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Background: Femur fractures are extremely painful due to the lowest pain threshold of the periosteum among the deep somatic structures. Perioperative Fascia Iliaca Compartment Block (FICB), when administered using a local anesthetic agent, bupivacaine, can reduce morbidity by providing satisfactory pain relief. Dexmedetomidine, an alpha-2 agonist, is known to prolong the local anesthetic effects without causing any significant side effects. We compared analgesic duration of ultrasound guided FICB with bupivacaine alone and bupivacaine with dexmedetomidine for postoperative analgesia. A prospective, randomized, double blinded study was conducted on 50 patientsMaterials And Method: aged 18 to 65 years undergoing femur fracture surgeries. Patients were divided into 2 groups of 25 each. Both groups received USG guided FICB. Group A received 28 ml 0.25% bupivacaine and 2 ml normal saline (NS). Group B received 28 ml 0.25% bupivacaine and 30 mcg dexmedetomidine in NS. Pain scores were assessed every 5 minutes until 15 minutes post FICB, during positioning for subarachnoid block and every 2 hours until 24 hours post-operatively. Total duration of analgesia, cumulative analgesia requested in 24 hours, Ramsay sedation and patient satisfaction scores were recorded. Results: The mean duration of analgesia in Group A was 419.4 ± 115.35 minutes (95%CI: 374.2 – 464.6) and in Group B was 656.6 ± 137.99 minutes (95%CI: 602.5 –710.7), p <0.001. Mean VAS score during positioning for SAB in Group A was 1.60 ± 0.50 and in Group B was 0.96 ± 0.68. USG guided FICB with dexmedetomidine is superior inConclusion: providing prolonged post-operative analgesia in comparison to bupivacaine alone
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Background: Numerous variations of intramedullary nailing have been evolved over the years for stable fixation and early mobilisation of subtrochanteric fracture, out of which one is proximal femoral nail. Aims and objectives 朩e conducted this study with an objective to evaluate the results of internal fixation of subtrochanteric fractures of the femur with proximal femoral nail � AO type Design.Methods:This was a prospective study carried out at our tertiary care institute on 30 patients who had suffered subtrochanteric fracture and were subsequently treated with a proximal femoral nail (PFN). Proximal femoral nail was inserted through the tip of greater trochanter. All patients were followed up for a period of one year; at an interval of 3 months and during each follow-up visit for the functional outcome by modified Harris Hip Score, was assessed in the form of walking, squatting, sitting and rising from chair.Results:Modified Harris hip score was used for the evaluation of results in our study which showed excellent result in 21 patients (70%), good results in 3 cases(10%), fair results in 3 patient (10%) and poor results in 3 cases(10%). The mean Harris hip score in our study was 90.6.Conclusion:PFN is an intramedullary load sharing implant. Reduction and management of subtrochanteric fractures is challenging in traumatology. Proximal femoral nailing spanning whole femur with proximal and distal locking appears to be a satisfactory implant in management of fractures of subtrochanteric femur.
