Methods: Male C57/BL6 mice (6 per group) were subjected to closed bilateral femoralshaftfracture with intramedullary nailing followed by administration of either 25 mg/kg/24 h DHEA diluted in saline with 0.1% ethanol or saline with 0.1% ethanol. The sham group was treated by isolated intramedullary nailing without fracture. Animals were sacrificed after 6, 24, or 72 h. Serum TNF α , IL-1 β , IL-6, IL-10, MCP-1, and KC concentrations were measured by Bio-Plex Pro Tm analysis. Acute pulmonary inflammation was assessed by histology, pulmonary myeloperoxidase (MPO) activity, and pulmonary IL-6 concentration.
A total of 96 patients with femoralshaftfracture treated in our hospital between January 2013 and January 2013 were selected, and the inclusion criteria were: (1) fracture types were diagnosed by X-ray; (2) with single fracture; (3) with femoralfracture for the first time; (4) with normal blood coagulation function; (5) patients signed informed consent. Exclusion criteria were: (1) with severe heart, liver and kidney dysfunction and could not tolerate surgical trauma; (2) with pathological fracture; (3) with severe osteoporosis; (4) with incomplete clinical data. 96 patients conformed to the above criteria and were randomly divided into observation group and control group ( n =48). Control group included 26 male cases and 22 female cases, they were 31-78 years old and (57.94±7.12) years old in average, and AO typing was: 21 cases with 32-A type, 18 cases with 32-B type and 9 with 32-C; observation group included 25 male cases and 23 female cases, they were 32-79 years old and (57.85±7.51) years old in average, and AO typing was: 20 cases with 32-A type, 17 cases with 32-B type and 11 with 32-C. Two groups of patients showed no statistically significant difference in the distribution of gender, age and fracture typing ( P >0.05) and were comparable.
the limb, and attached the limb using bandages (Figure 3). This technique was used for 93 interventions over the period of 2 years and 4 months, including 14 percutaneous fixation of femoral neck fractures, 8 with plate/screw type implants for intertrochanteric or subtrochanteric fractures, 37 IM nailing for femoralshaftfracture. They did not report any difficulties concerning the manipulation of the radioscopy and noted the absence of perioperative complications. They also reported that they did not have to move the unaffected leg during the procedure. However, they did not describe the characteristics of the patient group. They mention success of this procedure in polymorbid obese patients without further discussion. The question whether the use of this technique is appropriate in patients with thromboembolic disorders remains unclear.
Femoralshaftfracture is a type of clinical severe fracture, and without timely anatomical reduction and fixation, it can lead to poor blood supply and even necrosis of fracture end. Selecting reasonable surgical procedure and conducting early surgery are the best treatment for femoralshaft fractures, both magnetic navigation intramedullary nail and traditional intramedullary nail fixation are the clinical common operation methods at present, and the comparison of their advantages and disadvantages has been controversial  . Intramedullary nail fixation technology is relatively mature, but the repeated drilling and locking as well as nail loosening and breaking during operation has become its biggest technical barriers. Magnetic navigation intramedullary nail, after the improvement of existing intramedullary nail, can accurately determine the position of the far end lock hole, and the magnetic detector has high sensitivity, so the frontal plane of locking nail spindle is without deviation during drilling, which significantly reduces the locking failure rate. The current domestic research on magnetic navigation intramedullary nailing is still in its infancy, and there are fewer reports about its application value for patients with femoralshaftfracture. In the study, the above two types of internal fracture fixation were applied in patients with femoralshaftfracture in our hospital, and the differences in surgical trauma, bone metabolism and other aspects were mainly elaborated.
Purpose: Rigid interlocking nailing for femoralshaftfracture is ideal for use in ado- lescents in terms of stability of the fracture and convenience for the patient. Howev- er, numerous authors have reported that rigid interlocking nailing has some limita- tions in this age group due to the risk of complications. We evaluated the results of intramedullary nailing for femoralshaft fractures with an interlocking humeral nail in older children and adolescents. Materials and Methods: We retrospectively re- viewed records of patients treated with an interlocking humeral nail. Radiographs were examined for proximal femoral change and evidence of osteonecrosis. Out- comes were assessed by major or minor complications that occurred after operative treatment. Results: Twenty-four femoralshaft fractures in 23 patients were enrolled. The mean age at the time of operation was 12 years and 8 months and the mean fol- low-up period was 21 months. Bony union was achieved in all patients without any complications related to the procedure such as infection, nonunion, malalignment and limb length discrepancy. All fractures were clinically and radiographically united within an average eight weeks. No patients developed avascular necrosis of the fem- oral head and coxa valga. Conclusion: Intramedullary nailing through the greater trochanter using a rigid interlocking humeral nail is effective and safe for the treat- ment of femoralshaft fractures in older children and adolescents.
