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1.
Arch Osteoporos ; 16(1): 68, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846869

RESUMO

This study analyzed the outcome of orthogeriatric patients with hip fracture 4 months after surgery. The overall mortality rate was 12.2%. Sixty-five percent presented a degradation in walking ability, and 16% had to move to a nursing home. Early geriatric rehabilitation reduces the mortality rate and increases the rate of anti-osteoporotic treatment. PURPOSE: Hip fractures are increasingly common with severe consequences. Therefore, the German Trauma Society (DGU) implemented an orthogeriatric co-management and developed the concept for certified Centre for Geriatric Trauma DGU. The patients' treatment data and the optional 120 days of follow-up were collected in the Registry for Geriatric Trauma DGU (ATR-DGU). This study analyzed these 4-month treatment results. METHODS: A retrospective analysis of the ATR-DGU was conducted. Outcome parameters were the rate of readmission, rate of re-surgery, anti-osteoporotic therapy, housing, mortality, walking ability, and quality of life (QoL) 120 days post-surgery. The influence of the early geriatric rehabilitation (EGR) was evaluated using a regression analysis. RESULTS: The follow-up data from 9780 patients were included. After 120 days, the mortality rate was 12.2%, the readmission rate 4%, and the re-surgery rate 3%. The anti-osteoporotic treatment increased from 20% at admission to 32%; 65% of the patients had a degradation in walking ability, and 16% of the patients who lived in their domestic environment pre-surgery had to move to a nursing home. QoL was distinctly reduced. The EGR showed a positive influence of anti-osteoporotic treatment (p<0.001) and mortality (p=0.011) but led to a slight reduction in QoL (p=0.026). CONCLUSION: The 4-month treatment results of the ATR-DGU are comparable to international studies. The EGR led to a significant rise in anti-osteoporotic treatment and a reduction in mortality with a slight reduction in QoL.


Assuntos
Fraturas do Fêmur , Fraturas do Quadril , Idoso , Fraturas do Fêmur/cirurgia , Fêmur , Fraturas do Quadril/cirurgia , Humanos , Qualidade de Vida , Estudos Retrospectivos , Centros de Traumatologia
2.
Medicine (Baltimore) ; 100(17): e25708, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907153

RESUMO

ABSTRACT: The aim of this study was to evaluate the risk factors related to osteosynthesis failure in patients with concomitant ipsilateral femoral neck and shaft fractures, including old age; smoking habit; comminuted fragments; infra-isthmus fracture; angular malreduction; unsatisfactory reduction (fracture gap >5 mm); and treatment with single construct.Patients over the age of 20 with concomitant ipsilateral femoral neck and shaft fractures diagnosed at a level one medical center between 2003 and 2019 were included. Treatment modalities included single construct with/without an antirotational screw for the neck and dual constructs. Radiographic outcomes were assessed from anteroposterior and lateral hip radiographs at follow-up. Fisher exact test was used to analyze categorical variables. The presence of avascular necrosis of the femoral head, delayed union, atrophic or hypertrophic nonunion of the femoral shaft fracture, and loss of reduction were identified as factors related to treatment failure.A total of 22 patients were included in this study. The average age was 58.5 years, and the majority was male (68.2%). The minimum radiographic follow-up duration was 12 months, and the median follow-up time was 12 (interquartile range 12-24) months.Femoral neck osteosynthesis failed in 3 patients, whereas femoral shaft osteosynthesis failed in 12 patients. Fisher exact test demonstrated the failure of femoral shaft osteosynthesis was significantly more frequent in the single-construct cohort in 16 infra-isthmus femoral fracture cases (P = .034).In ipsilateral femoral neck and infra-isthmus shaft fractures, it is better to treat the neck and shaft fractures with separate implants (dual constructs).In a dual-construct cohort, separate plate fixation of the femoral shaft achieved a better result in terms of bone union than retrograde nailing of the shaft (bone union rate: 4/8 vs 0/2).


