks after discharge from acute care. Receiver operating characteristic curves were used to determine optimal cut-off scores for all outcomes based on discharge destination. Outcomes demonstrating a significant area under the curve were entered as dichotomous independent variables (i.e., above or below ROC-derived cut-off values) in subsequent logistic regression analyses to determine predictors of discharge destination. SEE Score ≥53 (odds ratio [OR]=5.975, 95% confidence interval [CI]=1.674-21.333, P=0.006), female sex (OR=3.421, 95% CI=1.187-9.861, P=0.023), ≥8 physiotherapy sessions (OR=4.633, 95% CI=1.559-13.771, P=0.006), MMSE Score ≥17 (OR=3.374, 95% CI=1.047-10.873, P=0.042), and caregiver availability (OR=3.766, 95% CI=1.133-12.520, P=0.030) were identified as significant predictors of home discharge. Exercise self-efficacy, female sex, more physiotherapy rehabilitation training, better pre-operative cognitive function, and caregiver availability emerged as important predictors of home discharge following femoral fracture. These findings are highly translational and may be useful for informing clinical guidelines and policy decisions regarding rehabilitation potential and discharge pathway selection during early hospitalization following femoral fracture surgery.

Orthopaedic Out of Bed Project (OOBP): improving early mobilisation following femoral fracture using a therapy-led education programme

Delayed mobilisation following hip fracture surgery is detrimental to patients and health systems. Prolonged hospital stay additionally results in decreased function and increased mortality. Our hospital was underperforming against the...

Fat Embolism Syndrome after Femoral Fracture Fixation due to Pedestrian Injury

Fat embolism syndrome (FES) is a rare but serious complication that primarily occurs in patients with long bone fractures. Herein, we report a case of sudden death due to FES, which was later confirmed by autopsy. The clinical course and pathological findings of the case are also presented. A 79-year-old male pedestrian was struck by a car while crossing a crosswalk, and due to the impact, he flew 4.5 meters away. He was admitted to the emergency room and diagnosed with an intertrochanteric fracture of the right femur. Upon admission, he had clear consciousness and normal vital signs. The patient died 27 hours after trauma during surgery for a right femur fracture. Histological examination revealed fat droplets in lung tissue. The diagnosis of FES was confirmed based on clinical and histological findings.

A comprehensive analysis of intraoperative factors associated with acute-on-chronic kidney injury in elderly trauma patients: blood loss as a key predictor

BackgroundPostoperative acute kidney injury (AKI) is a critical issue in geriatric patients with pre-existing chronic kidney disease (CKD) undergoing orthopedic trauma surgery. The goal of this study was to investigate modifiable intraoperative risk factors for AKI.MethodsA retrospective study was conducted on 206 geriatric patients with CKD, who underwent orthopedic trauma surgery. Several variables, including intraoperative blood loss, postoperative hypoalbuminemia, intraoperative blood pressure and long-term use of potentially nephrotoxic drugs, were analyzed.ResultsPostoperative AKI (KIDGO) was observed in 25.2% of the patients. The 1-year mortality rate increased significantly from 26.7% to 30.8% in patients who developed AKI. Primary risk factors for AKI were blood loss (p < 0.001), postoperative hypoalbuminemia (p = 0.050), and potentially nephrotoxic drugs prior to admission (angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, diuretics, antibiotics, NSAIDs) (p = 0.003). Furthermore, the AKI stage negatively correlated with propofol dose per body weight (p = 0.001) and there was a significant association between AKI and the use of cement (p = 0.027). No significant association between intraoperative hypotension and AKI was observed in any statistical test. Femur fracture surgeries showed the greatest blood loss (524mL ± 357mL, p = 0.005), particularly intramedullary nailing at the proximal femur (598mL ± 395mL) and revision surgery (769mL ± 436mL).ConclusionIn geriatric trauma patients with pre-existing CKD, intraoperative blood loss, postoperative hypoalbuminemia, and pre-admission use of potentially nephrotoxic drugs are associated with postoperative AKI. The findings highlight the necessity to mitigate intraoperative blood loss and promote ortho-geriatric co-management to reduce the incidence and subsequent mortality in this high-risk population.

