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Schaefer RO, Eberlein SC, Klenke FM, Bastian JD, Hecker A. Staged treatment of a comminuted femoral fracture with Masquelet technique and 3D printed reposition guides. Trauma Case Rep 2022; 42:100723. [PMID: 36303888 PMCID: PMC9593800 DOI: 10.1016/j.tcr.2022.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background Comminuted femoral fractures pose a challenge to the trauma surgeon due to the absence of bony references during surgery. Therefore, malalignment of length and axis can occur and necessitate revision surgery. During the last decade, 3D-planning has evolved as a surgical aid in difficult cases. Case report An 18-year-old male patient suffered a polytrauma following a motorcycle accident. This report is about the treatment of a 3rd degree open and comminuted fracture of the left distal femur. The fracture was treated with Masquelet's two-staged technique. With the intent of avoiding malalignment, the second stage surgery was performed with the aid of 3D-planned reduction guides. Despite complex fracture pattern, complete fracture union was achieved with acceptable final alignment (side-to-side comparison of length, axis and femoral torsion). Conclusion In this case, performing Masquelet's two-staged surgery with the aid of 3D-printed reposition guides yielded favorable results in regards to rotational malalignment. The malrotation of the femur was reduced after the second operation to a clinically acceptable side-to-side difference (10°). This technique remains technically challenging due to soft tissue tension and limited possibility of soft tissue release.
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de Ruijter M, Lucke J, Yuan J, Derksen R. Patient experience from a doctor's perspective: A case report concerning treatment, fracture healing and rehabilitation of multiple complex injuries due to a high energy motor vehicle collision. Trauma Case Rep 2022; 42:100699. [PMID: 36210916 PMCID: PMC9535306 DOI: 10.1016/j.tcr.2022.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/24/2022] Open
Abstract
A 35-year old healthy male trauma surgery chief resident, suffered a high-speed motor vehicle collision. The patient sustained the following injuries: a Gustilo-Anderson grade 2 open comminuted intra-articular fracture of the left distal femur (AO 33C3.3), a Hawkins 1A neck fracture of the right talus (AO 81.2A), an undisplaced Lisfranc injury of the right foot comprising avulsion fractures at the base of the 1st, 2nd and 5th metatarsal as well as the cuboid bone suggesting ligament injury and 2nd to 5th carpometacarpal dislocations of the right (non-dominant) hand with comminuted fractures of the capitate, hamate, trapezoid and the base of the fifth metacarpal bone. A staged-treatment approach ensued. An external fixator (ex-fix) was placed over the left knee, followed by definitive fixation of the distal femoral fracture using a Qwix screw, Non-Contact Bridging (NCB) plate and Locking Compression Plate (LCP). An ex-fix was placed over the right wrist, followed by open reduction and k-wire fixation. The talar fracture of the right foot was treated with a single lag screw and the Lisfranc injury was treated non-operatively with four weeks of non-weight bearing cast immobilization. An intensive clinical rehabilitation program was started, including early use of Continuous Passive Motion (CPM), daily non-weightbearing swimming pool exercises, hand, physical and recreational therapy. One year after the injury the patient was rehabilitated and resumed his surgical residency. Two years after the injury, limited flexion and pain in the left leg remains, possibly related to partial union of the femoral fracture. Range of motion (ROM) of the right ankle and wrist remains limited, not causing significant functional impairment. Lessons learned from a patient experience combined with detailed descriptions of injuries, rehabilitation and long term outcomes can be used as a reference for treating patients with comparable injuries.
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Huang C, Fu Z, Wang Q, You R, Zhao F. Treatment of the Hoffa fracture of the lateral femoral condyle with cannulated screws in combination with an anti-gliding steel plate, a retrospective observational study. BMC Surg 2022; 22:354. [PMID: 36192727 PMCID: PMC9531427 DOI: 10.1186/s12893-022-01803-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The stability of the Hoffa fracture fixed with a cannulated screw is limited. In the present work, we adopted two cannulated screws from anterior to posterior and posteriorly anti-gliding plate to treat 12 cases with Hoffa fracture of the lateral femoral condyle. Methods Open reduction and internal fixation were performed in 12 patients with Hoffa fractures of the lateral femoral condyle. The Hoffa fracture end was fixed with an anti-gliding steel plate based on cannulated screw fixation in the rear of the distal femur. All patients were followed for 12–24 months, with a median of 15.3 ± 4.6 months. Results All fractures were bony union, with a healing time of 3–6 months (median, 4.5 months). The Letenneur evaluation system was used to assess efficacy. Four indexes were observed, including knee range of motion (ROM), stability, pain, and dependent ambulation. The results revealed that eight cases were excellent and four cases good, with a good rate of 100%. Conclusion The surgical treatment with cannulated screws in combination with an anti-gliding steel plate could fix the end of the Hoffa fracture, which could acquire strong internal fixation and a good curative effect.