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Background:Fracture femur is common in elderly. Spinal anesthesia (SA) in elderly patients can be associated with major hemodynamic changes whereas lumbar plexus block (LPB) can provide ideal perioperativeanalgesia as there is no hemodynamic instability or depression of pulmonary functions. The purpose of this study is to compare the efficacy of SA versus LPB for intraoperative anesthesia and postoperative analgesia in fracture femur surgery.Materials andMethods: This prospective randomized controlled study was carried out 70 patients of either sex with age >20 years, ASA physical status I -III scheduled for fracture femur surgery. Patients were randomly classified into two equal groups (n = 35); group I(SA) received SA by heavy bupivacaine HCL 0.5% 2.5-3.5 ml and group II (LBP) received posterior LPB by 30-35 ml bupivacaine 0.5% Results:The time for performing the block was significantly longer in group LPB than group SA. The onset of sensory and motor block was significantly increased in group LPB than group SA. The intraoperative HR was significantly increased, and intraoperative MAP was significantly decreased in group SA compared to group LPB at 5, 10, 15, 20, 25 and 30 minutes. Postoperative HR and MAP was significantly increased in group SA compared to group LPB at 1 and 6 h. Postoperative VAS was significantly increased in group SA than group LPB at 1 and 6 h. The duration of sensory and motor block was significantly increased in group LPB than group SA. The time of postoperative first analgesic requirement was significantly longer and the total pethidine consumption in the 1st24 h was significantly lower in group LPB than group SA. SA was associated with significant increase in hypotension, nausea, vomiting and headache.Conclusion:LPB is an effective alternative to SA as an anesthetic technique for femur fracture surgeries. LBP offers a more stable intraoperative hemodynamics and provides longer duration of analgesia postoperatively with less side effects. However, SA has shorter time for performing the block with earlier onset of sensory and motor block
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Introduction: With various options available like unipolar, bipolar hemiarthroplasty or total hip arthroplasty, it would be wise to choose hemiarthroplasty as it is a procedure with a short operating time with lesser morbidity for elderly patients with displaced intra-capsular neck femur fractures.This study is aimed primarily at comparing the functional results obtained after a hemiarthroplasty using Austin Moore’s prosthesis and cemented modular bipolar prosthesis and studying the associated complications in these cases. Materials and methods: A total of 68 elderly patients who had fulfilled the inclusion criteria were enrolled for this prospective, randomized, comparative study between 2 groups labeled as group A (Austin Moore’s prosthesis) and group B (bipolar prosthesis). Out of total 68 patients, 4 patients from group A were lost to follow up and 2 patients from group A died. Similar surgical approach, perioperative and follow up protocol were followed for both groups. Functional outcome measured using Harris hip score. Statistical comparison of functional outcome and clinic-radiological assessment were done for each patient at 3 months, 6 months and 1 year. Results: The average age of the patient was 73.0 years in Group A and 76.0 years in Group B. After the end of 12 months, mean score was 86.50 in Group A which was comparable to 89.56 in Group B subjects. After duration of 12 months 94.1% of the subjects in Group B had excellent to good Balan B, Shetty SK, Shetty A, Chandran R, Mathias LJ. Displaced intra-capsular neck femur fractures in elderly: Austin Moore’s prosthesis or Cemented Modular Bipolar Prosthesis. IAIM, 2016; 3(7): 287-296. Page 288 treatment which was more compared to 78.6% of the cases in Group A, but the difference was not significant. Incidence of superficial infection and dislocation of prosthesis was equal in both groups. Complications rate were also comparable between the two groups. Conclusion: Primary Hemiarthroplasty is an efficient way for treatment of displaced intra-capsular neck femur fractures in the elderly patients more than or equal to 60 years. Percentage of patients achieving excellent to good outcome at the end of 1 year are more in group B. Long term studies are needed to compare complications with hemiarthroplasty using 2 different prostheses.
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ObjectiveTo investigate the influence of stress hyperglycemia on fracture healing of patients with fracture of shaft of femur pro-operation.MethodsTo retrospectively analyze the clinical data of 65 patients with fracture of shaft of femur.Then according to the blood sugar level of the initial admission,all patients were divided into high glucose group 41 cases and no high glucose group 24 cases.The difference of fracture healing time was compared between both groups.ResultsThe mean clinical fracture healing time in high glucose group was ( 11.5 ± 1.3 ) weeks.ConclusionOur study found that there was relationship between blood glucose level and fracture healing in patients with fracture of shaft of femur pro-operation,patients with stress hyperglycemia pre-operation seemed to have longer fracture healing time than the ones without.
