Proximal femoral nails antirotation, gamma nails, and. Locked plating lp of distal femoral fractures has become very popular. What is femoral shaft fracturetypescausestreatment. Knee fracture management in the emergency department clinical. A total of 21% n 12 and 16% n 7 were open fractures in the retrograde nailing and lcp group, respectively figure 1. Jul 27, 20 septic and aseptic nonunions were included. Fractures of proximal femur are classified as intracapsular, which includes femoral neck and head fractures, or extracapsular, which includes. 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. 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. Previously the trend in treatment of these fractures leaned towards closed. When performing the procedure, the barrel of the plate must slide and engage the lag screw, ultimately developing a sliding dynamic hip device. Present indications include all patients with femoral shaft fractures and open physis. Distal femoral locking compression plate fixation in. A high rate of union can be expected with satisfactory anatomic and functional results.
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. In a recent analysis comparing different treatment options in femoral shaft fractures, it could be clearly stated. For distal femoral fractures, in the absence of a total knee arthroplasty implant, the classification introduced by the aoasif organisation and later adopted by the ota classification committee has been universally adopted by the clinicians. Surgical management of fracture of distal end of femur in. 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. Femur tubular with slight anterior bow average femur is 48 cm x 2. Ii proximal femoral fractures nonoperative treatment of 31b1 fractures. May 04, 2016 blade plate fixation it is the earliest form of fixation in distal femoral fractures. 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. The key words including intertrochanteric fractures, proximal femoral nail antirotation, dynamic hip. The tipapex distance has become one of the main methods for predicting the failure of fixation and is a very useful tool when carrying out fixation of the proximal femur in these challenging fractures. Pdf outcome after short intramedullary nail fixation of unstable. The diversity of surgical options for the management of distal femoral fractures reflects the challenges inherent in these injuries.
In our study, we tried to present the results of proximal nailing surgery performed in the lateral decubitus. 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. Efficacy study of femoral nerve block in children with a. Surgical techniques for the management of proximal femoral. The incidence of nonunion of femoral neck fracture is approximately 18. Lesions of the menisci and osteochondral fractures can be ob served in 812%, while there are associated fractures of the patella in approximately 15% of cases. In high velocity injuries ipsilateral hip dislocation and acetabular fractures have to be excluded.
Intramedullary nail system for proximal femoral fractures. Implant failure in a proximal femoral fracture treated. Since then, several studies have provided data which seem to favour reamed over unreamed nailing to decrease. Femoral nerve blocks are effective for pain management and have less side effects than systemic analgesics. 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. 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. Operative treatment for femoral shaft nonunions, a systematic. Distal femur thighbone fractures of the knee orthoinfo. 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. Knee fracture management in the emergency department. Apr, 2020 femoral condyle insufficiency fractures are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. Dichotomous location of 160 atypical femoral fractures. 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.
Study comparing the advantages of proximal femoral nail. Operative treatment for femoral shaft nonunions, a. Despite guidance since the early 1990s concerning best practice management for these vulnerable patients 16, there remains. 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. The treatment of unstable trochanteric femoral fractures is still challenging, and the proximal femoral nails are becoming more commonly used. 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. 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. Nail dynamization for delayed union and nonunion in femur and. We thus undertook a retrospective study of paediatric. Outcome of intra articular distal femur fracture treated. Comparison between proximal femoral nail antirotation pfna.
Aoota classification pdf ao surgery reference ao foundation. In our study 100 distal femoral fractures were treated. Reports on nonunion after periprosthetic fractures were excluded. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. 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. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion nu, and revision is limited. 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.
Pdf long proximal femoral nail in ipsilateral fractures of proximal. Age, gender, fracture classification, operation time, intraoperation blood loss, reduction quality, and complications were extracted from patients medical records. Management of hip fractures in lateral position without a. Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. Proximal femoral fractures account for a large proportion of hospitalization among trauma cases. The proximal femoral nailing is usually performed on a fracture table under traction which is associated with some possible complications. Retrograde nailing for distal femur fractures in the elderly. Pedestrians getting hit by a car, falling from great heights etc. Two to six percent of femoral shaft fractures also have femoral neck fractures. Distal femoral fracture, internal fixation, distal femoral locking compression plate introduction distal femoral fractures, especially ao type c fractures are difficult to treat.
