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.
PURPOSE OF THE STUDY: The primary aim is to assess the proportion of children younger than two years with a femoral fracture who underwent a skeletal survey. The secondary aim of the study is to evaluate the patients' demographics, reported trauma mechanism, type of fracture, type of treatment and complication rate. MATERIAL AND METHODS This was a retrospective study of children younger than two years examined at the Department of Imaging Methods for a femoral fracture between 2015-2022. The type and site of the fracture were assessed on radiographs. The patients' medical records were used to assess which steps had been taken to evaluate for possible abusive etiology of the fracture. The data were correlated with the published guidelines for performing skeletal survey in young children with fractures. The patients' demographics, medical history, time interval from trauma or symptoms onset to medical examination, type of treatment, duration of orthopaedic follow-up in addition to the clinical fi ndings at the last orthopaedic follow-up visit were also retrieved from the patients' medical records. RESULTS A total of 40 children were included in the study, 21 of whom were girls (52.5%). The mean age was 13.8 months. 5 children (12.5 %) were younger than 6 months. 36 children (90%) had a history of trauma, the vast majority of whom suffered a fall. 21 patients (52.5%) sustained a distal metaphyseal fracture, 19 patients (47.5%) suffered a diaphyseal fracture. A spica cast was used in 12 patients (30%), which was applied under general anaesthesia in most cases. 28 patients (70%) received a long leg cast. A certain degree of stiffness following cast removal was the only documented complication. Based on the published guidelines, it was estimated that in 23 patients (57.5%) a skeletal survey should have been performed. However, this investigation was performed in 2 patients (5%) of the study population only. DISCUSSION Femoral fractures in young children are rare, especially in those younger than six months of age. The fractures were located in femoral diaphysis and in distal femoral metaphysis. Surgical treatment was not required, and no signifi cant complications were observed. Nonetheless, the study showed that the rate of child abuse screening was low. The skeletal survey was performed in two cases only, both children were younger than six months and had no history of trauma. Based on the published guidelines, however, it may be assumed that the skeletal survey should have been performed in more than half of the patients in the study. The failure to perform this investigation might have led to the abuse not being detected and the child being returned to the abusive environment. CONCLUSIONS Management of femoral fractures in patients younger than two years does not usually require hospitalisation and is not associated with the risk of complications. However, potential further harm may be caused if abusive etiology of the femoral fracture fails to be discovered. This study has shown that the rate of abuse evaluation is low. It is essential to initiate a multidisciplinary discussion on this topic to raise the physicians' awareness and to implement the screening for child abuse among young children with femoral fractures. This scientifi c paper also includes a summary of necessary steps to be taken in the evaluation of a young child with a femoral fracture. KEY WORDS: fractures, femur, children, infant, child abuse, radiography.
- MeSH
- celková anestezie MeSH
- dítě MeSH
- femur MeSH
- fraktury femuru * diagnostické zobrazování etiologie MeSH
- kojenec MeSH
- lidé MeSH
- ortopedie * MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Bisphosphonates are commonly used in the treatment of osteoporosis. Long-term use without drug holiday causes the risk of atypical fractures. Subtrochanteric and femoral stress fractures are among the frequently described complications. In our case report; a stress fracture of the scapular spine, a previously undescribed adverse effect of bisphosphonates, is presented. Key words: bisphosphonates, scapular spine, stress fracture, drug holiday.
