ABSTRACT
RESUMEN Introducción: el tratamiento ideal en las fracturas estables del extremo proximal de fémur lo constituye el Sistema Dinámico de cadera. Objetivo: Evaluar la efectividad de su uso en dichas fracturas. Diseño metodológico: se realizó un estudio observacional, descriptivo, de tipo longitudinal de los pacientes intervenidos quirúrgicamente por fractura del extremo proximal de fémur en el Hospital Provincial José Ramón López Tabrane, de Matanzas en el periodo comprendido entre enero del 2013 y diciembre del 2015, quedando la muestra constituida por 128 pacientes. Resultados: encontramos un predominio de las femeninas (60%) y el grupo de edades más representado el de 70 a 79 años con 50 pacientes. Predominaron las fracturas extracapsulares con 122 pacientes, siendo dentro de la variedad del DHS la placa de 130 grados la más usada en 81% de los casos. Se operó el 78 % de los pacientes antes de las 2 horas, presentando 12 complicaciones locales, dentro de las cuales resaltó el colapso de la fractura con 4 pacientes. El 70 % de los pacientes apoyó antes de las 12 semanas, presentando 33 % de fallecidos en el primer año de operado. El 92 % de los pacientes fueron evaluados de bien al final de los resultados. Conclusiones: el Sistema Dinámico de Cadera constituye el método de osteosíntesis ideal en fracturas estables con muy buenos resultados funcionales y con temprana indicación de carga de peso; recomendamos su uso en las fracturas estables del extremo proximal de fémur por sus buenos resultados (AU).
SUMMARY Introduction: the ideal treatment for stable fractures of the proximal end of the femur is the Dynamic Hip System. Objective: to evaluate the effectiveness of its use in such fractures. Methodological design: a longitudinal, descriptive, observational study of patients operated on for fractures of the proximal end of the femur was carried out at the José Ramón López Tabrane Provincial Hospital, Matanzas, between January 2013 and December 2015. The sample consisted of 128 patients. Results: we found a predominance of females (60%) and the most represented age group was 70-79 years old with 50 patients. Extracapsular fractures predominated with 122 patients, being within the DHS variety the 130 degree plate the most used in 81% of the cases. Seventy-eight percent of the patients were operated before 2 hours, presenting 12 local complications, among which the collapse of the fracture stood out with 4 patients. Seventy percent of the patients supported before 12 weeks, presenting 33% of deaths in the first year of surgery. Ninety-two percent of the patients were evaluated as being well at the end of the results. Conclusions: The Dynamic Hip System constitutes the ideal method of osteosynthesis in stable fractures with very good functional results and with early indication of weight load;we recommend its use in stable fractures of the proximal end of the femur because of its good results (AU).
Subject(s)
Humans , Male , Female , Aged , Femoral Fractures/rehabilitation , Hip Fractures/rehabilitation , Surgical Procedures, Operative/methods , Incidence , Frail Elderly , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Hip Fractures/diagnosisABSTRACT
Introduction: The surgeries over the proximal end of femur is common procedure in orthopaedics. Knowledge ofproximal femur’s morphometry can be helpful in reducing the risk of complications linked to surgeries done inthis region due to vascular, metabolic or traumatic causes. The present study is therefore conducted to providedata on the morphometric values of proximal femur and to customize the implant design to suit the Telanganapopulation and thereby reducing the complications.Objectives: 1.To study the various measurements of proximal end of femur 2. To compare the results withprevious studies.Materials and Methods: A total of 180 dry femur have been collected from Department of Anatomy, MamataMedical College. With the aid of the vernier calliper, goniometer and osteometric board, measurements such asfemoral length, transverse diameter of the head, anterior neck length and angle of the neck shaft were measured.Results: The average length of the left femur was 43.33 ± 2.72 cm and 42.95 ± 3.29 cm of the right femur. Theanterior neck length of the right femur was 2.69 ± 0.41 cm, and left femur was 2.61 ±0.34 cm. The neck shaft angleof left femur was 120.3° ± 5.26 and right femur was 119.92° ± 6.27.Conclusion: Relative to other populations, this study showed the measurements of proximal femur in Telanganapopulation were different. The results of this study can be significant in anthropological and medico-legalpractice as well as for the diagnosis and treatment planning of radiologists and orthopaedic surgeons.
ABSTRACT
Introduction: In orthopaedic surgery, trochanteric region is an important as it’s an entry point, usually lateral side of the great trochanter, although anterior and posterior approaches have variable interest. For implants such as plates and DHS (dynamic hip screw), lateral approach is standard. After skin, fat tissue and fascia lata, vastuslateralismuscle is reached and elevated to approach lateral surface of subtrochanteric area. For implants as intra-medullar nail, minimally invasive approach is in routine use. Despite abundant research of general femoral morphology, especially its specific morphological parts (femoral head, neck, shaft, and its distal part involved in knee joint). Materials andmethods: Study on 158 dry adult human femur of unknown age&sex collected fromthe department of anatomy and phase I students of KBNIMS, Kalaburagi, Karnataka. The broken or non-dried specimens were excluded fromthe study. Results: The third trochanter was present in 4.43% of the femora. Although the incidence was higher on the right side it was not statistically significant. Discussion: Another studywhich reported the side variations inWhites andNegroes, documented higher incidence on right side in White and on left side in Negro population; it also reported the trait to be more common in females in bothWhites and Negroes. Conclusion: The presence of third trochanter at the proximal part of the femur has been found to alter the break lines in the pertrochanteric fracture patients. This study dealt with the incidence of third trochanter in north Karnataka region.
ABSTRACT
The arterial supply of the proximal end of the human femur in 100 specimens ranging in age from newborn to 67 years were studied by perfusion method. A complete extracapsular anastomotic ring, formed by both the medial and the lateral femoral circumflex arteries, was present surrounding the base of the femoral neck in 71％. An incomplete subsynovial intraarticular anastomotic ring, formed by the four ascending cervical arterial groups (medial, posterior, lateral and anterior), was present at the margin of the articular cartilage in 74％ of the specimens. There might be defect at anterior, posterior or both aspects. The lateral epiphyseal arteries, giving off many multiarcaded branches towards the articular cartilage, supplied the superior, medial, central and the lateral parts of the head. The medial ascending cervical arteries supplied the infero-posterior part of the head. The medial epiphyseal arteries supplied a limited subfoveal area. The nutrition of the free surface of the articular cartilage was derived from the vascular networks in the synovial membrane near the periphery of the articular cartilage and the fovea capitis femoris, and from the synovial fluid. The nutrition of its deep part near the chondro-osseous junction was derived from the looped epiphyseal capillaries. The superior metaphyseal arteries supplied the lateral two thirds of the neck. The medial, anterior and posterior ascending short cervical arteries supplied the corresponding areas of the neck. During the ossification of the chondroepiphysis the medial and lateral epiphyseal vessels and the medial ascending cervical artery established particular vascular anastomotic arch in the epiphysis. With epiphyseal plate closure in the adult the diaphyseal arteries crossed into the head, established free anastomoses with the epiphyseal arteries. The clinical significance of the topographical characteristics, the course and the distribution of the arterial supply to the proximal end of the femur were discussed.