Case 10: Distal Femoral Fracture Treated Initially with Internal Fixation Converted to Circular External Fixation due to Nonunion and Hardware Failure

2015 ◽  
pp. 67-71
Author(s):  
Lane Wimberly ◽  
Alexander Cherkashin ◽  
Mikhail Samchukov
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Femoral Fracture ◽  
Distal Femoral Fracture ◽  
Hardware Failure

scholarly journals Outcomes of Hindfoot and Ankle Arthrodesis in Neuropathic Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
David Macknet ◽  
Andrew Wohler ◽  
Carroll P. Jones ◽  
J. Kent Ellington ◽  
Bruce E. Cohen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Limb Salvage ◽  
Median Number ◽  
Ankle Arthrodesis ◽  
High Rate ◽  
Hardware Failure ◽  
Radiographic Outcomes ◽  
Fixation Group

Category: Ankle Arthritis, Diabetes, Hindfoot Introduction/Purpose: Charcot neuropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity which can end with amputation. The foot and ankle surgeon’s aim is to reconstruct the high risk foot with the creation of a stable plantigrade foot, while reducing the risk of ulceration and allowing the patient to mobilize in commercially available footwear. There are numerous techniques for the reconstruction of the neuropathic hindfoot, but the most utilized of these include multiplanar external fixation or internal fixation with a plate or intramedullary nail. It is our goal to further elucidate outcomes of Charcot patients undergoing corrective ankle and hindfoot fusion comparing internal versus external fixation. Methods: We retrospectively collected 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent arthrodesis for Charcot arthropathy, 56 of which met our inclusion and exclusion criteria. This included 47 who had internal fixation as their primary procedure and 9 patients who underwent external fixation with a multi-planar external fixator. Our median follow up time was 3.4 years (IQR .5 to 12.9). Preoperatively we collected basic demographic variables, reasons for neuropathy, and ulcer status. Postoperatively we collected complications including infection, hardware failure, ulceration, recurrent deformity, and radiographic outcomes including union and hardware backout. Reoperation numbers and indications were also collected. Our primary outcome was limb salvage at final follow up. Secondarily, we collected final ambulatory and footwear status. Results: The limb salvage rate was 82% with 10 patients undergoing amputation, which did not vary between groups (p=.99). The primary reasons for amputation were persistent infection (4 of 10) and nonunion (4 of 10). Thirteen (24%) patients developed an infection. The median number of reoperations per patient was 1 (IQR 0-2) with the patients who underwent amputation undergoing a median of 2 (IQR 2-4) reoperations. The rate of union was 54%, occurring at a median of 26.5 (IQR 12-47) months. 44% (4/9) of patients in the external fixation group had a preoperative ulceration versus 19% (9/47) of the patients in the internal fixation group (p=.19). Preoperative ulceration was not a risk factor for amputation. Forty-two (75%) patients were ambulatory at final follow up. Conclusion: We report on the single largest series of Charcot patients undergoing hindfoot and ankle arthrodesis. The surgical management of this population has a high rate of complications with infection and reoperation being common. Despite a high nonunion rate most patients are able to ambulate in a brace or orthotic. Limb salvage can be expected with either internal or external fixation techniques.

A new internal fixation concept for the distal femoral fracture after total knee arthroplasty

2003 ◽  
Vol 26 (6) ◽  
pp. 803-808
Author(s):  
Chuan‐Mu Chen ◽  
Chan‐Tsung Yang ◽  
Hung‐Wen Wei ◽  
Jiaun‐Jong Liau ◽  
Cheng‐Kung Cheng
Keyword(s):  
Total Knee Arthroplasty ◽  
Internal Fixation ◽  
Knee Arthroplasty ◽  
Femoral Fracture ◽  
Distal Femoral Fracture ◽  
Total Knee

scholarly journals The management of intra-articular lateral femoral condyle (Hoffa) fracture of the knee using arthroscopy-assisted fixation: a case report

2018 ◽  
Vol 6 (11) ◽  
pp. 3759
Author(s):  
I. G. N. Wien Aryana ◽  
Trimanto Wibowo
Keyword(s):  
Internal Fixation ◽  
Femoral Fracture ◽  
Motor Vehicle ◽  
Lateral Condyle ◽  
X Rays ◽  
Distal Femoral Fracture ◽  
X Ray ◽  
Hoffa Fracture ◽  
Limited Range Of Motion ◽  
The Right