Assuntos
Fraturas do Fêmur , Fraturas do Colo Femoral , Fixação Intramedular de Fraturas , Fixadores Internos , Complicações Pós-Operatórias , Assistência ao Convalescente/métodos , Feminino , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/cirurgia , Fraturas do Colo Femoral/diagnóstico , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Fraturas Cominutivas/diagnóstico , Fraturas Cominutivas/epidemiologia , Fraturas Cominutivas/cirurgia , Humanos , Fixadores Internos/normas , Fixadores Internos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Taiwan/epidemiologia , Falha de Tratamento
3.
Medicine (Baltimore) ; 100(14): e25253, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832086

RESUMO

RATIONALE: Hoffa fracture is a rare fracture confined to the coronal-plane involving femoral condyles. This occurs simultaneously with rotational dislocation of the knee joint is extremely rare. Up to now, there is no valid recommendation for the treatment of the Hoffa fracture. PATIENT CONCERNS: A 50-year-old female patient broke her knee joint while skiing, experiencing severe pain in the right knee, which was swollen. She presented limited function of the knee and movement upon arrival in the emergency room. DIAGNOSIS: Comminuted Hoffa fracture in the right knee associated with rotational dislocation in the knee joint. INTERVENTIONS: We treated the dislocated knee joint through manual reduction initially. During the operation, we used posterolateral approach to expose the fracture fragments, thereafter using headless compression screws and a buttress plate to provide sufficient stability for the fracture. Early postoperative rehabilitation was encouraged. OUTCOMES: The patient finally achieved fracture healing three months after operation. In addition, she achieved 0-130° range of function of the knee after four months post-operation, and the patient obtained a satisfactory prognosis after our treatment. LESSONS: By using appropriate surgical approach to obtain enough exposure, headless compression screws and the buttress plate provided adequate stability during early active rehabilitation, which resulted in satisfactory results in the treatment of the injury. We reviewed literatures regarding the treatment of Hoffa fracture to demonstrate that our treatment was effective.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/instrumentação , Luxações Articulares/terapia , Articulação do Joelho/cirurgia , Placas Ósseas , Parafusos Ósseos , Feminino , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Esqui/lesões
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 439-444, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855827

RESUMO

Objective: To investigate the effectiveness of the extended Carlson approach in the treatment of lateral femoral condylar Hoffa fractures. Methods: The clinical data of 17 patients with lateral femoral condyle Hoffa fractures between September 2012 and January 2019 were retrospectively analyzed. There were 10 males and 7 females, with a mean age of 43 years (range, 32-68 years). Fractures were caused by traffic accident in 9 cases, by falling from height in 6 cases, and by the other mechanism in 2 cases. According to the Letenneur's classification, there were 8 cases of typeⅠ, 6 cases of type Ⅱ, and 3 cases of type Ⅲ. The mean time from injury to operation was 7 days (range, 3-32 days). All patients were treated with extended Carlson approach. Patients with Letenneur types Ⅰ and Ⅲ were fixed by a posterior antigliding plate combined with headless compression screws from anteroposterior direction, and patients with Letenneur typeⅡ were fixed by headless compression screws from anteroposterior direction. The anteroposterior and lateral X-ray films, CT and three-dimensional reconstruction of the knee joint were taken after operation to assess fracture healing and position of the internal fixators. The knee function was evaluated according to Letenneur's functional assessment system. Results: All patients were followed up 13-28 months (mean, 15 months). All the incisions healed by first intention, and no complication such as fracture redisplacement, fracture nonunion, internal fixator fracture, and common peroneal nerve injury occurred. The mean time of fracture healing was 18 weeks (range, 16-32 weeks). At last follow-up, according to Letenneur's functional assessment system, the knee function was excellent in 12 cases and good in 5 cases, with an excellent and good rate of 100%. Conclusion: The extended Carlson approach for the treatment of lateral femoral condylar Hoffa fractures has the advantages of clear exposure, easy reduction and fixation, high fracture healing rate, few complications, and good recovery of knee joint function.


