Cases reported "Femoral Fractures"

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1/128. Use of the fork plate for internal fixation of periprosthetic fractures and osteotomies in connection with total knee replacement.

    Six cases of periprosthetic fractures of the distal femur following total knee arthroplasty were treated with a newly developed fork plate. Instead of the blade of the condylar plate, this implant features two prongs that are adaptable in length. Because of the space between the prongs, the distal femoral fragment surrounds the anchorage pegs of the prosthesis and can be gripped near the joint line. The average patient age was 74 years. Follow-up ranged between 2 and 54 months. All patients were mobilized immediately postoperatively. Full weight bearing and bone consolidation was achieved by 9 weeks postoperatively.
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2/128. Femoral bone regeneration subsequent to impaction grafting during hip revision: histologic analysis of a human biopsy specimen.

    Cemented revision with impaction grafting shows encouraging early clinical results; postoperative biopsy specimens taken from the proximal femur in humans have demonstrated viable trabecular and cortical bone. Human radiographic studies also illustrate density changes within the proximal femur, consistent with remodeling of bone-graft. In an animal experiment, bone incorporation was shown in the proximal femur, but graft lysis was reported around the distal portion of the implant. We report on a patient who sustained a traumatic femoral fracture at the level of the tip of the femoral component 27 months after revision with impaction grafting and a collarless polished taper stem. At the time of open reduction and internal fixation of the fracture, we obtained circumferential biopsy specimens from the fracture site. Three distinct zones could be identified histologically: i) an inner zone consisting of bone-cement, fibrous tissue, and partially necrotic trabeculae with evidence of bone remodeling; ii) a middle zone consisting of viable trabecular bone and probable neocortex formation with fewer particles of bone-cement; and iii) an outer zone with viable cortex. Fibrous tissue was present around some of the incorporating bone-graft fragments, but no continuous fibrous membrane was present. Cement particles were identified, but no polyethylene debris was found by light microscopy. biopsy specimens from the distal aspect of the prosthesis may not reflect changes seen proximally, but based on the available tissue, this case illustrated histological evidence of bone-graft remodeling after impaction grafting. These results are consistent with our expectations based on radiographic findings and clinical results.
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3/128. Transcranial doppler detection of fat emboli.

    BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.
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4/128. Femoral neck fracture complicating intramedullary nailing of femoral shaft.

    Intramedullary nailing of the femur is now established as a routine treatment for femoral shaft fractures. A recognised complication of this technique is the occasional jamming of the intramedullary reaming device within the femoral canal although surprisingly we could not find any reports in the literature. We describe a case in which the removal of such a reamer resulted in an iatrogenic intracapsular fracture of the femoral neck, a serious complication of this problem not previously described in the English literature. This resulted in an intraoperative decision to change the fixation device to accommodate this.
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5/128. Endoscopic bone graft for delayed union and nonunion.

    We performed endoscopic bone grafting for eight patients of delayed union and nonunion which developed after femoral and humeral shaft fractures. The mean interval from initial intervention to endoscopic bone grafting was 7.3 months. Six patients of delayed union and nonunion healed at 4.1 months on average. Two patients had unsatisfactory healing and eventually underwent non-endoscopic revisional surgery. There was no intraoperative on postoperative complication. Endoscopic bone grafting can be a less invasive alternative, obtaining rapid bone union in cases of compromised healing of the diaphyseal fracture.
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6/128. Surgery for a fractured femur and elective ICU admission at 113 yr of age.

    Disability and medical dependence increase with age and as the percentage of the population over 80 yr old increases, demands on our healthcare budget will likewise grow. Clinical decision making should always balance the physiological state of the patient against the likely prognosis of the pathological state. Age may influence this decision-making process in an indirect way, as a perceived measure of physiological status, but whether age alone may be used as criteria for the type or degree of clinical intervention is a contentious point. In light of these issues, we present a woman of 113 yr, admitted to hospital with a fractured shaft of femur. The patient underwent surgery and was electively admitted to the intensive care unit for postoperative treatment. She survived surgery and several complications and was subsequently returned to the community where she celebrated her 114th birthday.
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7/128. Distal femoral fracture through the screw hole of a ligament augmentation device fixation.

    SUMMARY: Complications associated with fixation of artificial ligaments in augmented repair of the anterior cruciate ligament (ACL) have been reported throughout the literature. However, fractures following ligament augmentation device (LAD) fixation appear to be rare. We report the case of a 43-year-old woman, injured in a road accident, who sustained a depressed fracture of the tibial plateau and knee instability. The fracture was reduced and the medial collateral ligament and the menisci were sutured. The torn ACL was repaired using the Marshall technique and augmented with an LAD in an over-the-top technique. Twenty-five months postoperatively, the patient sustained a distal femoral fracture through the screw hole of the former LAD fixation after a simple fall on the street.
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8/128. Hill-Sachs type lesion of the femoral head in a case of hip instability.

    A Hill-Sachs lesion of the shoulder is an indicator of shoulder instability. hip instability is also a well-recognized phenomenon. However, no operative or arthroscopic features have previously been reported that support the diagnosis of hip instability. We present a case report of a Hill-Sachs type lesion of the femoral head in a patient with acetabular dysplasia revealed by arthroscopy of the hip. We suggest that finding a Hill-Sachs type lesion of the femoral head may also be regarded as indicative of joint instability, just as it is in the shoulder.
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9/128. Multiple fracture of medullary tube during intramedullary nailing of long bone fractures.

    Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.
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10/128. Arterial injury during retrograde femoral nailing: a case report of injury to a branch of the profunda femoris artery.

    The management of femoral shaft fractures by retrograde intramedullary nailing is becoming more widespread. There have been no reported intraoperative neurovascular injuries to the surrounding anatomy using the retrograde femoral nailing technique. We report a case of injury to a branch of the profunda femoris artery during placement of the anteroposterior proximal locking screw.
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