Novel technique of removal of broken intra-medullary nail from femur with secondary DCS plating

<p class="abstract">Femoral shaft fractures are one of the commonest fractures of the lower limb which are frequently operated with intramedullary nailing which enables immediate post-operative mobilization of the patient. There could be various causes of nail breakage – some of the notable being weight bearing over the non-union of the femur shaft, or a re-trauma over the operated limb causing both the implant and the nail to be broken. There are various methods of removal of the broken implant the commonest being the use of T-reamer technique. However not always can this be used due to varied intra-operative obstacles in different cases as described in this case below. We have a 35 year old male patient who was brought to us 2 hours after an alleged history of slip and fall following which he had sustained right sided subtrochanteric femur fracture with a broken implant – intramedullary interlock nail. The patient is a previously operated case of right sided femur shaft fracture with interlocking nailing done 15 years back. The patient was operated with – broken implant removal on the right side along with a secondary DCS plating with bone grafting for the subtrochanteric femur fracture. Intra operative period was met with a certain number of challenges and difficulties in view of a 15 year old implant for removal which was successfully with removed with DCS plating done. As is obvious with the above case, it would be quite imperative to say that older the implant, more difficult it becomes for its removal. </p>

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Butterfly Fragment in the Femoral Shaft Fractures Treated by Intramedullary Nail: Do We Need to Reduce It or Not?

10.21203/rs.3.rs-51108/v1 ◽

2020 ◽

Author(s):

Tayyar Kürşat Dabak ◽

Osman Ci̇van ◽

Hakan Özdemi̇r

Keyword(s):

Intramedullary Nail ◽

Fragment Size ◽

Femoral Shaft ◽

Shaft Fracture ◽

Variance Analysis ◽

Gap Size ◽

Femur Shaft Fracture ◽

Femoral Shaft Fractures ◽

Significant Difference ◽

Femur Shaft

Abstract Background: Limited data is available regarding the effect of gap size, fragment size and position of fragment on union in fragmented femur shaft fracture. The aim of the study is to analyze the effect of these parameters on union and determine cut-off values that necessitate reduction of fragment. Methods: Total of 59 patients with fragmented femur shaft fracture were reviewed and the effect of fragment size, gap size and fragment position on union were evaluated on 3rd, 6th and 12th month graphies from medical record of patients. Union rate was determined due to Radiographic Union Score of Femur. Patients were divided into small gap ( 10 mm) or large gap (10 mm), reverse fragment or non-reverse fragment and small fragment (50 mm) or large fragment (50mm) groups. Kruskal–Wallis Variance Analysis and Mann Whitney U test was used for comparisons among groups. The post-hoc Mann Whitney U-Test with Bonferroni Correction was used when the Kruskal Wallis Variance Analysis determined a significant difference.Results: In comparison of union scores of groups in regarding gap size and fragment size, there was not significant difference between groups at 3rd, 6th and 12th months. Union scores in the 3rd month (p=0,011) and 6th month (p=0,039) were lower in the reverse group than non-reverse group. But there was not statistically significant difference between two groups at 12th month (p=0.819). There was no significant difference in union rates in respect to intramedullary nail types. There was an indirect correlation between age and mean union score at 12th month. Conclusions: we could not determine any cutoff value regarding gap width and fragment size in the treatment of the femoral shaft fractures by IMN. Although there was a tendency to decrease in union scores due to the increase in the gap size, any significant difference was not determined. Only the reverse position of fragment had an adverse effect on the union until 6th months but the union score of reverse group reached the result of the non-reverse group by 12th months.

