Ipsilateral Femoral Fracture Research Articles

Complicated injuries to the pelvis and acetabulum

Injuries of the joints of the pelvis and of the acetabulum are still a problem even today. When the joints of the pelvis are damaged the risk of complicated pelvic injuries, that is to say pelvic injuries with damage to the soft tissues in and around the pelvis, is increased threefold. The lethality, the overall gravity of the injuries, the probability of haemorrhagic complications and the proportion of associated pelvic injuries are also increased. Even when anatomical reconstruction of the lower limb girdle is achieved, long-term secondary conditions such as pain and genitourinary and neurological scquelae frequently persist. Complicated pelvic injuries, i. e. pelvic injury with concomitant damage to organs and soft tissues in the pelvis and pelvic injuries with ipsilateral femoral fracture (floating hip) are special cases. Haemodynamic stabilization of the patient and the treatment of organic lesions must be the first priorities in the interdisciplinary therapy. Even when these priorities are correctly observed, the lethality is almost three times as high as in the case of pelvic injuries not involving soft-tissue damage. Acetabular fractures are a particular challenge even compared with other joint fractures. Operative treatment with anatomical joint reconstruction and stable internal fixation has been shown to have the best results. In addition to the type of fracture and the personal experience of the surgeon concerned, such fracture-specific factors as the presence of further fractures of the posterior wall, comminuted fractures, joint depression fractures and intra-articular fragments increasingly play a part. The long-term result worsens with increasing number of these additional pathologies. The primary cartilaginous damage caused by the accident seems to have a considerable influence on the long-term result following acetabular fractures.

Complex injuries of the pelvis and acetabulum

Injuries of the joints of the pelvis and of the acetabulum are still a problem even today. When the joints of the pelvis are damaged the risk of complicated pelvic injuries, that is to say pelvic injuries with damage to the soft tissues in and around the pelvis, is increased threefold. The lethality, the overall gravity of the injuries, the probability of haemorrhagic complications and the proportion of associated pelvic injuries are also increased. Even when anatomical reconstruction of the lower limb girdle is achieved, long-term secondary conditions such as pain and genitourinary and neurological sequelae frequently persist. Complicated pelvic injuries, i.e. pelvic injury with concomitant damage to organs and soft tissues in the pelvis and pelvic injuries with ipsilateral femoral fracture (floating hip) are special cases. Haemodynamic stabilization of the patient and the treatment of organic lesions must be the first priorities in the interdisciplinary therapy. Even when these priorities are correctly observed, the lethality is almost three times as high as in the case of pelvic injuries not involving soft-tissue damage. Acetabular fractures are a particular challenge even compared with other joint fractures. Operative treatment with anatomical joint reconstruction and stable internal fixation has been shown to have the best results. In addition to the type of fracture and the personal experience of the surgeon concerned, such fracture-specific factors as the presence of further fractures of the posterior wall, comminuted fractures, joint depression fractures and intra-articular fragments increasingly play a part. The long-term result worsens with increasing number of these additional pathologies. The primary cartilaginous damage caused by the accident seems to have a considerable influence on the long-term result following acetabular fractures.

Treatment of Ipsilateral Femur and Tibia Fractures

Treatment of Ipsilateral Femur and Tibia Fractures

Management of Ipsilateral Femoral Fracture After Hip Arthroplasty

Management of Ipsilateral Femoral Fracture After Hip Arthroplasty

Open Fractures of the Tibia in Children

Summary We treated 38 patients from 4 to 15 years old and with open growth plates for open fractures of the tibia. The average follow-up was 33 months (range, 9-122). All patients had repeated operative debridement, parenteral antibiotics, and immobilization by cast or fixation. Outcomes were analyzed with respect to age at the time of injury, grade of injury, and type of immobilization. The time to union was prolonged and averaged 21 weeks (range, 6-82). No patients younger than 11 years required bone grafting for union. The deep infection and nonunion rate was 8%, with all of these occurring in patients older than 11 years. Clinically significant leg-length discrepancy or functional limitation was encountered only in patients with an ipsilateral femur fracture or with deep infection requiring osseous debridement. Our data suggest that open tibia fractures in children older than 11 years have nonunion and infection rates that parallel those of adult patients, but that younger children have a more benign course. With aggressive wound care and adequate stabilization, few complications or sequelae should occur in open tibial shaft fractures in younger patients.

