Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

Background: Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.Methods: 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.Results: Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients <50 was 103 degree and for patients>50 ROM was 98.66 degree. Conclusions: Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.

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Locked Plating Versus Spiral Blade Retrograde Nailing in Supracondylar Femoral Fractures

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80605 ◽

2012 ◽

Author(s):

Soroush Assari ◽

Alan Kaufman ◽

Kurosh Darvish ◽

Saqib Rehman ◽

Jung Park ◽

...

Keyword(s):

Bone Fractures ◽

Weight Bearing ◽

Femoral Fractures ◽

The Elderly ◽

Long Bone ◽

Supracondylar Fractures ◽

Locked Plating ◽

Early Weight Bearing ◽

Femur Fractures ◽

Retrograde Femoral Nailing

Comminuted supracondylar femur fractures in the elderly are often treated with either retrograde femoral nailing or locked plating. Early weight-bearing is typically restricted after fixing supracondylar fractures, thereby impairing the patient’s mobilization. In general, surgeons are more comfortable allowing early weight-bearing of long bone fractures after nailing rather than plating, but early studies of retrograde nails for supracondylar fractures using standard distal locking showed poor fixation compared with locked plating.

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Locking condylar plate: best device to treat supracondylar fractures of the femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190966 ◽

2019 ◽

Vol 5 (3) ◽

pp. 393

Author(s):

Irwant V. Pallewad ◽

Vijay B. Kagne ◽

Jayshree J. Upadhye

Keyword(s):

Fracture Fixation ◽

Distal Femur ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Research Centre ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Femur Fractures ◽

Fractures Of The Femur

Background: Supracondylar fractures of the femur in adults account for only 7% of all femoral fractures. However, these fractures present with numerous complications. The purpose of this study was to assess the outcome of locking condylar plate in supracondylar fractures of femur in adults.Methods: This study was based on 25 patients of supracondylar fracture of the femur treated with locking condylar plate at Srinivas Institute of Medical Sciences and Research Centre, Mukka, Suratkal, Mangalore. The patients were followed up for 1 year.Results: In present study, 84% fractures were sustained due to road traffic accidents. In 23 (92%) patients, full weight bearing was achieved at 20 weeks while only 2 (8%) patients required more than 20 weeks. 80% of cases required less than 16 weeks for union while 20% required more than 16 weeks. Average injury to surgery time was 3.62 days in the present series. Superficial stitch infection occurred in two cases. Deep infection occurred in a grade 2 compound fracture in a male who was treated initially with debridement and antibiotics.Conclusions: Good results are seen by distal femur locking condylar plate alone. It is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation. Advantage of the mechanical properties of a locking plate is definitely useful.

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Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04152-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Daisuke Takahashi ◽

Yoshihiro Noyama ◽

Tsuyoshi Asano ◽

Tomohiro Shimizu ◽

Tohru Irie ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Plate Fixation ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Loading Test ◽

Lateral Plate ◽

Element Analysis ◽

Periprosthetic Femoral Fractures

Abstract Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

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A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214188 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1194

Author(s):

S. F. Kammar ◽

Karthik B. ◽

V. K. Bhasme ◽

Suryakanth Kalluraya

Keyword(s):

Clinical Outcomes ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Lateral View ◽

Successful Outcome ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

The Mean

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

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Treatment of pertrochanteric fractures in elderly patients: is dynamic fixation so important?

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-5-502-507 ◽

2021 ◽

Vol 27 (5) ◽

pp. 502-507

Author(s):

I.M. Shcherbakov ◽

◽

V.E. Dubrov ◽

A.S. Shkoda ◽

Yu.S. Zlobina ◽

...