Assuntos
Fraturas do Fêmur , Adulto , Idoso , Parafusos Ósseos , Feminino , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Bone Joint J ; 103-B(4): 769-774, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789468

RESUMO

AIMS: Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity). METHODS: Patients aged ≥ 16 years with a fractured femur or tibia and a MESS of ≥ 7 were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (January 2007 to December 2018). Cases were grouped into surgical amputation or limb salvage. Descriptive analysis were used to examine return to work rates, three-level EuroQol five-dimension questionnaire (EQ-5D-3L), and Glasgow Outcome Scale-Extended (GOS-E) outcomes at 12 and 24 months post-injury. RESULTS: In all, 111 patients were included: 90 (81%) patients who underwent salvage and 21 (19%) patients with surgical amputation. The mean age of patients was 45.8 years (SD 15.8), 93 (84%) were male, 37 (33%) were involved in motor vehicle collisions, and the mean MESS score was 8.2 (SD 1.4). Two-year outcomes in the cohort were poor: six (7%) patients achieved a GOS-E good recovery, the mean EQ-5D-3L summary score was 0.52 (SD 0.27), and 17 (20%) patients had returned to work. CONCLUSION: A small proportion of patients with severe lower limb injury (MESS ≥ 7) achieved a good level of function 24 months post-injury. Further follow-up is needed to better understand the long-term trajectory of these patients, including delayed amputation, hospital readmissions, and healthcare utilization. Cite this article: Bone Joint J 2021;103-B(4):769-774.


Assuntos
Fraturas do Fêmur/cirurgia , Escala de Gravidade do Ferimento , Traumatismos da Perna/cirurgia , Fraturas da Tíbia/cirurgia , Amputação , Feminino , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sistema de Registros , Vitória
6.
Bone Joint J ; 103-B(4): 635-643, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789473

RESUMO

AIMS: Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA). METHODS: This was a retrospective cohort study of 60 consecutive unilateral (PDFFs) of Su types II (40/60) and III (20/60) in patients aged ≥ 60 years: 33 underwent LLP-ORIF (mean age 81.3 years (SD 10.5), BMI 26.7 (SD 5.5); 29/33 female); and 27 underwent DFA (mean age 78.8 years (SD 8.3); BMI 26.7 (SD 6.6); 19/27 female). The primary outcome measure was reoperation. Secondary outcomes included perioperative complications, calculated blood loss, transfusion requirements, functional mobility status, length of acute hospital stay, discharge destination and mortality. Kaplan-Meier survival analysis was performed. Cox multivariate regression analysis was performed to identify risk factors for reoperation after LLP-ORIF. RESULTS: Follow-up was at mean 3.8 years (1.0 to 10.4). One-year mortality was 13% (8/60). Reoperation was more common following LLP-ORIF: 7/33 versus 0/27 (p = 0.008). Five-year survival for reoperation was significantly better following DFA; 100% compared to 70.8% (95% confidence interval (CI) 51.8% to 89.8%, p = 0.006). There was no difference for the endpoint mechanical failure (including radiological loosening); ORIF 74.5% (56.3 to 92.7), and DFA 78.2% (52.3 to 100, p = 0.182). Reoperation following LLP-ORIF was independently associated with medial comminution; hazard ratio (HR) 10.7 (1.45 to 79.5, p = 0.020). Anatomical reduction was protective against reoperation; HR 0.11 (0.013 to 0.96, p = 0.046). When inadequately fixed fractures were excluded, there was no difference in five-year survival for either reoperation (p = 0.156) or mechanical failure (p = 0.453). CONCLUSION: Absolute reoperation rates are higher following LLP fixation of low PDFFs compared to DFA. Where LLP-ORIF was well performed with augmentation of medial comminution, there was no difference in survival compared to DFA. Though necessary in very low fractures, DFA should be used with caution in patients with greater life expectancies due to the risk of longer term aseptic loosening. Cite this article: Bone Joint J 2021;103-B(4):635-643.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Feminino , Fraturas do Fêmur/mortalidade , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/mortalidade , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Recuperação de Função Fisiológica , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 307-311, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719238

