MyMedR

A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur

Deshmukh RG, Lou KK, Neo CB, Yew KS, Rozman I, George J

Injury, 1998 Apr;29(3):207-10.

Closed intramedullary nailing is a successful method of treating adult femoral shaft fractures. In comminuted or segmental fractures, this operation is associated with an incidence of rotational malalignment and malunion. After locked nailing, this can only be corrected by further operation. A simple method of judging and obtaining rotational alignment in such cases intra-operatively is described. A comparison of two groups of patients with such fractures, one using this technique and the other using conventional methods of judging alignment, revealed statistically significant improvement in rotational alignment (p = 0.016).

Matched MeSH terms: Femoral Fractures/surgery*

Supracondylar nailing for difficult distal femur fractures

Saw A, Lau CP

J Orthop Surg (Hong Kong), 2003 Dec;11(2):141-7.

PMID: 14676338

To evaluate outcome following supracondylar nailing for distal femur fractures.

Matched MeSH terms: Femoral Fractures/surgery*

Fulltext Comparison study between reamed and unreamed nailing of closed femoral fractures

Selvakumar K, Saw KY, Fathima M

Med J Malaysia, 2001 Dec;56 Suppl D:24-8.

PMID: 14569762

Intramedullary nailing is an accepted procedures for femoral fractures gives uniformly good results. Various methods of intramedullary fixation have been practiced in the past. Recently intramedullary fixation without reaming has come into vogue. Preservation of the endosteal blood supply, less blood loss and quicker union have been the alleged benefits of not reaming the medullary canal. This study is a prospective randomised study conducted to compare intramedullary nail fixation of closed femoral fractures with and without a reaming procedure to assess the validity of the above assumptions. One hundred and two consecutive cases of skeletally mature patients with closed fracture of femoral shaft were randomised into two groups, i.e. Reamed (52) and Unreamed (50). The average follow-up was 36 weeks (range 28-86 weeks). Average time taken for various stages of the operation and total operating time were longer in the reamed group (109.9 min vs 78.6 min) and the blood loss was also increased (320 mls vs. 190 mls). Bridging and callus formation were seen to occur earlier in the reamed group compared to the unreamed enabling the patients in the reamed group to return to normal functions earlier. Limb length discrepancy and rotational alignment measured clinically and with CT scan did not however show any significant difference between the two methods. Nails used in this study group were notably of a smaller diameter and of shorter length when compared to those used in the western population highlighting the difference in the femur in the Asian population. Complications were notably more in the unreamed group where these were screw breakage (3/50) delayed unions (9/50) and non-unions (4/50). In the reamed group however there were only delayed union (2/50) and all fractures eventually united without any implant failure. We conclude that closed, reamed, antegrade insertion of an intramedullary nail is the treatment of choice in femoral shaft fractures, especially those involving the distal 1/3. The unreamed procedure should be reserved for certain exceptions, such as in polytrauma, where a shorter operative time and less blood loss is desired.

Matched MeSH terms: Femoral Fractures/surgery*

The tampered implant. Intra-medullary nailing of the femur for fracture of the shaft-unusual difficulty in extraction: case report

Subramanian N

Med J Malaysia, 1973 Dec;28(2):123-4.

PMID: 4276229

Matched MeSH terms: Femoral Fractures/surgery*

Fulltext Computed tomographic findings of cerebral fat embolism following multiple bone fractures

Law HL, Wong SL, Tan S

Singapore Med J, 2013 Feb;54(2):e28-30.

PMID: 23462838

Fat embolism to the lungs and brain is an uncommon complication following fractures. Few reports with descriptions of computed tomographic (CT) findings of emboli to the brain or cerebral fat embolism are available. We report a case of cerebral fat embolism following multiple skeletal fractures and present its CT findings here.

Matched MeSH terms: Femoral Fractures/complications

Fulltext Clinical measurement of longitudinal femoral overgrowth following fracture in children

Nordin S, Ros MD, Faisham WI

Singapore Med J, 2001 Dec;42(12):563-5.

PMID: 11989577

We have studied residual limb length inequality following femoral shaft fractures in 62 children. From 61.2% of the children who had shortening of more than 1 cm at union, 34.21% still maintained the shortening at the completion of study. The longitudinal femoral overgrowth occurred significantly during the first 18 months of the fracture in 77.4% of the children, with an average of 1.17 cm. Children with proximal-third fractures and those who sustained the fractures before eight years of age have higher capability to correct the limb length disparity.

Matched MeSH terms: Femoral Fractures/physiopathology*

Fulltext Simple approach to the management of aseptic non-union of the shaft of long bones

Devnani AS

Singapore Med J, 2001 Jan;42(1):20-5.

PMID: 11361233

Internal fixation with a plate in the management of non-union for shaft of long bones has been condemned but the review of the literature does not provide such unequivocal evidence. Also there are certain situations where it is either technically not feasible or contraindicated to do closed intramedullary nailing. This study was done to see the outcome of plate-fixation for the treatment of non-union of the shaft of long bones.

