Fracture Of Right Femur Research Articles

Supercutaneous Plating Technique: A Case Report of Locking Plate Used as an External Fixator

Introduction: Open fracture is one of the most common and challenging healthcare problem in orthopedic practice1.Despite improvements in implant design, management of open fractures remain a challenge for the orthopedic surgeon. Locked compression plates (LCP) have advantages of angular stability from the locking-head mechanism and less irritation when compared with traditional external fixators due to their low profiles. Here is a case report of the same. Case Report: A 50-year-old lady, a municipal worker by occupation, came to casualty with alleged history of road traffic accident and injury to right thigh and knee. Plain radiograph of of right femur with knee revealed a supracondylar fracture of right femur. As a definitive treatment, patient underwent open reduction and supercutaneous plating. Skin grafting was done for the external wound over distal thigh. The External fixation plate for right distal knee was removed after 6 weeks and knee ROM of 0 to 100 degree flexion was achieved by one year. Conclusion: Open fractures can be treated by external fixation using the LCP plates, which are safe, reliable and have acceptable functional outcomes with minimal complication rates. Its advantages also include ease of performing surgery and ease of removing plate after fracture healing. Keywords: Supercutaneous plating, LCP- locking compression plate, External fixator

D1 MTE1 Case 2: Young male with chronic hepatitis and bony deformity

19 years old gentleman presented with deformity of lower limbs noticed two years back. Significant past h/o jaundice at 8 years of age, h/o fracture of right femur at 17 years of age following fall from bicycle and an atraumatic fracture at the same site one year later. He underwent cataract surgery one year back where he was found to have bilateral renal stone disease with elevated creatinine. He had short stature with scoliosis and apparent genu valgum on right. Biochemical evaluation showed CrCl of 40 ml/min/m2 with increased liver enzymes. He had hypophosphatemia with low-normal s.calcium, elevated ALP, elevated PTH (242 pg/ml) and normal 25(OH)D3. Urine evaluation showed impaired acidification along with glycosuria and phosphaturia in the presence of systemic acidosis and normoglycemia. Skeletal survey showed generalized rarefaction; DXA showed osteopenia. MBD secondary to RTA was considered. Ultrasound showed coarsened liver echotexture. Suspecting Wilson's disease, s.ceruloplamin and 24hrs urinary copper was done but was normal and KF ring was absent. Therefore, liver biopsy was done suggesting chronic hepatitis with dry weight copper of 127.23 mcg/gm (normal < 45 mcg/g) which was <4ULN needed for diagnosis. Can the diagnosis of Wilson's disease be made from the above findings or else, any alternative diagnosis to be considered?

Use of Antibiotic Beading Technique in Treatment of Osteomyelitis in a Local Hospital of Islamabad, Pakistan

Despite the advancement in prevention and treatment against infection, osteomyelitis has always remained a challenge for an orthopedic surgeon. Although this problem is more prevalent in developing countries rather than developed countries, still it cannot be overlooked. That's why we have aimed this case study to consider the therapeutic plan and techniques used for the treatment of osteomyelitis. A 67 years old male was presented in a local public hospital of Islamabad, Pakistan with severe pain in right lateral thigh unable to move hip and knee joint and swelling. Emergency treatment included diclofenac. X-rays result showed fracture of right femur. Cultures DHS fixation (Dynamic Hip Screw fixation) was done, pus was drained and culture reports indicated Staphylococcus areas that was sensitive to Cefotaxime. The therapy plan included antibiotics along with pain killers, but the infection was not treated. Beside x-ray. Finally this infection was treated using antibiotics beading technique.

Periprosthetic fracture of right femur and internal fixation and loosening after replacement of right hip joint

Periprosthetic fracture of right femur and internal fixation and loosening after replacement of right hip joint

Proximal And Distal Femur Replacement For Patient With Non Union Fracture Of Intertrochanteric And Supracondylar Of Femur In A District Hospital