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Wang C, Sun L, Wang Q, Ma T, Zhang K, Li Z. The technique of "autologous bone grafting through channels" combined with double-plate fixation is effective treatment of femoral nonunion. INTERNATIONAL ORTHOPAEDICS 2022; 46:2385-2391. [PMID: 35849163 DOI: 10.1007/s00264-022-05519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aims of this retrospective study were to evaluate the effective treatment of femoral nonunion using the technique of "autologous bone grafting through channels" combined with double-plate fixation. METHODS In this study, 186 patients with nonunion fracture of femur who underwent surgery using the technique of "autologous bone grafting through channels" combined with double-plate fixation in Hong Hui Hospital from May 2010 to July 2020 were enrolled. Totally, 122 males and 64 females with mean age of 44 years were evaluated. These patients were evaluated for the full clinical and radiological union time, duration of follow-up, levels of post-operative limb shortening, and range of motion of adjacent joints, and incidence of serious complications. RESULTS The mean follow-up time was 22 ± 6.2 months (range 12-44 months). Mean union time from surgery using our technique to full clinical and radiological union was 7.6 ± 1.2 months (range 4-9 months). All patients have achieved the union after one operation or two operations using the technique. The one-operation union rate is 98.4%. Post-operative severe complications were seen in seven patients which included deep vein thrombosis; the surgical site infection and the fracture nonunion. The range of motion in the adjacent joint of 17.7% (33/186) in all patients have an effect to the limb function. Six patients have the limb shortening more than 10 mm after surgery. CONCLUSION The technique of "autologous bone grafting through channels" combined with double-plate fixation is showed to be safe, effective, and easy to master and operate surgical option for treating the femoral nonunion.
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Walsh ME, Sorensen J, Blake C, Johnsen SP, Kristensen PK. Geographic variation in hip fracture surgery rate, care quality and outcomes: a comparison between national registries in Ireland and Denmark. Arch Osteoporos 2022; 17:128. [PMID: 36161538 DOI: 10.1007/s11657-022-01169-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/12/2022] [Indexed: 02/03/2023]
Abstract
Ireland and Denmark have similar hip fracture surgery rates but differences in care quality indicators and patterns of intracapsular fracture repair. Very high variation in total hip arthroplasty rate within both countries and higher observed early mortality in Denmark require further investigation. PURPOSE To explore and compare geographic variation of hip fracture surgery rate, care quality and outcomes in Ireland and Denmark. METHODS Patients aged ≥ 65 years with surgically treated hip fracture were included from the Irish Hip Fracture Database (years = 2017-2020, n = 12,904) and the Danish Multidisciplinary Hip Fracture Registry (years = 2016-2017, n = 12,924). The age and sex standardised rate of hip fracture surgery and the proportion of patients with seven process quality indicators, three surgery types and four outcomes were calculated. Systematic components of variation (SCV) were calculated based on hospital area (6 Irish hospital groups, 5 Danish regions). RESULTS The age and sex standardised rate of hip fracture surgery per 1000 older population in 2017 was 4.7 (95% CI = 4.4-5.1) in Ireland and 5.3 (95% CI = 5.1-5.5) in Denmark. Ireland had lower rates of surgery within 36 h (59% versus 84%), nutritional assessment (27% versus 84%) and pre-discharge mobility recording (52% versus 92%). Patterns of intracapsular fracture repair also differed between countries (hemiarthroplasty: Ireland = 85%, Denmark = 52%). Both countries had very high variation for total hip arthroplasty (THA) provision (SCV Ireland = 10.6, Denmark = 97.9). Ireland had longer hospital stays (median 12 versus 7 days), but lower 7-day (1.0% versus 3.1%) and 14-day (2.0% versus 5.5%) mortality. CONCLUSION Ireland and Denmark have similar hip fracture surgery rates, but differences in care quality, surgery patterns and outcomes. High variation in THA provision and observed differences in mortality require further exploration. In Ireland, there is scope for improvement regarding early surgery, mobility, nutrition assessment and improved post-discharge follow-up.
