The bone transport technique uses the principle of distraction-osteogenesis and fill bone defects with the aid of an external fixator. In order to evaluate the clinical effect of femoral internal fixation with Ortho-Bridge System after bone transport, 4 patients after femoral bone transport from October 2020 to October 2022 are studied in this paper. Among them, 3 patients ran refracture of femur after removal of the Limb reconstruction system, 1 patient just finish femoral bone transport and request internal fixation. The surgery results show that Ortho-Bridge System can be used in the situation that conventional Locking compression plate and intramedullary nail are not suitable due to anatomical variation after femoral bone transport. Key words: femoral fracture; Ortho-Bridge System; bone transport; postoperative complications of bone transport.
- MeSH
- dospělí MeSH
- externí fixátory MeSH
- femur chirurgie MeSH
- fraktury femuru * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- osteogeneze pomocí distrakčního aparátu metody přístrojové vybavení MeSH
- pooperační komplikace etiologie MeSH
- vnitřní fixace fraktury metody přístrojové vybavení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Significant malrotation of the femur after osteosynthesis is a serious complication of treatment and has a number of consequences for the patients and causes deterioration of their quality of life. Therefore, it is necessary to be familiar with intraoperative techniques to control the correct rotation, mostly clinical and radiological, which give us the possibility to minimize rotational errors. In the postoperative period, with even a slight suspicion of malrotation, it is necessary to proceed to its exact verification and, in indicated cases, to perform necessary correction. We recommend one of the CT techniques as a very reliable method, however in younger patients we prefer to use MRI. Early diagnosis of the rotational error and especially its size is essential from the point of view of potential reconstructive surgery, which is then chosen also with regard to the location of the original lesion. Key words: femoral osteosynthesis, limb malrotation, methods of measuring.
- MeSH
- femur chirurgie diagnostické zobrazování MeSH
- fraktury femuru * chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- počítačová rentgenová tomografie MeSH
- pooperační komplikace diagnóza etiologie MeSH
- vnitřní fixace fraktury * škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
Proximal femur fractures (PFF) pose a major challenge in elderly patients with severe comorbidities and receiving antithrombotic therapy since according to the latest guidelines the surgery should be performed as soon as possible, preferably within 24 hours, to reduce mortality and morbidity. This review outlines the practical approach to surgical management of PFF that relies on increasing evidence of safety of early surgery in patients with PFF receiving antiplatelet and anticoagulant therapy. We have also used information from the existing evidence-based guidelines for elective/planned surgery in patients with antithrombotic therapy. The practical approach can be summarised as follows: • Antiplatelet therapy - discontinuation of acetylsalicylic acid (ASA) and clopidogrel in monotherapy or in combination is not necessary prior to surgery. In case of bleeding, antifibrinolytic therapy is recommended as well as administration of platelet concentrate which is rarely needed. • In patients taking warfarin, reversal of its effects is recommended by early administration of vitamin K to allow surgery to be performed within 24 hours. Prothrombin complex concentrate (PCC) as a second-line drug is reserved for extreme cases only. Warfarin therapy is resumed 24 hours after surgery. • Direct oral anticoagulants must be discontinued 24-48 hours prior to surgery, possibly longer depending on the type of drug, time of administration of the last dose, and renal function. In extreme cases, an antidote (idarucizumab, off-label andexanet) can be administered prior to surgery, or PCC in case they are unavailable. Anticoagulation therapy is resumed in 24-48 hours. • Neuraxial anaesthesia is possible when ASA is taken by the patient and in case of effective warfarin reversal. • In early surgery and rapid restart of anticoagulant therapy, bridging therapy with LMWH is not indicated except for in cases with extreme risk of thrombosis. Key words: proximal femur fracture, antiplatelet therapy, anticoagulant therapy, perioperative management.
