Surgical Treatment Of Femoral Fractures Research Articles

Accelerated operative recovery in elderly patients with femoral fractures: Our experience of ten years with 870 patients

Background: The WHO considers elderly as an individual who is ≥ 60 y of age, and there are ≥ 37.7 million elderly people. In 2006, the ACERTO Project (Acceleration of Total Post-Operative Recovery) was introduced in Brazil in colorectal surgeries, and in elderly orthopedic femur fractures in 2010, with primary objective for the patient to early return to independent life. The objective of this descriptive study is to evaluate the clinical results 870 elderly patients undergoing surgical treatment of femoral fractures in ten years (2010-2019) after employing the perioperative acceleration protocol.
 Methodology: It was a cross-sectional, prospective study in patients ≥ 60 y, of both genders, undergoing corrective hip fracture for ten years at a hospital covered by the Brazilian Public Health System (SUS). The data regarding preoperative condition of the patients, fasting status, mode of anesthesia, drugs used, intra-operatively measured variables and immediate post-operative variables measured in the PACU, quality of lumbar plexus block analgesia, presence of delirium in the first day of postoperative was obtained from the study protocol. The deaths during the first postoperative month were noted.
 Results: A total of 829 patients underwent surgery for a fracture of the hip, under spinal anesthesia, of whom 583 were women and 246 were men. The average hospital stay was 10.2 ± 7.1 days, and it was associated with the age. The mean fasting time was 2:50 ± 0:32 h. The dose of isobaric bupivacaine was 9.62 ± 1:85 mg. The cephalad spread varied from T12 to T5. The duration of the spinal block was 2:50 ± 0:38 h, the time for the use of dextrinomaltose in PACU was 1:39 ± 0:47 h, the time in the PACU was 2:03 ± 0:46 h and the time to reintroduce normal meals was 6:18 ± 1:02 h. Arterial hypotension occurred in 36 (4.3%) patients, bradycardia in 4 (0.4%), and delirium in 16 patients. Eleven (1.3%) patients were sent to the ICU due to surgical problems. There were no deaths directly related to anesthesia or surgery.
 Conclusion: The implementation of the ACERTO Project in 829 patients with femur fracture of the Brazilian Public Health System, showed favorable results regarding length of stay, patient satisfaction, decreased use of bladder tube and drains, and referral to ICU, with early discharge to residence.
 Citation: Imbelloni LE, Teixeira DMP, Lima U, Ventura TB, Lacerda S, Brasileiro, Barbosa R, Sales MBL, Duarte M, Filho GBDM. Accelerated operative recovery in elderly patients with femoral fractures: Our experience of ten years with 870 patients. Anaesth. pain intensive care 2022;26(5):608-615; DOI: 10.35975/apic.v26i5.1992

Prevalence of ipsilateral knee ligament injuries associated with femoral shaft fractures in Menoufia University Hospitals

ObjectiveThis study was designed to estimate the prevalence of ipsilateral knee ligament injuries associated with fracture shaft femur in Menoufia University Hospitals.BackgroundIpsilateral knee ligament injuries associated with femoral shaft fractures are a common finding but can be easily missed during early management of initial trauma.Patients and methodsAfter femoral fixation with intramedullary rod placement, external fixation, or plate fixation, all patients underwent a thorough physical examination of the involved limb including varus and valgus stress tests, Lachman test, anterior drawer test, and posterior drawer test, under anesthesia. Clinical assessments were performed and compared with the contralateral knee.ResultsThe most common mechanism of injury observed was RTA. Of the 44 patients who were studied, 15 (34.1%) patients had a knee ligament injury. Of the 15 patients, 47% had a cruciate ligament injury. The ligament injury was not treated at the time of the osteosynthesis procedure.ConclusionWe highlight the difficulty of diagnosis of ipsilateral knee ligament injuries at the time of admission and the need for systemic physical examination after surgical treatment of femoral fractures.

An integrated computer-aided approach for parametric investigation of anatomic plate design

ABSTRACT Personalized anatomic plate is used in the surgical treatment of femoral fracture for the good matching between individual femur and plate. However, the development process of personalized plate is time-consuming and laborious at present due to anatomic and fracture differences between individuals. To improve the efficiency and quality of plate design, this study proposes an integrated computer-aided approach for parametric investigation of anatomic plate design. Based on the constraint deformation of femur template, a reference model was constructed, and major fracture segments were quickly restored to each original anatomic region by rigid registration to the reference model. The experimental results indicate that personalized anatomic plates can be constructed and edited quickly and intuitively with semantic parameters in high level, and contribute to the improvement of design efficiency and quality of customized plates for individuals.

Adjuvant Teriparatide Therapy for Surgical Treatment of Femoral Fractures; Does It Work?

PurposeAtypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects.Materials and MethodsThirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed.ResultsTwelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea.ConclusionEven appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.