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Yuan H, Yu H, Zhu Y, Xiang L, Wang H. Effect of Age on the Patterns of Traumatic Femoral Fractures: Seven Years of Experience at a Regional Tertiary Hospital. Orthop Surg 2022; 14:2132-2140. [PMID: 35929600 PMCID: PMC9483057 DOI: 10.1111/os.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/11/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Femoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital. Methods The records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications. Results The patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ2 = 301.699, p < 0.001), osteoporosis (χ2 = 375.463, p < 0.001), injury time of day (χ2 = 114.913, p < 0.001), injury cause (χ2 = 748.187, p < 0.001), injury location (χ2 = 490.153, p < 0.001), fracture side (χ2 = 57.000, p < 0.001), fracture site (χ2 = 806.650, p < 0.001), associated injuries (χ2 = 322.921, p < 0.001), coma after injury (χ2 = 147.814, p < 0.001), non‐surgery‐related complications (χ2 = 7.895, p = 0.019), and surgery‐related complications (χ2 = 82.186, p < 0.001). The YA group had a significantly higher percentage of patients with surgery‐related complications than the OP group. The OP group had a higher frequency of non‐surgery‐related complications than the YA group and CH group. The most common non‐surgery‐related complications were pneumonia (7.1%) in the OP group and deep venous thrombosis (6.4%) in the YA group. Multivariable logistic regression showed that young adults, high‐energy injury, outdoors, coma after injury, and fracture sites except for the proximal region were independent risk factors for associated injuries. Older age, male, and fracture site except for the proximal region were independent risk factors for complications. Conclusions Traumatic femoral fractures are mostly the result of low‐energy trauma and predominantly affect the proximal site of the femur among older people. A higher rate of shaft fractures, fractures occurring outdoors, and associated injuries were observed among young adults and children than among older people.
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Huang X, Chen Y, Chen B, Zheng K, Lin C, Lin F, Luo X. Reamed versus unreamed intramedullary nailing for the treatment of femoral shaft fractures among adults: A meta-analysis of randomized controlled trials. J Orthop Sci 2022; 27:850-858. [PMID: 34303590 DOI: 10.1016/j.jos.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/03/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this meta-analysis is to compare the merits and drawbacks between reamed intramedullary nailing (RIN) and unreamed intramedullary nailing (URIN) among adults. METHODS We comprehensively searched PubMed, MEDLINE database through the PubMed search engine, Google Scholar, Cochrane Library, Embase, VIPI (Database for Chinese Technical Periodicals), and CNKI (China National Knowledge Infrastructure) from inception to March 2020. Outcomes of interest included nonunion rates, implant failure rates, secondary procedure rates, blood loss, acute respiratory distress syndrome (ARDS) rates, and pulmonary complications rates. RESULTS Eight randomized controlled trials were included. The result of nonunion rates shows that the nonunion rate is significantly lower in the RIN group (RR = 0.20, 95% CI = 0.09-0.48, Z = 3.63, P = 0.0003). There were no significant differences for the risk of implant failure rates (RR = 0.55, 95% CI = 0.18-1.69, Z = 1.04, P = 0.30). The secondary procedure rates were significantly lower in the RIN group (RR = 0.28, 95% CI = 0.12-0.66, Z = 2.91, P = 0.004). The result shows that the blood loss of URIN group is significantly lower (RR = 145.52, 95% CI = 39.68-251.36, Z = 2.69, P = 0.007). The result shows that there was no significant difference in the ARDS rates (RR = 1.53, 95% CI = 0.37-6.29, Z = 0.59, P = 0.55) and the pulmonary complications rates between RIN group and URIN group (RR = 1.59, 95% CI = 0.61-4.17, Z = 0.94, P = 0.35). CONCLUSIONS Reamed intramedullary nailing would lead to lower nonunion rate, secondary procedure rate and more blood loss. Unreamed intramedullary nailing is related to a higher nonunion rate, secondary procedure rate and less blood loss. No significant difference is found in implant failure rate, ARDS rate and pulmonary complication rate between the two groups.