- MeSH
- antikoagulancia * škodlivé účinky aplikace a dávkování terapeutické užití MeSH
- Aspirin škodlivé účinky terapeutické užití aplikace a dávkování MeSH
- fraktury femuru chirurgie MeSH
- fraktury proximálního femuru MeSH
- inhibitory agregace trombocytů * škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- warfarin škodlivé účinky terapeutické užití aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Large femoral defects after trauma, femoral non-unions, fractures complicated by osteomyelitis or defects after bone tumour resection present high burden and increased morbidity for patient and are challenging for reconstructive surgeons. Defects larger than 6 cm and smaller defects after failed spongioplasty are suitable for reconstruction using a free, eventually a pedicled vascularised bone flap. The free fibular flap is preferred but an iliac crest free flap or a pedicled medial femoral condyle flap can be also used. These vascularised flaps are ideal for bridging defects of long bones and can be also used as osteocutaneous or osteomuscular flaps for coverage of soft tissue defect if present. The patients and their families were informed that data will be submitted for publication and they gave their written informed consent prior to the submission. The study was approved by the institutional ethic committee. METHODS: We analysed a group of eight patients with large diaphyseal or distal metaphyseal femoral defects. A free fibular flap was used in six patients, a pedicled medial ipsilateral femoral condyle flap was used in two patients and a defect in one patient was reconstructed using an iliac crest free flap. RESULTS: All flaps healed completely in all patients and no fracture of the flap was detected during the study period. In one patient, a locking plate broke and was replaced by a compression plate. At the last check-up all patients were able to step on the reconstructed limb with full weight. DISCUSSION: Although our study comprises a heterogeneous group of cases, they all have been successfully treated by a similar technique, adapted in each case specifically to the needs of the patient. A major limitation parameter of reconstruction by a free vascularised flap is the size of bone defect needed to be reconstructed. In case of a bone defect longer than 6 cm and a concomitant soft tissue disruption, a vascularised double-barrel fibula is the preferred. CONCLUSION: Large femoral defects can be successfully reconstructed with good long-term results using suitable free or pedicled vascularised bone flaps, especially preferring the free fibular flap.
- MeSH
- chirurgické laloky * MeSH
- dospělí MeSH
- femur * chirurgie transplantace MeSH
- fibula transplantace chirurgie zranění MeSH
- fraktury femuru chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- senioři MeSH
- transplantace kostí * metody MeSH
- volné tkáňové laloky transplantace MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Zlomeniny proximálního femuru jsou jedny z nejčastějších zlomenin. Patří sem zlomeniny krčku femuru a zlomeniny trochanterického segmentu. Průměrný věk pacientů se pohybuje kolem 80 let a téměř tři čtvrtiny tvoří ženy. To znamená, že zlomeniny proximálního femuru jsou problémem nejen terapeutickým, ale i sociálním a ekonomickým. Až na výjimky je léčba zlomenin proximálního femuru operační. U zlomenin krčku femuru převažuje aloplastika, u trochanterických zlomenin osteosyntéza. Nejčastější komplikací osteosyntézy u zlomenin krčku femuru je avaskulární nekróza hlavice femuru, u trochanterických zlomenin je to mechanické selhání osteosyntézy.
Fractures of the proximal femur are among the most common fractures. They include fractures of the femoral neck and fractures of the trochanteric segment. The average age of patients is around 80 years and almost three quarters are women. This means that proximal femur fractures are not only a therapeutic problem, but also a social and economic issue. But for few exceptions, proximal femur fractures are treated operatively, with arthroplasty prevailing in femoral neck fractures and internal fixation in trochanteric fractures. The most common complication of internal fixation in femoral neck fractures is avascular necrosis of the femoral head, in trochanteric fractures it is mechanical failure of internal fixation.
BACKGROUND: Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19). OBJECTIVE: To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. MATERIAL AND METHODS: Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. RESULTS: In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‐month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‐month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). CONCLUSION: The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.
- MeSH
- COVID-19 * mortalita MeSH
- délka pobytu statistika a číselné údaje MeSH
- fraktury femuru mortalita chirurgie MeSH
- fraktury kyčle mortalita chirurgie MeSH
- fraktury proximálního femuru MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- pečovatelské domovy * statistika a číselné údaje MeSH
- reoperace statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- SARS-CoV-2 MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Německo MeSH
PURPOSE OF THE STUDY: Surgical options for paediatric femoral fractures include fl exible intramedullary nailing (FIN), plating, and external fi xators. Length unstable fractures are usually spiral, long oblique, or comminuted and are often associated with > 2 cm of shortening. The purpose of this study was to see whether FIN is effective for managing unstable femur fractures in children. MATERIAL AND METHODS: An electronic literature search was performed up to 25 February 2022 in Cochrane Library, PubMed, and Embase databases using a combination of MeSH search terms and keywords related to the population (e.g., "child" AND "diaphyses" AND "femur"), and intervention (e.g., "nail" OR "ESIN"). The data extracted included the study details, Demographic data, surgical details, postoperative immobilization, complications, and outcome. RESULTS: Eight studies with a total sample size of 369 patients were reviewed. The mean operative time, blood loss, and length of stay in the hospital were 67.62±12.32 minutes, 33.82±16.82 ml, and 4.9±1.27 days, respectively. The results were excellent in 61.92% of the patients, satisfactory in 32.61%, and poor in 5.43%. 4.54% of patients had major complications requiring reoperation and 32.46% of patients had minor complications. the most common complication was nail prominence seen in 26.30% of patients. Locked Ender's nail was associated with the least reoperation, malunion, and LLD rate compared to other types of FIN. CONCLUSIONS: FIN along with a single walking spica cast is a good choice in all forms of paediatric femoral fracture patterns allowing proper alignment and rotation. Locked Ender's nail is safe and effective for managing unstable paediatric femur fracture. KEY WORDS: pediatric femur fracture, length unstable, fl exible intramedullary nailing, submuscular plating, Flynn criterion.
