Antegrade Nailing for Midshaft Femur Fractures

BACKGROUND According to WHO, It has been reported that there has been a rise in road traffic accidents globally due to many factors. Consequently this has contributed to an increase in fracture of the femur in hospitals. The annual incidence of these Fractures has been estimated to be 10 per 100,000 persons and this incidence has been noticed to be higher among the youths decreasing after the age of 40 and then increasing in the elderly. These fractures are either managed conservatively or operatively. OBJECTIVE the aim of this study was to determine if there is a significant difference in knee joint functional outcome in patients with femur shaft fractures managed operatively and conservatively at Ndola Teaching Hospital at the orthopedics clinic and physiotherapy. This in future might help to place emphasis on government to sensitize the right measures needed to improve on the functional outcome of a knee joint in patients with femur fracture who are treated operatively or conservatively METHODS the method used for the study was a complete enumeration of all patients with femur fractures that were admitted at orthopedic ward, visited the orthopedic clinic and physiotherapy sessions at NTH between the period of July 2019 to September 2019. Data collected will be analyzed using a statistical data software called Statistical Package of Social Sciences (SPSS). The independent variable that will be considered in the study are age, DOI, DOA, femur shaft fractures, treatment and others that that will meet the selection Criteria. The dependent variable will be “Knee Joint Functional Outcome”. RESULTS Results did not show statistically significant difference in knee functional outcome for two methods (conservative or operative). In the current study it was noted that there was much reduction in swelling in the operative in comparison to the conservative group. We may therefore conclude that the operative management promises a better outcome especially when done on time. However it seemed the operative procedure was not preferred for any conservative approach however the study has shown an in depth feasibility study to affirm such findings in order to inform on policy or management paradigim shift. CONCLUSIONS There is need for further intervention in the management of femur fracture which complicates to poor knee joint function

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Correction to: Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-019-02488-2 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1835-1836

Author(s):

Prasoon Kumar ◽

Rajesh Kumar Rajnish ◽

Deepak Neradi ◽

Vishal Kumar ◽

Saurabh Agarwal ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Review Of Literature ◽

Neck Of Femur ◽

Femur Fractures

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Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study

BMJ Open ◽

10.1136/bmjopen-2020-039960 ◽

2021 ◽

Vol 11 (5) ◽

pp. e039960

Author(s):

Michael Blauth ◽

Alexander Joeris ◽

Elke Rometsch ◽

Kathrin Espinoza-Rebmann ◽

Pannida Wattanapanom ◽

...

Keyword(s):

Adverse Events ◽

Multicentre Study ◽

Usual Care ◽

Proximal Femur ◽

Interdisciplinary Treatment ◽

Proximal Femur Fracture ◽

Geriatric Fracture ◽

Femur Fractures ◽

Prospective Multicentre Study ◽

Registration Number

ObjectiveThe aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.DesignCohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SettingInternational (six countries, three continents) multicentre study.Participants281 patients aged ≥70 with operatively treated proximal femur fractures.InterventionsTreatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.Outcome measuresPrimary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.ResultsPatients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).ConclusionsContrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.Trial registration numberClinicalTrials.gov: NCT02297581.

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A comparison between Asians and Caucasians in the dimensions of the femoral isthmus based on a 3D-CT analysis of 1189 adult femurs

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01740-x ◽

2021 ◽

Author(s):

Darius M. Thiesen ◽

Dimitris Ntalos ◽

Alexander Korthaus ◽

Andreas Petersik ◽

Karl-Heinz Frosch ◽

...

Keyword(s):

