Femoral Intramedullary Fixation Research Articles

PENG block associated with dexmedetomidine sedation for intramedullary femoral fixation in high-risk elderly patients: a case series and review of the literature.

Hip fracture is a major cause of hospitalization among the elderly population. The standard surgical treatment involves early repair to reduce mortality and morbidity. One type of treatment in the case of intertrochanteric and subtrochanteric fractures is intramedullary nailing, as it decreases soft tissue damage and permits early weight bearing. The most common anesthesia technique combines spinal anesthesia with a peripheral block. In cases where spinal anesthesia is contraindicated, general anesthesia is preferred. However, both techniques can lead to significant complications, especially in patients with multiple comorbidities. Pain management after hip surgery, particularly in elderly and frail individuals, poses a challenge. The pericapsular nerve group block (PENG) targets the innervation of the anterior portion of the hip joint and is increasingly used for pain management related to hip surgery. This paper presents a case series of three elderly patients who underwent pericapsular nerve group block (PENG) block combined with dexmedetomidine sedation for intramedullary femoral fixation. The PENG block can be effectively used as the sole anesthetic technique for managing elderly patients undergoing intramedullary femoral fixation while on antiplatelet drugs. This procedure effectively controlled pain during both the surgical and postoperative periods. The addition of dexmedetomidine for sedation enables comfortable and safe procedures, minimizing the risk of perioperative neurocognitive dysfunctions and without adverse effects on cardiorespiratory function.

155 Fracture of Pubic Rami During Hip Fracture Fixation - a Rare Case of Traction Table Related Injury

Abstract Background Traction tables form the mainstay of closed reduction techniques for lower limb fracture and in particular hip fractures. They offer a versatile solution to continuous traction required in a variety of operations such as closed intramedullary femoral fixation and hip fixation. Counter traction on the table is provided by the perineal post, this has been associated with significant complications such as neuropraxia, erectile dysfunction, cutaneous necrosis, and urethral injuries. Case presentation We present a case of an elderly and co-morbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intra-operatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table. Conclusions Closed reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed fixation should be accounted for when managing this complex and often frail group of patients.

Study on Zoledronic Acid Reducing Acute Bone Loss and Fracture Rates in Elderly Postoperative Patients with Intertrochanteric Fractures.

ObjectiveTo observe the effect of zoledronic acid on the reduction of acute bone loss and fracture rate in elderly postoperative patients with intertrochanteric fracture.MethodsFrom August 2012 to January 2015, a total of 482 patients with senile osteoporotic femoral intertrochanteric fracture, who accepted proximal femoral intramedullary fixation under anesthesia were analysed. The patients were divided into two groups. Treatment group (353 cases) were treated with 100 mL/5 mg of zoledronic acid injection in 1 week after operation, as well as orally taken 600 mg/d of calcium carbonate and active vitamin D3 400 IU/d. Control group (129 cases) were given the same dose of calcium carbonate and active vitamin D3 orally. Efficacy evaluation were conducted during different periods of medicationResultsCompared with pre‐medication, indexes of bone metabolism (TARP‐5b, CTX) in the treatment group were brought down, especially significantly statistically different after 12 months of medication. The treatment group performed superior to control group in alleviating the pain of back and posture changing (P < 0.05), improving bone density (P < 0.05), depressing re‐fracture rate (P < 0.01) after 24 months of medication. In addition, BP, PF and MH dimension scores were demonstrated with statistical significance (P < 0.05).ConclusionsThe application of zoledronic acidin elderly postoperative patients with intertrochanteric fracture can not only relieve acute bone loss, reduce the incidence rate of re‐fracture, alleviate osteoporosis pain and the pain from osteoporotic fracture, but also improve bone metabolism and quality of life, which may offer an acceptable clinical opinion

The Use of Precision Alignment Technology to Circumvent Patient- Specific Roadblocks in Performing Total Knee Arthroplasty