- MeSH
- bisfosfonáty škodlivé účinky MeSH
- fraktury femuru * chemicky indukované diagnostické zobrazování chirurgie MeSH
- fraktury páteře * chemicky indukované komplikace MeSH
- fraktury proximálního humeru * MeSH
- inhibitory kostní resorpce * škodlivé účinky MeSH
- lidé MeSH
- stresové fraktury * chemicky indukované diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- bisfosfonáty škodlivé účinky MeSH
- fraktury femuru * diagnóza diagnostické zobrazování MeSH
- inhibitory kostní resorpce * škodlivé účinky MeSH
- lidé MeSH
- nemoci kostí * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Functional results after internal fixation of trochanteric femoral fractures may be negatively affected by healing in a non-physiological position. The aim of this study was to evaluate the occurrence and severity of femoral malrotation after nailing of trochanteric fractures. MATERIALS AND METHODS: The authors conducted a prospective study focused on a CT analysis of malrotation after intramedullary nailing of trochanteric fractures (AO 31A1-3) in 101 patients. We recorded the type of fracture, method of anesthesia, scheduled surgery vs. acute surgery, and the surgeon's experience as possible risk factors for limb malrotation after trochanteric fracture surgeries. RESULTS: The average extent of malrotation was 9° of internal rotation ranging from 29° of external to 48°of internal rotation. In 35% of patients, we observed a rotation greater than 15°, and in 15 patients (15%), the rotation was greater than 25°. The risk of significant internal malrotation was significantly higher than external malrotation (37 vs. 4 patients). None of the factors observed proved to be statistically significant. The effect of general anesthesia and the type of intertrochanteric fracture came closest to having a significant effect on rotational error. CONCLUSION: Improper reduction of a trochanteric fracture is a common problem that can lead to femur malrotation. In our study, a rotational error greater than 15° occurred in 35% of the patients, but none of the monitored factors represented a statistically significant risk for this complication.
- MeSH
- femur diagnostické zobrazování chirurgie MeSH
- fraktury femuru * diagnostické zobrazování etiologie chirurgie MeSH
- fraktury kyčle * komplikace diagnostické zobrazování chirurgie MeSH
- intramedulární fixace fraktury * škodlivé účinky metody MeSH
- kostní hřeby škodlivé účinky MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: The aim of this study was to answer the question whether our newly developed injectable biodegradable "self-setting" polymer-composite as a bone adhesive is a good "bone-glue" candidate to efficiently fix comminuted fractures of pig femoral bones used as an ex-vivo experimental model. METHODS: Mechanical properties of adhesive prepared from α-tricalcium phosphate (TCP) powder and thermogelling copolymer were optimized by selecting the appropriate composition with adhesion enhancers based on dopamine and sodium iodinate. Setting time and injectability were controlled by rheology. Ex-vivo experiments of fixed pig bones were provided in terms of either the three-point bending test of bending wedge type fractured pig femurs (with LCP) or the axial compression test of 45° oblique fractured femurs (without LCP) in physiological saline solution at 37 °C. Fractured bones treated with optimized adhesive before and after bending tests were imaged by X-ray microtomography (μCT). RESULTS: Based on the rheological measurement, the adhesive modified with both dopamine and sodium iodinate exhibited optimal thixotropic properties required for injection via thin 22 G needle. This optimal adhesive composition showed an 8 min lag phase (processing time) followed by fast increase in storage modulus at 37 °C up to 1 GPa within 110 min. Self-setting of dopamine/iodinate modified adhesive was completed in 48 h exhibiting the maximum strength at compression of 7.98 MPa ± 1.39 MPa. Whereas unmodified adhesive failed in glue-to-bone adhesion, dopamine and dopamine/iodinate modified adhesive used for 45° oblique fracture fixation showed good and similar strength at compression (3.05 and 2.79 MPa, respectively). However, significantly higher elasticity of about 250% exhibited adhesive with iodinate enhancer. Moreover, mechanical properties of B2 fractures fixed with both LCP and dopamine/iodinate adhesive were approaching closely to the properties of original bone. Excellent adhesion between the adhesive and the bone fragments was proved by μCT. CONCLUSION: The polymer-composite bone adhesive modified with dopamine/iodinate exhibited very good fixation ability of femoral artificial comminuted fractures in an experimental model.
- MeSH
- biomechanika MeSH
- diafýzy MeSH
- femur diagnostické zobrazování MeSH
- fixace fraktury MeSH
- fraktury femuru * diagnostické zobrazování MeSH
- kostní cementy * MeSH
- kostní destičky MeSH
- prasata MeSH
- vnitřní fixace fraktury MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
In patients with defect bone growth and dwarfism, fractures of the weight bearing skeleton are relatively rare due to their reduced mobility. When they do occur, their treatment and potential surgery are complicated. The commonly used therapeutic procedures are not applicable, the available implants are not suitable, if a surgery is necessary. An individual approach and often times also improvisation is needed. It is important to realize that these patients do not suffer from an intellectual disability and are fully aware of their physical impairment, which we must not make worse without an effort for adequate treatment. This case study presents our solution of a supracondylar femoral fracture in a patient with achondroplasia and extreme obesity. A proximal humeral nail was used for distal femoral fracture osteosynthesis by a retrograde approach. To the knowledge of authors, this study reports on the first case of supracondylar femoral fracture surgery in patients with achondroplasia. Key words: achondroplasia, dwarfism, supracondylar femoral fracture, extreme obesity.
