Treatment of Common Hip Fractures: Evidence Report/Technology
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Femoral Shaft Fractures Andrew Chen, MD University of North Carolina
Femoral Shaft Fractures Andrew Chen, MD University of North Carolina Core Curriculum V5 Disclosure All figures belong to Andrew Chen, MD unless otherwise indicated Core Curriculum V5 Objectives • Review initial management of femoral shaft fractures and possible concomitant injuries • Discuss multiple options with intramedullary nailing • Antegrade/retrograde • Starting point • Reaming • Patient positioning • Understand commonly associated complications Core Curriculum V5 Femoral Shaft Fractures • Bimodal distribution • Young patients after high-energy trauma • Elderly patients after falls from standing secondary to osteopenia/osteoporosis • MVC, MCC, pedestrian struck, fall from height, and gunshot wounds most common mechanisms • Intramedullary nail as “gold standard” treatment, which has continued to evolve since introduction by Gerhard Küntscher around World War II Core Curriculum V5 Anatomy • Largest and strongest bone in body • Anterior bow with radius of curvature ~120 cm1 • Blood supply from primary nutrient vessel through linea aspera and small periosteal vessels • Deformity pattern dependent on attached musculature • Proximal fragment • Flexed (gluteus medius/minimus on greater trochanter) • Abducted (iliopsoas on lesser trochanter) • Distal fragment • Varus (adductors inserting on medial aspect distal femur) • Extension (gastrocnemius attaching on distal aspect of posterior femur) Courtesy of Rockwood and Green’s Fracture in Adults2 Core Curriculum V5 Femur Fracture Classification: AO/OTA • Bone Segment 32 • Type A • Simple • -
Delayed Massive Hemothorax Requiring
Clin Exp Emerg Med 2018;5(1):60-65 https://doi.org/10.15441/ceem.16.190 Case Report Delayed massive hemothorax requiring eISSN: 2383-4625 surgery after blunt thoracic trauma over a 5-year period: complicating rib fracture with sharp edge associated with diaphragm injury Received: 26 September 2017 Revised: 28 January 2018 Sung Wook Chang, Kyoung Min Ryu, Jae-Wook Ryu Accepted: 20 February 2018 Trauma Center, Department of Thoracic and Cardiovascular Surgery, Dankook University Hospital, Cheonan, Korea Correspondence to: Jae-Wook Ryu Department of Thoracic and Cardiovascular Surgery, Dankook Delayed massive hemothorax requiring surgery is relatively uncommon and can potentially be University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea life-threatening. Here, we aimed to describe the nature and cause of delayed massive hemotho- E-mail: [email protected] rax requiring immediate surgery. Over 5 years, 1,278 consecutive patients were admitted after blunt trauma. Delayed hemothorax is defined as presenting with a follow-up chest radiograph and computed tomography showing blunting or effusion. A massive hemothorax is defined as blood drainage >1,500 mL after closed thoracostomy and continuous bleeding at 200 mL/hr for at least four hours. Five patients were identified all requiring emergency surgery. Delayed mas- sive hemothorax presented 63.6±21.3 hours after blunt chest trauma. All patients had superfi- cial diaphragmatic lacerations caused by the sharp edge of a broken rib. The mean preoperative chest tube drainage was 3,126±463 mL. We emphasize the high-risk of massive hemothorax in patients who have a broken rib with sharp edges. -
Rare Combination of Ipsilateral Acetabular Fracture-Dislocation and Pertrochanteric Fracture
A Case Report & Literature Review Rare Combination of Ipsilateral Acetabular Fracture-Dislocation and Pertrochanteric Fracture Kevin M. Kuhn, CDR, MC, USN, John A. Boudreau, MD, and J. Tracy Watson, MD oral fractures. Other case reports have described acetabular Abstract fracture-dislocations associated with femoral neck fractures.1-3 Acetabular fracture-dislocations are severe This case report describes an acetabular fracture-dislocation injuries that require urgent closed reduction associated with an ipsilateral pertrochanteric fracture and sub- of the hip and often require surgery to restore trochanteric extension. hip stability. Other authors have described We propose a staged treatment strategy consisting of early acetabular fracture-dislocations associated minimally invasive reduction of the hip and delayed reduction with femoral neck