Analysis and Optimization of a 6-DoF 3-RRPS Parallel Mechanism for Robot-Assisted Long-Bone Fracture Surgery

Abstract Robot-assisted femur repair has been of increased interest in recent literature due to the success of robot-assisted surgeries and current reoperation rates for femur fracture surgeries. The current limitation of robot-assisted femur fracture surgery is the lack of large force generation and sufficient workspace size in traditional mechanisms. To address these challenges, our group has created a 3-RRPS parallel mechanism, Robossis, which maintains the strength of parallel mechanisms while improving the translational and rotational workspace volume. In this paper, an optimal design methodology of parallel mechanisms for application to robot-assisted femur fracture surgery using a single-objective genetic algorithm is proposed. The genetic algorithm will use a single-objective function to evaluate the various configurations based on the clinical and mechanical design criteria for femur fracture surgery as well as the global conditioning index. The objective function is composed of the desired translational and rotational workspaces based on the design criteria, dynamic load-carrying capacity, and the homogeneous Jacobian global conditioning index. Lastly, experimental results of Robossis were obtained to validate the kinematic solution and the mechanism itself; Robossis had an average error of 0.31 mm during experimental force testing.

Fascia Iliaca Block versus Intra-Venous Analgesia for Positioning of Neck Femur Fracture in Patient Undergoing Spinal Anathesia

Abstract Background Fracture of the femur is a well-known reason for surgical repair in patients of all ages. Locations include the neck, intertrochanteric, shaft, and distal fractures. Spinal anesthesia is the commonly used, preferred method for surgery and is associated with lower odds of mortality compared to general anesthesia. Spinal anesthesia is administered in either a sitting or lateral decubitus position. Positioning patients with a fractured femur for spinal anesthesia is challenging since minimal movement of the overriding fracture ends can cause extreme pain. Objective To elaborate the efficacy and safety of FICB with intravenous analgesic (IVA) on the quality for positioning before spinal anesthesia in participants with a femur fracture. Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into two groups (n = 25; each); group FICB and control group. Results The study results show that there was no statistically significant difference found between FICB group and FENT group regarding demographic data and characteristics of the studied patients. While there was statistically significant increase in the quality of patient positioning in FICB group than FENT group with p-value = 0.021; also there was statistically significant increase in the patient satisfaction in FICB group than FENT group with p-value =0.021. And a statistically significant increase was found in the time to first rescue analgesic postoperative in FICB group than FENT group with p-value &amp;lt; 0.001. Conclusion Fascia Iliaca Compartment Block is more efficacious than intravenous fentanyl for positioning during spinal anaesthesia in surgery for fracture femur. Fascia Iliaca Compartment Block provides superior analgesia, better quality of patient positioning, greater patient satisfaction thereby reducing the time taken to perform spinal anaesthesia in sitting position compared to i.v. fentanyl in fracture femur surgery.

FOAM DRESSING ON WOUND HEALING PROSES IN POST FRACTURE OPERATION PATIENTS

Modern wound dressing is a technique of wound care that focuses on moist principles so that the use of wound dressing plays an important role in accelerating the wound healing process. This study aims to determine the Effect of Modern Wound Care with Foam Dressing on the Wound Healing Process of Post Patient's Femur Fracture Surgery. The study used a pre-experiment one group pretest posttest design. The sampling used was accident sampling. The independent variable of the study was modern wound care with foam dressing, and the dependent variable of the study was the wound healing process, assessed by Bates-Jensen Wound Assessment tools. The results of the study before the intervention, the mean Bates-Jensen Wound Assessment score was 23.50 with a standard deviation of 1.080, a minimum value of 23.00 and a maximum value of 26.00. The results of the study after the intervention, the mean score was 15.50 with a standard deviation of 0.850, a minimum value of 15.50 and a maximum value of 17.00. Post operative wound care with foam dressings is expected to be applied and routinely carried out according to the wound care schedule of postoperative patients in order to improve the quality of health services.

Timing of Complications Following Surgery for Distal Femur Fractures in Older Adults.

