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Background: Treatment of supraintercondylar (AO/OTA 33-C) and supracondylar (AO/OTA 33-A) femur fractures is generally challenging. Standard treatments include open reduction and internal fixation. However, optimal implants are now being well-defined. This study focus on the comparison between clinical and functional outcomes of fractures treated with condylar buttress plates (CBPs)., Methods: We treated 87 patients with supraintercondylar or supracondylar femur fracture from 2004 to 2008, including 30 supraintercondylar and 24 supracondylar fractures treated with CBPs. Both knee and function scores (per Knee Society) were given to clinical and functional outcomes, and concomitant knee function was assessed per Mize criteria., Results: Union rate of supraintercondylar fractures was 90 % (27/30) and supracondylar fractures was 91.7 % (22/24) (P = 0.68). In supraintercondylar group, 16.7 % revealed postoperative varus deformity, whereas none in supracondylar group (P = 0.045). Knee Society knee score was 73.6 in supraintercondylar group and 85.5 in supracondylar group (P = 0.009); and function score was 62.5 in supraintercondylar group and 83.1 in supracondylar group (P = 0.023). A satisfactory result based on modified Mize criteria was achieved in 50 % of supraintercondylar fractures and in 79.1 % of supracondylar fractures (P = 0.09)., Conclusions: Use of CBPs for supraintercondylar and supracondylar femur fractures treatment led to a high union rate. However, a high rate of varus deformity occurred in patients with supraintercondylar but not supracondylar fractures. Moreover, CBP treatment in patients with supracondylar fractures led to better functional outcomes than those with supraintercondylar fractures.

Background: Both pelvic fractures and femoral shaft fractures are caused by high-energy injuries. When unstable pelvic fractures and femoral shaft fractures occur concomitantly, the optimal treatment method is controversial. The aim of this study was to establish a reasonable principle for treating such complicated injuries., Methods: Forty patients sustaining unstable pelvic fractures and concomitant femoral shaft fractures were treated in a 7-year period. The initial management of the fractures was started at the emergency service according to the Advanced Trauma Life Support protocol. Unstable pelvic fractures were wrapped by cloth sheets and femoral shaft fractures were immobilized with a splint. Angiography was performed on patients with unstable hemodynamic status. The definitive treatment for combined fractures was performed after stabilizing the hemodynamics. Closed nailing was used for femoral shaft fractures, and pelvic fractures were treated with various techniques., Results: The mortality rate was 12.5% (5/40) during admission. Thirty-three patients were followed up for an average of 32 months (range, 12-76 months). There were 33 cases of unstable pelvic fractures and 36 instances of femoral shaft fractures. The union rate for pelvic fractures was 100% (33/33), while femoral shaft fractures had a 94.4% (34/36) union rate. The average healing time was 3.3 months (range, 1.6-8.1 months) and 4.1 months (range, 2.5-18.2 months) for pelvic and femoral shaft fractures, respectively. After fracture, 34 hips (94%) achieved a satisfactory result in the Harris hip score and 30 knees (83%) achieved a satisfactory result in the Mize knee score., Conclusions: Stabilization of the hemodynamics in patients with combined fractures should be the first aim. Angiography to stop arterial bleeding in the pelvis is often life-saving. The definitive treatment for combined fractures, such as pelvic fractures and femoral shaft fractures, should wait until hemodynamics is stabilized.

Background: Subtrochanteric fractures possess unique characteristics, and no single device used in their treatment is considered absolutely superior to others. Use of sliding compression screws (SCSs) is technically simple. The feasibility of SCS stabilization was evaluated using indirect reduction of fracture fragments., Methods: One hundred and thirty-one acute subtrochanteric fractures without extensive shaft involvement were treated using this technique, and they were classified into 4 groups to evaluate the success rate. After the lag screw was inserted into the femoral head, the side plate was applied onto the distal fragment without exploring the fracture site. At least 4 cortical screws were used to stabilize the distal fragment. Postoperatively, ambulation with protected weight bearing was encouraged at as early a time as was possible., Results: One hundred and thirteen fractures were followed-up for 12 to approximately 38 (mean, 22) months. The union rate was 94.7% (107/113), and the time period until union occurred was 2.5 to approximately 8 (mean, 3.8) months. No statistical difference was noted among the individual groups. Complications included 6 nonunions (5.3%), which were associated with infection in 1 case (0.9%) and implant failure in 2 cases (1.8%)., Conclusions: Compared to other techniques, indirect reduction with SCS stabilization is a feasible method for treating acute subtrochanteric fractures. However, because plate insertion normally requires a large dissecting wound and biomechanically the tension band principle might not be applicable, there may be greatly increased complications with extensively comminuted fractures. Accordingly, if this technique is used for carefully selected fractures, a high success rate can be expected.