fractures, but to our knowl- and fixation of the fractures. This strategy may be useful in edge, this case report is the first to describe an managing a polytraumatized patient who may not be stable acetabular fracture-dislocation in association enough to undergo early definitive management, or a patient with an ipsilateral pertrochanteric fracture and who requires prolonged transfer to receive definitive care. subtrochanteric extension. The patient provided written informed consent for print The polytraumatized patient initially was not and electronic publication of this case report. stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mmAJO Schanz Case Report screw was introduced percutaneously into the A 44-year-old man was involved in a head-on motor vehicle femoral head through the primary fracture site collision at highway speed. He was taken to a local hospital, under fluoroscopic guidance. -
Accuracy of Diagnosis of Distal Radial Fractures by Ultrasound Ahmad Saladdin Sultan, Muddather Abdul Aziz, Yakdhan Z
The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3115-3122 Accuracy of Diagnosis of Distal Radial Fractures by Ultrasound Ahmad Saladdin Sultan, Muddather Abdul Aziz, Yakdhan Z. Alsaleem Mosul Teaching Hospital, Emergency Medicine Department, Mosul, Iraq Corresponding author: Ahmad Saladdin <[email protected] ABSTRACT Background: although distal radial fracture account up to 20% of all fractures, it forms the most common fracture in upper extremities. Distal radial fracture has six types the most common one is Colle's fracture. The gold standard for diagnosis of distal radial fracture is conventional radiograph. Despite using ultrasound in tendon rupture, localizing foreign bodies, ultrasound started to be used for diagnosing bone fracture especially distal radius. Aim of the work: this study aimed to detect the accuracy of ultrasound in the diagnosis of distal radial fracture. Patients and methods: this was a selective prospective case series study in the Emergency Department, Al-Jumhoori Teaching Hospital,78 patients were included in this study, their age ranged between 6-45 years with mean age 17.1. 59 were males and 19 females. Duration of the study was one year (January2013 - January 2014). Results: by analyzing data of 78 patients for distal radial fracture ultrasound and comparing the results with the gold standard conventional radiograph we found that sensitivity of ultrasound in detecting fracture was 95.5%, specificity 100%, accuracy 96.15%, positive predictive value 100% and negative predictive value 80%. Conclusion: results of the current work demonstrated that ultrasound can be considered as a promising alternative to routine radiograph in diagnosis of the distal radial fractures and the horizon still open for further studies of use of ultrasound in diagnosis of other types of fractures. -
Pseudogout at the Knee Joint Will Frequently Occur After Hip Fracture
Harato and Yoshida Journal of Orthopaedic Surgery and Research (2015) 10:4 DOI 10.1186/s13018-014-0145-9 RESEARCH ARTICLE Open Access Pseudogout at the knee joint will frequently occur after hip fracture and lead to the knee pain in the early postoperative period Kengo Harato1,3*† and Hiroki Yoshida2† Abstract Background: Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery. However, unfortunately, very little has been reported on this phenomenon in the literature. The purpose of the current study was to investigate the relationship between symptomatic knee effusion and postoperative knee pain and to clarify the reason of the effusion accompanied by hip fracture. Methods: A total of 100 patients over 65 years of age with an acute hip fracture after fall were prospectively followed up. Knee effusion was assessed on admission and at the operating room before the surgery. If knee effusion was observed at thetimeofthesurgery,synovialfluidwascollectedintosyringes to investigate the cause of the effusion using a compensated polarized light microscope. Furthermore, for each patient, we evaluated age, sex, radiographic knee osteoarthritis (OA), type of the fracture, laterality, severity of the fracture, and postoperative knee pain during rehabilitation. These factors were compared between patients with and without knee effusion at the time of the surgery. As a statistical analysis, we used Mann–Whitney U-test for patients’ age and categorical variables were analyzed by chi-square test or Fisher’sexacttest. Results: A total of 30 patients presented symptomatic knee effusion at the time of the surgery. -
