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Background: Fracture of the femur is one of the most common fractures that, if not stabilized and treated properly, may lead to severe disability, impairment of the individual's efficiency, and numerous complications. This study aimed to evaluate the treatment results of femoral shaft fracture with two methods intramedullary nail (IMN) and Plate. Materials and methods: In this cross-sectional study, 60 patients with femoral bone fractures were admitted to Imam Khomeini Hospital in Jiroft in 2020 and were treated for at least one year after discharge. They were divided into two treatment groups - Plate fracture fixation (n = 30) and IMN fracture fixation (n = 30). Data were collected using a researcher-made checklist including patient demographics and treatment outcomes. The collected data were analyzed using SPSS-v 26 statistical software and descriptive and inferential statistical tests at a significance level of p < 0.05. Results: Patients in the Plate treatment group were generally older (50–60 years) compared to the IMN treatment group (30–40 years), and there were more men than women in both groups. Only 10% of patients in each group developed superficial infections after surgery. There were more cases of deep infections in the Plate group, but it was not statistically significant. The IMN group had fewer cases of malignancy and claudication compared to the Plate group. Patients in the IMN group also returned to functional activities faster than those in the Plate group, which was a statistically significant difference. Conclusion: Considering that deep infection, non-union, malunion, claudication, and ability to return to functional activities in the group using nails treated was less than the group treated with plates, the treatment method of femoral fracture using IMN is the preferred treatment method. [ABSTRACT FROM AUTHOR]

Introduction: Heterotopic ossifications (HOs) are a well-known complication following total hip arthroplasty. Yet only little is known about the development of HOs following a femoral fracture and intramedullary stabilization in polytraumatized patients. Thus, the present study aimed to investigate whether the development of HOs is being observed more frequently in patients suffering polytrauma compared to those with single-extremity trauma. Materials and Methods: The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2010 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions), (2) had an Injury Severity Score ≥16, (3) suffered a femoral fracture, and (4) were treated with intramedullary stabilization. Furthermore, a control group was established to match the polytrauma group (sex, age), who were suffering from single-extremity trauma (femoral fracture) which was treated with intramedullary stabilization. Subsequently, X-rays of the hip were performed and evaluated for up to one-year post-trauma. Results: Our study group consisted of 36 patients in total (91.7% male; mean age 39.4 ± 17.4 years, range: 18–82 years). The polytrauma (PT) group included 12 patients (mean age 39.5 years, median ISS 28), whereas the control group (single-extremity-trauma) included 24 patients (mean age 39.3 years). We documented HOs in nine (75%) patients in the PT group vs. five (20.8%) patients in the single-extremity group (p = 0.03). Conclusion: In this study, we were able to demonstrate that heterotopic ossifications are being observed significantly more frequently in patients suffering from polytrauma in comparison to patients with single-extremity trauma following intramedullary stabilization after a femoral fracture. [ABSTRACT FROM AUTHOR]

Since 2014, the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, has been the preferred implant for these injuries at our institution, however, speculations have been made whether it is more prone to failure compared to other implants. Thus, the aim of the study was to describe the cohort treated with the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, at our department from 2014 to 2020, including the number of failures. Secondary, whether specific outcome measures were significantly overrepresented in the failure group. Patients were identified through the hospital database, and demographic data was extracted from patient files. X-rays were evaluated for injury type, osteosynthesis characteristics, and whether the construct failed during follow-up. Thanks to the national patient record database a minimum of patients was lost to follow-up. After exclusion 159 patients (165 osteosyntheses, descriptive part) and 108 patients (112 osteosyntheses, subgroup analysis) were eligible for inclusion. The VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, was used for most AO-type fractures and inserted as both neutralization, buttress, and bridging plates. Overall failure was seen in 8 % of osteosyntheses. Significantly more failures were seen in patients with increased Body Mass Index (BMI) (24 vs. 32, p = 0,046) and those treated for a periprosthetic fractures (41 % vs. 89 %, p = 0,005). We did not see an association between failure and plate length, bridge span, screw density or the degree of medial support. The VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes is a versatile plate with failure rates comparable to previously reported studies. This study confirmed that elevated BMI may be a risk factor for failure, while other previously reported risk factors were not associated with failure in this study. [ABSTRACT FROM AUTHOR]

