scholarly journals Comparison of Atypical and Osteoporotic Femoral Shaft Fractures in the Elderly: A Multicenter Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Takanori Miura ◽  
Hiroaki Kijima ◽  
Noriyuki Ishikawa ◽  
Toshihito Ebina ◽  
Takayuki Tani ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Bone Healing ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
High Energy ◽  
Healing Time ◽  
Atypical Femoral Fractures ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

Background. In atypical femoral fractures, owing to the high rates of complications and delayed healing that accompany the plate fixation, the most favorable treatment is intramedullary nailing. Although there is insufficient evidence, plate fixation is chosen due to anterolateral bowing of the femur. This study compared the bone healing time and rates of complications in atypical femoral shaft fractures and osteoporotic femoral shaft fractures. Methods. We searched the medical records of 3 institutions in Japan for patients with femoral shaft fractures who visited between 1 January 2010 and 31 December 2015. We identified 65 patients and excluded 37 among these due to high-energy injuries or being younger than 65 years. Among the remaining patients, we identified 17 and 11 women with atypical (AFF group) and osteoporotic femoral shaft fractures (OP group), respectively. Results. In surgical method, there were differences in intramedullary nailing (94.1% versus 27.2%) (p<0.01). The mean bone healing time was 11.1 months versus 6.7 months in 2 groups (p<0.01). Iatrogenic femoral fractures during intramedullary nail insertion were observed in both groups, and reoperation was only seen in atypical femoral fractures treated with a plate fixation, but there was no difference in the rate of complications (23.5% versus 9.1%). Conclusions. In the atypical femoral fracture group, intramedullary nailing was more chosen, but the bone healing time was delayed and plate fixation cases needed reoperation. There was no significant difference in the rate of complications between the 2 groups.

scholarly journals The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

2020 ◽  
Author(s):  
Zhaofeng Jia ◽  
Shijin Wang ◽  
Tinghui Xiao ◽  
Wei Jiang ◽  
Tianjian Zhou ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Lateral Displacement ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Limb Length Discrepancy ◽  
Bony Union ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Lateral Displacements

Abstract Background: Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopaedic traction table. However, lateral displacement and angulation persist. Methods: In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results: The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, nonunion, malunion and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion: Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

scholarly journals The Epidemiology of Adult Distal Femoral Shaft Fractures in a Central London Major Trauma Centre Over Five Years

2017 ◽  
Vol 11 (1) ◽  
pp. 1277-1291 ◽  
Author(s):  
Akib Majed Khan ◽  
Quen Oat Tang ◽  
Dominic Spicer
Keyword(s):  
Major Trauma ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
High Energy ◽  
Locking Plates ◽  
Mechanism Of Injury ◽  
Femoral Shaft Fractures ◽  
Technical Requirements ◽  
Shaft Fractures ◽  
Major Trauma Centre

Background:Distal femoral fractures account for 3-6% of adult femoral fractures and 0.4% of all fractures and are associated with significant morbidity and mortality rates. As countries develop inter-hospital trauma networks and adapt healthcare policy for an aging population there is growing importance for research within this field.Methods:Hospital coding and registry records at the central London Major Trauma Center identified 219 patients with distal femoral shaft fractures that occurred between December 2010 and January 2016. CT-Scans were reviewed resulting in exclusion of 73 inappropriately coded, 10 pediatric and 12 periprosthetic cases. Demographics, mechanism of injury, AO/OTA fracture classification and management were analyzed for the remaining 124 patients with 125 fractures. Mann Whitney U and Chi Squared tests were used during analyses.Results:The cases show bimodal distribution with younger patients being male (median age 65.6) compared to female (median age 71). Injury caused through high-energy mechanisms were more common in men (70.5%) whilst women sustained injuries mainly from low-energy mechanisms (82.7%) (p<0.0001). Majority of fractures were 33-A (52.0%) followed by 33-B (30.4%) and 33-C (17.6%). Ninety-two (73.6%) underwent operative management. The most common operation was locking plates (64.1%) followed by intramedullary nailing (19.6%).Interpretation:The epidemiology of a rare fracture pattern with variable degrees of complexity is described. A significant correlation between biological sex and mechanism of injury was identified. The fixation technique favored was multidirectional locking plates. Technical requirements for fixation and low prevalence of 33-C fractures warrant consideration of locating treatment at centers with high caseloads and experience.