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Comment on "Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients: A retrospective multicenter study". Injury 2022; 53:2695. [PMID: 35410739 DOI: 10.1016/j.injury.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
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Tang MT, Liu CF, Liu JL, Saijilafu, Wang Z. Multiple stress fractures of unilateral femur: A case report. World J Clin Cases 2022; 10:4280-4287. [PMID: 35665126 PMCID: PMC9131223 DOI: 10.12998/wjcc.v10.i13.4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stress fractures of the femoral neck are not common in clinical practice, and simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur are even more rare. We introduce a case of this type of fracture that was treated in our department, analyze the causes, and review similar stress fractures reported in the literature to provide references for the diagnosis and treatment of such conditions.
CASE SUMMARY A 62-year-old female, with a free medical history, was admitted to the hospital mainly due to pain in the right hip and worsening pain in the right thigh. The patient had no obvious history of trauma. X-ray and computed tomography showed fracture of the femoral neck and proximal femur. The patient had undergone surgery 1 year prior to address a fracture of the left proximal femur that had occurred in a traffic accident. Our first consideration was stress fracture of the femoral neck; however, simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur were seen. The femoral neck stress fracture was a tension fracture, with obvious displacement and varus deformity of the hip. Considering that the patient was an elderly female, we performed total hip arthroplasty. Follow-up X-rays showed that the stress fracture of the proximal femur had mostly healed after 3 mo.
CONCLUSION Muscle fatigue and hip varus deformity provide an anatomical basis for the occurrence of femoral neck stress fractures.
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Grewal MUS, Bawale MR, Singh PB, Sandiford MA, Samsani MS. The use of Nottingham Hip Fracture score as a predictor of 1-year mortality risk for periprosthetic hip fractures. Injury 2022; 53:610-614. [PMID: 34986978 DOI: 10.1016/j.injury.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
AIMS The primary aim was to determine if the Nottingham Hip Fracture Score (NHFS) could be used to stratify 1-year mortality risk amongst periprosthetic hip fracture patients. The secondary aim was to identify 1year mortality rates amongst surgically managed periprosthetic hip fractures. METHODS Our electronic fracture database was interrogated for all Vancouver B or C periprosthetic fractures between September 2009 to April 2019; 83 patients were identified. All available data was then collected from radiographic, electronic and paper notes. The NHFS was retrospectively calculated for each patient. Statistical analysis was performed to identify factors significantly affecting 12month mortality using Akaike's information criterion corrected for small sample sizes (AICc), binomial logistic regression was performed using each variable; the p-values presented are for the coefficients of the regressor. RESULTS Periprosthetic fractures have a 1year mortality risk of 26.5%, 30 day mortality was 4.82%. The NHFS was found to be highly predictive of 1-year mortality amongst this patient cohort (p = 0.0001). We find that each unit increase in the NHFS is correlated with a 2.7times increase in mortality rate. There was no evidence that time lag from presentation to surgery led to an increased mortality (p = 0.455). CONCLUSION The NHFS can be used to stratify the 1-year mortality risk amongst patients who have periprosthetic hip fracture; this is a new finding not previously published to our knowledge. Given that time to surgery does not correlate with mortality, patients should be risk stratified on admission with NHFS. Time is then available to conduct a multi-disciplinary approach to optimize the patient, personnel and equipment. The introduction of a parallel multidisciplinary pathway to neck of femur fractures is long overdue and must be expedited.
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Townsend O, Jain S, Lamb JN, Scott CEH, Dunlop DG, Pandit HG. Periprosthetic femoral fracture type and location are influenced by the presence of an ipsilateral knee arthroplasty implant: A case-control study of 84 interprosthetic femoral fractures. Injury 2022; 53:645-652. [PMID: 34893307 DOI: 10.1016/j.injury.2021.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/13/2021] [Accepted: 11/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This multicentre case-control study compares Vancouver Classification System (VCS) grade and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture type in interprosthetic femoral fractures (IPFFs) between primary total hip arthroplasty (THA) and ipsilateral total knee arthroplasty (TKA) to periprosthetic femoral fracture (PFF) without ipsilateral TKA. METHODS Data were collected following institutional approval. Eighty-four IPFFs were assessed for VCS grade and AO/OTA type. Each IPFF case (84) was matched to five PFF controls (360) by age, gender and stem fixation philosophy (SMD<0.1). VCS grade and AO/OTA type were compared between the IPFF and PFF groups using weighted proportions and medians. RESULTS Median (IQR) age of IPFF patients was 81.75 (76.57-85.33) years and 61 (72.6%) were female. The commonest VCS grade was B1 (34, 40.5%). The commonest AO/OTA type was spiral (51.8% of VCS B fractures; 50.0% of VCS C fractures). A greater proportion of fractures occurred distal to the stem in IPFF patients versus PFF patients (33.3% versus 18.2%, p = 0.003). VCS grade was significantly different between groups (p = 0.015). For VCS C fractures, twice as many AO/OTA transverse and wedge fractures occurred in the IPFF group compared to the PFF group (25.0% versus 12.6% and 7.1% versus 3.3%, respectively) although the overall difference was not statistically significant (p = 0.407). CONCLUSION The presence of an ipsilateral TKA affects the location of PFF with more fractures occurring distal to the stem. A greater proportion of bending type fractures occurred when an ipsilateral TKA was present. These unstable fractures often require more complex surgery.
