scholarly journals Violation of consolidation of the femur after untimely dynamization of the intramedullary blocking rod

2021 ◽  
pp. 69-72
Author(s):  
Diomyd Chabanenko ◽  
Oleksandr Polіvoda
Keyword(s):  
Femoral Fracture ◽  
Distal Part ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Joint Control ◽  
Posterior View ◽  
Intramedullary Osteosynthesis ◽  
Fracture Consolidation ◽  
The Right

Violation of femoral fracture consolidation after blocking intra­medullary osteosynthesis is a fairly common pathology, and requires the attention of physicians due to its prevalence. There are several reasons for this complication: it is the instabi­lity in the system «bone-implant», and the untimely dynamization of the locking nail. Methods. This article presents a case of fracture violated consolidation after blocking intramedullary osteosynthesis caused a nonunion due to nail failure. Results. Patient was injured on 29.12.2018, as a result of a traffic accident. 01.15.2019, the surgery was performed:  closed reduction, blocking intramedullary osteosynthesis of the fracture of the middle shaft of the right thigh, static fixation of the nail. Next visit to the clinic was on 02.01.2020, because of pain in the middle third of the thigh, problems with axial weight-bearing on the right leg, limitation of the flexion in the right knee joint. Control radiographs demonstrated no signs of consolidation of the femoral shaft fracture, and migration of the distal locking screw. 08.01.2020 revision surgical treatment was performed. Given the presence of 5 mutually perpendicular holes in the distal part of the nail, two of them were locked in the anterio-posterior view by the free hand method, the migrated screw in the distal part of the nail was replaced, and the nail was dynamized in the proximal part taking into account its design features. Conclusions. To normalize the consolidation processes in patients with nonunion femoral fractures, bone physiology and the positive effect of autocompression should be considered. The described case demonstrates the necessity for timely dynamization of the blocking nail, which confirms our own observations and literature data. Despite the fact that the dynamization of the nail was performed 1 year after blocking intramedullary osteosynthesis, fracture consolidation occurred 5 months after its implementation. Key words. Femoral fracture, blocked intramedullary osteosynthesis, disorders consolidation, dynamization of the construction.

scholarly journals A Suspicious Atypical Fracture of 5th Metatarsal Bone: A Case Report

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Byeong-Seop Park ◽  
Seungbum Koo ◽  
Won-keun Park ◽  
Ki-bum Kwon ◽  
Kyoung Min Lee
Keyword(s):  
Callus Formation ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Metatarsal Bone ◽  
Atypical Fracture ◽  
Atypical Fractures ◽  
Strenuous Activity ◽  
History Of ◽  
Surgical Fixation ◽  
The Right

Category: Trauma Introduction/Purpose: Long-term usage of bisphosphonate can severely suppress bone turnover and alter bone mechanical properties, thereby resulting in atypical fractures that mainly occur at the femur.We present a rare case of suspicious atypical fracture of the metatarsal bone. Methods: A 63-year-old woman presented to our clinic with a primary complain of a one-week history of pain in her right foot. The patient had no history of trauma to the right foot and denied any strenuous activity. She experienced lateral foot pain while walking within her home. She was on alendronate therapy for osteoporosis for a decade. X ray and CT examination revealed a fifth metatarsal fracture whose features were compatible with those of atypical femoral fractures (Figure 1). Results: The patient was advised to discontinue alendronate and underwent percutaneous surgical fixation of the fracture via a proximal approach using a 4.0-mm half-threaded cannulated screw. Postoperatively, a short leg cast was created and the patients performed non-weight bearing ambulation until the cast was removed at the sixth postoperative week. Radiography in the sixth postoperative week revealed callus formation. Conclusion: Our findings suggest that physicians must keep in mind that atypical fractures could possibly occur at bones other than the femur.

scholarly journals Pseudoaneurysm of the superficial femoral artery after retrograde intramedullary nailing for a supracondylar femoral fracture

2014 ◽  
Vol 96 (7) ◽  
pp. e1-e3 ◽  
Author(s):  
Ryosuke Hirota ◽  
Makoto Emori ◽  
Toshiro Ito ◽  
Kota Watanabe ◽  
Akira Hirano ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Femoral Fracture ◽  
Surgical Repair ◽  
Vascular Complications ◽  
Femoral Fractures ◽  
Supracondylar Femoral Fracture ◽  
Bony Fragment ◽  
The Right ◽  
Enhanced Computed Tomography

Vascular complications of distal femoral fractures are rare but can have disastrous consequences if not recognised and treated promptly. We present the case of a 55-year-old woman who developed a pseudoaneurysm of the superficial femoral artery after osteosynthesis to repair a supracondylar femoral fracture. Eight weeks after surgery, swelling of the right thigh persisted and was accompanied by severe pain. Enhanced computed tomography revealed a pseudoaneurysm in the medial aspect of the affected thigh. Open surgical repair was performed by direct arterial suture. Although the true aetiology of the development of the pseudoaneurysm is unknown, a bony fragment from the reduction manoeuvre may have damaged the adventitia of the superficial femoral artery. In cases of continuous thigh swelling after osteosynthesis to repair a supracondylar femoral fracture, a diagnosis of pseudoaneurysm should be considered and treatment should be initiated immediately.