Open fractures of the tibia in children.

We treated 38 patients from 4 to 15 years old and with open growth plates for open fractures of the tibia. The average follow-up was 33 months (range, 9-122). All patients had repeated operative debridement, parenteral antibiotics, and immobilization by cast or fixation. Outcomes were analyzed with respect to age at the time of injury, grade of injury, and type of immobilization. The time to union was prolonged and averaged 21 weeks (range, 6-82). No patients younger than 11 years required bone grafting for union. The deep infection and nonunion rate was 8%, with all of these occurring in patients older than 11 years. Clinically significant leg-length discrepancy or functional limitation was encountered only in patients with an ipsilateral femur fracture or with deep infection requiring osseous debridement. Our data suggest that open tibia fractures in children older than 11 years have nonunion and infection rates that parallel those of adult patients, but that younger children have a more benign course. With aggressive wound care and adequate stabilization, few complications or sequelae should occur in open tibial shaft fractures in younger patients.

Treatment of the Ipsilateral fracture of Femur and Tibia in Children

Treatment of the Ipsilateral fracture of Femur and Tibia in Children

Clinical Experiences on a Ipsilateral Femoral Fracture after Total Hip Arthroplasty

Clinical Experiences on a Ipsilateral Femoral Fracture after Total Hip Arthroplasty

Open fractures of the tibia in children

The results of the treatment of open tibial fractures in 58 children aged between 3 and 15 years are reviewed. There were 25 Gustilo Type I, 22 Type II and 10 Type III fractures. At operation 37 wounds were closed primarily and 21 wounds were left open. Of these 21, 13 healed by secondary intention and eight required split skin grafting or soft tissue flap coverage. Stable fractures were immobilized in an above-knee plaster in 48 cases (83 per cent) and six fractures treated with external fixation (10 per cent). Two patients (3.5 per cent) had cast immobilization of the tibial fracture and traction for an ipsilateral femoral fracture. Two patients (3.5 per cent) with Gustilo Type IIIc injuries required an amputation, one ‘ de novo’ as the limb was not salvageable and one 4 days after failed vascular reconstruction. All fractures healed primarily without bone grafting, although there were three cases of delayed union and seven cases of malunion. Six children had superficial wound infections but there were no cases of deep infection or osteomyelitis. There was one case of compartment syndrome.

Fractures of the ipsilateral femur after hip arthroplasty: A statistical analysis of outcome based on 487 patients

A complete review of the literature revealed 487 patients in 26 published reports with ipsilateral femur fractures occurring about the femoral prosthetic stem. This review included general surveys, multicenter studies, and case reports. Based on these studies, the authors divided the fractures into six types: type 1, intertrochanteric; type 2, proximal femur; type 3, spanning the prosthesis tip; type 4, distal to the prosthesis tip; type 5, comminuted blowout; and type 6, supracondylar. Type 1–5 fractures were stratified into the following treatment groups: traction, casting and partial weight bearing, cerclage wiring, screw/plate fixation, long-stem revision with plus/minus supplementation fixation or bone-graft, and other less frequently reported techniques. A statistical analysis of each type of fracture in terms of the various treatments used and the clinical outcome was performed. The best results based on the literature would be cerclage wiring or long-stem revision for types 2, 3, and 5 fractures ( P < .02). For type 4 fractures, traction and long-stem revisions were about equally successful (at 77 and 74%, respectively), and were both superior to screw/plate fixation or cerclage fixation ( P < .01). Other factors, such as cemented versus cementless prostheses, stable versus unstable prostheses, overall medical condition of the patient, and other parameters, should be analyzed and considered when choosing a treatment course. Based on the authors' results, suggestions for the treatment of each fracture type are offered.