- MeSH
- dítě MeSH
- dolní končetina MeSH
- femur MeSH
- fraktury femuru * chirurgie MeSH
- interní fixátory MeSH
- intramedulární fixace fraktury * škodlivé účinky MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
PURPOSE OF THE STUDY: Intraarticular fractures of the distal femur rank among the most severe musculoskeletal injuries. Various treatment options, such as plate osteosynthesis or retrograde nailing, can be employed. This study aims to evaluate the clinical outcomes and complications of intraarticular distal femoral fractures treated with retrograde femoral nail, with particular emphasis on C3 fractures. MATERIAL AND METHODS: Between January 2016 and January 2023, 18 AO/33.C3 fractures were treated with a retrograde femoral nail. Of these, two were classified as 33.C1, eight as 33.C2 and eight as 33.C3. Twelve of the fractures were open. After the initial treatment and stabilizing the patient's overall condition, we proceeded with the definitive osteosynthesis. The first phase involved open reduction and fixation using individual screws to reconstruct the articular surface. The second phase consisted in retrograde nailing with correction of the length, axis and rotation of the femur. The evaluation criteria included: complication rate, number of revisions, knee range of motion, mechanical axis and length of the lower extremity, progression of gonarthrosis, pain level, need of walking support, Lysholm and Tegner Activity Score for functional outcome. RESULTS: Overall, we evaluated the complications and the outcomes of 12 patients (13 fractures). Of these, 8 patients experienced some kind of postoperative complications, primarily insufficient healing or nonunion, which were managed through revision surgery. Plate reosteosynthesis was used in 2 patients who were then excluded from the final clinical evaluation. No cases of deep infection or deep vein thrombosis were reported and no patient required total knee replacement. Seven AO/33.C3 fractures were individually evaluated. The average knee range of motion was nearly 0-93°, maximum flexion was 120°. On average, the lower extremity was 1.6 cm shorter and 7.3° varus to the mechanical axis. Only little progression of gonarthrosis was observed along with low levels of pain. The Lysholm Score ranged between 52 and 84 points (averaging 73.1). The mean Tegner Activity Score was 3.4. All results showed adequate improvement in 33.C2 and 33.C1 groups. DISCUSSION: The retrograde femoral nail demonstrates several advantages over the locking compression plate, particularly in biomechanical aspects. Various clinical studies have reported superior outcomes in terms of healing, complication rate, blood loss and functional outcome. Our study findings align with some of those international studies, particularly in the rate of infectious complications (0%), mean Lysholm Score (79.3 p.) and Tegner Activity Score (4.1). On the other hand, we observed a higher rate of revision surgery (53.8 %), mainly due to evaluating 33.C fractures only. The main advantage of this method lies in complete visualization, leading to better reconstruction of the articular surface coupled with excellent biomechanical properties of the intramedullary nail. CONCLUSIONS: Intraarticular distal femoral fractures pose significant challenges to treatment and frequently lead to permanent damage. The primary treatment goals involve achieving anatomical reposition of the articular surface, stable osteosynthesis, correction of the femoral length and axis and early rehabilitation. Our study demonstrates good clinical outcomes with a relatively low rate of complications. Patients are capable of walking without pain, achieving a good range of motion, returning to their occupations and becoming self-sufficient. Moreover, there were no infectious complications and no significant progression of gonarthrosis. KEY WORDS: retrograde femoral nail, intraarticular distal femoral fracture, functional outcome, complication rate.