Matched MeSH terms: Femoral Fractures/surgery

Fulltext Femoral overgrowth following plate fixation of the fractured femur in children

Sulaiman AR, Joehaimy J, Iskandar MA, Anwar Hau M, Ezane AM, Faisham WI

Singapore Med J, 2006 Aug;47(8):684-7.

PMID: 16865208

The purpose of this study is to determine the overgrowth phenomenon of the affected femur following plate fixation of femoral fractures in children.

Matched MeSH terms: Femoral Fractures/surgery*

Percutaneous intramedullary supracondylar nailing for fractures of distal femur

Patel K, Kapoor A, Daveshwar R, Golwala P

Med J Malaysia, 2004 May;59 Suppl B:206-7.

PMID: 15468890

A prospective study of 25 patients with supracondylar and intercondylar fracture of the femur was carried out from January 1999 to June 2003 at SSG Hospital, Baroda, India. Twenty-eight percent fractures were open and 72% were closed. Twelve pecent of the fractures had intraarticular extension. AO classification was used to classify the fractures. Eighty-four percent of the fractures were due to high velocity trauma. All the cases were operated by percutaneous supracondylar nailing. No postoperative complication related to fracture treatment was seen. Average follow up was 20.1 months (range 6-40 months). Average age of the patients was 31.5 years. Average time of union was 3.1 months (range 2-4 months). Average knee range of motion was 117 degrees. Even in open injuries, 85.7% had more than 110 infinity range of motion. All patients could return to their pre-injury lifestyle. Rating scale developed by Hospital for Special Surgery was used to quantify the results. Eighty-four percent showed excellent, 8% showed good and 8% showed fair results. Percutaneous supracondylar nailing is thus, an excellent method of treating fractures of distal femur.

Matched MeSH terms: Femoral Fractures/classification; Femoral Fractures/surgery*

Fulltext Ipsilateral femoral fracture non-union and delayed union treated by hybrid plate nail fixation and vascularized fibula bone grafting: a case report

Chan C, Ng W, Merican A

Malays Orthop J, 2013 Jul;7(2):41-4.

PMID: 25722826 MyJurnal DOI: 10.5704/MOJ.1307.012

Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

Matched MeSH terms: Femoral Fractures

Fulltext Close fracture complicated by acute haematogenous osteomyelitis

Baskaran S, Nahulan T, Kumar AS

Med J Malaysia, 2004 Dec;59 Suppl F:72-4.

PMID: 15941170

This is the first time we encountered a peculiar case of osteomyelitis complicating a closed fracture. The patient was a 38 year-old lady who presented just like any other patient with a closed fracture of the right femur. Intraoperatively we were surprised to find pus from the fracture site. This not only changed the surgical management but altered the subsequent outcome as well.

Matched MeSH terms: Femoral Fractures/complications*; Femoral Fractures/radiography; Femoral Fractures/surgery

Fulltext Insufficiency fractures related to low-dose adefovir dipivoxil treatment for chronic hepatitis B

Poh F, Sing WH, Mohan PC

Med J Malaysia, 2015 Feb;70(1):38-41.

PMID: 26032529

We present a case of a 53-year-old woman who developed multifocal insufficiency fractures associated with adefovir dipivoxil (ADV) induced osteomalacia, including recurring metatarsal insufficiency fractures and a subtrochanteric femoral insufficiency fracture requiring surgical fixation. She had received low-dose ADV treatment for 59 months for chronic hepatitis B viral infection at the time of presentation with subtrochanteric fracture. Imaging evidence of multifocal insufficiency fractures and metabolic disease on background of hypophosphatemia is attributed to hypophosphatemic osteomalacia from adefovir-induced renal proximal tubular dysfunction. Radiologists and clinicians should be aware of the possibility of insufficiency fractures in patients receiving ADV therapy to avoid delayed diagnosis and progression of high-risk proximal femoral fractures.

Matched MeSH terms: Femoral Fractures

Fulltext Superficial femoral artery thrombosis after midshaft femoral fracture fixation with an intramedullary nail: a case report

Ramachandran Rubenandran, Rampal Sanjiv, Sivalingarajah Prema, Tan Eng Kee, Devaraj Navin Kumar

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):316-318.

MyJurnal

Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dread- ed complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.

Matched MeSH terms: Femoral Fractures

Fulltext Fat embolism syndrome treated with methylprednisolone: a different perception or a misconception?

Mohd Shaffid Md Shariff, Hanizah Ngadiron, Firdaus Hayati, Affirul Chairil Ariffin

Borneo Journal of Medical Sciences, 2017;11(3):45-48.

MyJurnal

Fat embolism syndrome is manifested by the fat globule presence in the pulmonary and systemic circulation. A 34-year-old man was involved in a motor vehicle accident with a fracture of the left femur and avulsion fracture of the left posterior cruciate ligaments. He developed signs and symptoms that suggested an early diagnosis of fat embolism syndrome. Intravenous methylprednisolone administration was administered as part of the treatment. The role of methylprednisolone in a patient with fat embolism syndrome is controversial due to unproven effectiveness. In this case, fat embolism syndrome after a femur fracture was treated successfully with methylprednisolone.

