Pdf ipsilateral fractures of the proximal femur and femoral shaft are extremely uncommon injuries which occur in young adults who sustain a. The treatment of long bone fractures is a significant health problem, particularly for femoral fractures 2 345. Pdf outcome after short intramedullary nail fixation of unstable. Nail dynamization for delayed union and nonunion in femur. Retrograde nailing for distal femur fractures in the elderly. Aoota classification pdf ao surgery reference ao foundation. Shoulderclavicle implant set, va lcp proximal tibia implant. Jul 27, 20 septic and aseptic nonunions were included. The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. There are many ways to treat aseptic nonunion of femoral shaft fractures with reported varied success rate. Femoral shaft fractures shaft of femur fractures caused by a highenergy injury, such as road traffic accidents, or fall from height unless pathological fracture in patient with osteoporosis or metastatic disease. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression.
A report of 73 cases ramprakash lohiya1, vikas bachhal2, usman khan3, deepak kumar3, vishwapriya vijayvargiya3, sohan s sankhala3, rakesh bhargava3 and nipun jindal3 abstract background. Fractures of proximal femur are classified as intracapsular, which includes femoral neck and head fractures, or extracapsular, which includes. Present indications include all patients with femoral shaft fractures and open physis. Pfna augmentation for intertrochanteric femoral fractures the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In younger children, these fractures are usually due to falls. Dec 22, 2016 pfna augmentation for intertrochanteric femoral fractures the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. What is femoral shaft fracturetypescausestreatmenthealing.
Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. In high velocity injuries ipsilateral hip dislocation and acetabular fractures have to be excluded. For intramedullary fixation of proximal femoral fractures. Two to six percent of femoral shaft fractures also have femoral neck fractures. Flexible intramedullary nailing in paediatric femoral fractures. May 04, 2016 blade plate fixation it is the earliest form of fixation in distal femoral fractures. Outcome of retrograde intramedullary nailing and locking.
Comparison between proximal femoral nail antirotation pfna. Operative treatment for femoral shaft nonunions, a systematic. Dichotomous location of 160 atypical femoral fractures. The proximal femoral nailing is usually performed on a fracture table under traction which is associated with some possible complications. Intraarticular fractures of distal femur present a huge surgical challenge. Pdf long proximal femoral nail in ipsilateral fractures of proximal. Studies concerning several types of nonunions were included if the femoral shaft nonunions could be evaluated separately. Efficacy study of femoral nerve block in children with a. In a recent analysis comparing different treatment options in femoral shaft fractures, it could be clearly stated. Proximal femoral fractures account for a large proportion of hospitalization among trauma cases.
The incidence of nonunion of femoral neck fracture is approximately 18. Various approaches like medial parapatellar for medial condylar and hoffas fracture screw fixation, lateral parapatellar and lateral for lateral condylar fixation, posterior approach for open reduction of hoffas. Proximal femoral fractures rsna publications online. Femoral fracture bracing is a suitable method for distal third femoral shaft fractures. Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures.
A high rate of union can be expected with satisfactory anatomic and functional results. Subtrochanteric fractures are one of the common fractures encountered in todays orthopaedic practice. Osteoarthritis may result when there is a diastasis of 3 or more millimetres. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion nu, and revision is limited.
The treatment of unstable trochanteric femoral fractures is still challenging, and the proximal femoral nails are becoming more commonly used. Management is influenced by associated injuries or multiple trauma, fracture personality, age, family issues, and cost. Femoral shaft fractures are the most common major pediatric injuries managed by the orthopaedic surgeon. Management of hip fractures in lateral position without a. A classic bimodal distribution is found with a peak in frequency in young men in their 30s and elderly women in their 70s. Distal femur thighbone fractures of the knee orthoinfo. Fractures were classified according to ao classification. Since then, several studies have provided data which seem to favour reamed over unreamed nailing to decrease. Potential disadvantages are several weeks of skeletal traction in the hospital and excessive shortening in some comminuted fractures.
In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Listing a study does not mean it has been evaluated by the u. Retrograde nailing for distal third femoral shaft fractures. We thus undertook a retrospective study of paediatric. In our study 100 distal femoral fractures were treated. Exchange nailing and percutaneous bone grafting for. Improving the treatment of complex distal femoral fractures. Proximal femoral nails antirotation, gamma nails, and. All cases were fresh, 78 patients were males and 22 patients were females. Treatment protocol for proximal femoral periprosthetic. Amongst all these, exchange nailing is the simplest and most successful technique for treating aseptic non union of femoral shaft fractures.
Apr, 2020 femoral condyle insufficiency fractures are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. Always remember to complete a thorough trauma evaluation. Flexible intramedullary nailing in paediatric femoral. In this type of fracture of the femoral shaft, the bone is fractured such that the fragments of the bone stick out or pierce through the skin or there is a wound that penetrates down to the fractured bone.
Clinical outcomes of locked plating of distal femoral. If a femoral shaft fracture occurs from a lowerforce accident. Because of the forceful nature of these fractures, many patients also have other injuries, often of the head, chest, abdomen, pelvis, spine, and other limbs. Age, gender, fracture classification, operation time, intraoperation blood loss, reduction quality, and complications were extracted from patients medical records. Distal femoral fracture, internal fixation, distal femoral locking compression plate introduction distal femoral fractures, especially ao type c fractures are difficult to treat. Previously the trend in treatment of these fractures leaned towards closed. Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral. Femur tubular with slight anterior bow average femur is 48 cm x 2. Treatment protocol for proximal femoral periprosthetic fractures. When performing the procedure, the barrel of the plate must slide and engage the lag screw, ultimately developing a sliding dynamic hip device. In addition, child abuse should be considered in a young child with a femoral fracture. The key words including intertrochanteric fractures, proximal femoral nail antirotation, dynamic hip.