The strategy for the surgical treatment of femoral fractures in polytrauma

The review describes peculiarities of the choice of time and methods of osteosynthesis offemur fractures of different localization in patients with multiple injuries in accordance with modern concepts of treatment of severe multiple and associated lesions. Analysis of domestic and foreign literature shows that earlyfixation of the femur in case of polytrauma can reduce the mortality rate associated with complications and improve the functional outcome. Terms of osteosynthesis of the femur in polytrauma should be chosen taking into account the severity of the injury, the patient's condition, and the period of traumatic disease. The procedure of osteosynthesis must not be a threat to the clinical condition. The choice of the method for fixation of the femur depends of fracture type and location, the presence of fractures in the adjacent and remote segments. The minimally invasive techniques of osteosynthesis of the femur and staged surgical treatment of the victims in an unstable state should be chosen for the treatment of multiple injury in accordance with the concept of «Damage Control Orthopedics».

Injury of the knee ligaments associated with ipsilateral femoral shaft fractures

ObjectiveWith the objective of identifying the incidence of ipsilateral knee ligament injury, thirty-six patients with femoral shaft fractures were evaluated. MethodsDuring the osteosynthesis procedure to repair the femur while under anesthesia, all patients underwent a physical examination and X-ray examination. ResultsThe most common mechanism of injury observed was motorcycle accidents. Of the thirty-six patients that were studied, eleven patients (30.5%) had a knee ligament injury. Of the eleven patients, 64% had a cruciate ligament injury. The ligament injury was not treated at the time of the osteosynthesis procedure. ConclusionWe highlight the difficulty of diagnosis at the time of admission and the need for systematic physical examination before and after surgical treatment of femoral fracture.

Lesão ligamentar do joelho associada à fratura diafisária do fêmur ipsilateral

ObjectiveWith the objective of identifying the incidence of ipsilateral knee ligament injury, thirty-six patients with femoral shaft fractures were evaluated. MethodsDuring the osteosynthesis procedure to repair the femur while under anesthesia, all patients underwent a physical examination and x-ray examination. ResultsThe most common mechanism of injury observed was motorcycle accidents. Of the thirty-six patients that were studied, eleven patients (30.5%) had a knee ligament injury. Of the eleven patients, 64% had a cruciate ligament injury. The ligament injury was not treated at the time of the osteosynthesis procedure. ConclusionWe highlight the difficulty of diagnosis at time of admission and the need for systematic physical examination before and after surgical treatment of femoral fracture.

Surgical Treatment of an Osteopetrotic Patient with Postoperative Fractures: Lessons from Siblings with Osteopetrosis

Osteopetrosis is a rare, inherited disease characterized by dense and brittle bones, and it is associated with an increased risk of femoral fractures. However, the surgical treatment of the fracture patients with osteopetrosis is a subject of controversy, because it is difficult to compare the treatment effects between surgical treatment and conservative treatment in part due to the rarity of siblings with osteopetrosis. In fact, the genetic background and the environmental factors, such as living conditions and daily work, may influence the prognosis of the fracture patients with osteopetrosis. Here we describe siblings with osteopetrosis, a 23-year-old female patient and her older brother, both of whom had suffered from bilateral femoral fractures at their childhood. They do not have other brothers or sisters, and their parents are healthy. The younger sister had undergone surgical treatment for femoral fractures at the age of 8 years and recovered very well. In contrast, her brother had received the conservative treatment for femoral fractures at the age of 6 years, and thereafter he is badly disabled due to the malunion of the fractured femurs. Apparently, the surgical treatment is superior to the conservative treatment for the fracture patient with osteopetrosis. Unfortunately, fifteen years later, the sister fractured again at both femurs and underwent another operation. She recovered quickly from the second operation, indicating that second operation should be considered in osteopetrosis patients with postoperative fractures. The present report provides valuable information for the choice of treatment of femoral fractures associated with osteopetrosis.

Can heat and cold be parameterized? Clinical data of a preliminary study

The aim of this study was to demonstrate whether it is possible to objectively assess the effects of acupuncture by microcirculation-related parameters in the given clinical scenario, to evaluate the significance of the status of capillary perfusion prior to acupuncture for the treatment of a clinical cold pattern, and to evaluate the possible role of microcirculation-related parameters for the future parameterization of the traditional Chinese medicine (TCM) diagnosis. This prospective, uncontrolled, unblinded preliminary clinical trial included 32 elderly patients after surgical treatment for femoral fractures. For acupuncture treatment the patients received acupuncture with the "leopard spot technique" on the stomach meridian (Liangqiu, S34/ST34). Measurements of microcirculation-related parameters (velocity, blood flow, haemoglobin, oxygen saturation) by white light spectroscopy and laser Doppler were performed prior to and after acupuncture treatment. Two subgroups of patients after femur fracture could be identified: a low- and a high-perfusion group. Capillary flow velocity and blood flow were significantly augmented by acupuncture in the low-perfusion group only. In the high-perfusion group, there was no significant change of perfusion after acupuncture. The statistical analysis of all patients regardless of their pre-acupuncture perfusion status revealed no statistically significant alteration after acupuncture. The acupuncture effect may have been masked by the inhomogeneity of the overall group. Microcirculation-related parameters may be valuable to measure acupuncture effects objectively and to characterize the vegetative functions prior to acupuncture so as to homogenize the comparison groups in clinical trials. In our example, a local cold pattern (low capillary perfusion of the leg) could be treated successfully by a point which enhances qi and blood flow, whereas in heat pattern (high capillary perfusion) this intervention had no such effect. Future studies may be directed to correlate the vegetative status as measurable by TCM vegetative parameters with the key symptoms of TCM diagnosis.