Ipsilateral Knee Injury With Femoral Fracture Examination Under Anesthesia and Arthroscopic Evaluation

Forty adults with closed diaphyseal femoral fractures and no previous knee injury were prospectively studied to determine the incidence of concomitant ipsilateral extra- and intraarticular knee injury. After intramedullary nailing, examination under anesthesia and arthroscopy were performed. The mechanism of injury was high-energy trauma. Femoral fixation included 30 interlocked nails. The results of the examination showed laxity > Grade I in 52.5% of the patients. Significant arthroscopic findings included 19 partial (48%) and two complete (5%) anterior cruciate injuries; two partial (5%) and one complete (2.5%) posterior cruciate injuries; and five medial (12%) and eight lateral (20%) meniscus tears. Significant arthroscopic findings (anterior cruciate ligament or posterior cruciate ligament injuries, meniscal tear, osteochondral fracture) were noted in conjunction with effusion or laxity > Grade I in more than half of the group, and such findings were present in one third despite absence of effusion or laxity. This study documented the incidence and array of findings noted at arthroscopy. In all, 22 patients (55%) had significant arthroscopic findings. A high incidence of knee injuries, including many that were occult, occurred in conjunction with ipsilateral femoral shaft fractures. Based on these findings, the authors recommend a high index of suspicion for coexisting knee injuries with ipsilateral femoral fracture and use of appropriate diagnostic and therapeutic measures.

The uncemented bipolar hemiarthroplasty for displaced femoral neck fractures: 6-year follow-up of 171 cases

We report a study of 168 consecutive patients (171 prostheses) with a displaced femoral neck fracture and a physiologic age older than 75 years who were treated with an uncemented bipolar Monk hard-top hemiarthroplasty. Four prostheses dislocated postoperatively, but none after discharge. Two prostheses were later extracted. Five patients sustained an ipsilateral femoral fracture. Totally, 7 patients (4 percent) were reoperated on. One year after the operation, 22 percent of the patients were dead. An increased mortality rate was recorded during the first 6 months after surgery. At follow-up 6 (3-9) years after the operation, 4 of the 62 patients alive had weight-bearing pain. Three had subsidence of the prosthesis, but none had protrusion of the acetabulum. Ninety-five percent of the patients were free from complications requiring a reoperation or outpatient evaluation.

Trauma involving the proximal tibial epiphysis

Thirty injuries involving the proximal tibial epiphysis were treated during a period of 28 years. The epiphysis was displaced in 16 cases (53%). Three patients presented with peripheral ischemia on admission, and one patient with associated ipsilateral femoral fracture developed delayed thrombosis of the popliteal artery. The treatment results were satisfactory in 21 of the 27 (74%) who were reassessed according to Shelton's evaluation criteria after an average post-traumatic interval of 11.6 years. Three of the six patients with unsatisfactory outcome had a discrepancy in leg length of more than 2.5 cm after concomitant ipsilateral fracture of the femur or the tibia. One patient had a positive 3-cm anterior drawer sign, one patient had a 10 degree valgus deformity of the tibia, and one had to undergo above-knee-amputation because of delayed diagnosis of the vascular lesion.

Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures

A series of 110 patients with 114 fractures of the femur were reviewed an average of 3.9 years after injury. Demonstrable knee ligament laxity was present in 31 (27 per cent) of these patients, while 13 (11 per cent) complained of instability. Thirty-three patients with 34 ipsilateral femoral and tibial shaft fractures were examined an average of 3.7 years after injury. Demonstrable knee ligament laxity was present in 18 (53 per cent) of these patients, while 6 (18 per cent) complained of instability. Most of the patients with instability had a rupture of the anterior cruciate ligament with or without damage to other ligaments. We conclude that knee ligament injury is more common with ipsilateral fracture of the femur and tibia than with just a single ipsilateral femoral fracture. We advocate careful assessment of the knee in all cases of fracture of the femur.

Ipsilateral hip and femoral shaft fractures treated with compression hip screw and long side-plate.

