Femoral Fractures ; diagnosis ; surgery ; Femoral Neck Fractures ; diagnosis ; surgery ; Humans

PURPOSE: To analyze diagnostic process and clinical data in cases of fracture of the femoral shaft with fracture of the proximal femur. MATERIALS AND METHODS: We reviewed 24 cases of patient who undergone surgery for fracture of the femoral shaft with ipsilateral fracture of the proximal femur and more than 1 year of examination of follow up was available. Age, sex.location and classification of the fracture, the time of diagnosis and operation, the method of operation, the associated injuries, the time of bony union and complication were investigated, postoperative function was evaluated on Friedman and Wyman criteria. RESULTS: Bony union showed significant difference in the displacement and comminution of fracture, postoperative function revealed significant difference according to the associated injuries. The 6 cases (25%) out of 24 cases are failed early diagnosis, 4 cases out of 6 cases was detected during operation and 2cases was found after surgery. 21 cases out of 24 cases of femoral shaft fractures showed union, 23 cases out of 24 cases of femoral neck fractures showed union. There were eleven good, eleven fair, and two poor functional result according to Friedman and Wyman criteria. CONCLUSION: Precious clinical and radiologic examination is needed not to miss the diagnosis of proximal femur fractures in ipsilateral femoral shaft fractures with proximal femur fractures. Anatomical reduction and rigid fixation of proximal femur are important to reduce avascular necrosis of femoral head and nonunion of proximal femoral fractures.
Displacement (Psychology) ; Early Diagnosis ; Femoral Fractures ; Femoral Neck Fractures ; Femur ; Follow-Up Studies ; Head ; Humans ; Necrosis

A case of chordoma occurred in the right femoral head and gluteus maximus muscle is reported. The case was a 61 year old female who complained of severe painful limitation of motion of the hip and radiating pain to the posterior aspect of right thigh for ten months. Roentgenological study revealed pathological fracture of femoral neck with osteoporotic change. For the treatment of femoral neck fracture, Moore type prosthetic femoral head replacement was performed. The cut surface of the resected femoral head showed multiple necrotic foci here and there, whitishgrey in color and gellatinous in consistency. The diagnosis was confirmed as a chordoma by microscopic examination. Femoral head and gluteus maximus muscle is one of very rare site of chordoma in the previous literature.
Chordoma ; Diagnosis ; Female ; Femoral Neck Fractures ; Femur Neck ; Fractures, Spontaneous ; Head ; Hip ; Humans ; Thigh

OBJECTIVETo investigate the clinical characteristics, treatment options and causes of misdiagnosis of ipsilateral femoral neck and shaft fractures.

METHODSAmong 20 patients with ipsilateral femoral neck and shaft fractures, 19 were treated operatively and 1 was treated conservatively. Sixteen cases of femoral shaft fractures were treated by open reduction and internal fixation with compressive plate, and 2 cases were treated with interlocking intramedullary nailing. Eighteen femoral neck fractures were treated with cannulated screws. Another patient was treated with proximal femoral nail to fix both the neck and shaft. Delayed diagnosis for femoral neck fractures occurred in 2 cases preoperatively.

RESULTSA total of 19 patients were followed up. The follow up period ranged from 5 to 48 months with an average of 15 months. All the fractures were healed.

CONCLUSIONFor case of femoral shaft fracture caused by high energy injury, an AP pelvic film should be routinely taken. Once the femoral neck fracture is recognized, operative reduction and fixation should be performed in time. Femoral neck and shaft fractures should be fixed separately.

Adult ; Aged ; Female ; Femoral Fractures ; diagnosis ; surgery ; Femoral Neck Fractures ; diagnosis ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged

Femoral neck fractures are associated with femoral shaft fractures in 1% to 9% of cases. Undisplaced neck fractures are susceptible to displacement during shaft nailing. We report the case of a 57-year-old male patient in whom we performed standard intramedullary nailing for a femoral shaft fracture. In doing so, we identified a vertical radiolucent line at the femoral neck, which was thought to be further displacement of a hidden silent fracture or an iatrogenic fracture that developed during nail insertion. Consequently, we decided to switch to reconstructive femoral nailing. Postoperative hip imaging failed to show the femoral neck fracture that we saw in the operating room. Here, we discuss the aforementioned case and review the literature concerning this artifact.
*Artifacts ; Femoral Fractures/diagnosis/*radiography/surgery ; Femoral Neck Fractures/diagnosis/*radiography/surgery ; Fracture Fixation, Intramedullary ; Humans ; Male ; Middle Aged

A number of reports regarding atypical fractures of the femur have raised questions concerning the possible correlation between long-term bisphosphonate treatment and the occurrence of insufficiency fractures in the proximal femur. However, clinically, it is often confused whether is it a fatigue fracture because of implant induced stress concentration or a bisphosphonate-related atypical fracture, especially in a patient with a subtrochanteric fracture who receive bisphosphonate therapy after open reduction and internal fixation, such as dynamic hip screw (DHS) fixation for previous ipsilateral femoral neck or intertrochanteric fracture. The authors experienced a case of a progressive femoral insufficiency fracture in a woman who had been on Fosamax (Alendronic acid with Vitamin D; Merck & Co. Inc, NJ, USA) therapy for four years after ipsilateral femoral neck fracture treated with a two hole DHS system. Despite a high suspicion of an insufficiency femoral subtrochanteric fracture by bone scan, the occult fracture progressed to a displaced femoral subtrochanteric fracture one year after. The fracture site was fixed with a 6 hole DHS plate, and six months after reoperation the patient had no symptoms and the fracture site had united without any complication.
Alendronate ; Early Diagnosis ; Female ; Femoral Fractures ; Femoral Neck Fractures ; Femur ; Femur Neck ; Fractures, Closed ; Fractures, Stress ; Hip ; Humans ; Osteoporosis ; Reoperation ; Vitamins