These fractures are frequently comminuted and intraarticular, and they often involve osteoporotic bone, which makes it difficult to reduce and hold them while maintaining joint function and overall limb alignment. Proximal femoral nailing without a fracture table springerlink. The purpose of this study was to analyze the complications and clinical outcomes of lp treatment for distal femoral fractures. Distal femur ao type 33 b surgical options, results and. In recent years, the treatment of distal femoral fractures has evolved although these fractures remain complex to treat and carry an inconsistent prognosis. Nail dynamization for delayed union and nonunion in femur and. Comparison between proximal femoral nail antirotation. What is femoral shaft fracturetypescausestreatment. Nov 27, 20 distal femoral fractures reportedly account for less than 1% of all fractures and comprise between 4%6% of all femoral fractures. Surgical management of fracture of distal end of femur in. Surgical treatment of ipsilateral multilevel femoral fractures. Study comparing the advantages of proximal femoral nail over. Operative treatment for femoral shaft nonunions, a.
There is a bimodal distribution of fractures based on age and gender. Distal femur fractures in younger patients are usually caused by high energy injuries, such as falls from significant heights or motor vehicle collisions. The initial evaluation of a trauma patient with a femur fracture should include radiographs of the chest, ap pelvis, hip, and knee. The combination of ipsilateral femoral shaft and tibial shaft fractures, producing a floating knee, signals a high risk of multisystem injury in the patient. Union of the fracture was confirmed when the patient was able to bear weight on the extremity without pain and there is union in three cortices. Study comparing the advantages of proximal femoral nail. Distal fractures of the femur especially comminuted, intraarticular distal femoral fractures ao classification 33c remain challenging fractures for orthopaedic surgeons.
The diversity of surgical options for the management of distal femoral fractures reflects the challenges inherent in these injuries. Femoral shaft fractures are commonly associated with multisystem trauma. The incidence of subtrochanteric femoral fractures has increased significantly during recent decades, and this tendency will probably continue in the near future owing to the considerable increase in the life expectancy leading to an increasing geriatric population. Ii proximal femoral fractures nonoperative treatment of 31b1 fractures. Outcome of intra articular distal femur fracture treated.
The median age was 47 years ranging from 2070 years. An estimated 6% of all fractures of the femur accountfor the distal part of the bone. A total of 21% n 12 and 16% n 7 were open fractures in the retrograde nailing and lcp group, respectively figure 1. The femoral fractures are managed in this centre with closed intramedullary nailing with arbeitsgemeinschaft fur osteosynthesefragen ao universal femoral nail, and locked proximally and distally. Distal femur ao type a fractures trauma international. Reports on nonunion after periprosthetic fractures were excluded. Highenergy injuries can lead to severe cartilage damage. Rates of union in both femoral and tibial shaft fractures have been reported to range from 90% to 100% with the use of intramedullary nails. Implant failure in a proximal femoral fracture treated. Knee fracture management in the emergency department clinical. Supracondylar femoral fractures occur commonly among two populations, young patients involved in highenergy accidents including motor vehicle and motorcycle accidents and sports trauma and older patients, often osteoporotic, sustaining lowenergy fall. The full text of this article is available in pdf format. This type of fracture is known as an open or compound fracture and these types of fractures commonly are associated with increased damage to the surrounding. Pedestrians getting hit by a car, falling from great heights etc.
The diagnosis of delayed or nonunion was made with history, physical examination, and radiographs or ctscanning. Pfna augmentation for intertrochanteric femoral fractures. Femoral nerve blocks are effective for pain management and have less side effects than systemic analgesics. Pdf in this study we assess the clinical and radiological outcomes after surgical fixation of unstable, extracapsular fractures of the proximal femur. We present one of the largest case series of osteoporotic distal femoral fractures managed by the senior author mjp, a consultant, with a specialist interest in fragility fractures. In our study, we tried to present the results of proximal nailing surgery performed in the lateral decubitus. Locked plating lp of distal femoral fractures has become very popular. Despite guidance since the early 1990s concerning best practice management for these vulnerable patients 16, there remains.
Locking compression plate in distal femoral intraarticular. Incidence of fracture of distal femur is 7 percent. Surgical techniques for the management of proximal femoral. Early femoral condyle insufficiency fractures after total knee arthroplasty. Although bone has outstanding mechanical properties and a remarkable ability. Approach to treat type 33 b fractures surgical approaches to these fractures depend upon the condyle involved, location of the fracture line and also the presence of comminution. Nov 29, 2016 rates of union in both femoral and tibial shaft fractures have been reported to range from 90% to 100% with the use of intramedullary nails. Pediatric femoral shaft fractures presented by members of posna resident comprehensive fracture course treatment varies with age basic treatment guidelines 11 yr rigid im nail 511 yr flexible im nails 6 m5 yr spica cast 06 m pavlik harness but age isnt the only factor to consider im fixation is far from the only fixation option. Femoral shaft fractures are typically an emergency indication as delayed fracture stabilization is associated with an increased morbidity, and a longer hospitalization time 9. Efficacy study of femoral nerve block in children with a femur fracture the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Proximal femoral fractures present unique challenges for anaesthetic departments throughout great britain and ireland, involving the perioperative care of large numbers of older patients with signi. Intramedullary nail system for proximal femoral fractures. Dec 07, 2017 the most common cause of femoral shaft fracture is some type of highenergy force or collision to the thigh, such as seen in motorcycle or motor vehicle accidents.
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