scholarly journals Bisphosphonate-Induced Periprosthetic Fracture: A Cause of Painful Total Hip Arthroplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Rahul Bhattacharyya ◽  
Stephanie Spence ◽  
Gavin O’Neill ◽  
Kumar Periasamy
Keyword(s):  
Periprosthetic Fracture ◽  
Weight Bearing ◽  
Femoral Shaft ◽  
Interesting Case ◽  
X Rays ◽  
Mri Scan ◽  
Total Hip ◽  
Important Addition ◽  
The Right

Background. Cases have been reported in the literature of periprosthetic fractures associated with the use of bisphosphonates occurring in the long term following a Total Hip Replacement (THR). We report an interesting case of periprosthetic fracture secondary to bisphosphonate use only a few months after a THR.Case Report. A 72-year-old lady (on bisphosphonates for 10 years) underwent a THR for osteoarthritis. She was pain-free in the first four months postoperatively. Thereafter, she developed spontaneous onset of pain in the lateral aspect of her thigh and groin and found it difficult to weight-bear. X-rays and blood tests were unremarkable. An ultrasound and MRI scan showed no evidence of effusion/collection or periprosthetic fracture. A radionuclide bone scan showed an abnormal appearance of the right femoral shaft. A subsequent CT scan showed an oblique vertical split on the anterior surface of the upper right femoral shaft. This stress fracture was managed nonoperatively with protected weight bearing. She has progressed well with good clinical and radiological signs of fracture healing.Conclusion. This case is an important addition to our knowledge that bisphosphonate-induced periprosthetic stress fractures can be a cause of hip pain only a few months following a THR.

scholarly journals A comparative study of surgical management of subtrochanteric fractures in children

2012 ◽  
Vol 11 (2) ◽  
pp. 91-97
Author(s):  
Ramji Lal Sahu ◽  
Pratiksha Gupta
Keyword(s):  
Femoral Fracture ◽  
Weight Bearing ◽  
Medical Science ◽  
Femoral Fractures ◽  
Long Bone ◽  
Full Weight Bearing ◽  
Entry Site ◽  
Early Weight Bearing ◽  
Fractures In Children ◽  
Mean Time

Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result.DOI: http://dx.doi.org/10.3329/bjms.v11i2.9664 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 91-97

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 Fraturas Atípicas do Fémur Associadas a Terapêutica Prolongada com Bisfosfonatos

2013 ◽  
Vol 26 (6) ◽  
pp. 746
Author(s):  
Francisco Flores Santos ◽  
José Pinheiro da Silva ◽  
Paulo Felicíssimo
Keyword(s):  
Femoral Fracture ◽  
Scientific Evidence ◽  
Femoral Fractures ◽  
Osteoporotic Fractures ◽  
Femoral Shaft ◽  
Term Treatment ◽  
Atypical Femoral Fractures ◽  
Long Term Treatment

Introduction: Long-term treatment with bisphosphonates has been associated to atypical femoral fractures whose features are now clearly defined.Clinical Cases: We present two cases of female patients under bisphosphonate treatment for over 10 years who were admitted to our institution for subtrochanteric and femoral shaft fractures after low-energy trauma. They presented, respectively, a transverse and a short oblique femoral fracture, with thickening of the lateral cortex. They underwent surgical treatment obtaining good functional and imaging result.Discussion: These cases fulfill the established criteria for atypical femoral fracture, thereby illustrating a serious adverse event of long-term treatment with bisphosphonates. Such relationship has still not been clearly established by scientific evidence. However, its effectiveness in preventing osteoporotic fractures is well proven.Conclusion: The atypical femoral fractures are possibly a serious adverse effect of the long-term treatment with bisphosphonates. Scientific evidence still supports its use, however, the physician must be aware of these events and closely follow-up these patients.

scholarly journals Diaphyseal Femoral Fractures in Children: Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management

2018 ◽  
Vol 12 (1) ◽  
pp. 435-444
Author(s):  
Las J. Hwaizi ◽  
Areewan MS. Saeed ◽  
Mustafa N. Mahmood
Keyword(s):  
Conservative Management ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Elastic Stable Intramedullary Nailing ◽  
Return To School ◽  
Femoral Shaft Fractures ◽  
Spica Casting ◽  
Fractures In Children ◽  
Independent Ambulation