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Reverse distal femoral locking plate for subtrochanter femur fracture

Medical Journal of Indonesia ◽

10.13181/mji.v27i2.1377 ◽

2018 ◽

Vol 27 (2) ◽

Author(s):

Peter Giarso ◽

Ismail H. Dilogo

Keyword(s):

Distal Femur ◽

Locking Plate ◽

Femur Fracture ◽

Case Series ◽

Subtrochanteric Fracture ◽

Locking Compression Plate ◽

Non Union ◽

Functional Scores ◽

The Right ◽

Subtrochanteric Femur Fracture

In these case series, we used titanium locking compression plate-distal femur (LCP-DF) plate (Synthes) 9–11 hole using less invasive stabilization system or open reduction technique. This case series aims to determine the functional scores on reverse distal femoral locking plate for subtrochanteric femur fracture. A 34-year-old male with closed subtrochanteric fracture of the right femur (Seinsheimer 2B) with Harris hip scores (HHS) of 17, 96, and 97 obtained consecutively in 0, 6, and 12 months, respectively. A 24-year-old male with closed comminuted subtrochanteric fracture of the right femur (Seinsheimer V) with HHS of 13, 93, and 97 at 0, 6, and 12 months respectively. A 39-year-old male with non-union, left subtrochanteric femur fracture (Seinsheimer 2C) yielded HHS of 38, 73, and 77 at 0, 6, and 12 months, respectively. A 35-year-old female with close subtrochanteric fracture of the right femur (Seinsheimer IIB) yielded HHS of 23, 40, and 73 at 0, 6, and 12 months, respectively. Mean initial HHS and scores at 6 and 12 months reached 22, 75, and 86, respectively.

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Femur Shaft Fracture Fixation in Head-Injured Patients: When Is the Right Time?

Journal of Orthopaedic Trauma ◽

10.1097/bot.0b013e3181b6bdfc ◽

2010 ◽

Vol 24 (2) ◽

pp. 107-114 ◽

Cited By ~ 42

Author(s):

Michael A Flierl ◽

Jason W Stoneback ◽

Kathryn M Beauchamp ◽

David J Hak ◽

Steven J Morgan ◽

...

Keyword(s):

Fracture Fixation ◽

Shaft Fracture ◽

Femur Shaft Fracture ◽

Head Injured ◽

The Right ◽

Femur Shaft ◽

Injured Patients

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Massive heterotopic ossification after distal femur fracture

Scottish Medical Journal ◽

10.1177/0036933018783941 ◽

2018 ◽

Vol 63 (3) ◽

pp. 95-98

Author(s):

Gokhan Ozkocak ◽

Guzin Cakir Kandemirli ◽

Suheda Ozcakir

Keyword(s):

Soft Tissue ◽

Heterotopic Ossification ◽

Distal Femur ◽

Femur Fracture ◽

Femoral Shaft ◽

Distal Femur Fracture ◽

Significant Burden ◽

History Of ◽

The Right ◽

Thigh Region

Introduction Heterotopic ossification is the formation of lamellar bone in periarticular soft tissue that can be seen in paralysed patients or following trauma. It can cause significant burden to already debilitated patients. Case presentation A 12-year-old boy with paraplegia due to neuromyelitis optica presented with progressive right knee pain and swelling. There was no history of trauma to the knee. Anteroposterior radiograph of femur at the initial presentation showed a supracondylar femur fracture for which casting was performed. Six weeks later, when casting was removed, swelling along with increased rubor in distal thigh region was noted. Radiography of the right femur revealed an unhealed distal femur fracture along with massive ossification extending from lesser trochanter to fracture line along the soft tissue around the femoral shaft. Conclusion This case presented the clinical and imaging findings of a giant heterotopic ossification in the thigh region following an extra-articular fracture.

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Early Rehabilitation Following Surgical Fixation of a Femoral Shaft Fracture

Physical Therapy ◽

10.1093/ptj/86.4.558 ◽

2006 ◽

Vol 86 (4) ◽

pp. 558-572 ◽

Cited By ~ 14

Author(s):