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Las fracturas del extremo distal de fémur constituyen un grupo de lesiones de difícil manejo, cuyos resultados no son uniformemente buenos y cuyo tratamiento y recuperación requiere un considerable esfuerzo por parte del traumatólogo y del paciente. Su tratamiento a sufrido modificaciones considerables. El objetivo de este trabajo es describir la experiencia de nuestro centro en el manejo de las fracturas supracondileas de fémur. Se revisaron 76 historias con diagnostico de fractura supracondilea de fémur en el Hospital Central del IVSS Dr. Miguel Pérez Carreño, en el periodo comprendido de 2004 a 2008; de los cuales 87% son masculinos y 13% femenino, en una edad comprendida entre 10 a 76 años con una promedio de 35 años, el mecanismo de lesión mas frecuente fue heridas por arma de fuego con 37 casos (49%), las fracturas abiertas correspondieron a las tipo III A (69%). En 36 casos se observó un trazo de fractura metafisiario a causa de heridas por arma de fuego, con 47 días de hospitalización en promedio. El 58% de los pacientes recibió tratamiento quirúrgico, entre ellos DCS (48%), clavos endomedulares bloqueados (14%), placas anatómicas dístales de fémur (11%) y tutores en 4 casos, los clavos bloqueados retrógrados se colocaron a 3 pacientes. El 42% recibieron tratamiento conservador con yeso inguinopédico. Como complicaciones se reportaron pseudoartrosis en el 7%; rigidez articular 9% asociado con tornillos canulados, consolidación viciosa en un 25% y acortamiento de 5 cm en promedio de 13% (4 casos) asociado a tratamiento conservador. En cualquier caso el tipo de tratamiento, sea conservador o quirúrgico, requiere una previa valoración cuidadosa de la anatomía de la fractura y de la situación global del paciente.
Fractures of the distal femur are a group of injuries are difficult to manage, the results are not uniformly good and which treatment and recovery requires a considerable effort by the orthopedist and the patient. His treatment has undergone significant changes. The aim of this study is to describe our experience in the management of supracondylar fractures of the femur. 76 stories were revised diagnosis of supracondylar fracture of femur in the Central Hospital Dr. Miguel Perez Carreño IVSS in the period from 2004 to 2008, of whom 87% are male and 13% female, at an age between 10 to 76 years with an average of 35 years, the most frequent mechanism of injury was gunshot wounds in 37 cases (49%), open fractures corresponded to type III (69%). In 36 cases showed a metaphyseal fracture line due to gunshot wounds, with 47 days of hospitalization on average. 58% of the patients received surgical treatment, including DCS (48%), locked intramedullary nails (14%), distal femur anatomical plates (11%) and mentors in 4 cases, blocked retrograde nails were placed in 3 patients . 42% received conservative treatment with plaster inguinopédico. Complications included nonunion reported in 7% 9% joint stiffness associated with cannulated screws, malunion in 25% and shortening of 5 cm on average 13% (4 cases) associated with conservative treatment. In any case the type of treatment, whether conservative or surgical, requires prior careful assessment of the anatomy of the fracture and the overall situation of the patient.
Subject(s)
Humans , Male , Adult , Female , Bone Nails , Fractures, Open/therapy , Femoral Fractures/surgery , Femoral Fractures/therapy , Bone Plates , Pseudarthrosis/pathologyABSTRACT
@#ObjectiveTo observe the clinical effect of unstable femoral intertrochanteric fracture treated with DHS. Methods Summarized 37 cases of unstable femoral intertrochanteric fracture treated by DHS,all cases were commented by fracture type,operation method and clinical effect. ResultsWe have followed up 37 cases from 0.8 to 4.7 years with average of 2.5 years.Conclusions DHS is one of the best implants due to its merits of strong fixation, little complication and early rehabilitation exercise.
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Authors has analyzed 75 cases of the femoral shaft fractures in children, treated by 90-90 skeletal traction methods at Jung Ang Gil General Hospital during last six years, from March 1982 to April 1988. The results were as follows :1. The 90-90 Skeletal traction can be widely applicable to the age group ranging from 3 to 13 years, while other traction methods have a certain age limits. 2. Maintenance of initial reduction snd correction of angular and rotational deformity of femoral shaft fracture were easily achieved. In addition, later angular deformity can also be easily corrected. In angular deformity and instability type, the correction and maintenance of deformity and instability were helped by use of 2 cast slabs. 3. Follow-up observation as well as wound care of open fracture and associated soft tissue injury were relatively easy. 4. The period of immobilization necessory after fracture was not longer than the other methods of treatment, and during treatment, evaluation of bony alignment and union was possible by direct palpation and inspection with out the help of X-ray. 5. The limitation of knee motion as well as circulatory and neurogenic complication were not found. Therefore, these results revealed that 90-90 skeletal traction was the easy, safe and effective method in treatment of femoral shaft fractures in childeren.