Complex femoral fractures involving the hip and shaft are not rare findings in the emergency room. The primary problem in the care of these patients is the preservation of their lives. The fracture combination under discussion is only a part of the injury complex sustained by these individuals. After the acute problems have been brought under control, care of the fractured femur and hip must be planned. Recently, most centers have favored giving priority to hip fractures, rigid fixation and early mobilization. However, for the fixation implants, variable fixation methods have been reported but are imperfect. In the past 5 years we have had some experience using compression hip screws with long side-plate to fix the different injured parts of these dual shaft and hip fractures at the same time. It seemed that application of these devices in dual hip and proximal shaft fractures, which are devoid of physiological bowing of the shaft, would get the best results. But when they are applied to dual fractures of the hip and the middle portion of the shaft, certain techniques, like adequate distal fixation, the prebending of the plate, primary bone graft and mobilization of the non-weight bearing pattern should be strictly adhered to for assurance of early callus formation and prevention of implant failure.

Acute compartment syndrome of the thigh. A spectrum of injury.

Twenty-one compartment syndromes of the thigh in seventeen patients were identified for retrospective review. Ten of the compartment syndromes were associated with an ipsilateral femoral fracture; five of these femoral fractures were open. In five patients, the syndrome followed femoral intramedullary stabilization. The remaining eleven syndromes followed blunt trauma to the thigh, prolonged compression by body weight, or vascular injury. The patients who were awake and alert at the time of the examination complained of intense pain in the thigh, and they had neuromuscular deficits. For the patients who could not cooperate with a subjective physical examination because they were under general anesthesia or because of associated injuries, the measurement of compartment pressure assumed a more important diagnostic role. All of the patients had tense swelling of the involved thigh. The predisposing risk factors for the development of compartment syndromes of the thigh, which are common in the multiply injured population, include: systemic hypotension, a history of external compression of the thigh, the use of military antishock trousers, coagulopathy, vascular injury, and trauma to the thigh, with or without a fracture of the femur. In approximately one-half of these patients, a crush syndrome developed, with myoglobinuria, renal failure, and collapse of multiple organ systems. Eight patients (47 per cent) died as a result of multiple injuries. Of the nine patients (ten compartment syndromes) who survived, infection developed at the site of the fasciotomy in six. Follow-up examination revealed marked morbidity, including sensory deficit and motor weakness of the lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonoperative treatment of a postoperative fracture around an uncemented porous-coated femoral component

Ipsilateral femur fractures in patients who have had cemented total hip arthroplasty is an infrequent and hazardous complication. Operative treatment has been specifically recommended for type II fractures (those extending from the proximal portion of the femur shaft to beyond the distal tip of the prosthesis) because of the predictably unsatisfactory results with nonoperative treatment. The authors report the successful nonoperative treatment of a postoperative fracture around an uncemented porous-coated femoral component. They recommend nonoperative treatment for minimally displaced type II femoral shaft fractures around uncemented porous-coated prostheses.

A Clinical Study of Ipsilateral Fracture of Femur and Tibia

A Clinical Study of Ipsilateral Fracture of Femur and Tibia

Bilateral Traumatic Dislocation of the Hips with Ipsilateral Femoral Fracture

A rare case of bilateral traumatic dislocation of the hip with ipsilateral femoral shaft fractures occurred in a 29-year-old man. Reduction was achieved by manipulation, despite the presence of a femoral shaft fracture on one side. A review of the literature reveals reports of three similar cases.

下肢を中心とした多発性骨傷の治療経験

Fifty-four cases of multiple fractures included lower extremities were studied during the past eight years in our hospital.The total number of fractures were two hundred (lower extremities 129, upper extremities 38, and bodies 33).Fifty were open fractures. Five out of 54 cases were treated by conservative management, 35 by operative management and 9 by both. Complications were skull injuries (8 cases), thoracic injuries (2 cases), abdominal injuries (9 cases) and the others (3 cases).Those caused a long duration of hospitalization and time to healing. The end result was poor for ten of twelve patients of simultaneous ipsilateral femoral and tibial fractures; so called “floating knee fracture”.