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Objective To investigate the curative effect and prognosis of double-plate fixation in adults with femoral shaft fractures.Methods Eighty patients with femoral shaft fractures treated in our hospital between March 2016 and February 2014 were randomly divided into an observation group and a control group,with 40 patients in each group.The observation group received treatment with double locking internal fixation,and the control group received dynamic compression plate treatment.Knee joint dysfunction,infection,and fractures were compared between the two groups.The hospital for special surgery (HSS) standard for evaluation of knee joint function and Karlstr(o)m-Olerud score for femoral fractures were used to assess the curative effect.Results In the observation group,the incidence rates of infection,knee joint dysfunction,and fracture were lower than that in the control group (P ＜ 0.05);the HSS score for knee joint function and clinical curative effect in the observation group were higher than those in the control group (P ＜ 0.05).Conclusion Double-plate fixation for adult femoral shaft fractures can effectively reduce complications and allows for early initiation of functional exercise.
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PURPOSE: The purpose of this study is to analyze the clinical results of fixation using Sirus(R) nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal. MATERIALS AND METHODS: From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus(R) nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared. RESULTS: The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment. CONCLUSION: Using Sirus(R) nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.
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Humans , Femoral Fractures , Femur , Follow-Up Studies , Fracture Fixation, Intramedullary , Hemorrhage , Hip Fractures , Retrospective StudiesABSTRACT
10.3969/j.issn.2095-4344.2013.26.010
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Objective To compare the effect of two different treatment approaches on femoral shaft fractures in polytrauma patients.Methods One hundred and forty-eight polytrauma patients were selected as our subjects,who were hospitalized from Jan.2000 to Dec.2009.They were randomly divided into cast group and external fixation group.Patients in cast group were fixed with cast within the first 24 h after the injury and patients in external fixation group were stabilized with a unilateral external fix stent within the first 24 h after the injury.Results In cast group,71 of 75 patients were followed up and follow up periods was 26.4 months.Follow up data showed that 18 patients developed multiple organ failure (MOF) and 26 patients developed ARDS.The average healed periods was 5.9 month.Three patients developed nonunion and 4 cases developed wound infection.The average of the knee motion angle was 107 degrees (60 to 110 degrees).In external fixation group,68 patients were followed up and the follow-up period was 27.5 months.Of which,13 patients developed MOF and 12 patients developed ARDS.The average healed periods was 5.6 months.2 patients developed nonunion and 3 cases developed for.wound infection.The average of the knee motion angle was 120 degrees (60 to 140 degrees).Conclusion The damage control orthopedics surgery was proved as a safe and effective treatment approach for fractures of the shaft of the femur in selected multiply injured patients compared with cast methods.
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Pulmonary and systemic fat embolization has been recognized as a serious and life-threatening complication of pelvic and/or long bone fractures. However, articles on pulmonary and systemic fat embolism which have resulted from bilateral femoral shaft fractures alone are rarely found in the literature and the fates of such cases are under-reported as well. The authors recently experienced an early severe pulmonary and systemic fat embolism following bilateral femoral shaft fractures, resulting in a sudden death about 5 hours after injury. The authors report such a case and also review the relevant literature as to its cause, pathophysiology, clinical presentation, diagnosis, and treatment.
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PURPOSE: To evaluate the results of the operative method for ipsilateral femoral shaft and neck fractures using retrograde nailing technique. MATERIALS AND METHODS: Seventeen fractures (sixteen patients), followed-up more than 1 year, were included in this study. There were 14 men and 2 women, and the mean age was 44 years-old. According to the Winquist-Hansen classification, type II was most common with 11 cases. In femoral neck fractures, type B was most common with 13 cases according to AO-OTA classification and 6 of them were type II in Garden stage. After retrograde nailing of femoral shaft fractures, neck fractures were fixed by cannulated screw or dynamic hip screw. RESULTS: The average time for union of shaft fractures was 27.3 (14-60) weeks. Nonunion occurred in five patients, who required bone grafts or changes of fixation. The average time for union of neck fractures was 11 (8-12) weeks. All united, except for one case of nonunion with avascuar necrosis, which was a Garden stage IV fracture. Functional results using Friedman-Wyman criteria were good in 16 cases, and fair in one. The only fair result was nonunion of the femoral neck, which had the joint arthroplasty. CONCLUSION: Although the union rate of femoral shaft must be improved, retrograde nailing can provide an easy fixation and a favorable result for ipsilateral femoral neck fractures.