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Rick Hatch GF, Bolia IK, Lindsay A, Haratian A, Hasan LK, Cohen L, Weber AE. Supracondylar femur fracture following multiligament knee reconstruction with Internal Brace® augmentation: A case report. Trauma Case Rep 2022; 37:100584. [PMID: 35036510 PMCID: PMC8743244 DOI: 10.1016/j.tcr.2021.100584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/28/2022] Open
Abstract
This a case report of a 40-year-old male with left knee dislocation Type III and associated peroneal nerve palsy underwent delayed allograft reconstruction of his multiligament knee injury (MKI) with Internal Brace augmentation. The patient returned to work at 6 months postoperatively. He then fell and sustained a displaced supracondylar left femur fracture at the site of the internal brace augmentation of his lateral collateral ligament (LCL) reconstruction for which he underwent placement of a retrograde femoral nail. At 2 years of follow-up the patient had no evidence of knee instability. Level of evidence: V.
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Curtelin C, Delille E, Bailly C, Equy V, Hoffmann P, Courvoisier A, Riethmuller D. Femoral fracture during breech vaginal delivery: A case report. J Gynecol Obstet Hum Reprod 2022; 51:102310. [PMID: 34998975 DOI: 10.1016/j.jogoh.2022.102310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/24/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Femoral fracture is a rare but significant foetal injury, more frequent and likely to happen when the foetus is malpositioned or in a breech presentation. Cesarian section does not appear to be protective and all recent publications report cases occurring during cesarian section. We report a case that occurred in a vaginal delivery of a single footling breech presentation. This complication allows us to remind that femur fracture is a complication of breech delivery whatever the modality. The prognosis is good with early diagnosis.
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Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections? Arch Orthop Trauma Surg 2022; 142:2911-2917. [PMID: 34453205 PMCID: PMC9474588 DOI: 10.1007/s00402-021-04119-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Higher complication rates have been reported for total hip arthroplasty (THA) after osteosynthesis of proximal femur fractures (PFF). This study evaluated the infection risk for conversion of internal fixation of PFF to THA by a single-staged procedure in the absence of clear infection signs. METHODS Patients undergoing a one-staged conversion to THA (2013-2018) after prior internal fixation of the proximal femur were included. Preoperative diagnostics with laboratory results, hip aspirations as well as intraoperative microbiology and sonication were assessed. Postoperative complications were recorded as well as patient demographics, duration between initial and conversion to THA, explanted osteosynthesis and implanted THA. RESULTS Fifty-eight patients (24 male/34 female, 62.8 ± 14.5 years) were included with a mean time of 3.8 ± 7.5 years between internal fixation and conversion to THA (45 cementless, 3 cemented, 3 hybrid and 7 hybrid inverse THAs). Preoperative mean blood level CRP was 8.36 ± 14 mg/l (reference value < 5 mg/l) and leukocyte count was 7.11 ± 1.84^3/µl (4.5-10.000^3/µl). Fifty patients had intraoperative microbiological diagnostics, with either swabs in 86.2% and/or sonication in 29.3%. Positive microbiological results were recorded in 10% (5 of 50 patients), with pathogens identified being mainly Staphylococcus. Complications after conversion occurred in 9.6% including a postoperative low-grade infection rate of 5.8% after a mean of 2.5 years. CONCLUSION This study found a positive microbiological test result in 10% of a one-stage conversion of PFF fixation to THA. Moreover, we found a high infection rate (5.8%) for early postoperative periprosthetic joint infection. Interestingly, CRP has not been proven to be an adequate parameter for low-grade infections or occult colonized implants. Therefore, we recommend a comprehensive pre- and intraoperative diagnostic including hip aspiration, swabs and sonication when considering one-staged revision.
