Femur shaft fractures in artificial hip joint replacement

In a total of 1980 patients who underwent total hip replacement 0.8% suffered from intra- and postoperative fractures of the femoral shaft. These spontaneous fractures were preconditioned by damage of the cortical layer due to rheumatoid arthritis, aseptic and septic looseening of the prosthesis as well as local trauma. In most cases stability could be restored by plate osteosynthesis, sometimes in combination with change of the prosthesis.     

Anterior cruciate ligament injury in recreational alpine skiers: analysis of mechanisms and strategy for prevention

Between 1995 and 1997, a retrospective survey was conducted in Japan to classify the types of injuries sustained by recreational alpine skiers. The purpose of this study was to investigate the causes and mechanisms of lower-extremity equipment-related (LEER) anterior cruciate ligament (ACL) injury in this population. Seventy-seven (96%) of the 80 respondents reported that their ski bindings did not release their ski boots at the time of their accident, and 30 respondents (38%) reported functional failure of their ski bindings, or that the ski boots came off. By presenting this investigation, we hope to give sports medicine clinicians a better understanding of LEER injuries and insights into how to prevent such injuries. Received: November 30, 2000 / Accepted: September 13, 2001     

Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity

PurposeOver the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers.MethodsWe conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6 ± 7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5 mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up.ResultsMean follow-up was 18.2 ± 6 months (12–28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85 ± 14 points (59–100), UCLA score was 7.3 ± 1.6 (4–10) and Tegner score was 4.6 ± 1.3 (3–6). Mean KOOS score was 77 ± 15 (54–97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement.ConclusionIn our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by isolated antero-posterior screwing provides excellent clinical and radiological results. The anteromedial incision has a dual advantage of anatomical reduction, tibial spine fixation (in 80% of our cases) and posteromedial fragment reduction.     

Femur shaft fractures in toddlers and young children: rarely from child abuse

One hundred thirty-nine children younger than 4 years were identified retrospectively from the period of 1993 through 1997 to have an isolated fracture of the shaft of one or both femurs. Abuse was classified as group A (definite, likely, or questionable abuse) or group B (unknown cause, questionable accident, likely accident, or definite accident). The average age of the children was 2.3 +/- 1.1 years. Thirteen children, 9% of the total group, average age of 1.1 +/- 1.0 years, were likely to have been abused (group A). A total of 126 children, 91% of the total, average age 2.3 +/- 1.0 years, sustained their fracture most likely as a result of an accident (group B). Whether a child had not yet achieved walking age (toddler) was the strongest predictor of likely abuse. Ten (42%) of 24 of nonwalking children were in group A, whereas only three (2.6%) of 115 of walking children were in group A (p < 0.001). Child Protective Services may have been unnecessary in 42-63% of cases. Unless other evidence of abuse such as an inconsistent story, bruises, or other fractures are present, abuse is very unlikely to be involved in the walking-age child, analogous to the toddler fracture of the tibia.     

The risk of injury in experienced Alpine skiers.

In 981 skiing accidents the type of injury resulting was studied in relation to the skiing activity (long distance, cross country, and downhill) and to the type of boots used. From the patterns of injuries it appears that in downhill skiing not only the velocity but also the particular type of equipment used is responsible for the increased incidence and for the characteristic type of injuries. The alpine ski boot used in downhill skiing, however, seems to protect the ankle joint and the foot from injuries that are more common in cross-country and long distance skiing.     

Femur fractures and hemorrhagic shock: Implications for point of injury treatment

BackgroundFemur shaft fractures (FSF) are perceived as potentially life-threatening injuries due to significant blood loss. However, these injuries are rarely the sole cause of hemorrhagic shock. Clinical practice guidelines for the prehospital management of FSF are inconsistent, especially concerning the use and timing of traction splinting which is postulated to reduce bleeding. We sought to understand the association between FSF and shock, and identify risk factors for shock among casualties with FSF.MethodsThis is a retrospective analysis of trauma casualties treated by Israeli Defense Forces (IDF) medical teams between the years 2000–2020 and suffering from isolated FSF. Prehospital data from the IDF-Medical Corps Trauma Registry was merged with hospitalization data from the Israeli National Trauma Registry. Isolated FSF was analyzed by excluding casualties with an Injury Severity Score ≥ 16 and an Abbreviated Injury Scale ≥ 3 in other anatomical regions. Shock was defined as systolic blood pressure ≤ 90 mmHg and/or heart rate ≥ 130 beats per minute. A case series review was performed for casualties in shock with isolated FSF injuries. Multivariable logistic regression was performed to assess for injury characteristics associated with shock.ResultsDuring the study period, we identified 213 patients with FSF (4.9%) of which 129 were isolated injuries. Overall, 9.9% and 26.3% of casualties had concurrent thoracic and abdominal injuries, respectively. Most FSF were due to motor vehicle accidents (60.1%) and shock was present in 17.1%. In isolated FSF patients, gunshot and explosive injury mechanisms were prevalent (65.0%) with severe shock being present in 8.5%. Open fractures were present in 72.7% of isolated FSF patients in shock. Open FSF injuries were characterized by prehospital bleeding which was difficult to control. In a multivariable logistic regression model, severe concomitant injuries were associated with increased odds of shock.ConclusionsShock rarely presents when FSF is the primary injury. Such casualties predominantly suffer from open FSF which may present as difficult to control thigh bleeding. Our findings do not support urgent prehospital leg traction splinting which may result in delayed evacuation to definitive care. Casualties with shock and FSF should be investigated for other sources of bleeding. Leg traction splinting should be reserved for suspected FSF injuries with shock or persistent thigh bleeding.     

Femur fractures and lung complications: a prospective randomized study of reaming

Reaming the intramedullary canal during fixation of femoral shaft fractures may contribute to pulmonary morbidity in patients with trauma. The purpose of our study was to compare acute and late pulmonary complications after reamed or nonreamed nailing of femur fractures. Patients who had femoral shaft fractures were randomized prospectively to a reamed (n = 41) or nonreamed (n = 41) femoral nailing group. Arterial blood gases were measured before and after femur fixation. Ratios of PaO2/FiO2 and alveolar arterial gradients were calculated. Pulmonary complications (acute respiratory distress syndrome) (ARDS), pneumonia, and respiratory failure) were monitored. Age, gender, fracture site, fracture type, time to nailing, length of operation, Injury Severity Score, and Abbreviated Injury Scale-thorax were similar for the two groups. No significant differences were observed in the ratio of PaO2/FiO2 ratios or alveolar arterial (A-a) gradients before and after nailing. The overall incidence of pulmonary complications was 14.6% (eight patients who had reamed nailing and four patients who had nonreamed nailing), and given the sample size, definitive conclusions could not be reached because of inadequate statistical power. We were unable to document differences in pulmonary physiologic response or clinical outcome between patients having reamed and nonreamed femoral nailing. This study may serve as a pilot investigation for other clinical investigations.