Background: Ipsilateral femoral neck and shaft fractures are rare injuries and the treatment is complicated and versatile. No single device has been considered absolutely superior to others., Methods: Fifteen combined fractures in 15 patients were treated with Russell-Taylor reconstruction intramedullary nails (recon nails). Twelve surgeries were performed within 24 hours of trauma and the other 3 were delayed for 4-7 days due to associated life-threatening injuries. Postoperatively, protected weight bearing was permitted as early as possible., Results: The median operating time was 250 minutes (range 125-430 min) and median blood loss was 300 ml (range 100-600 ml). Thirteen patients were followed-up for a median of 22 months (range 13-45 months). The union rates for neck and shaft fractures were 84.6% and 69.2% respectively. The median union times were 3.0 months for neck fractures and 8.5 months for shaft fractures., Conclusions: Recon nails are alternative acceptable devices to treat combined fractures. However, the stability of neck fixation may be insufficient and restriction of vigorous activity is suggested to avoid fixation failure.

Background: For hip posterior fracture-dislocation, the current consensus is to perform joint reduction within 6 h to prevent sequelae. However, whether a closed reduction (CR) should be performed at the emergency department (ED) or in the operation theater (OT) remains debatable. We aimed to assess the incidence and factors predictive of CR failure at the ED in patients with hip posterior fracture-dislocation.Methods: Patients with hip posterior fracture-dislocation between 2009 and 2019 were included. Age, sex, body mass index (BMI), injury severity score, new injury severity score, time from injury to first reduction attempt (TIR), presence of associated femoral head fracture, posterior wall marginal impaction, and posterior wall fragment size were compared between patients with CR success and patients with CR failure at the ED.Results: Fifty-five patients with hip posterior fracture-dislocation experienced CR attempts at the ED and were enrolled in the study. Thirty-eight (69.1%) hips were reduced successfully at the ED, and 17 (30.9%) experienced failure. No significant differences in age, sex, BMI, presence of femoral head fracture, marginal impaction, or size of the posterior wall fragment were found between the groups. TIR was significantly shorter in the successful CR group (2.24 vs. 4.11 h, p = 0.01). According to receiver operating characteristic curve analysis, 3.5 h was the cut-off time.Conclusions: For patients with hip posterior fracture-dislocation, TIR was a critical factor for successful CR. If the time interval exceeds 3.5 h from injury, the success rate of bedside CR at the ER is likely to decrease, and the OT should be prepared in case of failed bedside CR.Level Of Evidence Iii: [ABSTRACT FROM AUTHOR]

Background: To date, no study has compared the surgical outcomes between posterior wall acetabular fractures with and without associated femoral head fractures. Therefore, we evaluated whether an associated femoral head fracture increases the incidence of fracture sequelae, including post-traumatic osteoarthritis (PTOA) and osteonecrosis of the femoral head (ONFH), following osteosynthesis for posterior wall acetabular fractures.Methods: This retrospective clinical study enrolled 183 patients who underwent osteosynthesis for posterior wall acetabular fractures between 2009 and 2019 at a level-1 trauma center. The incidence of PTOA, ONFH, and conversion to total hip arthroplasty (THA) was reviewed.Results: The incidence of PTOA, ONFH, and conversion to THA following osteosynthesis were 20.2%, 15.9%, and 17.5%, respectively. The average time for conversion to THA was 18.76 ± 20.15 months (range, 1-82). The results for the comparison of patients with associated femoral head fractures and isolated posterior wall acetabular fractures were insignificant (PTOA: 27.3% vs. 15.7%, p = 0.13; ONFH: 18.2% vs. 14.3%, p = 0.58; conversion to THA: 20.4% vs. 15.7%, p = 0.52). Upon evaluating other variables, only marginal impaction negatively affected ONFH incidence (odds ratio: 2.90).Conclusions: Our methods failed to demonstrate a significant difference in the rate of PTOA, ONFH, or conversion to THA in posterior wall acetabular fractures with and without an associated femoral head fracture. Beyond femoral head fractures, the marginal impaction of the acetabulum could have led to early sequelae.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]