Impaired Fracture Healing of the Distal Femur after High Energy Trauma

Treatment of patients with fractures of femur has a particular relevance in modern traumatology, especially in patients with polytrauma. The treatment of such fractures is complicated by the fact that it depends not only on the nature of the fracture, but also on the general condition of the patient. These fractures are caused by high-energy trauma, they have the tendency to be splintered or fragmented, and often accompanied by neurovascular complications, especially in the distal part. Such fractures are often accompanied by soft tissue damage. Purpose: improving the results of treatment of intra-and periarticular fractures of the distal femur in patients with polytrauma. Material and methods. In the present study, a prospective analysis of using conversion osteosynthesis in the treatment of 72 patients with intra-and periarticular fractures of the lower third of the femur patients with polytrauma, according to the ISS severity scale (ISS 17-40) was performed in a multidisciplinary hospital. Results. The most optimal time for conversion osteosynthesis to patients with polytrauma was 5-7 days, which prevented the occurrence of traumatic shock and prevented the occurrence of inflammatory complications in the postoperative period. Conclusion. The study confirmed the feasibility of conversion osteosynthesis in the treatment of patients with intra-and periarticular fractures of the lower third of the femur. The use of the technique of transferring the fixation of fragments by the external fixation to the internal osteosynthesis (conversion) contributed to a reduction in the duration of treatment of patients in the hospital with fractures of the long bones.

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Distal femur and knee

10.1093/med/9780198813170.003.0014 ◽

2018 ◽

Author(s):

Jim Hughes

Keyword(s):

Distal Femur ◽

High Energy ◽

The Body ◽

Long Bones ◽

Surgical Equipment ◽

Load Bearing ◽

High Energy Trauma ◽

Articular Surfaces ◽

Cerclage Wiring ◽

Selection Of

The knee is one of the main load-bearing joints of the body, and injuries to it can involve damage to the joint or articular surfaces, or fractures to the long bones in case of high-energy trauma. The position of the contralateral leg can cause difficulty in positioning for imaging, but good positioning and technique should allow demonstration of the region for intervention. This chapter covers a selection of orthopaedic procedures involving the distal femur and knee, covering distal femoral plating and LISS plates, tension band wiring of the patella, and cerclage wiring of the patella. Each procedure includes images that demonstrate the position of the C-arm, patient, and surgical equipment, with accompanying radiographs demonstrating the resulting images.

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MANAGEMENT OF DISTAL FEMUR FRACTURES IN ADULT WITH LOCKING COMPRESSION PLATE

International Journal of Advanced Research ◽

10.21474/ijar01/12367 ◽

2021 ◽

Vol 9 (01) ◽

pp. 895-902

Author(s):

Mohammed Moustafa Hamid Ali Nasser ◽

◽

Ali Tawfik Elalfy ◽

Mohammed Elsadek Atia ◽

Sameh Mohammed Holail ◽

...

Keyword(s):

Distal Femur ◽

Locking Plate ◽

Plate Fixation ◽

High Energy ◽

Locking Compression Plate ◽

University Hospitals ◽

High Energy Trauma ◽

Emergency Hospital ◽

Femur Fractures ◽

Compression Plate

Objective: To evaluate the clinical outcomes and radiological union of distal third femur fractures by using distal femur locking plate, in Zagazig university hospitals and KafrSaad emergency hospital. Design: Clinical trial. Methods: Data collected for the study was from the patients admitted in orthopedic department in Zagazig university hospitals and KafrSaad emergency hospital, with distal femur fracture AO 33,during the period of August 2019 to July 2020 and treated with open reduction and internal fixation with distal femur locking compression plate with 4.5 system. All patients were followed up for an average of 6 months. Outcomes were assessed by Neers score. Results: Outof 12 patients (4 were females&8were males), mean age was 45.6 years (20 to 70 years). 10 cases wereduo to high energy trauma and 2 cases wereduo to low high energy trauma.5 out of total 12 cases had open fractures and rest 7 cases had closed fractures.Out of total 12 cases, five cases were extra-articular and rest 7 cases were intra-articular. Out of 12 fractures treated, 8 fractures showed radiological signs of union within 12-16 weeks,3 fractures showed radiological signs of union within 20 weeks and one fracture showed radiological signs of union within 24 weeks.1 patient got superficial infection and no implantfailure, mean range of motion of all patients was 113Ã‚Â°. Conclusion:ORIF of distal femur fractures with locking compression plate provides good angular stability, restoration of limb alignment, length, rotation and give a good purchase in osteoporotic patientswith minimal complications. Best results are optioned when standard protocol of locking plate fixation is followed with good soft tissue care, early knee bending exercises and physiotherapy.