RESUMO

Objective: To evaluate the effectiveness of proximal femoral nail anti-rotation (PFNA) in treatment of high plane intertrochanteric femur fractures. Methods: A retrospective analysis was performed on 33 patients who underwent closed reduction and PFNA fixation for high plane intertrochanteric femur fracture between January 2016 and June 2019. There were 12 males and 21 females with an average age of 75.1 years (mean, 47-89 years). The fractures were caused by falling from height in 21 cases, by traffic accident in 7 cases, and by other injuries in 5 cases. Fractures were classified as type A in 14 cases and type B in 19 cases according to self-defined fracture classification criteria; and as type 31-A1.2 in 14 cases and as type 31-A2.2 in 19 cases according to AO/Orthopedic Trauma Association (AO/OTA) classification criteria. The time from injury to operation was 2-5 days (mean, 2.7 days). The operation time, intraoperative blood loss, hospital stay, fracture reduction quality, fracture healing time, internal fixation failure, and Parker-Palmer score were recorded. Results: The operation time was 40-75 minutes (mean, 55 minutes). The intraoperative blood loss was 50-150 mL (mean, 64 mL). The hospital stay was 5-15 days (mean, 8.7 days). All incisions healed by first intention. Twenty-eight patients were followed up 12-18 months with an average of 13.6 months. The fracture reduction quality was rated as excellent in 9 cases (32.1%), good in 17 cases (60.7%), and poor in 2 cases (7.1%) by Chang's criteria. Parker-Palmer score was 6-9 (mean, 7.9) at last follow-up. Conclusion: High plane intertrochanteric femur fracture is a special type of intertrochanteric fracture, which can be diagnosed by imaging examination. PFNA fixation can achieve satisfactory results and prevent the occurrence of internal fixation failure effectively.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Pinos Ortopédicos , Feminino , Fraturas do Fêmur/cirurgia , Fêmur , Fraturas do Quadril/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Medicine (Baltimore) ; 100(8): e24929, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663129

RESUMO

INTRODUCTION: Fat embolism syndrome (FES) is a known complication of long bone fracture and can affect multiple organs. The organ most commonly affected with FES is the lung. Severe cases of FES from long bone fracture can cause acute respiratory distress syndrome (ARDS). Although the treatment of ARDS remains challenging, it is reported that a lung protection strategy and prone positioning are effective. In addition, early fixation is reported to be beneficial in respiratory failure due to FES, though it may exacerbate respiratory failure during the perioperative period. We report the use of venovenous extracorporeal membrane oxygenation (VV-ECMO) for the successful perioperative management of a patient diagnosed with ARDS due to FES. PATIENT CONCERNS: A 24-year-old man injured in a traffic accident was brought to our emergency department due to shock and consciousness disorder. DIAGNOSIS: After examining the patient, we noted bilateral pneumothorax, liver and spleen injuries, and multiple long bone fractures. Four days after admission, he was diagnosed with FES due to a prolonged consciousness disorder, progressive hypoxia with diffuse lung damage, and cutaneous and mucosal petechiae. INTERVENTION: As respiratory failure progressed, VV-ECMO was initiated on the 6th day. To improve the respiratory failure caused by ARDS, prone position therapy was necessary. Thus, we performed osteosynthesis on the 9th day under ECMO. Prone position therapy was started after surgery. OUTCOMES: Subsequently, his respiratory condition and chest radiographs improved steadily. VV-ECMO was discontinued on the 17th day and the ventilator was removed on the 28th day. His consciousness levels improved without residual central nervous system complications. CONCLUSION: Our study reveals the successful improvement of FES-induced ARDS by osteosynthesis and prone positioning under VV-ECMO. This strategy prioritizes supportive treatment over pharmacologic interventions.


Assuntos
Embolia Gordurosa/etiologia , Oxigenação por Membrana Extracorpórea/métodos , Fraturas do Fêmur/complicações , /terapia , Acidentes de Trânsito , Fraturas do Fêmur/cirurgia , Humanos , Masculino , Decúbito Ventral , Adulto Jovem
10.
Zhongguo Gu Shang ; 34(3): 255-9, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787171