The goal of total knee arthroplasty (TKA) is to provide the patient with a well-functioning, pain-free knee that will last for many years. To improve implant survival, the goal is to position the prosthesis in a way that restores proper biomechanical alignment, and advances in technology have enabled arthroplasty surgeons to produce accurate results on a more consistent basis. One of these advances is the use of computer-assisted orthopaedic surgery (CAOS) to assist in proper component alignment and produce accurate restoration of the biomechanical axis consistently.1–17 Functional scores and revision-free survival are at least equivalent to conventional arthroplasty.17–26 Traditional cutting guides for TKA rely on intramedullary femoral instruments, and either intramedullary or extramedullary tibial instruments, to obtain proper axial alignment. In cases where retained hardware is present, or in patients with knee osteoarthritis associated with pre-existing femoral or tibial extra-articular deformity, CAOS has proved to be an exceptionally useful, effective, and appealing option.27–37 A portable, accelerometer-based navigation device (OrthAlign, OrthAlign Inc., Aliso Viejo, CA) for TKA has demonstrated promising results with regard to the alignment accuracy of large-console CAOS systems.10–14 We present three patients who underwent TKA with retained femoral hardware. Two patients had intramedullary femoral fixation and one patient had an interference screw from a previous anterior cruciate ligament (ACL) reconstruction that would interfere with the use of a conventional intramedullary alignment guide. A novel, portable, accelerometer-based navigation (OrthAlign® precision alignment system, OrthAlign Inc., Aliso Viejo, CA) guide enabled performance of TKA without the need for surgical removal of hardware.

Fascia iliaca block associated only with deep sedation in high-risk patients, taking P2Y12 receptor inhibitors, for intramedullary femoral fixation in intertrochanteric hip fracture: a series of 3 cases

ObjectiveWe present a series of 3 cases in which the impact in outcome was, first of all, related to the capacity to offer early and safer treatment to some hip fracture high-risk patients using a fascia iliaca block (FIB; ropivacaine 0,5% 20 cc and mepivacaine 1,3% 15 cc, given 30 minutes before incision) associated only with deep sedation, contributing to better practice and outcome. Case reportsAll elderly patients were American Society of Anesthesiologists IV patients, under P2Y12 receptor inhibitors, suffering from an intertrochanteric fracture, and purposed for intramedullary femoral fixation (IMF). All patients have been managed successfully through a deep sedation using a low-dose infusion of propofol and bolus of fentanyl without face mask ventilation, supraglottic device placement, or endotracheal intubation after an FIB. Bispectral index was always greater than 75, and no CO2 retention or respiratory depression was present. No signs of pain or hemodynamic instability were observed. ConclusionsIn these cases, surgery would be postponed if the choice was neuroaxial anesthesia, particularly because of P2Y12 receptor inhibitors' effect.FIB puncture site is distal to the fracture and incision site, but proximal local anesthetic migration through the interfascial planes allows for constant block of femoral nerve and lateral cutaneous of femur nerve and, less constantly, block of obturator. FIB may reduce the risk of perineural hematoma associated with several injections in nerve vicinity of different lumbar plexus branches.Frequently, indications for extramedullary or IMF are overlapping, but IMF is associated with less blood loss and may be managed using a low anesthetic depth if an FIB is done, increasing safety. This way, these less invasive surgical techniques combined with an adjusted anesthetic technique may have a crucial role in high-risk patients, particularly if taking P2Y12 receptor inhibitors. In these cases of IMF, surgical manipulation of sciatic and/or inferior subcostal nerves territories was managed with systemic analgesia and deep sedation.

Intramedullary Femoral Fixation interferes with Testosterone Action on Muscle Cross-sectional Area in a Person with Spinal Cord Injury

Intramedullary Femoral Fixation interferes with Testosterone Action on Muscle Cross-sectional Area in a Person with Spinal Cord Injury

Enhancing Osseointegration of Orthopaedic Implants with Titania Nanotube Surfaces