Proximal Femur ◽

Strong Predictor ◽

Matched Pair ◽

3D Ct ◽

Femur Fractures ◽

Matched Pair Analysis ◽

Significant Difference ◽

Ct Analysis ◽

Ct Data ◽

The Individual

Abstract Introduction For successful intramedullary implant placement at the femur, such as nailing in unstable proximal femur fractures, the use of an implant that at least reaches or exceeds the femoral isthmus and yields sufficient thickness is recommended. A number of complications after intramedullary femoral nailing have been reported, particularly in Asians. To understand the anatomical features of the proximal femur and their ethnic differences, we aimed to accurately calculate the femoral isthmus dimensions and proximal distance of Asians and Caucasians. Methods In total, 1189 Asian and Caucasian segmented 3D CT data sets of femurs were analyzed. The individual femoral isthmus diameter was precisely computed to investigate whether gender, femur length, age, ethnicity or body mass index have an influence on isthmus diameters. Results The mean isthmus diameter of all femurs was 10.71 ± 2.2 mm. A significantly larger diameter was found in Asians when compared to Caucasians (p < 0.001). Age was a strong predictor of the isthmus diameter variability in females (p < 0.001, adjusted r2 = 0.299). With every year of life, the isthmus showed a widening of 0.08 mm in women. A Matched Pair Analysis of 150 female femurs showed a significant difference between isthmus diameter in Asian and Caucasian femurs (p = 0.05). In 50% of the cases the isthmus was found in a range of 2.4 cm between 16.9 and 19.3 cm distal to the tip of the greater trochanter. The female Asian femur differs from Caucasians as it is wider at the isthmus. Conclusions In absolute values, the proximal isthmus distance did not show much variation but is more proximal in Asians. The detailed data presented may be helpful in the development of future implant designs. The length and thickness of future standard implants may be considered based on the findings.

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Bone Nano‐mechanical Properties and Relationship to Bone Turnover and Architecture in Patients with Atypical Femur Fractures: A Prospective Nested Case–Control Study

JBMR Plus ◽

10.1002/jbm4.10523 ◽

2021 ◽

Author(s):

LV Griffin ◽

E Warner ◽

S Palnitkar ◽

S Qiu ◽

M Honasoge ◽

...

Keyword(s):

Mechanical Properties ◽

Bone Turnover ◽

Case Control Study ◽

Case Control ◽

Femur Fractures ◽

Atypical Femur Fractures ◽

Nested Case Control ◽

Control Study

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Periprosthetic Joint Infection Prophylaxis in the Elderly after Hip Hemiarthroplasty in Proximal Femur Fractures: Insights and Challenges

Antibiotics ◽

10.3390/antibiotics10040429 ◽

2021 ◽

Vol 10 (4) ◽

pp. 429

Author(s):

Dolors Rodríguez-Pardo ◽

Laura Escolà-Vergé ◽

Júlia Sellarès-Nadal ◽

Pablo S. Corona ◽

Benito Almirante ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Antimicrobial Prophylaxis ◽

Joint Infection ◽

Asymptomatic Bacteriuria ◽

Infection Prophylaxis ◽

Beta Lactam ◽

Hip Hemiarthroplasty ◽

Femur Fractures ◽

Published Evidence ◽

Prophylactic Measures

We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely used agent and is replaced by clindamycin or a glycopeptide in beta-lactam allergies. A personalized antibiotic scheme may be considered when colonization by a multidrug-resistant microorganism (MDRO) is suspected. Particularly in methicillin-resistant Staphylococcus aureus (MRSA) colonization or a high prevalence of MRSA-caused PJIs a glycopeptide with cefazolin is recommended. Strategies such as cutaneous decolonization of MDROs, mainly MRSA, or preoperative asymptomatic bacteriuria treatment have also been addressed with debatable results. Some areas of research are early detection protocols in MDRO colonizations by polymerase-chain-reaction (PCR), the use of alternative antimicrobial prophylaxis, and antibiotic-impregnated bone cement in HHA. Given that published evidence addressing PJI prophylactic strategies in PFFs requiring HHA is scarce, PJIs can be reduced by combining different prevention strategies after identifying individuals who will benefit from personalized prophylaxis.

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Union rates and functional outcome of double plating of the femur: systematic review of the literature

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03767-6 ◽

2021 ◽

Author(s):

M. F. Lodde ◽

M. J. Raschke ◽

J. Stolberg-Stolberg ◽

J. Everding ◽

S. Rosslenbroich ◽

...

Keyword(s):

Systematic Review ◽

Fracture Healing ◽

Functional Outcome ◽

Femoral Fractures ◽

Periprosthetic Fractures ◽

Level Of Evidence ◽

Distal Femoral Fractures ◽

Femur Fractures ◽

Meta Analyses ◽

Double Plating

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

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