The purpose of this study was to identify the timing and nature of complications associated with distal femur fracture surgery in patients aged 65 and older using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The ACS NSQIP database was queried for adults aged 65 and older who received surgical treatment for a distal femur fracture between 01 January 2015 and 31 December 2021. Cox regression models and risk tables adjusted for baseline clinical characteristics were created for 14 complications (Superficial Surgical Site Infection (SSI), Deep SSI, Organ/Space SSI, Pneumonia, Pulmonary Embolism (PE), Deep Venous Thrombosis (DVT), Urinary Tract Infection (UTI), Stroke/Cerebrovascular accident (CVA), Myocardial Infarction (MI), Renal Failure, Cardiac Arrest (CA), Re-operation, Sepsis, and Death within 30days of surgery). Model summaries were used to identify significant variables with a Bonferroni correction applied. A total of 3956 adults met inclusion criteria and were included in analysis. The most common complications were UTI (5.2%), death (4.1%), and pneumonia (3.4%). Complications typically occurred within 14days after surgery, except for SSI, which occurred between post-op days 11 and 24. Distal femur fractures are a substantial source of morbidity and mortality in the older adult population. Our findings underscore the need for comprehensive preoperative risk assessment and patient management strategies to mitigate the impact of identified risk factors in this vulnerable population.

A COMPARATIVE EVALUATION OF FEMORAL NERVE BLOCK AND INTRAVENOUS FENTANYL FOR POSITIONING DURING SPINAL ANAESTHESIA IN SURGERY OF FEMUR FRACTURE

Background:Femur surgeries are very common surgeriesRegional anaesthesia is common for that.Giving position for it is real task for anaesthetist.This challange can be overcome by giving Femoral nerve block.Ultrasonography guided blocks are getting famous in last 5 years.we have studied USG guided femoral nerve block for positioning for spinal anaesthesia in fracture femur patients. Methods: This study was conducted at tertiary care hospital on 60 elective patients posted for elective femur fracture surgeries, with ASA grade I and II, in age group of 18-70 years. The patients were randomly divided into 2 groups – Group FNB and Group FENT. In FNB group, patients received USG guided FNB 15 minutes prior to positioning with 15 ml, 1.5 % lignocaine with Adrenaline. In FENT group, patients received injection fentanyl 1µg/kg IV 15 minutes prior to positioning for SA.Both the groups were evaluated for Hemodynamic changes, VAS score, Rescue requirements of fentanyl aliquots, Performance time, Patients satisfaction, Anesthetists satisfaction and Perioperative complications. Results :Both the groups were comparable with respect to age, gender, ASA grade, HR and MAP.In our study,Hemodynamic stability was observed in both groups. VAS Score was lesser in Group FNB (0.93±0.87mins) compared to GroupFENT (1.72±1.09 mins) prior to positioning for SA (p value &lt;0.003). Rescue requirement of fentanyl aliquots for positioning It was less in Group FNB (0.06±0.25 mins) compared to Group FENT (0.34±0.61 mins) (p value&lt;0.02 ). Performance time was shorter in Group FNB (15.33±1.27 mins) compared to Group FENT (16.72±3.07 mins) (p value&lt;0.02 ). Patients satisfaction was less in Group FENT as compared to Group FNB. (p value &lt; 0.03). Anesthetists satisfaction was less in Group FENT as compared to Group FNB. (p value &lt; 0.02). Perioperative complications: In FNB group out of 30 patients, 1 patient had shivering. In FENT group out of 30 patients, 2 patients had shivering and 1 patient had hypotension. Conclusion: US guided femoral nerve block is more advantageous than IV fentanyl for position of fracture femur patients.

The Effect of the Administration of Bovine Xenograft on the Accelerated Healing of Femoral Fracture in Domestic Dogs

Bovine xenografting is a method of grafting bovine bones to other species. This study aimed to determine the effect of the administration of bovine xenografts on accelerated healing in domestic dogs with femoral fractures. This study used a total of 4 dogs (two individuals as the treatment group and other two as the control group) diagnosed with diaphyseal femoral fractures. The bovine xenograft in the form of hydroxyapatite (Ca10(PO4)6(OH)) was synthesized in this study. The femur fracture surgery was carried out using the open reduction and internal fixation (ORIF) method, followed by the administration of 10 grams of Hydroxyapatite powder from the bovine bone in the fracture area, in the treatment group. The control group was not treated with Hydroxyapatite. Radiographic examinations were carried out on days 0, 14, and 45 post-operation. The parameters observed included the formation of radiopaque mass on the radiographic imaging, indicating the formation of calli around the fracture area. The radiographic examination showed that in the treatment group, the radiopaque mass was apparent on day 14 post-operation while it was not observable in the control group. On day 45 post-operation, the mass was more clearly visible in the treatment group, while it was barely visible in the control group. This research indicated that bovine xenograft has the potential to accelerate the fracture healing process in domestic dogs