Category: Basic Sciences/Biologics Introduction/Purpose: Solid biologic fixation at the bone-implant interface provides long-term stability of orthopaedic implants. Historically, coatings and surface treatments on implant surfaces have been used to promote osseointegration of orthopaedic implants. The purpose of this research study is to evaluate two morphologies of titania nanotube (TiNT) surfaces via in vitro experiments as well as an in vivo model of femoral intramedullary fixation, in order to assess the influence of TiNT structure on de novo bone formation and bone-implant stability. Methods: TiNT structures were grown from Ti-6Al-4 V materials via an established electrochemical anodization process. Samples were either sonicated then annealed (Aligned TiNT) or annealed without prior sonication (Trabecular TiNT), to produce different morphologies. As-received titanium alloy was the control. Marrow-derived stem cells were isolated from long bones of Sprague Dawley rats and cultured on samples. Alkaline phosphatase (ALP) and osteocalcin (OC) expression by stem cells were assessed via ELISA. Cells were lysed and subjected to quantitative polymerase chain reaction (qPCR) to assess Col1a1, osteonectin, and IGF- 1 expression. An in vivo study evaluated bone formation at 4- and 12-week endpoints. Eight female Sprague Dawley rats per group per endpoint received bilateral Ti-6Al-4 V K-wires as femoral implants. Left femur received control, while right femur received Aligned/Trabecular TiNT K-wire. Bone formation was assessed via microCT, backscatter electron imaging (BEI), and non- decalcified histologic analyses. Results: Aligned and Trabecular TiNT groups demonstrated higher ALP activity than control at 2 and 3 weeks. The in vivo study demonstrated increased bone volume fractions (BV/TV) and total bone volume (TBV) for TiNT surfaces (microCT). The ratio of both BV/TV and TBV in the distal VOI were nearly equivalent for both TiNT surfaces, indicating similar bone formation between both TiNT surfaces and control. In the midshaft VOI, the ratios between TiNT surfaces and control were 1.5 or greater, indicating increased bone formation. At 12 weeks, the bone-implant contact fraction ratio (BEI) showed Aligned TiNT and Trabecular TiNT were 1.3 and 1.4 times greater than control, respectively. Histologic analysis showed both TiNT surfaces had 1.5 times the bone-implant contact as control. Conclusion: In vitro studies demonstrated improved support for osteogenic functions of cultured marrow-derived stem cells on TiNT surfaces compared to controls. μCT, BEI, and histologic analyses associated with the in vivo study demonstrated increased bone formation in the TiNT femora, at specific timepoints and VOIs.

Length-Preserving Intramedullary Femoral Fixation for Traumatic Leg Amputation.

We present the case of a twenty-one-year-old woman with a traumatic left leg amputation, substantial proximal skin degloving, and an ipsilateral femoral fracture treated with revision amputation distal to the fracture site and retrograde femoral nailing through the amputation site. A short retrograde femoral nail is a surgical option to fix a femoral shaft fracture proximal to a traumatic amputation in order to preserve limb length for effective prosthetic fit and ambulation.

THE TWO-EVENT CONSTRUCT OF POSTINJURY MULTIPLE ORGAN FAILURE

THE TWO-EVENT CONSTRUCT OF POSTINJURY MULTIPLE ORGAN FAILURE

High prevalence of erectile dysfunction in young male patients after intramedullary femoral nailing

Objectives To evaluate, given the central role of the pudendal nerves in erection, the impact of potential infraclinical lesions on male sexual function. After intramedullary femoral fixation, countertraction on the fracture table has sporadically been involved in pudendal neurapraxia. Patients with tibial fractures served as controls. Methods A total of 168 patients treated for femoral or tibial shaft fractures by intramedullary nailing were mailed the International Index of Erectile Function questionnaire, which addresses all aspects of male sexual function and permits grading of the severity of erectile dysfunction (ED). Univariate and multivariate analyses were conducted to test for factors associated with ED. Results Of the 168 patients, 101 (60.1%) returned the questionnaire. A greater proportion of ED was observed in sexually active patients after femoral fracture than after tibial fracture (40.5% versus 12.5%, P <0.01). The differential prevalence of ED in both groups subjected to comparable high-energy trauma suggested that post-traumatic stress disorder was of marginal importance in ED occurring after femoral nailing. Greater intraoperative doses of curare were associated with better sexual functioning in sexually active patients after femoral fracture (10.6 versus 7.5 mg in patients without and with ED, respectively, P = 0.02), suggesting that postoperative ED could be partially prevented by optimal muscle relaxation during fracture reduction. Conclusions Erectile dysfunction was shown to be highly prevalent after intramedullary nailing of femoral shaft fractures. Greater intraoperative curare doses, resulting in optimal relaxation and reduced pressure on the pudendal nerves by the perineal post, were associated with better sexual functioning.