Keyword(s):

Elderly Patients ◽

Weight Bearing ◽

Femoral Fractures ◽

Early Time ◽

Functional Results ◽

Full Weight Bearing ◽

Pertrochanteric Fractures ◽

Results Of Treatment ◽

Bone Fragments ◽

One Year

Abstract. Introduction The problem of complications after surgical treatment of pertrochanteric fractures in elderly patients is relevant and far from a solution. Materials and methods The retrospective study was based on the analysis of the results of treatment of 129 patients with pertrochanteric femoral fractures (average age 76 years). All fractures in the early time from trauma were fixed with two types of cephalomedullary nails, either dynamic or static. All patients could not limit the load on the operated limb after surgery because of different reasons. Results The results of treatment were evaluated in 109 patients after one year. In dynamic cephalomedullary fixator group (59 patients), there were 7 orthopedic complications with a functional Harris scale result of 68 points (range, 26 to 94 points). In static cephalomedullary fixator group (50 patients), there were 14 orthopedic complications with a functional Harris score of 56.5 points (range, 15 to 92 points). Discussion Higher results of treatment in the group of dynamic fixator in the condition of full-weight bearing on the operated limb may be associated with the possibility of dynamization of the part of fixator in response to bone resorption in the contact area of bone fragments. The use of dynamic cephalomedullary fixators instead of static ones for treatment of pertrochanteric femoral fractures in elderly patients exercising full weight-bearing leads to a decrease in orthopedic complications (from 28 to 11.9 %) and improves the functional results of treatment.

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Titel Treatment of Hand and Wrist Fractures with the Stryker Hand Plating System

10.21203/rs.3.rs-609662/v1 ◽

2021 ◽

Author(s):

Christoph Biehl ◽

Sabine Stötzel ◽

Lydia Schock ◽

Gabor Szalay ◽

Christian Heiss

Keyword(s):

Tissue Injury ◽

Soft Tissue Injury ◽

Early Mobilization ◽

Fracture Treatment ◽

Outcome Study ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Wrist Fractures ◽

Hand Fractures ◽

The Mean

Abstract Background: 10% of all fractures occur in the fingers and metacarpal region. Early mobilization with preservation of grip function is the goal of any therapy for these injuries. Osteosyntheses with plates are used in complex fractures that do not allow any other treatment. The aim of this retrospective study was to evaluate the performance and safety of the Stryker Hand System.Patients and Methods: Between 2010 and 2019, 190 patients underwent surgical treatment with plates for fractures of the fingers and metacarpal region. Of these, 140 operations could be analyzed according to the inclusion criteria based on clinical and radiological parameters.Results: Three-quarters of the patients were male. The mean age at the time of surgery was 39.3 ± 15.97 years. Falling was the leading cause for hand fractures, and the commonest were fractures of the shaft (>52%). More than 15% were complex hand injuries with more than one fractured finger. The majority of patients were healthy non-smokers without systemic diseases and relevant medical history. Conclusion: The Stryker Finger Plates are safe implants with good results that are consistent with those reported in the literature. The trend is also toward stable-angle implants for fracture treatment of the finger, in order to enable the earliest possible functional, safe mobilization. The maxim that the extent of the soft tissue injury is responsible for the result continues to apply.Level of Evidence Level: IV; Outcome-study, retrospective

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Factors Associated With Inability to Bear Weight Following Hip Fracture Surgery: An Analysis of the ACS-NSQIP Hip Fracture Procedure Targeted Database

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319837481 ◽

2019 ◽

Vol 10 ◽

pp. 215145931983748 ◽

Cited By ~ 1

Author(s):

Azeem Tariq Malik ◽

Catherine Quatman-Yates ◽

Laura S. Phieffer ◽

Thuan V. Ly ◽

Safdar N. Khan ◽

...

Keyword(s):