ideal traction position, all the attachments of the table were secured in their respective posi- tions and the entire operating bed was inclined to raise the injured side approximately 20 degrees for more convenient greater trochanter opening and nailing. Traction is released imme- diately once the intramedullary nail crosses the fracture site. This prevents over distraction at the fracture site, as well as any complications due to prolonged traction. When preoperative preparation was assisted by the traction bed, the displacement trend of the femoralshaftfracture could be accurately diagnosed with a pre-reduction procedure. This technique simpli- fies the intraoperative reduction and the inser- tion of the guide pin. However, according to pre- vious studies comparing traction bed assisted treatment of femoralshaft fractures to manual reduction, the traction bed did not effectively decrease surgery time or improve the quality of the operation. Preoperative preparation also increased the risks associated with X-ray expo- sure [3, 5, 10]. Nevertheless, our experience with manual closed reduction has shown that this technique requires significant radiographic exposure. Additionally the technique requires additional personnel, is often hard to accom- plish and frequently requires subsequent open Table 4. Comparison of surgical outcomes between AO types B and
A 20-year-old fit and healthy female was admitted to the emergency department after collision with a snowgun when skiing. The patient sustained a femoralshaftfracture (AO 32-A2.3) and was treated with intramedullary nailing one hour after the accident (Expert R/AFN, 10/400; DePuy-Synthes, Johnson & Johnson, Warsaw, IN). Due to narrow intramedullary canal, SynReam® (DePuy-Synthes, Johnson & Johnson, Warsaw, IN) was used to enlarge the intramedullary canal diameter up to 11,5 mm to ensure nail insertion. Operation time was 32 minutes, no compli- cations occurred. 14 hours after surgery the patient com- plained about vision loss in both eyes. She couldn’t read the text messages on her cellphone any longer and re- ported feeling uncomfortable, dizzy and weak. No other visual or neurological symptoms were present at this point. Blood pressure was relatively low 80/40 mmHg and was 100/50 mmHG after infusion of 250 ml Voluven® (HES 130/0,4) 6% and 500 ml Ringer’ s solution, but visual symp- toms persisted without improvement. Laboratory findings included elevated leukocytes 18.3 × 10 3 /μl (normal range 4.3-10.0) and LDH 245 U/l (normal range 120–240). Sub- sequently the patient was referred to a neurologist for neurologic examination and MRI scans of the brain were ordered. However, no pathologic finding, neither in the neurologic examination nor in the MRI scans were de- tected. The patient was eventually referred to an ophthal- mology department, where Purtscher’s retinopathy was diagnosed after slit lamp examination and funduscopy.
There are some reports of patients with Klippel- Trenaunay syndrome (KTS) who suffered femoralshaftfracture [17, 18]. KTS is characterized by capil- lary malformations and venous anomalies with bony and soft tissue hypertrophy in 1 or more limbs . Gupta et al. reported a patient with KTS and femoralshaftfracture that was treated by external fixation fol- lowing closed reduction. In this case (a 12-year-old girl), the elastic intramedullary nail was quite difficult to insert due to poor bone quality and risk of cortical perforation. The fracture eventually united 4.5 months after surgery . Although the present case lacked the diagnostic criteria for KTS, a more difficult situ- ation existed in that the skin incision involved the AVMs, the femoralshaft was very thin, and closed re- duction was difficult. Finally, we applied a TSF on the femur and reduction was obtained.
male and 7 patients were female, and the age of these pa- tients ranged within 18–61 years old, with an average age of 37.8 years old. Among these patients, the surgery was performed on the left side in 10 patients and on the right side in 8 patients. In line with the femoralshaftfracture AO classification, four patients were A1 type, four patients were A2 type, two patients were A3 type, two patients were B1 type, two patients were B2 type, two patients were B3 type, and two patients were C2 type. The reasons for the injury were as follows: car accident (n = 11), falling accident (n = 6), and fall damage (n = 1). The femoralshaftfracture type was confirmed before the surgery through the front and lateral X-ray films, and a related therapeutic scheme would be made for each case. All patients received tibial tubercle traction after admission. The interval from admission to the day of surgery was approximately 3–7 days, with an average of 4.4 days (Table 1). This study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and was approved by the Ethics Committee of the Second Hospital of Shanxi Medical University. Written informed consent was ob- tained from all participants.