Matched MeSH terms: Femoral Fractures

Postoperative deep-vein thrombosis in Asian patients is not a rarity: a prospective study of 88 patients with no prophylaxis

Dhillon KS, Askander A, Doraismay S

J Bone Joint Surg Br, 1996 May;78(3):427-30.

PMID: 8636180

Postoperative deep-vein thrombosis (DVT) is believed to be rare in Asians. We studied 88 consecutive patients in Malaysia who had operations for fracture of the proximal femur or for total hip or knee replacement. No patient had prophylaxis against DVT; bilateral ascending venography was performed between six and ten days after operation. A total of 55 patients (62.5%) showed venographic evidence of DVT. The prevalence was greatest after total knee replacement (76.5%), less after total hip replacement (64.3%) and smallest in the fracture group (50%). One patient developed symptomatic pulmonary embolism. In contrast to other reports from Asia, we found an incidence of postoperative DVT which is similar to that reported in Western populations. This suggests that the present practice of withholding routine prophylaxis against thromboembolism in Asian patients undergoing high-risk orthopaedic procedures should be reconsidered.

Matched MeSH terms: Femoral Fractures/surgery*

Long bone fractures among children in Malaysia

Iqbal QM

Int Surg, 1974 Aug;59(8):410-5.

PMID: 4853031

Matched MeSH terms: Femoral Fractures/epidemiology

Fulltext Can Paediatric Femoral Fracture Hip Spica Application be Done in the Outpatient Setting?

Yap ST, Lee N, Ang ML, Chui RW, Lim K, Arjandas M, et al.

Malays Orthop J, 2021 Mar;15(1):105-112.

PMID: 33880156 DOI: 10.5704/MOJ.2103.016

Introduction: Hip spica casting is a standard treatment for children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution.

Materials and Methods: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared.

Results: There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05), increased average hospital stay (41.2 ± 31.1h vs. 19.2 ± 15.0h, p<0.05) and average hospital charges (US$1857.14 vs US$775.49, p<0.05). Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length. Both cohorts had a similar proportion of unacceptable reduction and revision casting rate.

Conclusion: Both cohorts presented similar spica casting outcomes of fracture reduction and follow-up period. With spica cast application in operating theatre reporting higher hospital charges and prolonged hospital stay, the outpatient clinic should always be considered for hip spica application.

Matched MeSH terms: Femoral Fractures

Fulltext More Evidence for Teriparatide after Fixation of Atypical Femoral Fractures: Report of Four Cases

Lee WC, Chua T

Malays Orthop J, 2021 Mar;15(1):138-140.

PMID: 33880163 DOI: 10.5704/MOJ.2103.023

Atypical femoral fractures (AFF) have low union rates. The use of teriparatide has been advocated for the post-operative healing of AFF, but the evidence is limited to case reports and some series due to its low incidence. We present a case series of four female patients to support the use of teriparatide after the surgical fixation of their AFF. Three of the patients had a complete AFF and one had an incomplete fracture. Their mean age was 70 (52 - 87) years, mean body mass index 24.6 (18.3 - 29.3), mean bone mineral density T-score of -2.3 (-4.8/-1.0), with a prior history of anti-resorptive therapy with bisphosphonates and denosumab. Teriparatide was started at an average of 8 (2-18) days post-fixation, with 20mcg daily for six months. Immediate full weight-bearing was permitted in three patients, while one was non-weight bearing for two months. The mean time to union was 12 (10 - 14) weeks. No side effects were observed over a mean follow-up of 58 (50 - 72) weeks. The use of teriparatide facilitated the quick union of AFF after surgical fixation. It appeared to be safe and promoted fracture healing in AFF.

Matched MeSH terms: Femoral Fractures

Composite vascularised osteocutaneous fibula and sural nerve graft for severe open tibial fracture--functional outcome at one year: a case report

Halim AS, Yusof I

J Orthop Surg (Hong Kong), 2004 Jun;12(1):110-3.

PMID: 15237132

Management of severe open tibial fracture with neurovascular injury is difficult and controversial. Primary amputation is an acceptable option as salvaging the injured, insensate, and ischaemic limb may result in chronic osteomyelitis and non-functional limb. We report a case of open tibial fracture associated with segmental bone and soft tissue loss, posterior tibial nerve and artery injuries, which was further complicated by chronic osteo-myelitis treated with composite vascularised osteocutaneous fibula and sural nerve graft. Functional outcome of the injured limb at one-year follow-up was satisfactory: the patient was capable of achieving full weightbearing and was able to appreciate crude touch, pain, proprioception, and temperature at the plantar aspect of the foot. There was no pressure sore or ulceration.

Matched MeSH terms: Femoral Fractures/surgery

Displaying publications 41 - 59 of 59 in total