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Adult , Female , Humans , Male , Arthroplasty , Classification , Femoral Neck Fractures , Femur Neck , Fracture Fixation, Intramedullary , Hip , Joints , Neck , Necrosis , TransplantsABSTRACT
[Objective]To investigate the effect of proximal femoral intramedullary nail with spiral blade for the treatment of femoral peritrochanteric fractures with femoral shaft fractures.[Method]From January 2002 to October 2006,21 patients of femoral peritrochanteric fractures with femoral shaft fractures were treated by minimal invasive technique with proximal femoral intramedullary nail and spiral blade.[Result]All 21 patients were followed up from 9 months to 5 years,with an average of 13 months,fractures healed in all patients.There was no nail and screw broken or loosening.The hip and knee joints of ingived limbs retained good function.[Conclusion]It is a good internal fixation operation for treatment of femoral peritrochanteric fractures with femoral shaft fractures(according to the patient's age,the type of fracture and the Singh index of the bone)by using minimal invasive technique with proximal femoral intramedullary nail and spiral blade,the key of treatment is the anatomic reduction of the fractures under minimal invasive surgery.
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Objective To evaluate the value of Orthopaedic POSSUM scoring system in predicting mortality and morbidity for the patients underwent femoral shaft fractures.Methods The mortality and incidence of postoperative complications was predicted with in a retrospective study of 155 cases of femoral shaft fractures.Results The estimated incidence of postoperative complications is 45/155, which has no statistical significance with the real incidence 39/155 (?2=0.59,P=0.44), The estimated morbidity by POSSUM is more accurate in high-risk subgroup than in low-risk one. The estimated mortality is 10/155, which also has no statistical significance with the real mortality 8/155 (?2=0.24,P=0.63).Conclusion The POSSUM scoring system can predict postoperative mortality and morbidity for the patients underwent femoral shaft fractures efficiently.
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Objective To observe the clinical outcomes of the treatment of comminuted femoral shaft fractures with combination of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator. Methods 35 cases of comminuted femoral shaft fractures were treated with combined use of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator. Of the 35 cases, 25 were type B and 10 type C according to AO classification. 1 case had bilateral femoral shaft fracture of type B. Results All the fractures were followed up for 12 to 24 months (averaging 18.5 months). By second attention, all the fractures healed except 1 case who had to undergo secondary surgery because his shape memory sawtooth-arm block hoop internal fixator had dropped. The intramedullary interlocking nails were taken out 18 to 24 months postoperatively. The excellent rate was 98.2%according to Klemm grading system. Conclusion In treatment of comminuted femoral shaft fractures, the combined use of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator can take advantages of the 2 devices so as to secure anatomic reduction and reliable fixation.
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Objective To explore the indication and the procedure of operative treatment for femoral shaft fractures with retrograde intramedullary nailing through knee joint. Methods In the 12 cases of femoral shaft fracture, a 5cm incision inside the patella ligament was made under radioscopy, with the knee flexing to 30?to 40?, and the interlocking nail was inserted reversely through femoral intercondylar. Open reduction was done in 5 cases to correct dislocation, and closed reduction in 7 cases. Results All the cases were followed up for an average of one year. Their fractures healed, and their function of the knee joint recovered well. Conclusions The interlocking nail inserted reversely through the knee joint is a feasible therapy to treat femoral shaft fractures. It is simple, and provides rigid fixation and early functional exercises to recover the knee joint. It does not affect the knee joint function in a short term, but its long term effects still need further follow up.
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Objective The correlation of union of femoral shaft fracture with selection of therapies was analyzed to explore the importance of protecting the periosteum and soft tissue,and to observe the influence of Chinese medicine.Methods A retrospective study was carried out in 478 femoral shaft fracture patients hospitalized in Zhongshan Hospital of TCM from 2001 to 2008.According to the selection of therapies,the patients were separated into conservative group(N=198) and operative group(N=280).The conservative group was then divided into two subgroups: conservative treatment alone(N=105),and conservative treatment combined with oral use of Chinese medicine(N=93).The operative group was divided into three subgroups: open reduction and fixation with dynamic compression plate(N=113),open reduction and fixation with limited contact-dynamic compression plate(N=98),and closed reduction and fixation with intramedullary nail(N=69).The correlation of union of femoral shaft fracture and selection of therapies was analyzed.Results The union rate in the conservative group was higher than that of the operative group(P
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Since May 1981, the standard method of treatment of the femoral shaft fractures at the Daejeon EuIji Deneral Hospital has been the closed intramedullary nailing technique of Kuntscher. We performed intramedullary nailing on thirty-five fractures of femoral shaft in 35 patients. Closed intramedullary nailing was used in twenty-eight femora and open intramedullary nailing with cerclage wiring in seven fractures, in which large butterfly fragment was present, precluding control of rotation or length, or both. The overall rate of union was 97 percent. The range of motion of the knee at follow up was good in 80%, fair in 14%, poor in 6% (Good Full extension; loss of flexion less than 10 degrees. Fair Any loss of extension;loss of flexion of 10 to 50 degrees, Poor Loss of more than 10 degrees of extension; range of flexion-extension less than 90 degrees). The advantages of this technique include the negligible risk of infection, the rapid stabilization of fracture, thus facilitating management of other associated injuries, the rapid return of function of the knee, and early union of fracture and return to work. It is authors' opinion that when proper equipment and expertise are available, than closed intramedullary nailing is the treatment of choice not only for simple uncomminuted fracture of the femoral shaft but also for open comminuted fractures.