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.
Adult ; Bone Transplantation* ; Case Report ; Endoscopy* ; Female ; Femoral Fractures/surgery* ; Femoral Fractures/radiography ; Femoral Fractures/physiopathology ; Human ; Humeral Fractures/surgery* ; Humeral Fractures/radiography ; Humeral Fractures/physiopathology ; Male ; Middle Age ; Time Factors ; Wound Healing*

OBJECTIVETo compare the biomechanics of three internal fixations for distal femoral fractures,and to choose suitable clinical internal fixation according to experimental date.

METHODSThe fracture models of femoral condydle were made on 12 fresh cadaver femurs (C1 type of AO classification). The fractures were fixed by supracondylar intramedullary interlocking nails (A), L-shaped condyle plates (B) and compressed plates (C) respectively. The straining, displacement, rigidity and intensity of femoral supracondyla of the three internal fixations of distal femoral fractures were observed and analyzed by biomechanics. These three different internal fixation methods were compared by experimental stress analysis. These results were further confirmed by theoretical analysis using finite element method (FFM).

RESULTSUnder the same load condition, supracondylar intramedullary interlocking nail fixation was the best on the intensity and rigidity,while for compressed plate and L-shaped condyle plate, the femoral condyle intensity and rigidity were worse (P < 0.05). There were distinct differences in stress and displacement among three methods (P < 0.01).

CONCLUSIONSupracondylar intermedullary interlocking nail is the best method among the three internal fixation methods. It has advantage such as screw location, solid fixation and less complication. It is a good internal fixation method for distal femoral fracture.

Adult ; Biomechanical Phenomena ; Femoral Fractures ; physiopathology ; surgery ; Finite Element Analysis ; Fracture Fixation, Internal ; methods ; Humans ; Male

Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and cannulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane (coxa valga or coxa vara). We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side (Garden type 4 and Pauwel type 3). The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the radiographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture.
Adult ; Bone Screws ; Femoral Neck Fractures ; diagnostic imaging ; physiopathology ; surgery ; Fracture Fixation, Internal ; Humans ; Male

OBJECTIVETo investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture.

METHODSFrom June 2007 to September 2013, 8 patients (8 hips) with severe comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain, function, range of motion to evaluate clinical effects.

RESULTSThere was no untoward reaction in 8 patients. And bed rest at 3 months after operation, waiting for acetabulum fracture healed to out-of-bed activity. There was no complications such as pneumonia, bedsore and so on in the patients. Follow-up time was from 9 to 72 months with an average of 35.8 months, the wound healed, there was no the subsidence and loosening of prosthesis, no dislocation and infection. The mean of Harris score was 87.5 points after operation.

CONCLUSIONThe effect of the hip replacement in treating severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic complication, may serve as a substitute for internal fixation of difficult operation. The long-term efficacy is necessary to further observe.

Acetabulum ; injuries ; surgery ; Adult ; Arthroplasty, Replacement, Hip ; methods ; Femoral Fractures ; physiopathology ; surgery ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular

PURPOSELiterature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures.

METHODSThe study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5-12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n=17) or stainless steel (n=17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria.

RESULTSBased on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed in titanium group but five in stainless steel group.

CONCLUSIONMajority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

Bone Nails ; Child ; Child, Preschool ; Female ; Femoral Fractures ; physiopathology ; surgery ; Humans ; Male ; Range of Motion, Articular ; Stainless Steel ; Titanium

OBJECTIVETo explore the features of rats organs functional changes after femur shaft fracture combined with brain injury through testing biochemical indicators in rats.

METHODSThirty 4-month-old male SD rats, weight (280 +/- 10) g, were divided into 5 groups according to random number table involving normal control group, at the 1st day of injured group, the 2nd day injured group, the 3rd day injured group, the 5th day injured group, the 7th day injured group, 5 rats in each group. The animal injury model of right femur shaft fracture combined with brain injury were made by instruments in 5 injured groups. At the 1st, 2nd, 3rd, 5th, 7th day after made model, the biochemical indicators of blood serum from abdominal aorta including AST, ALT ,Cr, BUN, LDH and CK were detected and compared.

RESULTSThe biochemical indicator of blood serum (AST, ALT, Cr, BUN, LDH, CK) changed significantly among different groups. AST, ALT, BUN and CK reached peaks at the 1st day after injured (P<0.05). Cr reached peaks at the 3rd day after injured (P<0.05). LDH reached peak at the 2nd day after injured (P<0.05).