RESUMO

OBJECTIVE: To analyze and compare the clinical efficacy of different types of surgical treatment of periprosthetic femoral fracture(PFF) after hip arthroplasty (HA). METHODS: From September 2010 to September 2016, 47 patients (47 hips) with periprosthetic fractures after total hip arthroplasty were retrospectively analyzed, including 13 males and 34 females. According to Vancouver classification, there were 2 patients with type AG, 17 patients with type B1, 19 patients with type B2, 7 patients with type B3 and 2 patients with type C. The age of patients ranged from 56 to 94 (71.5±8.3) years. After admission, nutritional risk screening (NRS2002) was used to assess the nutritionalstatus of the patients. Eighteen patients (38%) had malnutrition risk (NRS>3 points). After admission, the patients were given corresponding surgical treatment according to different types. Intraoperative blood loss was recorded. Harris score was used to evaluate the hip function. VAS pain score was performed on admission and after operation. RESULTS: All the 47 patients were followed up for 19 to 62 (34±11) months. The Harris scores were (41.8±12.1) and (89.0±2.6) respectively before and 1 year after operation, and the difference was statistically significant (t=29.7, P<0.01). The VAS pain scores were (8.0±0.6) and (0.5±0.6) respectively before and 1 year after operation, and the difference was statistically significant(t=80.7, P<0.01). The intraoperative blood loss was (730±68) ml and (688±127) ml in patients with type B1 malnutrition risk and patients without malnutrition risk, and the difference was statistically significant (t=4.6, P<0.05);the intraoperative blood loss was (916±118) ml and (884±88) ml in patients with type B2 malnutrition risk and patients without malnutrition risk, and the difference was statistically significant (t=8.7, P<0.05). At the last follow-up, all the fractures were healed and the force line of lower limbs was good. No loosening, displacement, fracture of internal fixation, loosening and dislocation of prosthesis occurred during the follow-up period. CONCLUSION: The treatment of hip periprosthetic fracture patients should be based on the general situation of patients, imaging data, intraoperative correction classification, etc. to develop individualized treatment plan in line with patients. For patients with preoperative malnutrition risk, preoperative nutritional intervention may reduce intraoperative bleeding.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Prótese de Quadril , Fraturas Periprotéticas , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Feminino , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
11.
Zhongguo Gu Shang ; 34(3): 288-92, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787177

RESUMO

OBJECTIVE: To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing. METHODS: From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation. RESULTS: All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening). CONCLUSION: It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas não Consolidadas , Adulto , Pinos Ortopédicos , Placas Ósseas , Transplante Ósseo , Feminino , Fraturas do Fêmur/cirurgia , Fêmur , Consolidação da Fratura , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
12.
Chirurg ; 92(5): 485-496, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33528629

RESUMO

Femoral fractures in childhood are rare and are usually the result of severe trauma. Conservative treatment (overhead extension, hip spica cast) can be used in children up to 3 years of age and beyond that elastic stable intramedullary nailing (ESIN) is the method of choice. The prognosis is very good if the surgical technique is adequate. In adolescents > 50 kg in body weight solid nails implanted via the greater trochanter are an alternative (adolescent lateral femoral nail, ALFN). External fixators and plate osteosynthesis are indicated in special situations. Femoral neck fractures are very seldom seen in this age group. Besides Kirschner (K)-wires and screw osteosynthesis a special pediatric hip plate is available in this situation. In the distal metaphysis mostly stable fractures occur in disabled children, which can usually be treated conservatively. In addition, pathological fractures occur in juvenile bone cysts and complex injuries in adolescents, which need stabilization by descending ESIN or with plates. At the distal growth plate relevant growth disturbances are possible.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Adolescente , Pinos Ortopédicos , Placas Ósseas , Fios Ortopédicos , Criança , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos
13.
Bone Joint J ; 103-B(2): 309-320, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517729