Therapeutic evidence of tranexamic acid effectiveness in reducing postoperative blood loss among patients with femoral shaft fractures: a randomized clinical trial

Abstract Objective We aimed to evaluate the effect of tranexamic acid on decreasing surgery-related blood loss among patients diagnosed with femoral shaft fracture. Patients and methods This double-blinded, randomized, clinical trial was designed on 60 patients, who have been referred for femoral shaft fracture surgery to the Arak Valiasr Hospital. The eligible patients were assigned into intervention and control groups using balanced block randomization. For patients administered 10 mg/kg of intravenous tranexamic acid slowly to the first group before the surgery, when strict control of vital signs and standard monitoring were utilized throughout the procedure. The amount of blood loss during and after the surgery (6 and 24 h later) and hemoglobin and hematocrit at, before, and after the procedure was measured, and data was analyzed by SPSS 22 (IBM Corp.). Results The clinical evidence revealed lower levels of hemoglobin and hematocrit in the control than in the intervention group within postoperative 24 h (P=0.001), while less blood loss was observed in the intervention group during surgery and at 6 and 24 h later (P=0.001). Conclusion Our results highlight strong support for the hypothesis that in femoral shaft fractures, a tranexamic acid regime significantly decreases blood loss, and subsequently a postoperative improvement in hemoglobin and hematocrit levels was made in patients in the intervention group versus those in the control group. Hence, tranexamic acid administration seems to be an excellent, safe option for controlling bleeding in orthopedic surgeries, where a possible intraoperative blood loss is expected and the clinical circumstances of the patient allow them.

Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series

BackgroundThe gold standard anesthesiologic procedure for urgent femur fracture surgery is Spinal Anesthesia. It is not always feasible because of patients' severe comorbidities and difficulties in optimizing drug therapy in the appropriate time frame such as discontinuation of anticoagulant drugs. The use of four peripheral nerve blocks (tetra-block) can be a winning weapon when all seems lost.Case presentationWe present, in this case series, three Caucasian adult femur fractures (an 83-year-old woman, a 73-year-old man, and a 68-year-old woman) with different and major comorbidities (cardiac or circulatory disorders on anticoagulants therapy that were not discontinued on time; breast cancer and others) underwent the same anesthesiologic approach in the urgent setting. Ultrasound peripheral nerve blocks, that is femoral, lateral femoral cutaneous, obturator, and sciatic with parasacral approach were successfully performed in all patients who underwent intramedullary nailing for intertrochanteric fracture. We evaluated the adequacy of the anesthesia plane, postoperative pain control with the VAS scale, and the incidence of postoperative side effects.ConclusionsFour peripheral nerve blocks (Tetra-block) can be alternative anesthesiologic management in urgent settings, in patients where drug therapy cannot be optimized, as in antiplatelet and anticoagulant therapy.

A comparative study of intravenous fentanyl and ultrasound-guided femoral nerve block for positioning during spinal anaesthesia in femur fracture surgeries

Objective: To assist in the administration of spinal anesthesia for patients undergoing femur fracture procedures, we conducted comparison research to compare the analgesic efficiency of intravenous fentanyl against ultrasound-guided femoral nerve block (FNB). Material and Methods: A group of 112 patients ranging in age from 18 to 70 years old who had ASA Physical Status I and II and were having femur fracture procedures under spinal anaesthesia participated in the randomised, prospective, interventional trial. These individuals were divided into two groups through a random assignment process. Group FENT (n = 56) received Intravenous fentanyl 1 microgram/kilogram (µg/kg) and five minutes before positioning for spinal anaesthetic, group FNB (n = 56) received ultrasound-guided FNB with 20 millilitres (ml), 1.5% lignocaine and adrenaline (1:200,000). Results: Comparison of pain scores during positioning using the Visual Analog Scale (VAS) revealed that Group FENT had a score of 1.95 ± 0.585, whereas Group FNB had a score of 0.61 ± 0.562 (p-value 0.001). The FNB group demonstrated superior patient positioning quality. Patient satisfaction was similar in both groups, and no significant side effects were observed. Conclusion: FNB offers enhanced analgesia, improved patient positioning, higher patient satisfaction, reduced reliance on additional analgesia, and fewer side effects compared to intravenous fentanyl for spinal anesthesia.