Introduction:Non-union of intertrochanteric and supracondylar fractures of femur are uncommon which results in pain and functional disability, presenting major surgical challenge. We wish to report on two cases regarding endoprosthesis as management for non-union.Case Presentation:Patient A is 54 years old lady sustained closed comminuted intertochanteric fracture of right femur (31A2.3). She underwent open reduction, intramedullary nail with cerclage wire on day 3 post trauma. At 6 months, there is sign of avascular necrosis of femur head with non-union fracture site. Patient still complaining of pain, on non-weight bearing ambulation. At 1 year, patient underwent right proximal femur replacement. At 3 months post replacement, she is able to full weight bear with walking cane without pain. Patient B is 56 years old gentleman sustained Grade IIIa open comminuted fracture of right supracondylar with intercondylar split (33C2.2). He underwent emergency wound debridement, screw fixation with high tibial pin insertion. At 4 months, he underwent distal locking plate of right femur with synthetic bone grafting. At 8 months post fixation, there is non-union comminuted fracture of supracondylar, still unable to weight bear. At 1.5 year post trauma, patient underwent right distal femur replacement. At 3 weeks post replacement, he is able to full weight bear without aid.Discussion:Most failures of treatment occur in unstable fracture patterns of hip. (1) Endoprosthesis may provide as alternative treatment if internal fixation are recognized to be suboptimal, amount and quality of remaining distal bone stock and level of the non-union. (2,3) In both our cases, patient experienced marked improvement in functional capacity and pain free, which are the hallmarks of a successful salvage procedure. (4)Conclusion:Endoprosthesis can be consider as alternative treatment for non-union intertrochanteric and supracondylar fracture of femur, hence providing stable joint, pain free and early return to daily activities.

Application of non-operative management protocol in pediatric blunt splenic injuries with other associated injuries

Background: Non-operative management (NOM) has become the standard of care for isolated blunt splenic injuries with satisfactory success rates. However, literature is scarce about the non-operative management of blunt splenic injuries (BSI) with other associated injuries (OAI). The main aim of this study is to assess the applicability of protocol-based NOM in BSI with OAI.Methods: Protocol based resuscitative algorithm was followed for the management of patients with BSI and OAI. NOM was taken up in those patients who were hemodynamically stable and was not attempted in patients who remained hemodynamically unstable or developed hemodynamic instability even after the resuscitative efforts. The data was collected and analyzed.Results: Forty patients with the mean age of 7.05±3.9 years were studied. Fall from height formed the commonest mode of injury. The mean AAST grade was 2.55. The most common association was a left lung contusion (20%). Fifteen patients presented with shock among which two failed the protocol-based resuscitative efforts and were hence explored. One of the patients had lung contusion and the other dorsal vertebral fractures (3rd and 4th). Another patient with mesenteric tear and delayed hemorrhage was operated. Two other patients underwent surgical interventions for bowel perforation and fracture of right femur respectively. Spleen was preserved in both of these patients. Though, the NOM was successful in overall 87.5% patients, spleen specific success rate was 92.5%.Conclusions: Application of protocol-based NOM in patients with BSI with OAI is highly successful if instituted in properly selected patients especially those with low grades of injury and also in those with delayed presentation.

Carcinoma tongue presenting as pathological fracture of right femur

Carcinoma tongue presenting as pathological fracture of right femur - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.099, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Osteogenic potency of human bone marrow mesenchymal stem cells from femoral atrophic non-union fracture site

Objective: Mesenchymal stem cells (MSCs) exist in the site of atrophic non-union fracture. The aim of this study was to evaluate the osteogenic potency of MSCs in order to have a better understanding of the unclear pathophysiology of atrophic non-union fracture Methods: This is an in vitro experimental study. Sample was obtained from the non-union site of a patient with a 6-years-history of atrophic non-union fracture of right femur. The MSCs was isolated from the fracture site and was cultured in the growth medium. Confirmation of the MSCs was performed and then osteogenic differentiation was performed in mono-layered MSC grown in both home-made and commercial osteogenic media. To evaluate the osteogenic differentiation, we performed Alizarin red staining and colorimetric assay for alkaline phosphatase (ALP). Results: From Alizarin red staining, most cells in the osteoblast medium were stained red by the staining. The result of colorimetric assessment of ALP shows that peak concentration was reached after 4 minutes in osteogenic group and control group. Conclusion: The presence of ALP activity and positive Alizarin red staining in our study showed that MSCs stem cells obtained from site of atrophic non-union is capable to be differentiated into osteogenic cells. . J Clin Exp Invest 2014; 5 (2): 159-163

Evaluation of pulsed electromagnetic stimulation for the enhancement of femoral fracture healing in dogs

The clinical study was conducted on twelve dogs of either sex having midshaft oblique fracture of right femur and divided into two groups comprising of six animals in each group. Under anaesthetic combination of atropine sulphate, xylazine hydrochloride, diazepam and ketamine hydrochloride, the fractured fragments were reduced and stabilised with stack pinning and two cerclage wiring. Group I animals were treated as control and received only postoperative care and management. Group II animals were treated with pulsed electromagnetic field (PEMF) stimulation of 75 Hz for 20 min daily for 15 days for enhancement of fracture healing along with postoperative care and management. The clinical union of cutaneous wounds were observed on 9th and 7th day in animals of group I and II. Full weight bearing was observed on 50th day and 29th day in Group I and Group II animals respectively. Radiographically there was abundant periosteal callus with persistence of fracture line on 8th postoperative week in animals of group I and complete union of fracture with minimal periosteal callus on 6th postoperative week in animals of group II. Positive osteomedullographic signs and clearance of contrast medium in all the animals of group I and II on 60th postoperative day indicated reestablishment of intraosseous and extraosseous network. Pulsed electromagnetic stimulation was found to be an effective non invasive technique in enhancement of femoral fracture healing without any complication and can be used as an adjunct to internal fixation for fracture treatment