Fractures of the Proximal Humerus
Fractures of the Proximal Humerus David Rothberg, MDa,*, Thomas Higgins, MDb KEYWORDS Proximal humerus fracture Neer classification Fibular strut Shoulder arthroplasty KEY POINTS Proximal humeral fractures are common. Classification systems have evolved to develop treatment guidelines. Bone quality must be considered for treatment. Surgical stabilization may require augmentation. Arthroplasty must be considered especially in the elderly. INTRODUCTION common osteoporotic extremity fracture after hip fractures and distal radius fractures.1 Greater Proximal humeral fractures are common, with low- than 70% of these fractures occur in patients older energy injuries occurring in the elderly population than 60 years, with a 4:1 female/male ratio and an and less frequent higher-energy fractures striking incidence steadily increasing after the age of 40 young people. The decision to pursue operative years. or nonoperative treatment is driven by the func- Independent risk factors for proximal humeral tional goals and the degree of displacement of fractures include a recent decline in health status, the proximal humeral anatomic parts. Operative insulin-dependent diabetes mellitus, infrequent management is based on the ability to obtain walking, indicators of neuromuscular weakness, and maintain reduction, vascularity of the articular diminished femoral neck bone density, height/ segment, quality of soft-tissue attachments, and weight loss, previous falls, impaired balance, and bone porosity. Despite much study, the optimal maternal history of hip fractures.2 In a 3-decade treatment of significantly displaced fracture population-based study of osteoporotic proximal patterns remains controversial. humeral fractures, Palvanen and colleagues3 found that the incidence in patients older than 60 EPIDEMIOLOGY years increased by 13.7% per year of age. -
Intracapsular Femoral Neck Fractures—A Surgical Management Algorithm
medicina Review Intracapsular Femoral Neck Fractures—A Surgical Management Algorithm James W. A. Fletcher 1,2,* , Christoph Sommer 3, Henrik Eckardt 4, Matthias Knobe 5 , Boyko Gueorguiev 1 and Karl Stoffel 4 1 AO Research Institute Davos, 7270 Davos, Switzerland; [email protected] 2 Department for Health, University of Bath, Bath BA2 7AY, UK 3 Cantonal Hospital Graubünden, 7000 Chur, Switzerland; [email protected] 4 University Hospital Basel, 4052 Basel, Switzerland; [email protected] (H.E.); [email protected] (K.S.) 5 Department of Orthopaedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland; [email protected] * Correspondence: [email protected] Abstract: Background and Objectives: Femoral neck fractures are common and constitute one of the largest healthcare burdens of the modern age. Fractures within the joint capsule (intracapsular) provide a specific surgical challenge due to the difficulty in predicting rates of bony union and whether the blood supply to the femoral head has been disrupted in a way that would lead to avascular necrosis. Most femoral neck fractures are treated surgically, aiming to maintain mobility, whilst reducing pain and complications associated with prolonged bedrest. Materials and Methods: We performed a narrative review of intracapsular hip fracture management, highlighting the latest advancements in fixation techniques, generating an evidence-based algorithm for their management. Results: Multiple different fracture configurations are encountered within the category of intracapsular Citation: Fletcher, J.W.A.; Sommer, hip fractures, with each pattern having different optimal surgical strategies. Additionally, these C.; Eckardt, H.; Knobe, M.; Gueorguiev, B.; Stoffel, K. injuries typically occur in patients where further procedures due to operative complications are Intracapsular Femoral Neck associated with a considerable increase in mortality, highlighting the need for choosing the correct Fractures—A Surgical Management index operation. -
Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma