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High-Energy Trauma and Damage Control in the Lower Limb

10.21236/ada554076 ◽

2010 ◽

Cited By ~ 1

Author(s):

Charles J. Fox ◽

Peter Kreishman

Keyword(s):

Lower Limb ◽

Damage Control ◽

High Energy ◽

High Energy Trauma

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Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

Emergency Medicine Journal ◽

10.1136/emermed-2014-204083 ◽

2014 ◽

Vol 32 (7) ◽

pp. 535-538 ◽

Cited By ~ 2

Author(s):

Shahram Paydar ◽

Armin Ahmadi ◽

Behnam Dalfardi ◽

Alireza Shakibafard ◽

Hamidreza Abbasi ◽

...

Keyword(s):

High Energy ◽

Trauma Centre ◽

Economic Effects ◽

Trauma Patients ◽

Radiological Evaluation ◽

High Energy Trauma ◽

Level 1

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Angiography in patients with pelvic fractures and contrast extravasation on CT following high-energy trauma

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01628-w ◽

2021 ◽

Author(s):

Jonathan Hammerschlag ◽

Yehuda Hershkovitz ◽

Itamar Ashkenazi ◽

Zahar Shapira ◽

Igor Jeroukhimov

Keyword(s):

High Energy ◽

Pelvic Fractures ◽

Contrast Extravasation ◽

High Energy Trauma

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Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.11.067 ◽

2013 ◽

Vol 57 (5) ◽

pp. 1196-1203 ◽

Cited By ~ 40

Author(s):

Andrew G. Georgiadis ◽

Farah H. Mohammad ◽

Kristin T. Mizerik ◽

Timothy J. Nypaver ◽

Alexander D. Shepard

Keyword(s):

Vascular Injury ◽

Knee Dislocation ◽

High Energy ◽

Low Energy ◽

Morbidly Obese ◽

High Energy Trauma

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“FUNCTIONAL OUTCOME OF RETROGRADE NAILING IN THE MANAGEMENT OF SUPRACONDYLAR AND DISTAL FEMORAL FRACTURE”

10.36106/gjra/6411014 ◽

2021 ◽

pp. 107-109

Author(s):

Avinash Kumar Choudhary ◽

M.K Aseri ◽

Sumit Machra ◽

Devendra Singh

Keyword(s):