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He M, Fan Q, Zhu Y, Liu D, Liu X, Xu S, Peng J, Zhu Z. The need for nutritional assessment and interventions based on the prognostic nutritional index for patients with femoral fractures: a retrospective study. Perioper Med (Lond) 2021; 10:61. [PMID: 34930445 PMCID: PMC8686570 DOI: 10.1186/s13741-021-00232-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background The incidence of adverse perioperative outcomes in surgery for femoral fractures is high and associated with malnutrition. Here, we identified independent factors and assessed the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods This retrospective study included 343 patients who underwent surgery for a single femur fracture. Demographic characteristics, surgery and anaesthesia records and blood test results at admission, 1 day postoperatively and before discharge were evaluated using logistic regression analysis. The discriminatory ability of the independent factors was assessed using the receiver operating characteristic curve analysis, and DeLong’s test was used to compare the area under the curve (AUC). Results Overall, 159 patients (46.4%) experienced adverse perioperative outcomes. Amongst these, 123 (35.9%) had lower limb vein thrombus, 68 (19.8%) had hospital-acquired pneumonia, 6 (1.7%) were transferred to the postoperative intensive care unit, 4 (1.2%) had pulmonary embolism, 3 (0.9%) died during hospitalisation and 9 (2.6%) had other adverse outcomes, including incision disunion, renal and liver function impairment, acute heart failure, acute cerebral infarction and stress gastroenteritis. The PNI at admission, age, postoperative hospital stay, time to admission, hypertension, combined injures and surgery type were independent factors for adverse perioperative outcomes. Based on the AUC (PNI at admission: 0.772 [0.723–0.821], P < 0.001; age: 0.678 [0.622–0.734], P < 0.001; postoperative hospital stay: 0.608 [0.548–0.668], P = 0.001; time to admission: 0.585 [0.525–0.646], P = 0.006), the PNI at admission had optimal discrimination ability, indicating its superiority over other independent factors (age vs. PNI at admission, P = 0.002; postoperative hospital stay vs. PNI at admission, P < 0.001; time to admission vs. PNI at admission, P < 0.001). Conclusions Patients with femoral fractures require a nutritional assessment and appropriate nutritional intervention at admission, and that the PNI value at admission may be a good nutritional assessment indicator.
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Pasveer EH, Willems SA, Beetz I. Open lateral femoral condyle fracture concomitant with a vertical patella fracture in an adolescent: A case report. Trauma Case Rep 2021; 37:100575. [PMID: 34917741 PMCID: PMC8669457 DOI: 10.1016/j.tcr.2021.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/28/2022] Open
Abstract
We present the rare case of an open femoral condyle fracture (Gustilla IIIA) combined with a vertical patella fracture due to sharp injury after a traffic collision in a 17-year-old female. During subsequent operation, a locking compression plate was used for definitive fixation of the distal femur and the patella was reduced and fixated with two screws. Four months after surgery, the patient had practically full range of motion again and no secondary complications occurred. On control X-ray, there was consolidation of the fracture.
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Pflüger P, Bolierakis E, Wurm M, Horst K, Hildebrand F, Biberthaler P. Revision rate is higher in patients with periprosthetic femur fractures following revision arthroplasty in comparison with ORIF following our algorithm: a two-center 1 analysis of 129 patients. Eur J Trauma Emerg Surg 2021; 48:1913-1918. [PMID: 34767064 PMCID: PMC9192397 DOI: 10.1007/s00068-021-01832-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
Purpose Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients’ frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF. Methods A retrospective, multicenter study in the period 2009–2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria. Results A total of 129 patients with a mean age of 79 years (range 43–102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21–10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome. Conclusion Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.