PURPOSE OF THE STUDY In this study we aimed to investigate the clinical and radiographic results of AO/OTA 31 A3 fractures operated on with either a proximal femoral lateral locking plate or short cephalomedullary nails. MATERIAL AND METHODS/RESULTS Medical data of patients treated with either implant were evaluated retrospectively. Patients > 55 years old sustaining an AO 31 A3 type fracture with a minimum follow-up of one year from two institutions were included in the study. RESULTS In all, 22 patients in the plate group and 30 patients in the nail group were included. All patients achieved union excluding the patients with failure. No significant differences in the mean duration of surgery, pre- and postoperative hemoglobin levels, duration of union time, or need for an open reduction or revision surgery were observed between the two groups. Reduction quality was better in the nail group. Failure of fixation was detected in three patients in the plate group and in four patients in the nail group. The duration of hospital stay was longer in the plate group than the nail group (p = 0.007). Time to independent mobilization was significantly shorter in the nail group than the plate group (p = 0.027). The Harris hip score results were similar between the groups after one year (p = 0.479). CONCLUSIONS Both implants had similar radiographic and clinical outcomes treat 31 A3 intertrochanteric fractures if the lateral wall of the proximal fragment was intact and anatomical medial-posteromedial restoration of the fracture is performed. Although complication rates were similar between the two groups, nails enabled early mobilization of patients. Key words: intertrochanteric, 31 A3 fracture, fixation, PFLP, nail.
- MeSH
- fraktury femuru * diagnostické zobrazování chirurgie MeSH
- fraktury kyčle * diagnostické zobrazování chirurgie MeSH
- intramedulární fixace fraktury * škodlivé účinky MeSH
- kostní hřeby MeSH
- lidé středního věku MeSH
- lidé MeSH
- nehty MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
This study was conducted as an in vivo experiment in adult miniature pigs with the aim to test two new biomaterials. An iatrogenic defect was made into the central femoral diaphysis in the experimental animals and subsequently fixated by bridging plate osteosynthesis. Into the defect we implanted a cancellous autograft (control group), a pasty injectable scaffold (EXP A), and a porous 3D cylinder (EXP B). Radiological examination was performed in all animals at 0, 10, 20, 30 weeks after surgical procedure and histological assessment was performed. In the newly formed bone the osteoblastic activity was monitored. In terms of radiology, the most effective method was observed in the control group (completely healed 100%) compared to experimental groups EXP A (70.0%) and EXP B (62.5%). Histological assessment showed a higher cell count in the place of bone defect in the control group compared to experimental groups. Between the experimental groups, a higher count of bone marrow cells was found in group EXP B. Both newly developed biomaterials seem to be suitable as replacements for large bone defects, having good workability and applicability. However, compared to the control group treated with a cancellous autograft, the newly formed bone did not reach the same number of cells settling in and in some cases, full radiological healing was not reached. Nevertheless, the material was found to be grown into the original bone in all cases within the experimental groups. The new biomaterials have a great potential as a substitute in the treatment of large bone defects.
- MeSH
- autologní štěp chirurgie MeSH
- biokompatibilní materiály * klasifikace terapeutické užití MeSH
- fraktury femuru * diagnostické zobrazování terapie veterinární MeSH
- prasata chirurgie MeSH
- radiografie metody MeSH
- vnitřní fixace fraktury metody veterinární MeSH
- výzkum MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- MeSH
- fraktury femuru * diagnostické zobrazování terapie MeSH
- lidé MeSH
- myalgie diagnóza terapie MeSH
- senioři MeSH
- téměř pochybení ve zdravotní péči MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