Results Forty patients with ipsilateral and two patients with bilateral femoral fractures were studied. Arthroscopy revealed medial meniscus injury in 12 (27 %) knees. Three (7 %) lateral meniscus injuries, 18 (40.9 %) ACL injuries and 2 (4.5 %) PCL injuries were also found. In varus and valgus stress tests, 15 (34 %) MCL and 4 (9 %) LCL laxities were noticed. The Lachman test was positive in 3 (6 %), and ADT was positive in 2 (4.5 %) patients. Conclusions Based on our observations, concomitant ligamentous and meniscal knee injury is a common finding in femoralshaft fractures and rates of these injuries are generally in concert with reports from developed nations. Keywords Femur fracture Knee injury Arthroscopy Concomitant knee injury
Case presentation: We report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient (a Japanese man) was 20 years old. He experienced peri-prosthetic fracture of the femur, subsequent migration of the prosthesis, and a massive bone defect of the pelvic side acetabular roof. After bone union of the femoralshaftfracture, the patient was referred to our hospital for reconstruction of the acetabular roof. Intra-operatively, we placed two alloimplants of bone from around the transplanted femoral head into the weight-bearing region of the acetabular roof using an impaction bone graft method. We then implanted an acetabular roof reinforcement plate and a cemented polyethylene cup in the position of the original acetabular cup. Eighteen months post-operatively, X-rays showed union of the transplanted bone. Conclusions: Treatment of femoral neck fractures in young adults is usually accomplished by osteosynthesis, but it may be complicated by femoral head avascular necrosis or by infection or osteomyelitis. In such cases, once an infection has subsided, either hip hemiarthroplasty using a bipolar cup or total hip arthroplasty may be required. However, if the acetabular side articular cartilage is damaged, a bipolar cup should not be used. Total hip arthroplasty should be performed to prevent migration of the implant.
Robert J.Brumback, walter virkus 7 concluded in their study that femoralshaft fractures treated with undreamed nailing have been shown to have slightly higher rate of delayed union and non union compared with those of reamed nail. Reamed interlocking nail remains the treatment of choice for femoralshaftfracture in adults., since femoralshaft has rich periosteal blood supply reaming does not impede fracture healing. In our study we rountinely perform reamed interlocking nailing except in two open fracture cases.
Case presentation: A 56-year old female was admitted to our institution following a high-energy trauma (fall from 6 m). Initial radiographic and CT scan evaluation revealed a displaced femoralshaftfracture but no other femoral fractures were detected. Closed reduction and external fixation of the femoralshaftfracture was performed in the emergency setting. Follow-up radiologic evaluations revealed an ipsilateral laterally displaced femoral neck fracture. Despite cephalomedullary nail fixation of both fractures performed on the third day from the initial injury, the patient developed a non-union of the femoral neck fracture, which led to cut-out of the lag screw with associated varus failure of the femoral neck fracture requiring surgical revision and implant of a bipolar hemiarthroplasty at one year follow up. The postoperative course was uneventful and the patient had a full long-term recovery. Conclusion: This case report exemplifies the need to maintain the highest level of suspiciousness for the concomitant presence of an ipsilateral femoral neck fracture when treating polytraumatized patients who sustained a femoralshaftfracture as a consequence of a high-energy trauma. Furthermore, the pre-operative standardized radiological evaluation (plain x-ray and CT scan) might not always help in ruling out these fractures. It is therefore necessary to adopt additional standardized radiographic protocols not only in the pre-operative but also in the intra-operative and immediate post-operative settings.
Case presentation: A 69-year-old Japanese woman with a right cementless total hip arthroplasty undertaken 44 months previously had a right femoralshaftfracture that occurred without trauma. She related that the bone fractured while she was standing, after which she fell down. Radiographs showed a noncomminuted transverse fracture located at the tip of the stem with localized periosteal thickening of the lateral cortex. The fracture was complete, extending through both cortices, and was associated with a medial spike. Her history revealed that she had been taking prednisolone to treat dermatomyositis and interstitial pneumonia for approximately 15 years. Alendronate was administered for more than 7 years. We performed open reduction and internal fixation using a locking plate with cable grip. The latest follow-up was performed 2 years after the fracture surgery. Bony union was successful. She regained the ability to walk, although her activity was limited by her comorbidities. Conclusions: Although the current definition of an atypical femoralfracture excludes periprosthetic fractures, there may be a periprosthetic fracture with the same or similar pathology as that of an atypical femoralfracture. We must be vigilant and aware of this type of fracture, especially in patients with prolonged bisphosphonate use.