A Comparative Study between Intramedullary Fixation and External Fixation of Femur Shaft Fracture in Polytrauma Patients in Jharkhand

2021 ◽  
Vol 8 (32) ◽  
pp. 2933-2937
Author(s):  
Supantha Panja
Keyword(s):  
Comparative Study ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
Complication Rate ◽  
Gold Standard ◽  
Femoral Shaft ◽  
High Energy ◽  
Definitive Treatment ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

BACKGROUND Femoral shaft fractures result from high energy trauma and maybe associated with life threatening conditions. Typical in younger people is associated with polytrauma. Though intramedullary nailing (IMN) is the gold standard option of treatment, external fixation (EF) can also be used temporarily or definitively, in such cases. The aim of this study was to compare the functional outcome of these two procedures. METHODS This prospective comparative study was conducted at our centre over a period of 6 years. Age, sex of the patients, laterality, type of fracture with mean follow up, union time, and complications such as delayed union, angular deformities, and limb length discrepancies were tabulated and compared. RESULTS There were more cases of open fractures in the EF group compared to IMN group. In the IMN group the average surgery duration was 95.76 minutes and it was 69.4 minutes in the EF group. The average time for bone union was 25.66 weeks in IMF group and 28.22 weeks in EF group. Complication rate was higher in EF group with 11 complications (7 major & 4 minor) compared to IMN group with only 6 cases presenting with complications (3 each of major & minor). CONCLUSIONS Though IMN is the gold standard in treatment of femoral shaft fractures, EF in polytrauma is an alternative method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate. KEYWORDS Femoral Shaft Fractures, Intramedullary Nailing, External Fixation, Polytrauma, Definitive Treatment

scholarly journals A study on role of intramedullary interlocking nailing in the complex femoral shaft fractures

2019 ◽  
Vol 5 (5) ◽  
pp. 843
Author(s):  
Veera Kumaran ◽  
Sachidhanandham .
Keyword(s):  
Weight Bearing ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
High Energy ◽  
Rotational Stability ◽  
Full Weight Bearing ◽  
Care Hospital ◽  
Femoral Shaft Fractures ◽  
Interlocking Nailing ◽  
Shaft Fractures

<p class="abstract"><strong>Background:</strong> Fractures of the shaft of the femur are a major cause of morbidity and mortality in patients who sustain high energy trauma. Morbidity arises from limb shortening, malalignment, knee contractures and other complications of fracture.</p><p class="abstract"><strong>Methods:</strong> The aim of our study is to analyze the results of complex femoral shaft fractures treated by intramedullary interlocking nailing in our institution. Totally 20 cases of complex femoral fractures from 2007-2009 were treated with intramedullary interlocking at Krishanakumar Orthopedic Care Hospital, Nagercoil were included in our study.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that fracture of femur is most common in 2nd, 3rd and 4th decade of life, with mean age of 35.85 years. Vehicular accident in 17 patients was observed to be the main cause of fracture in our series (85%). 4 patients started full weight bearing at 10th week, 9 patients were able to bear full weight at 12th week, 4 patients at 14th week and 2 at 16th week. Average time of full weight bearing was 12.4 weeks. One patient developed deep infection (osteomyelitis) at 12 weeks and later non union was seen and unable to bear full weight.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary interlocking nailing for complex femoral fractures has been established worldwide as the gold standard treatment because of its load sharing property, internal splinting, and rotational stability. These contribute the stable osteosynthesis.</p><p class="abstract"> </p>

scholarly journals The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

2020 ◽  
Author(s):  
Zhaofeng Jia ◽  
Shijin Wang ◽  
Tinghui Xiao ◽  
Wei Jiang ◽  
Tianjian Zhou ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Lateral Displacement ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Limb Length Discrepancy ◽  
Bony Union ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Lateral Displacements

Abstract Background Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopaedic traction table. However, lateral displacement and angulation persist. Methods In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, nonunion, malunion and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

scholarly journals Osteogenesis and Histostructure of Femoral Muscles When Modeling a Femoral Fracture with Immediate or Delayed Osteosynthesis Using an Interlocking Intramedullary Antegrade Rod

Biomeditsina ◽  
2020 ◽  
pp. 78-88
Author(s):  
G. N. Filimonova ◽  
N. I. Antonov ◽  
A. A. Emanov
Keyword(s):  
Bone Healing ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Biceps Femoris ◽  
Quadriceps Femoris ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Group I ◽  
Intramedullary Rod ◽  
Group Ii

Interlocked intramedullary osteosynthesis is the most common method for treating femoral shaft fractures. The aim — to reveal specifi c characteristics of the histostructure of canine femoral muscles when healing femoral fractures under osteosynthesis using interlocking intramedullary reinforcement with an antegrade metal rod. Femoral shaft fractures were modelled in 9 mongrel dogs. The fractures were fi xed with an intramedullary rod. In Group I (n=4), osteosynthesis was started immediately after bone injury. In Group II (n=5), osteosynthesis was started 4 days after fracture (delayed osteosynthesis). M. biceps femoris and M. quadriceps femoris were studied. In Group I and Group II, bone healing occurred following 42 and 70 days, respectively. A unifi ed bone marrow cavity and cortical layer had been formed by day 70 and day 100 in Group I and Group II, respectively. The histostructure of M. quadriceps femoris in Group I remained largely unchanged throughout the experiment, while M. biceps femoris underwent the process of structural reorganization on days 42 and 70 of the experiment. The Group of delayed osteosynthesis demonstrated changes in the histostructure of both muscles, including an increased diversity of fi bre diameters, an increased number of nuclei in myocytes, fi brosis of the interstitial space and perimysial arterial vessels. These changes were more pronounced in M. biceps femoris. Three months after injury, the histostructure of the muscles under study, even in the Group of delayed osteosynthesis, had no signifi cant differences and tended to the intact norm. In femoral fractures, the earliest possible fi xation of bone fragments with an inter locking antegrade intramedullary rod is recommended. A complete bone healing in such cases occurs a month earlier than in those with delayed osteosynthesis. The femoral muscles of the anterior group are injured to a lesser extent than those of the posterior group.