RESUMO

AIMS: The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter). METHODS: This retrospective cohort study assessed 152 operatively managed consecutive unilateral Vancouver B fractures involving Exeter stems; 130 were managed with open reduction and internal fixation (ORIF) and 22 with revision arthroplasty. Mean follow-up was 6.5 years (SD 2.6; 3.2 to 12.1). The primary outcome measure was revision of at least one component. Kaplan-Meier survival analysis was performed. Regression analysis was used to identify risk factors for revision following ORIF. Secondary outcomes included any reoperation, complications, blood transfusion, length of hospital stay, and mortality. RESULTS: Fractures (B1 n = 74 (49%); B2 n = 50 (33%); and B3 n = 28 (18%)) occurred at median of 4.2 years (interquartile range (IQR) 1.2 to 9.2) after primary total hip arthroplasty (THA) (n = 138) or hemiarthroplasty (n = 14). Rates of revision and reoperation were significantly higher following revision arthroplasty compared to ORIF for B2 (p = 0.001) and B3 fractures (p = 0.050). Five-year survival was significantly better following ORIF: 92% (95% confidence interval (CI) 86.4% to 97.4%) versus 63% (95% CI 41.7% to 83.3%), p < 0.001. ORIF was associated with reduced blood transfusion requirement and reoperations, but there were no differences in medical complications, hospital stay, or mortality between surgical groups. No independent predictors of revision following ORIF were identified: where the bone-cement interface was intact, fixation of B2 or B3 fractures was not associated with an increased risk of revision. CONCLUSION: When the bone-cement interface was intact and the fracture was anatomically reducible, all Vancouver B fractures around Exeter stems could be managed with fixation as opposed to revision arthroplasty. Fixation was associated with reduced need for blood transfusion and lower risk of revision surgery compared with revision arthroplasty. Cite this article: Bone Joint J 2021;103-B(2):309-320.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Redução Aberta , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cimentos para Ossos , Feminino , Fraturas do Fêmur/etiologia , Seguimentos , Prótese de Quadril , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Reoperação/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
14.
Medicine (Baltimore) ; 100(4): e23616, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530163

RESUMO

RATIONALE: Pediatric femoral shaft combined with ipsilateral femoral neck fractures are very rare but challenging injuries fraught with the development of avascular necrosis, coxa vara, and leg length discrepancy. Majority of the previous reports indicated the neck femur fracture was fixed with cannulated screws or/and pins, femoral shaft fracture was stabilized with a plate and screws. However, we used cannulated screws combined with elastic stable intramedullary nails to minimally invasive procedures treat this type of injury and achieved good follow-up results. PATIENT CONCERNS: A 7-year-old boy (Case 1) was hospitalized due to a traffic accident resulting in swelling and deformity of the right thigh accompanied by limited mobility of hip and knee. A 5-year-old male child (Case 2) presented with pain and swelling in the bilateral lower limb after fall from approximately 12 feet. DIAGNOSES: Physical examination, X-ray film, and computed tomography were performed. Both patients were diagnosed with ipsilateral femoral neck and shaft fracture. INTERVENTIONS: The fractures were reduced closed by image-intensifier imaging. Two partially threaded cancellous screws were used to fix femoral neck fracture, and elastic intramedullary nails were performed to stable the femoral shaft fracture. Postoperatively, the patients were immobilized in a one-and-a-half hip spica cast for six weeks. The internal fixations were removed after one year. OUTCOMES: Case one was follow-up at 14 months and the other one was followed up for 3 years. And at the last follow-up showed a normal and painless hip function. No clinical complications were found during follow-up visit, including head penetration, implant failure, fracture nonunion, avascular necrosis and hip varus deformity. LESSONS: Clinician should carefully check and read relevant imaging data to avoid missed diagnosis. And the internal fixation method described in this paper may be more minimally invasive.


Assuntos
Fraturas do Fêmur/cirurgia , Fraturas do Colo Femoral/cirurgia , Colo do Fêmur/lesões , Fixação Intramedular de Fraturas/métodos , Pinos Ortopédicos , Placas Ósseas , Parafusos Ósseos , Criança , Pré-Escolar , Colo do Fêmur/cirurgia , Humanos , Masculino
15.
Oper Orthop Traumatol ; 33(1): 46-54, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33501513

RESUMO

OBJECTIVE: Minimally invasive, sufficiently stable for movement and partial weight bearing, osteosythesis of pertrochanteric femoral fractures in children < 6-8 years using elastic, stable intramedullary nailing (ESIN). INDICATIONS: Proximal, pertrochanteric femoral fractures Delbet type IV in children < 6 years. CONTRAINDICATIONS: Comminuted fractures, femoral neck fractures. SURGICAL TECHNIQUE: By inserting three elastic titanium nails (TEN), prebent in the proximal third, retrograde into the femur, a stable 3­point support stabilizes the proximal fragment. For further improvement of stability, EndCaps can be used. POSTOPERATIVE MANAGEMENT: Partial weight bearing (sole-contact) for 4-5 weeks. X­ray controls immediately after surgery and after 4-5 weeks. No sports for 3 months. RESULTS: In our patient population we have good experience with this technique for very rare pertrochanteric fractures in children younger than 6-8 years. With minimally invasive access, exercise-stable administration can be achieved without a pelvic leg cast.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Pinos Ortopédicos , Criança , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Consolidação da Fratura , Humanos , Resultado do Tratamento
16.
J Bone Joint Surg Am ; 103(2): 123-130, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33476100