CONCLUSIONAfter brain injury combined with right femoral fractures in rats, a variety of serum biochemical indicators increase significantly, especially in early 3 days after injured. These indicators shows indirectly heart, liver and kidney organ dysfunction by trauma.

Animals ; Brain Injuries ; complications ; Femoral Fractures ; complications ; Male ; Multiple Organ Failure ; etiology ; metabolism ; pathology ; physiopathology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo discuss the indications, surgical procedures, and curative effect of dynamic hip screw (DHS) in the treatment of femoral neck fracture in the elderly.

METHODSA retrospective study was conducted to analyse the clinical data of 42 elderly patients who had been treated for femoral neck fracture with DHS in our department between June 2009 and November 2011. There were 21 males and 21 females with a mean age of 68.5 years (range 60-75 years). According to the Garden Classification, there were 19 cases of type II, 21 cases of type III and 2 cases of type IV fractures. By the Singh Index Classification, there were 3 cases of level 2, 19 cases of level 3 and 20 cases of level 4 fractures. The Harris criterion, complications and function recovery after opera- tion were analysed.

RESULTSThe average hospitalization time in 42 patients was 11.2 days (range 7-21 days). All patients were followed up for 12-26 months (mean 18 months). No lung infection, deep venous thrombosis or other complications occurred. Partial backing-out of the screws was found in 2 cases. The internal fixation device was withdrawn after fracture healing. Internal fixation cutting was found in 1 case, and he had a good recovery after total hip arthroplasty. The time for fracture healing ranged from 3-6 months (average 4.5 months). According to Harris criterion, 15 cases were rated as excellent, 24 good, 2 fair and 1 poor. The Harris scale was significantly improved from 30.52±2.71 preoperatively to 86.61±2.53 at 6 months postoperatively (P<0.05).

CONCLUSIONDHS, being minimal invasive, allowing early activity and weight-bearing, is advisable for treatment of elderly patients with femoral neck fracture. In addition, it can avoid complications seen in artificial joint replacement. It is especially suitable for patients with mild osteoporosis.

Aged ; Bone Screws ; Female ; Femoral Neck Fractures ; physiopathology ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Recovery of Function ; Retrospective Studies

Bone maintenance theory considers that the external load is the direct stimulating source of the bone remodeling. In this article, the method of experimental observation of self-repairing process of the bone defect and related results are introduced. Firstly, a hole was drilled in the rabbit thighbone so that the continuity of the bone was changed. Then bone defect model was established, and the thighbone data were obtained by using CT scanning, and the self-repairing process of bone defects caused by growth factor were observed and analyzed by MIMICS software. Finally, the relationship between volume changes of sclerotin was established, and scientific bases were provided for introducing the bionic topology optimization method to the remodeling process. The experimental results showed that the self-repairing of the each layer sclerotin of the young rabbits was faster than that of the adult ones under the same condition. In addition, the volume always changes contrarily between the spongy bone and enamel bone during the self-repairing process of bone defect.
Animals ; Bone Regeneration ; physiology ; Female ; Femoral Fractures ; physiopathology ; Femur ; injuries ; Fracture Healing ; physiology ; Male ; Osteogenesis ; physiology ; Rabbits

Adult ; Arthroscopes ; Female ; Femoral Fractures ; pathology ; physiopathology ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo study the mechanical properties and the clinical results of minimum-contact plate in the treatment of fractures.

METHODSFour-point bending and torsion tests were conducted to compare the new minimum contact plate (MCP) with dynamic compression plate (DCP) and limited contact dynamic compression plate (LC-DCP). The fracture healing time and growth of bony callus were observed in 29 cases of long bone fracture fixed with MCP to evaluate the advantages of this kind of plate.

RESULTSThe 29 patients who underwent MCP were followed up from 6 to 14 months. The average healing time for femoral, tibial and humeral fractures was 12, 13 and 10 weeks, respectively. All fractures were healed. No displacement of fracture, screw pullout, deformation or break of the plate were found.

CONCLUSIONSThe bending stiffness of MCP is significantly greater than that of DCP and LC-DCP (P<0.05). MCP can protect the periosteal blood supply against avascular osseous necrosis and accelerate bone healing. It is a kind of reliable and effective plate in treatment of fractures.

Adolescent ; Adult ; Aged ; Biomechanical Phenomena ; Bone Plates ; Child ; Female ; Femoral Fractures ; physiopathology ; surgery ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Fracture Healing ; Fractures, Closed ; physiopathology ; surgery ; Fractures, Open ; physiopathology ; surgery ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Male ; Middle Aged ; Tibial Fractures ; physiopathology ; surgery ; Torsion Abnormality ; Treatment Outcome