scholarly journals Adverse Events following Intramedullary Nailing in Metastatic Pathological versus Non-Pathological Femoral Shaft Fractures: A Retrospective Comparative Study

2021 ◽  
Author(s):  
Chirathit Anusitviwat ◽  
Khanin Iamthanaporn ◽  
Pakjai Tuntarattanapong ◽  
Boonsin Tangtrakulwanich ◽  
Tippawan Liabsuetrakul
Keyword(s):  
Regression Analysis ◽  
Adverse Events ◽  
Intramedullary Nailing ◽  
Multivariate Logistic Regression Analysis ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Multivariate Regression Analysis ◽  
Pathological Fractures ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

Abstract Background: Antegrade intramedullary nailing is indicated for treating metastatic pathological femoral shaft fractures. Although good functional outcomes could be obtained from internal fixation, postoperative adverse events have been reported in patients with pathological fractures and non-pathological fractures. Not only adverse events but also their consequences including, readmission and reoperation, need to be considered. Few studies have assessed the risk of postoperative adverse events, reoperation, and readmission without comparison. Therefore, this study aimed to compare the risk of in-hospital adverse events and consequences after discharge between patients with metastatic pathological and non-pathological femoral fractures undergoing intramedullary nailing.Methods: We conducted a retrospective study by extracting records from the Hospital Information System database. We accessed patients with pathological metastatic pathological and non-pathological femoral shaft fractures undergoing intramedullary nailing by the International Classification of Diseases code; from June 2006 to 2020. We then tracked the in-hospital medical and surgical adverse events postoperatively, along with the consequences after discharge. The in-hospital adverse events risk between the two groups of patients were analyzed and compared by multivariate logistic regression analysis.Results: Included patients consisted of 48 in pathological groups and 185 in non-pathological groups. Significantly higher rates of surgical and medical adverse events in patients with pathological fractures compared to patients with non-pathological fractures were observed. After adjusting for potential confounding factors in multivariate regression analysis, patients with pathological fractures had higher odds of both adverse surgical (adjusted OR 2.43, 95% CI 1.15 - 5.13) and medical adverse events (adjusted OR 2.81, 95% CI 1.13 - 7.03).Conclusions: Patients with metastatic pathological femoral shaft fractures undergoing intramedullary nailing were more likely to experience postoperative adverse events than patients with non-pathological fractures.

scholarly journals Complications after intramedullary nail fixation of pathological versus non-pathological femoral shaft fractures: a retrospective cohort study in 233 patients

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Chirathit Anusitviwat ◽  
Khanin Iamthanaporn ◽  
Pakjai Tuntarattanapong ◽  
Boonsin Tangtrakulwanich ◽  
Tippawan Liabsuetrakul
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Intramedullary Nailing ◽  
Pathological Fracture ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Pathological Fractures ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Pathological Group

Abstract Background Postoperative adverse events after intramedullary nailing have been reported in patients with metastatic pathological and non-pathological femoral fractures. Other consequences to be considered are readmission and reoperation. Few studies have compared the risks of postoperative adverse events, reoperation, and readmission after intramedullary nailing of pathological and non-pathological femur fractures. This study was designed to test the hypothesis that patients with pathological femoral fractures had more adverse events, readmission, and reoperation following surgical fixation than non-pathological femoral fractures. Methods This was a retrospective observational cohort study, conducted at an academic medical center in Thailand. The data from patients with femoral shaft fractures undergoing long intramedullary nailing, from June 1, 2006, to June 30, 2020, were included. Patients who had a pathological fracture from a primary bone tumor, metabolic bone disease, or inadequate/missing information were excluded. Patients with pathological fractures from metastatic bone disease were assigned to be the pathological group whereas those with traumatic fractures were assigned to be the non-pathological group. The primary outcome was the risk of inpatient adverse events as compared between the two groups. The secondary outcome was the risk of consequences after discharge as compared between the two groups. Outcomes were analyzed by using multivariate logistic regression analysis. Results The total number of patients was 48 in the pathological fracture group and 185 in the non-pathological group. There were significantly higher rates of surgical and medical adverse events in patients with pathological fractures compared to patients with non-pathological fractures. After adjusting for potential confounding factors in multivariate regression analysis, patients with pathological fractures had higher odds of both adverse surgical (adjusted OR 2.43, 95 % CI 1.15–5.13) and medical adverse events (adjusted OR 2.81, 95 % CI 1.13–7.03). Conclusions Patients with metastatic pathological femoral shaft fractures undergoing intramedullary nailing were more likely to experience postoperative adverse events than patients with non-pathological fractures.

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