RESUMO

BACKGROUND: Atypical femoral fracture (AFF) is associated with high prevalence rates of prodromal symptoms, bilateral involvement, complications, and the need for prophylactic fixation due to a risk of an impending fracture. Although most complete AFF cases have an asymptomatic contralateral femur at the initial presentation, there is lack of clarity on its progression. We evaluated the radiographic progression of asymptomatic contralateral femora in patients with a complete AFF and investigated the characteristics of these patients. METHODS: The medical records of 80 consecutive patients who had been treated for a complete AFF were retrospectively evaluated. We excluded 14 patients who had been lost to follow-up, 10 whose contralateral femur initially had been symptomatic and had been treated simultaneously, and 3 whose contralateral femur had previously been treated surgically. The remaining 53 patients were all women with an average age of 71.8 years. The average duration of bisphosphonate (BP) use was 63.6 months, and the mean follow-up duration was 48.9 months. All of the contralateral femora were asymptomatic and were divided into 2 grades according to the initial radiographic findings. We evaluated the prevalence of radiographic progression according to the grades and compared patient characteristics between the progression and non-progression groups. RESULTS: Radiographic progression was noted in 18 patients (34%) during the follow-up: 3 (12%) of 25 in grade 1 and 15 (53.6%) of 28 in grade 2 (p < 0.001). The mean time to progression for these 18 patients was 25.6 months, which also differed significantly depending on the grade (p = 0.02). Eleven and 9 (61.1% and 25.7%) of the patients received BP postoperatively in the progression and non-progression groups, respectively (p = 0.01). CONCLUSIONS: The prevalence of radiographic progression was relatively high, even though the contralateral femur was initially asymptomatic, and differed significantly according to the initial radiographic grade. The frequency of postoperative BP use was significantly higher in the progression group. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas do Fêmur/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Progressão da Doença , Feminino , Fraturas do Fêmur/classificação , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/cirurgia , Fêmur/lesões , Fêmur/cirurgia , Fixação Intramedular de Fraturas , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Instr Course Lect ; 70: 101-120, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438907

RESUMO

Femur fractures range from simple oblique or transverse fractures to complex, comminuted types. The reduction and fixation of these fractures can be challenging, with difficulty in attaining fracture alignment, length, and rotation. Added to this complexity can be associated bone loss in open fractures. Various methods and techniques have been described to achieve an acceptable reduction for fracture healing without detriment to the patient's functional outcome. This chapter describes femur fractures from the subtrochanteric to supracondylar regions with fracture reduction aids, patient position, reduction tools, and implant use including plates and nails, either individually or in conjunction. Reduction starts with closed or percutaneous techniques because these are the most biologically friendly and minimize additional iatrogenic soft-tissue injury. However, obtaining an acceptable reduction may require escalation to open techniques. This chapter is divided into sections: the first details femoral nailing and the second details femoral plating.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Pinos Ortopédicos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fêmur , Fixação Interna de Fraturas , Humanos , Resultado do Tratamento
18.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419755

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease with an estimated annual incidence of 0.5-6.8 per million. It is characterised by necrotising vasculitis with multiorgan eosinophilic infiltration. Pulmonary manifestations are the most common presentation of EGPA, and cardiac complications are the most common cause of death. Anaesthetic management of EGPA is challenging due to perioperative pulmonary complications, multiorgan involvement and greater risk of cholinesterase enzyme deficiency. We are reporting the anaesthetic management of a 58-year-old woman, diagnosed with EGPA 3 years ago, who underwent urgent intramedullary nail insertion for a femur fracture. The anaesthetic technique comprised femoral nerve block and spinal anaesthesia, thereby avoiding (1) the need for upper airway manipulation, (2) potential adverse effects of anticholinesterase drugs (for reversal of neuromuscular blockade) and (3) histamine release associated with morphine administration perioperatively. Surgery and anaesthesia were uneventful.