- MeSH
- fraktury femuru * chirurgie MeSH
- intraartikulární fraktury chirurgie MeSH
- intramedulární fixace fraktury metody přístrojové vybavení MeSH
- kostní hřeby * MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace etiologie MeSH
- reoperace metody MeSH
- rozsah kloubních pohybů MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY The aim of the study was to determine the incidence of primary malignancies metastasizing to the area of the proximal femur, to evaluate the localization of the lesions and fractures, to compare the results of the selected surgical therapy, survival time of the patients and postoperative complications. MATERIAL AND METHODS We retrospectively evaluated the group of patients operated on from 2012 to 2021. The study included 45 patients (24 women and 21 men) with a pathological lesion or a pathological fracture in the area of the proximal femur. The average age was 67 years (38-90). There were 30 (67%) cases of pathological fracture and 15 (33%) cases of pathological lesions in the cohort. In each patient, the perioperative biopsy or resected sample was sent for histological examination. The type of primary malignancy with the localization of lesions and fractures was assessed. Furthermore, we evaluated the outcomes of the surgical method chosen and its complications. We monitored the patients' functional score using the Karnofsky performance status and survival interval. RESULTS The most common primary malignancy was multiple myeloma in 10 cases (22%), followed by seven cases (16%) of breast and lung cancer and 6 cases (13%) of clear cell renal cell carcinoma. Internal fixation was used in 15 cases (33%). Tumor resection with hip joint replacement was performed in 29 patients (64%). One patient was treated with percutaneous femoroplasty. Out of a total of 45 patients, 10 patients (22%) survived for less than three months. The survival rate of more than one year was observed in 21 patients (47%). A total of seven complications occurred in six patients (15%). Fewer complications occurred in the group of patients with a pathological fracture compared to the group with an impending fracture. DISCUSSION Pathological lesions in the bone or an already existing pathological fracture are signs of advanced cancer. Better outcomes are reported in patients who underwent prophylactic surgery, which was, however, not confirmed by our study. The incidence of individual primary malignancies, the postoperative complications and the patient survival corresponded to the statistical data reported by the other authors. CONCLUSIONS In patients with a pathological lesion of the proximal femur, operative treatment will increase the quality of life, either when choosing osteosynthesis or joint replacement, while prophylactic treatment is usually associated with a better prognosis. As a less invasive procedure with lower blood loss, osteosynthesis is indicated for palliative therapy in patients with a limited expected survival time or in patients with a prognosis of healing of the lesion. Reconstruction of the joint with an arthroplasty is indicated in patients with a better prognosis or in cases excluding safe osteosynthesis. Our study confirmed good outcomes with the use of an uncemented revision femoral component. Key words: metastasis, osteolysis, pathological fracture, proximal femur.
- MeSH
- femur chirurgie MeSH
- fraktury femuru * etiologie chirurgie MeSH
- fraktury spontánní * etiologie chirurgie MeSH
- kvalita života MeSH
- lidé MeSH
- nádory * komplikace MeSH
- pooperační komplikace epidemiologie etiologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
BACKGROUND: Femoral posterior hip dislocation with associated femoral head fractures (Pipkin fractures) are rare high-energy injuries. Published treatment modalities involve conservative treatment, head fragment resection, open reduction and internal fixation, and total hip replacement. The experience with mini-invasive screw osteosynthesis of these fractures is the main focus of our study. METHODS: Seven Pipkin fractures (five Pipkin II and two Pipkin I) in six patients were treated by closed reduction of hip dislocation, followed by minimal invasive lag screw osteosynthesis. Cancellous screw(s) were inserted from the incision on the lateral hip through the femoral neck to the reduced fracture fragment. In all patients, postoperative CT was performed to check the quality of surgery. Active physiotherapy with immediate toe-touch weight bearing was the routine postoperative protocol. In all patients, radiological and clinical results were evaluated with the Thompson Epstein, Merle d'Aubigne and Postel score, and Harris hip score. RESULTS: All fractures united, and all femoral heads survived. Infectious complications were not observed, and no secondary surgery was needed. After an average follow-up of 18.4 months, the average Merle d'Aubigne and Postel score was 17.7 points, while the mean Harris hip score reached 98.1 points. The majority of patients achieved an excellent Thompson-Epstein clinical and radiological outcome. All patients returned to their original occupation. CONCLUSIONS: Mini-invasive screw osteosynthesis can be used for the treatment of Pipkin type I-II femoral head fractures. Successful reduction of hip dislocation and head fracture is necessary for using this technique. Long-term follow-up is necessary to confirm this technique.
- MeSH
- fraktury femuru * komplikace chirurgie MeSH
- fraktury kyčle * diagnostické zobrazování chirurgie komplikace MeSH
- hlavice femuru diagnostické zobrazování chirurgie zranění MeSH
- kostní šrouby škodlivé účinky MeSH
- lidé MeSH
- luxace kyčle * komplikace chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