A Hoffa fracture is a type of supracondylar distal femoral fracture with fracture line located in the coronal plane. It is a rare injury consisting of tangential (coronal shear) fracture of distal femoral condyles. Unicondylar knee fractures are rare and present some diagnostic difficulties due to poor visibility on standard X-ray and are especially harder to identify in non-displaced fracture. A fifty-four-year-old male presented to our emergency room with a chief complaint of pain over his right knee that started 10 months prior. He previously was involved in a motor vehicle accident and underwent open reduction and internal fixation with plate and screws. Physical examination revealed swelling and tenderness over the right knee with limited range of motion. Plain X-ray showed union of tibia plateau fracture with plate and screws and no evidence of distal femoral fracture. A magnetic resonance imaging of the right knee was performed and revealed an intraarticular lateral condyle femur fracture with transverse configuration that was previously missed on plain X-ray. Arthroscopy-assisted reduction and internal fixation using antero-posterior and postero-anterior oriented screws were performed and good reduction was achieved. Diagnosis of this type of fracture is challenging and require some experience. Awareness of such entity and strong clinical suspicion are essential for diagnosis because most of the time the standard X-rays may appear normal. Arthroscopy-assisted fracture fixation using antero-posterior and postero-anterior oriented screws for Hoffa fracture offers many advantages and allows for early mobilization postoperatively without any loss of reduction.

scholarly journals Surgical treatment for patients with hemophilic pseudotumor-related femoral fracture: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Keyu Chen ◽  
Guiyong Jiang ◽  
Yaowen Xu ◽  
Yunping Yang ◽  
Zexiong Mao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
Femoral Fracture ◽  
Mechanical Stability ◽  
Demographic Data ◽  
Femoral Fractures ◽  
Fracture Stabilization ◽  
The Mean

Abstract Background Hemophilic pseudotumor (HPT)-related fracture is a rare but severe complication in patients with HPTs. These fractures often occur in femurs. There is no consensus on the standard surgical protocol for HPT-related femoral fracture. The present retrospective study evaluated the outcomes of these patients treated with surgical interventions. Methods Ten patients with HPT-related femoral fractures who were treated with 14 surgical procedures due to 11 fractures in our hospital from January 2014 to April 2020 were evaluated retrospectively. Demographic data, fracture location, complications after surgery, and follow-up outcomes were recorded and analyzed. The mean follow-up period was 39.7 months. Results The mean age at surgery was 31 years. Closed reduction external fixation (CREF) was originally performed in 2 patients, open reduction internal fixation (ORIF) was performed in 4 patients, screw fixation alone was performed in 1 patient, brace immobilization was performed in 1 patient, and amputation was performed in 3 patients. Bone union was observed in 5 patients, and an adequate callus was visible in 2 patients. Both patients with CREF had pin infections. Nonunion combined with external fixation (EF) failure occurred in 1 patient, and the plate was broken after ORIF. Three patients underwent autogenous or allogeneic cortical strut grafting. Three patients had HPT recurrence. Conclusions It is necessary to perform surgery in patients with HPT-related femoral fractures. Surgical treatments must consider fracture stabilization and HPT resection. Internal fixation is preferable, and EF should only be used for temporary fixation. If the HPT erodes more than one third of the bone diameter, strut grafts are necessary for mechanical stability. Amputation is an appropriate curative method in certain situations.

scholarly journals Surgical Treatment for Patients With Hemophilic Pseudotumor-Related Femoral Fracture: A Retrospective Study

2020 ◽  
Author(s):  
Keyu Chen ◽  
Guiyong Jiang ◽  
Yaowen Xu ◽  
Yunping Yang ◽  
Zexiong Mao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
Femoral Fracture ◽  
Mechanical Stability ◽  
Demographic Data ◽  
Femoral Fractures ◽  
Surgical Interventions ◽  
Fracture Stabilization

Abstract Purpose: Hemophilic pseudotumor (HPT)-related fracture is a rare but severe complication in patients with HPTs. These fractures often occur in femurs. There is no consensus on the standard surgical protocol for HPT-related femoral fracture. The aim of this retrospective study is to evaluate the outcome of these patients treated with surgical interventions.Methods: Ten patients with HPT-related femoral fractures who were treated with 12 surgical procedures in our hospital from Jan 2014 to April 2020 were retrospectively evaluated. Demographic data, fracture location, complications after operation and follow-up outcomes were recorded and analyzed with a mean follow-up period of 39.7 months.Results: Bone union was observed in five patients, an adequate callus was visible in two patients, and three patients underwent amputation. Both of 2 patients with closed reduction external fixation (CREF) had pin infection. Nonunion combined with external fixation (EF) failure occurred in one of whom, and the plate was broken after open reduction internal fixation. Three patients underwent autogenous or allogeneic cortical strut grafting. Three patients had HPT recurrence.Conclusion: It is necessary to perform surgery in patients with HPT-related femoral fractures. Surgical treatments must take both fracture stabilization and HPT resection into account. Internal fixation is preferable and EF should be dismissed unless for the purpose of temporary fixation. If the HPT erodes more than one-third of the bone diameter, struct grafts are necessary for mechanical stability. Amputation is a proper curative method in certain situations.

Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

2020 ◽  
Author(s):  
Hongfeng Sheng ◽  
Weixing Xu ◽  
Bin Xu ◽  
Hongpu Song ◽  
Di Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Theoretical Basis ◽  
New Technology ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

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