Assuntos
Raquianestesia , Eosinofilia/complicações , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Granulomatose com Poliangiite/complicações , Bloqueio Nervoso , Feminino , Fraturas do Fêmur/complicações , Humanos , Pessoa de Meia-Idade
19.
J Formos Med Assoc ; 120(1 Pt 2): 395-403, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32586721

RESUMO

BACKGROUND/PURPOSE: Orthopaedic Trauma Association (OTA) C-type distal femoral fractures can be very challenging to treat effectively. While locked plating is widely used in the complex distal femoral fracture, failure of locked plate fixation is not uncommon. First, we tried to determine the risk factor related to early failure of multiplanar OTA C-type fracture in the distal femur after fixation with lateral locked plate. Second, we tried to provide a strategy for surgeons to prevent pitfalls of early failure in the complex distal femoral fractures treated with lateral locked plating. METHODS: We retrospectively reviewed 44 adults with OTA C-type fractures of the distal femur treated with locked plate fixation between 2010 and 2016 at Tri-Service General Hospital. Average length of follow-up was 27.6 months (range, 12-54 months). Univariate and multivariate logistic regression were used to determine the association of variables on early failure of fixation. A p-value < 0.05 in univariate and multivariate analyses were considered significant. RESULTS: There were six patients experiencing early failure, and the early failure rate was 13.6%. The risk factors associated with early failure of complex distal femoral fracture identified by univariate analysis included sagittal oblique fracture pattern, longer working length and post-operative sagittal malalignment (odds ratio [OR] and 95% confidence intervals [CI]: 90.00 (6.85-1183.33), 0.55 (0.31-0.98) and 8.63 (1.077-69.075) respectively). The multivariate analysis showed only sagittal oblique fracture pattern was associated with early failure [OR: 52.348 (3.06-895.23)]. CONCLUSION: Sagittal oblique fracture was more likely to result in early postoperative failure. Early recognition of the fracture pattern should be considered to avoid catastrophic results.


Assuntos
Fraturas do Fêmur , Consolidação da Fratura , Placas Ósseas , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Resultado do Tratamento
20.
Bone Joint J ; 103-B(1): 71-78, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380191

RESUMO

AIMS: Periprosthetic fractures (PPFs) around cemented taper-slip femoral prostheses often result in a femoral component that is loose at the prosthesis-cement interface, but where the cement-bone interface remains well-fixed and bone stock is good. We aim to understand how best to classify and manage these fractures by using a modification of the Vancouver classification. METHODS: We reviewed 87 PPFs. Each was a first episode of fracture around a cemented femoral component, where surgical management consisted of revision surgery. Data regarding initial injury, intraoperative findings, and management were prospectively collected. Patient records and serial radiographs were reviewed to determine fracture classification, whether the bone cement was well fixed (B2W) or loose (B2L), and time to fracture union following treatment. RESULTS: In total, 47 B2W fractures (54.0%) and one B3 fracture (1.1%) had cement that remained well-fixed at the cement-bone interface. These cases were treated with cement-in-cement (CinC) revision arthroplasty. Overall, 43 fractures with follow-up united, and two patients sustained further fractures secondary to nonunion and required further revision surgery. A total of 19 B2L fractures (21.8%) and 19 B3 fractures (21.8%) had cement that was loose at the cement-bone interface. These cases were managed by revision arthroplasty with either cemented or uncemented femoral components, or proximal femoral arthroplasty. One case could not be classified. CONCLUSION: We endorse a modification of the original Vancouver system to include a subclassification of B2 fractures around cemented femoral prostheses to include B2W (where cement is well-fixed to bone) and B2L (where the cement is loose). Fractures around taper-slip design stems are more likely to fracture in a B2W pattern compared to fractures around composite beam design stems which are more likely to fracture in a B2L pattern. B2W fractures can reliably be managed with CinC revision. Cite this article: Bone Joint J 2021;103-B(1):71-78.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur/classificação , Fraturas Periprotéticas/classificação , Adulto , Idoso , Cimentos para Ossos , Feminino , Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/cirurgia , Falha de Prótese , Reoperação , Propriedades de Superfície
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