A case of unicameral bone cyst developed in proximal portion of left femur complicated with femoral neck fracture is reported. The case was 18 years old girl who complained of the swelling and pain over the left hip region and limited range of the motion of the hip for an year. Roentgenological study revealed a large lobulated cystic destruction involving the proximal portion of the left femur with thin cortical expansion and a pathological femoral neck fracture. Curettage of the cyst and cancellous bone graft paeked into the cyst were performed. The cyst measured 9cmX6cm in size and was composed of multiloculated cavities separated by fibroosseous septa. The cyst was filled with bloody gelatineous fluid. The diagnosis of unicameral bone cyst was confirmed by microscopic examination.
Bone Cysts ; Curettage ; Diagnosis ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Gelatin ; Hip ; Humans ; Transplants

Ipsilateral fractures of the femoral neck and shaft represent many difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coax vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from September 1989 to May 1995, and average follow-up period was 33 months(range, 12 to 101 months). The results obtained were as follows : 1. The most common cause of injury was traffic accident, and three femoral neck fractures were missed initially. 2. The most common site of femoral neck fractures was basicervical in 7 cases, and that of shaft fracture was middle 1/3 shaft in 5 cases. 3. The most common associated injury was ipsilateral knee injury(6 cases). 4. Five cases were treated with femoral reconstruction nail, two with multiple neck-pinning and retrograde interlocking IM nail, one with multiple screws for neck fracture and long dynamic compression plate for shaft fracture, and the other, multiple neck-pinning and antegrade interlocking IM nail. 5. The complications were a refracture of the shaft after removal of interlocking nail and a delayed union of shaft fracture which had been treated by reconstruction nailing. Coxa vara, delayed union and metal loosening were found in femoral neck fracture site, but all that were clinically acceptable. In conclusion, the fracture of femoral neck should be kept in mind not to be lost in case of high velocity-femoral shaft fracture, and if found, it should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority. Recently reconstruction nail for the treatment of these fractures was widely used, but that is technically difficult and might destroy the neck fracture during shaft fracture fixation. We recommend retrograde interlocking nail followed by multiple neckpinning might be safe and stable fixation for the ipsilateral neck and shaft fracture.
Accidents, Traffic ; Coxa Vara ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Fracture Fixation ; Head ; Knee ; Neck ; Necrosis

Authors clinically analysed the end results of the 58 elderly patients having fresh femoral neck fracture who were treated with multiple Knowles pinning, compression hip screw and femoral head replacement. All these 58 patients were treated between January 1982 and December 1986 at the Presbyterian Medical Center, Chonju. The factors that influenced the clinical results were analysed by type of fractures, early and late post-operative complications, quality of the fractured bone(osteoporosis), and functional evaluation with Jesse's hip grading method at least post-operative two year later. The results were summerized as follows : 1. The slip down was the most common cause of injuries. The transcervical type and Garden's type 153 was the most common type of fractures. 2. Average time interval between injury and diagnosis is 6 days. In case of delayed diagnosis, the fractures showed more displacement. 3. The osteoporotic change of femoral neck and spine was increased as physiological age advanced in parallel. 4. As the osteoporosis advanced, the fractures showed more displacement. 5. As the kosteoporosis advanced, the final results were worse, 6. The group treated with compression hip screw showed less complication and better functional result than patients operated with multiple knowles pinning. 7. This study suggests that the important factors that influenced the clinical results were type of fracture, the interval between injury and operation, method of trearment, and the quality of the fractured bone(degree of osteoporosis).
Aged ; Clinical Study ; Delayed Diagnosis ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Head ; Hip ; Humans ; Jeollabuk-do ; Methods ; Osteoporosis ; Protestantism ; Spine

Osteoporosis represents a reduced amount of bone tissue as compared with controls of same age and sex, and common feature of osteoporosis is a state of skeletal fragility leading to various fractures such as Colles' fracture, vertebral compression fracture, femur neck fracture, generally due to an inadequate amount of normally mineralized bone tissue, making the skeleton incapable of supporting normal mechanical demand. However it is difficult to quantify precisely its magnitude because of the variety of techniques used and the many bone sampling sites concerned. In 1970, Singh and associates(24.25) developed a method for grading the trabecular structure of the proximal end of the femur and reported that the femoral trabecular pattern index can clearly separate persons with osteoporosis from normal individuals. Cameron and its associstes developed an accurste method of determining bone mineral content by means of I-125 photon absorptiometry(5. 28). This method is consistently reproducible at the 98% level and has demonstrated agreement with ash measurement of cadaver bones at the 97% level. A comparative study of the usefulness of the femoral trabecular pattern index(Singh Index) and rsdial bone mineral content measurement by photon absorption was performed in 75 Kroean persons above forty years old. 25 of 75 persons were fracture patients due to osteoporosis. The results were as follows. 1. A significant difference in Singh index was noted between the fracture group snd control group. 2. A significant difference in bone mineral density was noted between the fracture group and control group. 3. A positive correlation was noted between the bone mineral denisty and Singh Index. 4. A significant difference in bone mineral density was noted between the fracture group and the control group which have same grade of Singh Index. So, we believe that bone mineral density is more objective and accurate than Singh Index. 5. We believe that both Singh Index and bone densitometer is useful in diagnosis and grading of osteoporosis.
Absorption ; Bone and Bones ; Bone Density ; Cadaver ; Colles' Fracture ; Diagnosis ; Femoral Neck Fractures ; Femur ; Fractures, Compression ; Humans ; Methods ; Miners ; Osteoporosis ; Skeleton