Background:Femoral shaft fractures are one of the most common fractures of the lower extremities in children. Although many approaches and options are available for their treatment, the most appropriate treatment option for school going children is still debatable.Objective:This study investigated the efficacy, safety, and outcome of surgical intervention with Elastic Stable Intramedullary Nailing (ESIN) in 3–12-year-old children with diaphyseal femoral fractures and compared them with those of conservative management.Methods:In this prospective study, 41 children with diaphyseal femoral fractures were recruited between April 2013 and April 2016. The fractures were divided into two equal groups: one treated with ESIN, and the other with early spica casting or noninvasive traction followed by hip spica casting. Demographic data, clinical information, and serial radiographic findings were collected and compared between the two groups. Flynn’s scoring criteria pertaining to time to union, assisted weight bearing, independent ambulation, return to school, and complications were applied. Fischer’s exact test was used for statistical analyses.Results:Compared with spica casting-treated fractures, ESIN-treated fractures healed faster with lower average time to assisted weight bearing, independent ambulation, and return to school. Hip spica-treated children had a higher rate of major complications than ESIN-treated children. At 1-year follow-up, higher limb length discrepancy was reported in hip spica-treated children than in ESIN-treated children (P< 0.001).Conclusion:ESIN is a safe and effective approach for treating femoral shaft fractures in children; it provides better functional and radiographic outcomes than spica casting and can be used in preschool-age children.

scholarly journals Exchange Nailing as Revision Surgery for Post-operative Non-union of Atypical Femoral Fractures: A Case Report and Treatment Strategy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tomohiro Yasuda ◽  
Masayuki Arai ◽  
Daichi Shinohara ◽  
Yuki Samejima ◽  
Koji Kanzaki ◽  
...  
Keyword(s):  
Case Report ◽  
Revision Surgery ◽  
Femoral Fracture ◽  
Callus Formation ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Medullary Canal ◽  
Atypical Femoral Fractures ◽  
Non Union ◽  
Exchange Nailing

Introduction: Atypical femoral fractures account for only 0.5% of femoral shaft fractures, but delayed union or non-union occurs in 50% of atypical femoral fractures accompanied by femoral lateral bowing. Such fractures are difficult to treat. Case Report: The case was an 84-year-old woman. She was diagnosed post-operative non-union of atypical femoral fracture. We planned a revision surgery for post-operative non-union of the atypical proximal femoral fracture. A two-dimensional template was used to simulate the intramedullary nail (IMN). Due to the advanced femoral lateral bowing deformity, a mismatch with the nail was noted when the unaffected femur was used to construct the template. When the opposite side nail was used as a template, the nail was aligned with the medullary canal, and the tip of the nail coincided with the center of the medullary canal; hence, the opposite side nail was chosen. Radiographical assessments of healing of the fracture confirmed callus formation and complete bone union 3 months and 1 year after the operation, respectively. Conclusion: We found that exchange nailing as revision surgery for post-operative non-union of atypical femoral fractures combined with an IMN on the opposite side was useful. Keywords: Alendronate, femoral fracture, osteoporosis, revision surgery.

scholarly journals Spontaneous fetal femoral fracture: a case report and literature review

2018 ◽  
Vol 46 (3) ◽  
pp. 1282-1287 ◽  
Author(s):  
Mingming Yu ◽  
Dapeng Xu ◽  
Aiguo Zhang ◽  
Jun Shen
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Femoral Fracture ◽  
Femoral Fractures ◽  
Timely Manner ◽  
Left Femur ◽  
X Ray ◽  
Clinical Presentations ◽  
The Right

Spontaneous fetal femoral fractures are uncommon in the paediatric setting. The major clinical presentations of a spontaneous fetal femoral fracture are femoral angulation, shortness of the femur and even a marked fracture line. This case report describes a spontaneous fetal femoral fracture of the right femur, which was detected by routine ultrasonography during the 19th week of gestation in a 24-year-old woman. On routine follow-up visits, the angulation of the right femur in the fetus gradually improved. A caesarean section was undertaken at 39 weeks +5 days of gestation and an X-ray was taken on the second day after birth, which showed that the fracture had healed and the callus had been absorbed. The lengths of the two femurs of the baby were not equal; the right femur was 84 mm, which was 11 mm shorter than the left femur. In cases like this, postnatal follow-up is essential so that an operation can be carried out in a timely manner when the deformity is apparent.

scholarly journals Is vitamin K2 a treatment choice for atypical femoral fractures in patients with secondary osteoporosis?

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110016
Author(s):  
Bingzhang Wang ◽  
Jiahao Tang ◽  
Sheji Weng ◽  
Liang Chen ◽  
Zongyi Wu ◽  
...  
Keyword(s):  
Rare Complication ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Left Thigh ◽  
Secondary Osteoporosis ◽  
Future Research ◽  
X Ray ◽  
Beneficial Effects ◽  
Patient Reported ◽  
The Right

An atypical femoral fracture (AFF) is a rare complication associated with excessive inhibition of osteoclast expression during treatment of osteoporosis. We herein describe a patient who had been treated with alendronate for more than 10 years and subsequently developed an AFF that healed after treatment with vitamin K2 (VK2). We also discuss the potential beneficial effects of VK2 on the healing of AFFs. A 48-year-old Asian man with secondary osteoporosis was treated with alendronate for more than 10 years. The patient underwent surgical treatment for a complete AFF of the right femur. Six months postoperatively, he complained of pain in his left thigh. X-ray examination revealed an incomplete AFF of the left femoral shaft. He was then treated with VK2. After 4 months of VK2 treatment, the patient reported that the pain in his left thigh had decreased, and follow-up X-ray examination demonstrated healing of the left AFF line. This case report indicates that VK2 may be a potential direction for pharmacological treatment of AFFs in future research.

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