Mark V Paterno ◽

Michael T Archdeacon ◽

Kevin R Ford ◽

Doug Galvin ◽

Timothy E Hewett

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accident ◽

Femur Fracture ◽

Functional Limitations ◽

Weight Bearing ◽

Knee Extensor ◽

Femoral Shaft ◽

Shaft Fracture ◽

Left Femur ◽

Hip Abductor

Abstract Background and Purpose. The purpose of this case report is to describe the outcome of a patient following fixation of a midshaft femur fracture and an evaluation-based, immediate-weight-bearing approach to rehabilitation. Case Description. The patient was a 28-year-old male manual laborer whose left femur was fractured in a head-on motor vehicle accident. The patient was treated with internal fixation of the left femur by use of an antegrade intramedullary nail. Following surgery, impairments in range of motion, knee extensor and hip abductor strength, and gait were observed. Intervention focused on immediate weight bearing and early progression of strengthening to address the observed impairments. Outcomes. All of the patient’s impairments improved, and he was able to return to work as a manual laborer within 6 months. Discussion. Immediate weight bearing with early strengthening activities following surgical correction of a midshaft femur fracture may result in early resolution of impairments and functional limitations and decreased disability.

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Repair of supracondylar femur fracture in a Lhasa Apso dog by cross pinning technique: A case report

10.51128/jfas.2020.a026 ◽

2020 ◽

Vol 1 (2) ◽

pp. 140-143

Author(s):

M. Raghunath ◽

P. Vidya Sagar ◽

P. Ravi Kumar ◽

B. Sailaja ◽

V. S. C. Bose

Keyword(s):

Case Report ◽

Hind Limb ◽

Femur Fracture ◽

Weight Bearing ◽

Supracondylar Fracture ◽

Implant Failure ◽

History Of ◽

K Wires ◽

The Right ◽

Radiographic Union

Abstract: A three-year-old Lhasa apso was presented with a history of fall from a height resulting in limping of the right hind limb. It was radiographically diagnosed as a complete, transverse, displaced supracondylar fracture of the femur. The fractured fragments were reduced and stabilized by cross pinning technique using k-wires, and the weight-bearing was seen from 3rd post-operative day. On the seventh post-operative day, the same animal was presented with limping on the same limb due to sudden fall from a height again. Radiographically it was confirmed as catastrophic implant failure with collapsed fragments. In surgery, the migrated pins were removed and the fragments were restabilized by cross pinning using k-wires. Post-operative application of robertjones bandage and regular physiotherapy was provided. The animal showed complete weight-bearing from 10th post-operative day, and the full radiographic union was observed on 35th post-operative day. Keywords: supracondylar fracture, k-wires, robertjones bandage, cross pinning technique

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Humeral shaft fracture associated with radial nerve palsy -a case report

Journal of Innovations in Applied Pharmaceutical Science (JIAPS) ◽

10.37022/jiaps.v6i3.251 ◽

2021 ◽

pp. 54-55

Author(s):

Rishitha M ◽

Akasha Sindhu M

Keyword(s):

Radial Nerve ◽

Nerve Palsy ◽

Wrist Joint ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Loss Of Function ◽

History Of ◽

The Right

Radial nerve palsy was induced by radial nerve compression, which was often caused by humerus bone fracture. This leads to pain, weakness, or loss of function mostly in the wrist, hand, and fingers. We reported a case of a 24-year-old male patient with complaints of swelling of the right-hand wrist joint and pain during extension and flexion while moving. He had a three-month history of mild displaced humeral shaft fracture from a traffic accident and an intramedullary Ender nailing was performed. He now has been admitted with swelling in his right wrist joint and pain while moving his hand. The case was diagnosed as Radial nerve palsy. Surgery was performed, the proximal and distal ends of the radial nerve were separated at the humeral bone's surface. The radial nerve stumps were enough long to be sutured. Our one-month follow-up shows no complications. The majority cases of radial nerve palsy will resolve within a few weeks after surgery, as our patient did, and the most prominent is patient education.

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A Clinical Study of the Femur Shaft Fracture in Children Treated by 90 - 90 Traction

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1989.24.3.761 ◽

1989 ◽

Vol 24 (3) ◽

pp. 761

Author(s):

Soo Kil Kim ◽

Keung Bae Lee ◽

Sae Jung Oh ◽

Kye Seok Yang

Keyword(s):

Clinical Study ◽

Shaft Fracture ◽

Femur Shaft Fracture ◽

Femur Shaft

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00331 ◽

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.

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