Femoral Fracture ◽

Distal Femur ◽

Femoral Fractures ◽

High Energy ◽

Valgus Deformity ◽

Minor Trauma ◽

Rating Score ◽

Joint Congruency ◽

Distal Femoral Fractures

INTRODUCTION: Fractures of the Distal femur are complex injuries that pose a challenge to the orthopaedic surgeon. It constitutes about 6 % of all femoral fractures. It usually occurs during high energy trauma in younger patients and frequently are associated with concomitant injuries. In contrast, elderly patients with severe osteopenia might sustain solitary distal femoral fractures from minor trauma such as a simple fall. Proper diagnosis and treatment leads to early mobilization and rehabilitation of patients. MATERIAL AND METHODS :This prospective study was conducted in Department of Orthopedics at Dr. S. N. Medical College and Associated group of Hospital, Jodhpur ,Rajasthan ,India on 30 patients who underwent the surgery with retrograde intramedullary interlocking nail in the management of extra-articular supracondylar femoral fracture from August 2019 to November 2020. On follow up axial alignment was assessed and functional analysis was quantied using NEERS RATING SYSTEM, Radiographs was analyzed for correction, maintenance of position or loss of reduction. function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients. RESULTS: In our study 30 patients with supracondylar & distal femoral fractures based on AO Classication on MULLER ET AL underwent retrograde supracondylar nail, long term nal result were rated using NEER'S RATING SCORE , which gives point for pain, function, working, joint movement ,gross and radiological appearance. NEER'S RATING SCORE assigned for each patient after 24 weeks of follow up. After accessing this score out of total 30 patients, 10 have excellent score, 10 have good score, 8 have fair score and next 2 have poor score. Function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients,out of 30 patients 9 patients have an excellent result , 8 have good ,12 have fair and only 1 patient have poor result CONCLUSION:The retrograde intramedullary locked nail provides the surgeon with a different option in treatment of specic supracondylar fracture patterns. It offers a practical advantages of simple and efcient technique for patients with polytrauma, oating knee injuries and in elderly. this technique is very useful in distal femur fracture where antegrade nailing does not provide stability and also where plate xation is not suitable due to soft tissue condition.

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Scapulothoracic dissociation

British Journal of Radiology ◽

10.1259/bjr.20190090 ◽

2019 ◽

Vol 92 (1101) ◽

pp. 20190090

Author(s):

Kimia Khalatbari Kani ◽

Felix S Chew

Keyword(s):

Differential Diagnosis ◽

Shoulder Girdle ◽

High Energy ◽

Imaging Evaluation ◽

Acute Setting ◽

High Energy Trauma ◽

Diagnosis And Management ◽

Life Threatening ◽

Spectrum Imaging ◽

Scapulothoracic Dissociation

Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.

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Factors Influencing Functional Outcomes of Subtalar Fusion for Posttraumatic Arthritis After Calcaneal Fracture

Foot & Ankle International ◽

10.1177/1071100718777492 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1062-1069 ◽

Cited By ~ 8

Author(s):

Quirine M.J. van der Vliet ◽

Falco Hietbrink ◽

Fabio Casari ◽

Luke P.H. Leenen ◽

Marilyn Heng

Keyword(s):

Quality Of Life ◽

Functional Outcomes ◽

Calcaneal Fracture ◽

High Energy ◽

Posttraumatic Arthritis ◽

High Energy Trauma ◽

Subtalar Arthrodesis ◽

Subtalar Fusion ◽

Subtalar Arthritis

Background: Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis. This study aimed to identify factors associated with functional outcomes and quality of life after subtalar fusion for posttraumatic subtalar arthritis after calcaneal fracture. Methods: This is a retrospective study with follow-up by questionnaire in two level 1 trauma centers. Patients who underwent subtalar arthrodesis for posttraumatic arthritis after a calcaneal fracture between 2001 and 2016 were identified and contacted for completion of a survey consisting of the Foot and Ankle Ability Measure (FAAM), Maryland Foot Score (MFS), Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire, EuroQol 5-dimensional (EQ-5D) questionnaire, and EuroQol visual analog scale (EQ-VAS). Exclusion criteria were initial subtalar arthrodesis at an outside facility, primary arthrodesis for fracture, initial arthrodesis earlier than 2001, amputation of the fused foot or leg, younger than 18 years at time of fusion, and inability to communicate in English. A total of 159 patients met our inclusion criteria. Eighty-four patients completed the questionnaires, resulting in a response rate of 59%. Results: Median FAAM score was 79 (interquartile range [IQR], 48-90), median MFS was 74 (IQR, 56-86), and median PROMIS PF was 45 (IQR, 38-51). Quality of life was significantly lower when compared to a reference population ( P = .001). Smoking was independently associated with worse outcomes. Complications after fusion (such as nonunion, implant failure, and infectious complications), high-energy trauma, and ipsilateral injury were also predictors for poorer outcomes. Conclusion: Acceptable functional outcomes and quality of life were observed after subtalar fusion. Smoking, complications after subtalar fusion, high-energy trauma, and presence of ipsilateral injuries were independently associated with worse functionality and quality of life. Level of Evidence: Prognostic level III, comparative series.

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