Interesting Polytrauma Cases Managed at R L Jalappa Hospital and Research Centre, Kolar - Traumatic Hip Dislocations

Traumatic hip dislocations are extremely rare occurrences. About 50 cases have been reported so far in the world literature. However with increase in the speeding road traffic accidents [RTA] one should be aware of the same and promptly treat them. Here we report four patients who sustained traumatic hip dislocations following RTA. In the first case, patient also had fractures of superior and inferior pubic ramii, closed fracture of left tibia, closed fracture of right femur and open type- 2 fracture of right tibia. He was resuscitated in the emergency room and closed reduction of both hips and IM nailing of right femur was done followed by IM nailing of both tibiae. The patient was non weight bearing for about 6 months. The first patient was followed up for about 4 years and is asymptomatic with union of all fractures. The other three patients had only hip dislocation and was managed on similar lines and six month follow up has shown no secondary changes in the hip joints. Key words: Hip dislocations, Anterior dislocation, Posterior dislocation, IM nailing

Adverse Reactions to 6% Hydroxyethyl Starch in the Operating Room

Sir, We are reporting a case of allergic reaction to 6% Hydroxyethyl Starch (HES) in the operating room. A 18-year-old male with intertrochanteric fracture in right femur was referred for pre-anaesthetic check-up for dynamic hip screw fixation. Patient had no history of drug allergies and surgery was planned under American Society of Anaesthesiologists grade I (ASA-I). Successful subarachnoid block was achieved with 0.5% Bupivacaine. Crystalloids like Ringer Lactate, 5% Dextrose in 0.9% Sodium Chloride were used to correct fasting status of patient and also as intraoperative fluid of choice. During surgery, pulse volume was low and blood pressure was 90/60mm Hg. 6% HES was used to correct the blood pressure. 6% HES is highly effective plasma expander, less expensive as compared to others and was available in our operating theatres. After few minutes of colloid transfusion, patient started to develop cough, difficulty in breathing, tachypnoea, tachycardia (120/min), hypotension (80/50mmHg). 6% HES transfusion was stopped and 100% oxygen was delivered to the patient via a face mask. Normal saline bolus was given, followed by intravenous (IV) Chlorpheniramine Maleate, Hydrocortisone, Ephedrine, which made the patient haemodynamically stable after some time. HES is synthetic nonprotein colloid solutions that are modified natural polysaccharides consisting of hydroxyethylated polymers of glucose. They are defined by concentration, molar substitution ratio and average molecular weight [1]. The side effects of HES range from mild allergic reactions to severe anaphylactoid reactions. However, their incidences are lowest as compared to those of other colloids and very few cases have been reported till date [2,3]. We couldn’t perform tests like measurement of serum tryptase, plasma histamine or allergen-specific IgE in our patient. We would like to attribute HES as the cause of allergic reaction, because of the signs and symptoms caused soon after its initiation. Here, we would like to stress on the importance of identification of allergic reactions/anaphylaxis intraoperatively, when a colloid is given to a patient, though it is rare. Diagnosis is difficult in a patient under general anaesthesia, as various types of medications are used. Awareness, aggressive therapy with hydration, vasopressors, antihistamines and steroids result in better outcomes in such patients.

Effects of novel β titanium alloy with high strenghth and low elastic modulus on bone healing of osteoporotic fracture in rats

Objective To investigate the effects of a novel |3 titanium fixation with high strength and low elastic modulus on bone healing of osteoporotic fracture and its effects on stress shielding.Methods Forty female Sprague-Dawley rats were oophorectomized before establishment of femur fracture model.The fracture of left femur was stabilized by titanium alloy pin with high elastic modulus (110 Gpa,high elasticity modulus group) and the fracture of right femur by titanium alloy pin with low elastic modu-lus (30 Gpa, low elasticity modulus group).Six and 12 weeks later, the bone volume (BV) , total vol-ume (TV) and bone volume fraction (BVF) were detected by Micro-CT, and the maximum load was de-tected by biomechanical test.The effects of two titanium alloy pins on formation of bony calluses and me-chanical properties of bones were compared.Results Compared with the low elasticity modulus group, more collagen and bony callus, thicker bone trabeculae and more regular lamellar bone were found in the high elasticity modulus group.In low elasticity modulus group, TV (ROI1) was increased obvious-ly at week 6, with no statistical differences in BV (ROI 1), BV (ROI 2) and maximum load between two groups (P < 0.05).TV and BV in region ROI 1 in the low elasticity modulus group were significantly higher than that in high elasticity modulus group (P < 0.05) , while BV in region ROI 2 in low elasticity modulus group was significantly higher than that in high elasticity modulus group at week 12 postoperative-ly (P<0.05).Biomechnical test indicated that the maximum load in low elasticity modulus group was higher than that in high elasticity modulus group.Conclusions The novel B titanium alloy with high strength and low elastic modulus helps reduce effects of stress shielding, diminish bone resorption, in-crease the fibrous callus formation at the initial phase and improve the quality of bone healing at the later phase. Key words: Osteoporosis; Femoral fractures; Titanium; Rats; Elastic modulus