This is an enhanced PDF from The Journal of Bone and Joint Surgery The PDF of the article you requested follows this cover page. Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma Lawrence B. Bone and Peter Giannoudis J Bone Joint Surg Am. 2011;93:311-317. doi:10.2106/JBJS.J.00334 This information is current as of January 25, 2011 Reprints and Permissions Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. Publisher Information The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org 311 COPYRIGHT Ó 2011 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Current Concepts Review Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma By Lawrence B. Bone, MD, and Peter Giannoudis, MD, FRCS Thirty years ago, the standard of care for the multiply injured tients with multiple injuries, defined as an ISS of ‡18, and patient with fractures was placement of the fractured limb in a patients with essentially an isolated femoral fracture and an splint or skeletal traction, until the patient was considered stable ISS of <18. Pulmonary complications consisting of ARDS, enough to undergo surgery for fracture fixation1. This led to a pulmonary dysfunction, fat emboli, pulmonary emboli, and number of complications2, such as adult respiratory distress pneumonia were present in 38% (fourteen) of thirty-seven syndrome (ARDS), infection, pneumonia, malunion, non- patients in the late fixation/multiple injuries group and 4% union, and death, particularly when the patient had a high (two) of forty-six in the early fixation/multiple injuries group; Injury Severity Score (ISS)3. -
Osteoarthritis Epidemiologicosteoarthritis and Genetic Aspects Epidemiologic and Genetic Aspects
From the Department of Orthopedics, Clinical Sciences From the DepartmentLund University, of Orthopedics, Lund, Sweden Clinical Sciences Lund University, Lund, Sweden Osteoarthritis EpidemiologicOsteoarthritis and genetic aspects Epidemiologic and genetic aspects Jonas Franklin Jonas Franklin Thesis 2010 Thesis 2010 Contact address Jonas Franklin Department of Orthopedics Akureyri University Hospital IS-600 Akureyri Iceland E-mail: [email protected] ISSN 1652-8220 ISBN 978-91-86443-87-0 Lund University, Faculty of Medicine Doctoral Dissertation Series 2010:71 Printed in Sweden Mediatryck, Lund 2010 To Hlíf Atli Egill and Jóhann Jonas Franklin 1 Contents List of papers, 2 Radiographic techniques, 17 Radiographic classification, 17 Definitions and abbreviations, 3 Statistical methods, 17 Thesis at a glance, 4 Ethics, 18 Description of contributions, 6 Data encryption and protection of the individual, 18 Introduction, 7 Symptoms and signs of osteoarthritis, 7 Summary of results of papers I-V, 19 Natural history of osteoarthritis, 8 Discussion, 24 Radiographic features of osteoarthritis, 8 Research methodology, 24 Definition of osteoarthritis, 9 Abnormal mechanical loading is a risk factor for Definition of hip fractures, 9 OA, 25 Study methodology, 9 Natural history of OA, 27 Epidemiology of osteoarthritis, 11 OA and hip fracture, 28 Epidemiology of hip fractures, 11 Conclusions, 30 Risk factors for osteoarthritis ,12 Summary, 31 Risk factors for hip fracture, 13 Populärvetenskaplig sammanfattning på Aims, 14 svenska, 33 Patients and methods, 15 Ágrip á íslensku, 35 Overview of patient/subject allocation, 15 Acknowledgements, 37 Patient identification, 15 References, 38 Populations examined, 16 2 Osteoarthritis - Epidemiologic and genetic aspects List of papers This thesis is based on the following papers: I. -
Fracture Lower Extremity Part II
CONTENTS FEMUR SHAFT BOTH BONE SUBTROCHANTERIC TIBIAL PLAFON FRACTURE LOWER FRACTURE ANKLE EXTREMITIES: PART 2 FRACTURE FEMUR FOOT SUPRACONDYLAR FRACTURE FEMUR CALCANEUS PATELLA TALUS WORAWAT LIMTHONGKUL, M.D. 14 JAN 2013 TIBIA LISFRANC’S TIBIAL PLATEAU METATARSAL 1 2 SUBTROCHANTERIC FRACTURE FEMUR A PART OF FRACTURE OCCUR BETWEEN TIP OF LESSER TROCHANTER AND A POINT 5 SUBTROCHANTERIC CM DISTALLY CALCAR FEMORALE FRACTURE LARGE FORCES ARE NEEDED TO CAUSE FRACTURES IN 5 CM YOUNG & ADULT INJURY IS RELATIVELY TRIVIAL IN ELDERLY 2° CAUSE: OSTEOPOROSIS, OSTEOMALACIA, PAGET’S 3 4 SUBTROCHANTERIC FRACTURE FEMUR TREATMENT INITIAL FEMUR SHAFT TRACTION DEFINITE FRACTURE ORIF WITH INTRAMEDULLARY NAIL OR 95 DEGREE HIP- SCREW-PLATE 5 6 FEMUR FRACTURE FILM HIPS SEVERE PAIN, UNABLE TO BEAR WEIGHT 10% ASSOCIATE FEMORAL SUPRACONDYLAR NECK FRACTURE FEMUR FRACTURE TREATMENT: ORIF WITH IM NAIL OR P&S COMPLICATION: HEMORRHAGE, NEUROVASCULAR INJURY, FAT EMBOLI 7 8 SUPRACONDYLAR FEMUR FRACTURE SUPRACONDYLAR ZONE DIRECT VIOLENCE IS THE USUAL CAUSE PATELLA FRACTURE LOOK FOR INTRA- ARTICULAR INVOLVEMENT CHECK TIBIAL PULSE TREATMENT: ORIF WITH P&S 9 10 PATELLA FRACTURE PATELLA FRACTURE FUNCTION: LENGTHENING THE ANTERIOR LEVER ARM DDX: BIPATITE PATELLA AND INCREASING THE (SUPEROLATERAL) EFFICIENCY OF THE QUADRICEPS. TREATMENT: DIRECT VS INDIRECT NON-DISPLACE, INJURY INTACT EXTENSOR : CYLINDRICAL CAST TEST EXTENSOR MECHANISM DISPLACE, DISRUPT EXTENSOR: ORIF WITH VERTICAL FRACTURE: TBW MERCHANT VIEW 11 12 PATELLAR DISLOCATION ADOLESCENT FEMALE DISLOCATION AROUND USUALLY -