O custo direto da fratura de fêmur por quedas em pessoas idosas: análise no setor privado de saúde na cidade de Brasília, 2009

OBJETIVO: estimar o custo direto dos recursos médico-hospitalares utilizados no tratamento cirúrgico da fratura de fêmur decorrente de quedas durante a hospitalização e pós-operatório até dois meses após a lesão. MÉTODO: estudo transversal, descritivo e retrospectivo em pacientes de ambos os sexos, com 60 anos ou mais de idade, no período de janeiro de 2008 a junho de 2009. Os dados foram extraídos das contas hospitalares de um convênio credenciado à rede hospitalar privada da cidade de Brasília. RESULTADOS: a frequência de fratura por quedas para o sexo feminino foi 76,2% (n=16), e no masculino, 23,8%(n=5), sendo que 66,7% (n=14) das lesões resultaram em fratura de fêmur proximal. A média de permanência hospitalar das cirurgias foi de 7,1 dias e 2,7 dias em UTI. Houve 16 pacientes com fratura de fêmur e a média do tratamento cirúrgico foi R$ 39.160,75, totalizando R$ 626.572,06. O custo direto dos recursos médico-hospitalares durante a internação ficou entre R$ 8.293,55 e R$ 139.837,50; já no pós-operatório, corresponderam a 5,7% do custo total da internação. CONCLUSÃO: o custo cirúrgico da fratura de fêmur é considerável para os convênios do sistema de saúde suplementar e confirmou a vulnerabilidade do sexo feminino para as fraturas de quadril. As maiores despesas foram com a prótese, material e medicamentos, e variaram em função do tipo de cirurgia, período de hospitalização e faixa etária.

Evaluation of femoral reconstruction intramedullary nail fixation for femoral fracture combining with ipsilateral femoral intertrochanteric fracture

Objective To investigate an effective surgical treatment for complex femoral fracture and evaluate the efficacy of femoral reconstruction intramedullary nail fixation for femoral fracture combining with ipsilateral femoral intertrochanteric fracture.Methods Retrospective analysis was performed for 21 cases suffering from femoral fracture combining with ipsilateral femoral intertrochanteric fracture treated by femoral reconstruction intramedullary nail fixation from May 2000 to December 2004.Results 21 cases were followed up,ranging from 7 to 62 months,average 18.7 months,average time for fracture union was 6.9 months,and no postoperative infection,avascular necrosis of femoral head and failure of internal fixation occurred.According to Ma Yuanzhang criterion system,the percentage of excellent clinical result was 90.0%.Conclusion Femoral reconstruction intramedullary nail fixation is an ideal surgical treatment for femoral fracture combining with ipsilateral femoral intertrochanteric fracture.By this process,femoral head,neck and shaft become an intact body. Key words: Femoral bone; Fracture; Internal fixation; Intramedullary nail

Surgical Treatment of Femoral Fractures in Obese Children

1 Indiana University Medical Center/Riley Hospital for Children 702 Barnhill Drive, Room 4250 Indianapolis, IN [email protected]

Surgical Treatment of Femoral Fractures in Obese Children

In light of the increasing rate of obesity among children in the United States, this study examines whether obese children have an increased rate of complications following surgical treatment of femoral shaft fractures. A retrospective review of the charts of children between six and fourteen years of age who were treated operatively for a femoral shaft fracture was performed, and complications were identified. One hundred and three children (104 fractures), with a mean age at the time of injury of 9.3 years, were identified. Fifty-nine fractures were treated with external fixation, and forty-five were treated with an intramedullary rod. Six children (6%) were considered obese, with a weight for age at the 95th percentile or higher. An additional four children were extremely heavy at the 90th to the 94th percentile of weight for age. Three complications occurred in the six obese children, and one complication occurred in the four extremely heavy children. Eleven (12%) of the remaining ninety-three children had a complication. When examined according to treatment groups, the complication rate for heavier children was higher for both the group managed with an intramedullary rod and the group that had external fixation (p = 0.004). Obese children have an increased rate of postoperative complications compared with children who are not obese. Therefore, parents of obese children should be warned that such children may have a potentially increased risk of complications associated with surgical management of a femoral fracture.

Interlocking compression nailを用いた大腿骨骨幹部骨折の治療成績

Interlocking compression nailを用いた大腿骨骨幹部骨折の治療成績

Devenir à l'âge adulte de 50 fractures du fémur, opérées chez l'enfant, entre 3 et 13 ans

After a rewiew of the history of surgical treatment of femoral fractures in children, the author studies 50 cases (37 nailed and 13 plated) followed up to adulthood.