Fracture sous-trochantérienne traitée par clou centromédullaire chez un patient atteint d’une pycnodysostose

A rare case of a 54-year-old man with pycnodysostosis having subtrochanteric fracture of right femur is being reported. This patient had this fracture after a trivial fall while walking. He had typical facial features, short stature, open fontenella, short stubby hands, high arched furrowed palate and radiological features including open cranial sutures, obtuse angle of mandible, dysplasia of lower end of radius and ulna, notching of lumbar vertebra and generalized skeletal sclerosis. The fracture was treated with an intramedullary nail; the surgery was quite a tedious procedure where we faced per-operative difficulty in reaming. The fracture united in 12 weeks. Extramedullary osteosynthesis might offer a better alternative in such patients as marrow is narrow but healing is normal.

Subtrochanteric fracture managed by intramedullary nail in a patient with pycnodysostosis

A rare case of a 54-year-old man with pycnodysostosis having subtrochanteric fracture of right femur is being reported. This patient had this fracture after a trivial fall while walking. He had typical facial features, short stature, open fontenella, short stubby hands, high arched furrowed palate and radiological features including open cranial sutures, obtuse angle of mandible, dysplasia of lower end of radius and ulna, notching of lumbar vertebra and generalized skeletal sclerosis. The fracture was treated with an intramedullary nail; the surgery was quite a tedious procedure where we faced per-operative difficulty in reaming. The fracture united in 12 weeks. Extramedullary osteosynthesis might offer a better alternative in such patients as marrow is narrow but healing is normal.

SPINAL ANAESTHESIA IN A PATIENT WITH HUNTINGTON’S DISEASE – A CASE REPORT

Background. Huntington’s disease is a rare (estimated frequency of 1:10,000–15,000) autosomal dominant neurodegenerative disease. Anaesthetic experience with these patients is limited. Case description. A case of spinal anaesthesia of 62-year-old man with progressed stage of Huntington’s disease is described. An operation was made because of subtrochanteric fracture of the right femur. Spinal anaesthesia was done briefly and without any technical problems (needle G25, 3 ml of 0.5% isobaric bupivacain). So the choreatic movements of the legs were interrupted, and the movements of the upper part of the body with droperidol 2.5 mg intravenously. The surgical conditions were optimal. The operation was conducted without complications and finished within 90 minutes. The postoperative period was without any special problems. Conclusions. We would like to contribute our part to the anaesthetic experience in patients with Huntington’s disease and to show that spinal anaesthesia is suitable and safe also for procedure longer than one our.

Ｐａｇｅｔ骨病の２症例

2 cases of Paget's disease of bone with obvious symptoms in oral and maxillo-facial region were seen in Osaka Dental University Hospital.Case 1, a 32-year-old male with projection of zygomatic bone, alveolar expansion of maxilla and mandible, roots resorption of teeth, and malposed teeth was examined. His mother and elder brother were diagnosed Paget's disease of bone. In 4 year after the first visit, he had pathological fracture of right femur bone.Case 2, a 70-year-old female with projection of frontal and zygomatic bone, alveolar expansion of maxilla and mandible, and subperiosteal abscess of 876 region was examined. She recieved mamma carcinoma operation. After removal of offending teeth, discharging pus from extracted sockets had not subsided up to present.

Two Cases needed Revision Surgery after Replacement of Femoral Head Prosthesis

Two cases which needed revision surgery after replacement of femoral head prosthesis were reported. This report showed macrosopic and histological findings of two cases.One of the case which suffered necrosis of both heads of femur were carried out total hip replacements using prosthesis of trunnion type. After surgery, the patient complained pain of both hip joints and was pointed out a pathologic fracture of right femur and wide necrosis of both trochanteric parts on X-ray photographs. Another case was a patient who could not tolerate of his weight bearing on his right hip joinit after the femoral head replacement using acrylic prosthesis, causing pain on walking.Two patients were carried out the revision surgery in our clinic.