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Ben-Haim G, Zabatani A, Orion D, Leshem E, Irony A, Katorza E. The Pandemic's impacts on patients without Covid-19 on multidisciplinary aspects in emergency medicine care. Intern Emerg Med 2021; 16:2261-2268. [PMID: 33650082 PMCID: PMC7920545 DOI: 10.1007/s11739-021-02680-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022]
Abstract
The emergence of Covid-19 has caused a pandemic and is a major public health concern. Covid-19 has fundamentally challenged the global health care system in all aspects. However, there is a growing concern for the subsequent detrimental effects of continuing delays or adjustments on time-dependent treatments for Covid-19 negative patients. Patients arriving to the ED with STEMIs and acute CVA are currently presumed to have delays due to Covid-19 related concerns. The objective of this paper is to evaluate the implications of the Covid-19 pandemic on non-Covid19 patients in emergency care settings. We conducted a retrospective study from February 2020 to April 2020 and compared this to a parallel period in 2019 to assess the impact of the Covid-19 pandemic on three distinct non-Covid-19 ED diagnosis that require immediate intervention. Our primary outcome measures were time to primary PCI in acute STEMI, time to fibrinolysis in acute CVA, and time to femoral hip fracture correction surgery. Our secondary outcome measure included a composite outcome of length of stay in hospital and mortality. From 1 February 2020 to 30 April 2020, the total referrals to ED diagnosed with STEMI, Hip fracture and CVA of which required intervention were 197 within Covid-19 group 2020 compared to 250 in the control group 2019. Mean duration to intervention (PCI, surgery and tPA, respectively) did not differ between COVID-19 group and 2019 group. Among femoral hip fracture patients', the referral numbers to ED were significantly lower in Covid-19 era (p = 0.040) and the hospitalization stay was significantly shorter (p = 0.003). Among CVA patients', we found statistical differences among the number of referrals and the patients' age. Coping with the Covid-19 pandemic presents a challenge for the general healthcare system. Our results suggest that with proper management, despite the obstacles of isolation policies and social distancing, any negative impact on the quality of health care for the non-Covid-19 patients can be minimized in the emergency department setting.
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Efficacy of fascia iliaca nerve block in daily routine for children with femoral fractures in a pediatric emergency department. Arch Pediatr 2021; 28:544-547. [PMID: 34593294 DOI: 10.1016/j.arcped.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 04/13/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy of fascia iliaca nerve block (FINB), routinely used for children with femoral fractures, in a pediatric emergency department (PED). METHODS This retrospective, single-center, observational study examined FINB using ropivacaine and a 1% lidocaine hydrochloride solution, in all patients under 18 years of age admitted with a femoral fracture from January 2012 to December 2016. Pain was assessed using two validated pediatric pain scales: EVENDOL or a visual analog scale. A level of ≥ 4 on either scale indicates the need for an analgesic. The primary outcome was the percentage of patients who were pain free after the FINB procedure defined by a pain score of < 4. Secondary outcomes were the time spent between PED admission and FINB, the need of additional analgesics, side effects, and the success rate of FINB. RESULTS Of 161 patients screened, 144 were included. The median age was 3.2 years (range 2 months to 16 years) and 74% were boys. The number of children determined to be pain free (pain score < 4) increased from 36 (25%) before the FINB to 123 (85%) after the FINB (absolute risk difference 60%, 95% CI: 51%-70%). Overall, 21 children (15%) required a second analgesic after the FINB. CONCLUSION The routine use of FINB with ropivacaine and lidocaine by pediatric ED physicians provided effective pain relief for children admitted for a femoral fracture in the emergency department. Our data support the efficiency and feasibility of FINB for the antalgic management of children with femoral fracture.
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Cech A, Rieussec C, Kerschbaumer G, Seurat O, Corbet C, Vibert B, Tronc C, Ruatti S, Bouzat P, Tonetti J, Boudissa M. Complications and outcomes in 69 consecutive patients with floating hip. Orthop Traumatol Surg Res 2021; 107:102998. [PMID: 34214653 DOI: 10.1016/j.otsr.2021.102998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip. HYPOTHESIS A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate. METHODS Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring. RESULTS We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities. CONCLUSION Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C). LEVEL OF EVIDENCE IV; retrospective study.
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Yang J, Cui ZN, Dong JN, Lin WB, Jin JT, Tang XJ, Guo XB, Cui SB, Sun M, Ji CC. Early acute fat embolism syndrome caused by femoral fracture: A case report. World J Clin Cases 2021; 9:8260-8267. [PMID: 34621889 PMCID: PMC8462216 DOI: 10.12998/wjcc.v9.i27.8260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fat embolism syndrome (FES) is a rare complication caused by the presence of fat particles in the microcirculation, which usually occurs within 12-72 h after trauma. At present, there have been few cases of fat embolism presenting within 3 h after trauma. Here, we report a case of femoral fracture complicated with an acute fat embolism caused by a car accident.
