Reconstruction of Distal Intercondylar Femoral Fractures with Limited Internal Fixation and Ilizarov Tensioned-Wire External Fixation

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.

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

10.21203/rs.3.rs-129858/v1 ◽

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.

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Compensatory Tibial Overgrowth Following Healing of Closed Femoral Fractures in Young Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632448 ◽

1995 ◽

Vol 08 (03) ◽

pp. 159-162 ◽

Cited By ~ 7

Author(s):

L. Susan ◽

R. T. O’Brien ◽

K. A. Johnson

Keyword(s):

Internal Fixation ◽

Femoral Fractures ◽

Surgical Reduction ◽

Femoral Shortening ◽

Hindlimb Lameness ◽

Femoral Condyles

SummaryTwo young dogs examined for hindlimb lameness were found to have healed femoral fractures, 2-4 cm of femoral shortening, and 1 cm of compensatory ipsilateral tibial overgrowth. Neither dog had had surgery or internal fixation. Although tibial overgrowth partially corrected for limb shortening, both dogs had chronic intermittent lameness due to malformation of the femoral condyles and secondary stifle osteoarthritis.Compensatory tibial overgrowth was found in two young dogs with femoral fractures which had healed without any surgical reduction or internal fixation. Tibial overgrowth of approximately 1 cm in each case partially compensated for 2-4 cm of femoral shortening.

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

10.2196/preprints.20711 ◽

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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Fracture fixation strategy and specific muscle tissue availability of neutrophilic granulocytes following mono- and polytrauma: intramedullary nailing vs. external fixation of femoral fractures

European Journal of Medical Research ◽

10.1186/s40001-020-00461-y ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Johannes Greven ◽

Klemens Horst ◽

Zhi Qiao ◽

Felix Marius Bläsius ◽

Ümit Mert ◽

...

Keyword(s):

Clinical Practice ◽

External Fixation ◽

Intramedullary Nailing ◽

Muscle Tissue ◽

Femur Fracture ◽

Femoral Fractures ◽

Pig Model ◽

Minor Role ◽

Neutrophil Granulocytes ◽

Concomitant Injuries

Abstract Background In the stabilization of femoral fractures in mono- and polytrauma, clinical practice has shown better care through intramedullary nailing. However, the reason why this is the case is not fully understood. In addition to concomitant injuries, the immunological aspect is increasingly coming to the fore. Neutrophil granulocytes (PMNL), in particular next to other immunological cell types, seem to be associated with the fracture healing processes. For this reason, the early phase after fracture (up to 72 h after trauma) near the fracture zone in muscle tissue was investigated in a pig model. Material and methods A mono- and polytrauma pig model (sole femur fracture or blunt thoracic trauma, hemorrhagic shock, liver laceration, and femur fracture) was used to demonstrate the immunological situation through muscle biopsies and their analysis by histology and qRT-PCR during a 72 h follow-up phase. Two stabilization methods were used (intramedullary nail vs. external fixator) and compared with a nontraumatized sham group. Results Monotrauma shows higher PMNL numbers in muscle tissue compared with polytrauma (15.52 ± 5.39 mono vs. 8.23 ± 3.36 poly; p = 0.013), regardless of the treatment strategy. In contrast, polytrauma shows a longer lasting invasion of PMNL (24 h vs. 72 h). At 24 h in the case of monotrauma, the fracture treated with external fixation shows more PMNL than the fracture treated with intramedullary nailing (p = 0.026). This difference cannot be determined in polytrauma probably caused by a generalized immune response. Both monotrauma and polytrauma show a delayed PMNL increase in the muscle tissue of the uninjured side. The use of intramedullary nailing in monotrauma resulted in a significant increase in IL-6 (2 h after trauma) and IL-8 (24 and 48 h after trauma) transcription. Conclusion The reduction of PMNL invasion into the nearby muscle tissue of a monotrauma femur fracture stabilized by intramedullary nailing supports the advantages found in everyday clinical practice and therefore underlines the usage of nailing. For the polytrauma situation, the fixation seems to play a minor role, possibly due to a generalized immune reaction.

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