Exchange nailing and percutaneous bone grafting for. The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. Femoral fracture bracing is a suitable method for distal third femoral shaft fractures. Pdf ipsilateral fractures of the proximal femur and femoral shaft are extremely uncommon injuries which occur in young adults who sustain a.
Study comparing the advantages of proximal femoral nail over. A classic bimodal distribution is found with a peak in frequency in young men in their 30s and elderly women in their 70s. Pfna augmentation for intertrochanteric femoral fractures the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The initial evaluation of a trauma patient with a femur fracture should include radiographs of the chest, ap pelvis, hip, and knee.
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. Distal femur ao type 33 b surgical options, results and. Nail dynamization for delayed union and nonunion in femur. There are many ways to treat aseptic nonunion of femoral shaft fractures with reported varied success rate. 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. An estimated 6% of all fractures of the femur accountfor the distal part of the bone. Fractures were classified according to ao classification. Although bone has outstanding mechanical properties and a remarkable ability. Surgical treatment of ipsilateral multilevel femoral fractures. There is a bimodal distribution of fractures based on age and gender. Treatment protocol for proximal femoral periprosthetic. Distal femur fractures in younger patients are usually caused by high energy injuries, such as falls from significant heights or motor vehicle collisions. Comparison between proximal femoral nail antirotation.
Distal femur ao type a fractures trauma international. Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures. The full text of this article is available in pdf format. Amongst all these, exchange nailing is the simplest and most successful technique for treating aseptic non union of femoral shaft fractures. 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. In addition, child abuse should be considered in a young child with a femoral fracture. Subtrochanteric fractures are one of the common fractures encountered in todays orthopaedic practice. The median age was 47 years ranging from 2070 years. If a femoral shaft fracture occurs from a lowerforce accident.
In recent years, the treatment of distal femoral fractures has evolved although these fractures remain complex to treat and carry an inconsistent prognosis. Always remember to complete a thorough trauma evaluation. 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. The purpose of this study was to analyze the complications and clinical outcomes of lp treatment for distal 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. Proximal femoral nailing without a fracture table springerlink. The treatment of long bone fractures is a significant health problem, particularly for femoral fractures 2 345. The diagnosis of delayed or nonunion was made with history, physical examination, and radiographs or ctscanning. Flexible intramedullary nailing in paediatric femoral. Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral.
Clinical outcomes of locked plating of distal femoral. Intraarticular fractures of distal femur present a huge surgical challenge. Femoral shaft fractures are commonly associated with multisystem trauma. Fractures elsewhere in the femur or acetabulum, including femoral neck fractures, should be suspected and investigated. Femoral shaft fractures are typically an emergency indication as delayed fracture stabilization is associated with an increased morbidity, and a longer hospitalization time 9. Femoral shaft fractures are the most common major pediatric injuries managed by the orthopaedic surgeon. Management is influenced by associated injuries or multiple trauma, fracture personality, age, family issues, and cost. Highenergy injuries can lead to severe cartilage damage.
Locking compression plate in distal femoral intraarticular. Flexible intramedullary nailing in paediatric femoral fractures. Osteoarthritis may result when there is a diastasis of 3 or more millimetres. Early femoral condyle insufficiency fractures after total knee arthroplasty. Pdf in this study we assess the clinical and radiological outcomes after surgical fixation of unstable, extracapsular fractures of the proximal femur. Proximal femoral fractures rsna publications online. What is femoral shaft fracturetypescausestreatmenthealing.
Distal fractures of the femur especially comminuted, intraarticular distal femoral fractures ao classification 33c remain challenging fractures for orthopaedic surgeons. 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. For intramedullary fixation of proximal femoral fractures. Improving the treatment of complex distal femoral fractures. Shoulderclavicle implant set, va lcp proximal tibia implant. Retrograde nailing for distal third femoral shaft fractures. In younger children, these fractures are usually due to falls. Potential disadvantages are several weeks of skeletal traction in the hospital and excessive shortening in some comminuted fractures. All cases were fresh, 78 patients were males and 22 patients were females. Treatment protocol for proximal femoral periprosthetic fractures. Studies concerning several types of nonunions were included if the femoral shaft nonunions could be evaluated separately. Incidence of fracture of distal femur is 7 percent. The combination of ipsilateral femoral shaft and tibial shaft fractures, producing a floating knee, signals a high risk of multisystem injury in the patient. Outcome of retrograde intramedullary nailing and locking.