CASE SUMMARY A 29-year-old woman with pain, swelling and limited movement of her left lower limb after a car accident was taken by ambulance to our hospital. X-ray examination showed fracture of the middle and lower part of the left femur and fracture of the base of the left fifth metatarsal bone. She was hospitalized and admitted to the orthopedic ward. After the attending doctor performed tibial tubercle bone traction, the patient became confused, followed by respiratory distress. Finally, she was transferred to the intensive care unit. After nearly a month of treatment in the intensive care unit, the patient's cognitive function gradually recovered over 6 mo.
CONCLUSION For patients with early traumatic fractures, young emergency physicians and orthopedics should be aware of the possibility of FES.
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Iatrogenic sciatic nerve injury secondary to clamp placement around the femoral neck during proximal femoral fracture intramedullary nailing. Trauma Case Rep 2021; 35:100532. [PMID: 34541277 PMCID: PMC8436075 DOI: 10.1016/j.tcr.2021.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/21/2022] Open
Abstract
- 20-year-old male road-traffic accident - Sustained right acetabulum fracture, left proximal femur fracture, right patella fracture and pulmonary contusions - Had fixation within 4 days of his left proximal femur fracture and his right acetabulum:-Following fixation of his left femur fracture, developed symptoms of complete left sciatic nerve palsy.-At the time of surgery, a heygroves clamp around the neck of the femur was used to assist in the reduction of the fracture.-Subsequent exploration of the sciatic nerve showed several clamp indentations on it but fascicles in continuity. - Nerve conduction studies at 4 months post-operatively confirmed a high sciatic nerve injury. - The patient has still not recovered any function 1 year post-operatively.
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Nie Z, Ma W, Hu J. Models to predict the probability for intraoperative RBC transfusion during lumbar spinal stenosis and femoral fracture surgeries in aged patients. Transfus Apher Sci 2021; 60:103277. [PMID: 34563458 DOI: 10.1016/j.transci.2021.103277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The goal of this study was to predict the probability of transfusion of red blood cells and the volume of blood consumption based on the clinical characteristics of patients before surgery. METHODS The medical records of 565 patients over 65 years old who underwent posterior lumbar surgery and 586 patients over 65 years old receiving femoral fracture surgery were reviewed. The clinical characteristics of the patients were subjected to multivariate regression analysis. The scores of these factors' influences on intraoperative red blood cells infusion were based on the odds ratio of each multivariate risk factor. Non-linear regression was performed to predict the probability of intraoperative blood transfusion and the volume of blood used for patients with different scores. RESULTS The factors that significantly influenced blood use during lumbar spinal stenosis and femoral fracture surgery in aged patients(P < 0.05) included age, body mass index, abnormal coagulation function, preoperative hemoglobin, administration of antithrombotic drugs, multisegmental lesions of the lumbar spine, femoral shaft fracture, secondary lumbar surgery and the time from fracture to surgery exceeding 48 h. According to our risk scoring system, patients of posterior lumbar surgery scored 0-10 and patients of femoral fracture had a score of 0-12. More than 50 % of patients receiving an intraoperative red blood cells transfusion during surgery scored>1. CONCLUSION The scoring system can be used as a predictive model for the probability of red blood cells transfusion and the blood volume in aged patients undergoing lumbar spinal stenosis and femoral fracture surgeries.
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Camacho-Carrasco P, Renau-Cerrillo M, Campuzano-Bitterling B, Martinez-de-la-Mata J, Vives-Barquiel M. A modified cable wiring technique with C-shaped passer through a mini-open approach to assist reduction in femoral fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1407-1413. [PMID: 34532756 DOI: 10.1007/s00590-021-03119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
Femur fractures reduction can be technically challenging due to the deforming forces exerted by the muscles causing displacement of the fracture fragments. Cerclage wiring is one of the reduction techniques frequently performed, allowing anatomical reduction of the fragments and a more stable fixation when an accurate closed reduction is not possible. We describe a modified cerclage wiring through a minimally invasive technique, using a conventional cannulated C-shaped passer.
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Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm. Liau GZQ, Lin HY, Wang Y, Nistala KRY, Cheong CK, Hui JHP. Indian J Orthop. 2020 Oct 10;55(1):55-67. doi:10.1007/s43465-020-00281-6. eCollection 2021 Feb. Indian J Orthop 2021; 56:517-518. [PMID: 35251518 PMCID: PMC8854506 DOI: 10.1007/s43465-021-00453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/27/2021] [Indexed: 02/04/2023]
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