Pulmonary Dysfunction in Patients with Femoral Shaft Fracture Treated with Intramedullary Nailing by BRENT L
COPYRIGHT © 2001 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Pulmonary Dysfunction in Patients with Femoral Shaft Fracture Treated with Intramedullary Nailing BY BRENT L. NORRIS, MD, W. CHRISTOPHER PATTON, MD, JOSEPH N. RUDD JR., BSN, PHD, COLLEEN M. SCHMITT, MD, MHS, AND JEFFREY A. KLINE, MD Investigation performed at the University of Tennessee College of Medicine, Chattanooga, Tennessee, and the Carolinas Medical Center, Charlotte, North Carolina Background: This study was undertaken to determine whether alveolar dead space increases during intramedul- lary nailing of femoral shaft fractures and whether alveolar dead space predicts postoperative pulmonary dysfunc- tion in patients undergoing intramedullary nailing of a femoral shaft fracture. Methods: All patients with a femoral shaft fracture were prospectively enrolled in the study unless there was evi- dence of acute myocardial infarction, shock, or heart failure. Arterial blood gases were measured at three consec- utive time-periods after induction of general anesthesia: before intramedullary nailing and ten and thirty minutes after intramedullary nailing. The end-tidal carbon-dioxide level, minute ventilation, positive end-expiratory pres- sure, and percent of inspired and expired inhalation agent were recorded simultaneously with the blood-gas mea- surement. Postoperatively, all subjects were monitored for evidence of pulmonary dysfunction, defined as the need for mechanical ventilation or supplemental oxygen (at a fraction of inspired oxygen of >40%) in the presence of clinical signs of a respiratory rate of >20 breaths/min or the use of accessory muscles of respiration. Results: Seventy-four patients with a total of eighty femoral shaft fractures completed the study. Fifty fractures (62.5%) underwent nailing after reaming, and thirty fractures (37.5%) underwent nailing with minimal or no ream- ing. -
Medical Consultation for the Elderly Patient with Hip Fracture
J Am Board Fam Pract: first published as 10.3122/15572625-11-5-366 on 1 September 1998. Downloaded from CLINICAL REVIEW Medical Consultation for the Elderly Patient With Hip Fracture RichardJ Ackermann, MD Background: This article describes a family physician geriatrician's perspective on the comprehensive management of hip fracture in frail elderly patients. Primary care physicians might be called upon to pro vide medical consultation for these patients. Methods: Guidelines were developed by a combination of personal experience in consulting for several hun dred elderly patients with hip fracture at a large community hospital, literature review using the key words "hip fractures," "aged," and "aged, 80 and over," and educational presentations for family practice residents. Results and Conclusions: Elderly patients with hip fracture offer a prime opportunity for comprehensive geriatric assessment. Intertrochanteric fractures are almost always treated with internal fixation, whereas femoral neck fractures can be treated by either fixation or by hemiarthroplasty. Hip fracture should be re garded as a surgical urgency, and generally operation should not be delayed, even if patients have serious comorbidity. The family physician can be instrumental in preparing the patient for surgery, preventing and treating complications, and assisting in the placement and rehabilitation of patients after hospital dis charge. 0 Am Board Fam Pract 1998; 11:366-77.) As the result of an aging population, family physi Some hip fractures and the falls that precede cians are increasingly likely to participate in the them are probably preventable. Strategies to de care of elderly patients suffering hip fracture. This tect and treat osteoporosis, especially in high-risk copyright.