Hip Fracture ◽

Weight Bearing ◽

Early Mobilization ◽

Functional Health ◽

Full Weight Bearing ◽

Improvement Program ◽

Patient Factors ◽

Hip Fracture Surgery ◽

Acs Nsqip ◽

Medical Teams

Introduction: While the benefits of early mobility for prevention of complications such as pneumonia, thromboembolic events, and improved mortality have been well studied in postsurgical patients, it is unclear which patients may struggle to achieve full weight-bearing on the first postoperative day. Materials and Methods: The 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture Database was queried regarding the ability to achieve weight-bearing on first postoperative day for older adults. Cases that occurred secondary to malignancy were excluded or for which weight-bearing was unachievable on the first postoperative day due to medical reasons were excluded. Results: A total of 6404 patients met inclusion and exclusion criteria for the study, with 1640 (25.6%) patients unable to bear weight on the first postoperative day. Following adjusted analysis, nonmodifiable patient factors such as dependent (partial or total) functional health status, dyspnea with moderate exertion (odds ratio [OR]: 1.31 [95% confidence interval, CI: 1.04-1.65]), ventilator dependency, and preoperative dementia on presentation to hospital were associated with lack of achievement of weight-bearing on the first postoperative day. Modifiable patient factors such as presence of systemic inflammatory response syndrome (OR: 1.35 [95% CI: 1.11-1.64]), delirium, and low preoperative hematocrit and modifiable system factors including delayed time to surgery, total postoperative time >90 minutes, and transfer from an outside emergency department were also associated with inability to achieve weight-bearing on the first postoperative day. Discussion: Medical teams can utilize the results from this study to better identify patients preoperatively who may be at risk of not achieving early mobilization and proactively employ implement strategies to encourage mobility as soon as possible for hip fracture patients.

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A comparative study of surgical management of subtrochanteric fractures in children

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v11i2.9664 ◽

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

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Naproxen versus Acetaminophen for Therapy of Soft Tissue Injuries to the Ankle in Children

Annals of Pharmacotherapy ◽

10.1345/aph.1h596 ◽

2007 ◽

Vol 41 (9) ◽

pp. 1368-1374 ◽

Cited By ~ 18

Author(s):

Victoria A Cukiernik ◽

Rod Lim ◽

David Warren ◽

Jamie A Seabrook ◽

Doreen Matsui ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Self Report ◽

Ankle Injuries ◽

Intermittent Therapy ◽

Double Blind ◽

Significant Difference ◽

Degree Of Disability

Background: Musculoskeletal (MSK) ankle injuries cause significant morbidity in ambulatory pediatric populations. No optimal pharmacotherapy is available. Objective: To conduct a randomized, double-blind trial to compare 2 drug therapies for soft tissue injury of the ankle. Methods: Patients (N = 77, aged 8–14 y, 61% male) with ankle injuries presenting to a regional pediatric emergency department were assigned to receive either acetaminophen (15 mg/kg 4 times a day) or naproxen (5 mg/kg 4 times a day) in a double-blind fashion on a routine basis for a 5 day period. On days 0 and 7, patients rated their degree of disability and pain on weight bearing using a 10 cm visual analog scale developed for this study. In addition, they were examined by a physician who rated pain, tenderness on palpation, and swelling using a 4 point scale. There were 3 follow-up telephone calls on days 3, 14, and 21. Adherence was evaluated by self-report and pill count. Results: Both the acetaminophen and naproxen groups had significant improvement in degree of disability and pain from day 0 to day 7. There was no statistically significant difference in outcome between the 2 groups by patient self-evaluation or physician assessment. There also was no significant difference in adverse event rates between the 2 groups, and the majority of patients in both groups felt that the medication was helpful. Conclusions: No significant difference in efficacy of pain control or improvement of disability between the naproxen and acetaminophen groups suggests no preferential advantage for naproxen over acetaminophen for MSK injuries when given on a regular basis, with concurrent supportive treatment. Possible differential benefit from intermittent therapy needs to be evaluated among children with ankle injury.

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Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

Journal of Orthopaedic Surgery ◽

10.1177/23094990211024395 ◽

2021 ◽

Vol 29 (2) ◽

pp. 230949902110243

Author(s):

Cheng Ren ◽

Ming Li ◽

Liang Sun ◽

Zhong Li ◽

Yibo Xu ◽

...

Keyword(s):

Intramedullary Nailing ◽

Meta Analysis ◽

Weight Bearing ◽

Tibial Fractures ◽

Fixation Method ◽

Cochrane Library ◽

Full Weight Bearing ◽

Locked Plating ◽

Fixation Group ◽

Proximal Tibial Fractures

Objective: This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. Methods: We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Results: Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Conclusions: Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.

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