Femur fractures in chest-injured patients: is reaming contraindicated?

To determine if reamed femoral intramedullary nailing increases the pulmonary complications seen in chest-injured patients. Retrospective review of prospectively collected trauma database data from January 1991 to October 1994. Methodist Hospital, Indianapolis, Indiana, Level I Trauma Center. Group I: Chest-injured patients [chest Abbreviated Injury Score (AIS) > or = 2] without femur or tibia fractures. Group II: Chest-injured patients (chest AIS > or = 2) with femoral reamed intramedullary fixation. Group III: Chest-injured patients (chest AIS > or = 2) with femoral shaft fixation using nonreamed fixation (rush rods, plating, or external fixation). Group IV: Non-chest-injured patients (chest AIS < 2) with femoral reamed intramedullary fixation. MAIN OUTCOME MEASUREMENT/HYPOTHESIS: Reamed femoral intramedullary nailing does not alter pulmonary outcomes, even in chest-injured patients. Groups I and II had a very similar incidence of adult respiratory distress syndrome (ARDS), pneumonia, and number of ventilator days. Group III had a significantly higher incidence of ARDS and number of ventilator days than did Group I or II. Group III did not have a chest AIS score significantly different than Groups I and II. Group II had significantly higher ARDS and more ventilator days than did Group IV when only analyzing raw data. When injury severity was adjusted, there were no significant differences in pulmonary outcomes. Reamed intramedullary femoral fixation did not increase pulmonary morbidity in chest-injured patients.

牽引手術台使用によって生じた陰部神経麻ひ例

A Case of pudendal nerve palsy associated with intramedullary femoral fixation is reported. A 22-year-old man sustained the right femoral fracture with traffic accident. Immediately the skeletal traction with 5.5kg was done. Twelve days later, operation was performed with the patient in the lateral position on the Maquet fracture table. Open reduction was required, for closed reduction was impossible. Postoperatively the patient complained of the numbness of the right side of the penis and scrotum. He was unable to obtain an erection for three weeks. The preoperative sexual function had been normal. Two weeks later sensation gradually began to return and three months postoperatively he had normal sensation and sexual function.Since Aboulker (1974) ten cases of pudendal nerve palsies as a result of prolonged forceful traction on the fracture table have been reported in literature. A half of cases remained having some sexual dysfunction. To avoid this complication it is important to utilize the large and padded perineal post and to decrease the amount of traction.

Ipsilateral Femoral Neck and Shaft Fractures

A technique for ipsilateral femoral neck and shaft fracture using the sliding compression hip screw with plate combined with trochanteric antegrade Ender nailing of the femur was applied in two cases. Ender nails can be passed without difficulty past a compression hip screw and the bicortical plating screws. The hip and femur can be fixed internally through a single approach in a single position. Sliding compression hip screw devices can provide excellent preliminary stable femoral neck fixation. Blood supply to the femoral head is not disturbed while the femoral intramedullary fixation is performed. Antegrade Ender nailing avoids the common knee complications associated with other retrograde techniques. Decreased operative time, less blood loss, less technical difficulty, and early mobilization are important factors in the multiple-injured patient. Femoral intramedullary fixation may require open reduction, circlerage to ensure stability, and maintenance of alignment in case of significant comminution to allow early crutch ambulation. This mode of fixation may be advantageous for selected cases.

Pudendal-nerve palsies associated with closed intramedullary femoral fixation. A report of two cases and a study of the mechanism of injury.

Pudendal-nerve palsies associated with closed intramedullary femoral fixation. A report of two cases and a study of the mechanism of injury.