Results: from 72 patients how referred to our center, 50 patients (28 men) with mean age of 58.43±6.73 years complete the study. There was not significant difference between men and women age (56.5±21.17 vs. 59.72±16.38 years, P=0.55). 22 cases (40%) (7 men) by arthroplasty, 13 cases (26%) (10 men) by cannulated screw fixation and 15 cases (30%) (11) by dynamic hip screw (DHS) were treated. 14 patients (28%) including 4 men and 10 women were afoul complications that included avascular necrosis (3 patients), dislocation of prosthesis (2 patients), pulmonary embolism (one patient), intraoperative femoralshaftfracture (one patient), relocation of screw and shortening of the femoral neck (2 patients) and death in 5 patients who all of them were women (mean age of 79.35±5.81 years) and surgery by arthroplasty technique. morbidity and mortality were significantly higher in women (p=0.007)
Abstract Concomitant ipsilateral fractures of the neck and shaft of the femur in children are rare. The most recent report in this context found a total of only nine reported cases ( \ 12 years of age) following a search of the indexed English literature. These injuries occur in children due to high-velocity trauma, and there is no generally accepted method of treatment. We report three additional cases from the literature and two cases of our own. In our cases, one had a residual 10° varus deformity at the subtrochanteric level in the femur, but this did not affect hip function. Another patient exhibited a limp at final follow-up due to leg length discrepancy, and peroneal nerve palsy at the time of injury. We advocate operative stabilization of the femoralshaftfracture first to reduce the risk of further displacement and simplify the subsequent reduction of the femoral neck. The series shows that these rare injuries have a poor prognosis, with high rates of incidence of avascular necrosis, coxa vara, and leg length discrepancy.
Inclusion criteria included the femoral neck fracture and at the same time femoralshaftfracture in group A, femoral neck fracture in group B and exclusion criteria were as follows: Diabetes, immune deficiency, surgical site infection. Patients for up to 6 months after surgery, have been clinically examined on the monthly interval, and after that for up to two years underwent clinically examinations and radiologic evaluations at 3 month intervals. In addition, the time course required for tracking the AVN was at least two years and nonunion was considered of 9 month after surgery. The data collected for each patient included demographic characteristics and radiologic data such as age, sex, class femoral neck fracture, femoralshaft fractures class, status of union, avascular necrosis of the femoral head, union time to breakdown at the femoral neck and the femoralshaft, duration of delay in fixation, osteonecrosis of the femoral head. Union formation in the patients was a full weight bearing without pain in the affected limb due to radiologic consolidation in both AP and lateral view and observing the union at least in 3 determined cortexes. In the suspicious cases, the CT scan was used to further assessment of the union. The results were evaluated and compared with SPSS software.
around the tip of the main nail. The high shaftfracture rate, despite its theoretically better design, was likely to be attributed to this fact that the looseness of distal lock- ing screws existed, which was confirmed by the second revision surgery and would result in stress concentration at the tip of the main nail. The underlying cause may be osteoporosis, which results in the looseness of the PFNA fixation. In contrast, this high femoralshaftfracture rate is less observed in IT devices. Also, 11 cut-outs were ob- served in the PFNA-treated patients with osteoporosis. In patients with early postoperative excessive activity re- lated to cut-outs, we removed the PFNA device and im- plemented traction treatment. Based on the outcome of comparative analysis, no statistically significant differ- ences existed between groups in terms of fracture heal- ing or HHS. However, the IT device was superior to the
The resu lts of th e p resent series are c omparable to those of the other series on management of femoralshaftfracture i n chi ldren. It has definite a dvantages o ver t he other co nventional i mplants t hat hav e bee n use d i n t he management o f pediatric fractures. N otable ad vantages of this technique a re early union due to repeated micro- motion at fracture site, early mobilization, early weigh t bearing, scar acceptance, easy manipulation involved in implant rem oval and hi gh p atient sat isfaction rate. B e- sides these, unlike other implants TEN does not endanger either the epiphysis or the blood supply to femoral head. The excellent biocompatibility and elasticity of titanium have further enhanced the virtues of TEN. High grade of elasticity o f tit anium li mits the de gree a nd perm anence of deformation that the nail undergoes during insertion. More importantly elasticity promotes callus formation by limiting stress shielding.
The better results in the present study probably have multiple explanations. The use of the SFR in clinical practice makes the orthopaedic surgeons and residents more experienced with the AO/OTA classification of fractures. The online registration and classification process is pedagogically designed and easy to use, with pictograms for each fracture group. We also believe that the accuracy will be higher when validating fractures that are treated surgically, mainly due to a higher level of expertise in the classifying surgeon. In the present study, the effect could be of less importance, as many of the operations were performed by residents, the same individuals that are also in charge at A&E.