The bone transport technique uses the principle of distraction-osteogenesis and fill bone defects with the aid of an exter- nal fixator. In order to evaluate the clinical effect of femoral internal fixation with Ortho-Bridge System after bone transport, 4 patients after femoral bone transport from October 2020 to October 2022 are studied in this paper. Among them, 3 patients ran refracture of femur after removal of the Limb reconstruction system, 1 patient just finish femoral bone transport and request internal fixation. The surgery results show that Ortho-Bridge System can be used in the situation that conventional Locking compression plate and intramedullary nail are not suitable due to anatomical variation after femoral bone transport. [ABSTRACT FROM AUTHOR]

Abstract Background Fracture of the femur is one of the most common fractures that, if not stabilized and treated properly, may lead to severe disability, impairment of the individual’s efficiency, and numerous complications. This study aimed to evaluate the treatment results of femoral shaft fracture with two methods intramedullary nail (IMN) and Plate. Materials and methods In this cross-sectional study, 60 patients with femoral bone fractures were admitted to Imam Khomeini Hospital in Jiroft in 2020 and were treated for at least one year after discharge. They were divided into two treatment groups - Plate fracture fixation (n = 30) and IMN fracture fixation (n = 30). Data were collected using a researcher-made checklist including patient demographics and treatment outcomes. The collected data were analyzed using SPSS-v 26 statistical software and descriptive and inferential statistical tests at a significance level of p

Atypical femoral fracture can occur in situations of bone turnover suppression or the stress concentrations. Rarely, such fractures can also occur around an implant especially at a proximal or distal screw. This paper presents a case of an atypical femoral fracture at a proximal screw insertion site after implant removal with a literature review. [ABSTRACT FROM AUTHOR]

Background: Femoral fractures often lead to complications such as altered pulmonary hemodynamics. Right ventricular global longitudinal strain (RV GLS), which correlates with pulmonary hemodynamics, indicates the subclinical function of the right ventricle (RV). This study aimed to investigate the predictive value of RV GLS for the risk of adverse clinical composite outcomes in patients with femoral fractures. Methods: Data were obtained from a prospective single-center cohort of patients hospitalized for femoral fractures and followed up for at least 1 year between March 2021 and October 2022. The primary outcome was the development of an adverse composite clinical event, which included pneumonia, pulmonary oedema or effusion, pulmonary thromboembolism, and all-cause mortality within the 1-year period following surgery. Results: Among the 163 patients, 36 (22.09%) experienced adverse composite clinical events during 1-year follow-up. The adverse outcome group demonstrated poorer RV GLS and RV free wall strain values than the non-adverse outcome group. The optimal cut-off value of RV GLS for predicting composite adverse clinical events was −12.55%. The cumulative composite event-free survival rate was significantly lower in the RV GLS ≥ −12.55% group (log-rank p-value = 0.003). After adjusting for confounding factors, multivariate Cox proportional hazards regression analyses showed that RV GLS ≥ −12.55% independently increased the risk of composite adverse clinical events by 2.65-fold. Conclusions: Poor RV GLS is a significant predictor of adverse clinical outcomes in patients with femoral fractures. Specifically, an RV GLS value of ≥ −12.55% indicated a substantially increased risk of adverse events. [ABSTRACT FROM AUTHOR]

Abstract Background Femoral fractures significantly contribute to disability, predominantly in the elderly. Despite this, data on postoperative pneumonia following femoral fracture surgeries remains sparse. Our study sought to explore the incidence and impact of postoperative pneumonia on outcomes following such surgeries. Methods A retrospective study analyzed femoral fracture patients hospitalized from 2016 to 2022. We scrutinized postoperative outcomes, including pneumonia, hospital stay duration, intensive care unit (ICU) admissions, and in-hospital mortality. We established stringent diagnostic criteria for postoperative pneumonia, incorporating both clinical signs and radiological evidence, excluding patients with prior infections or those discharged within 24 h post-surgery. Statistical analyses involved Chi-square and t-tests, linear regression, and logestic regression using SPSS. Results Out of 636 patients, 10.8% were diagnosed with postoperative pneumonia. The average age was 79.55 ± 8.57 years, with a male prevalence of 47.8%. Common comorbidities were hypertension (78.3%), diabetes (60.9%), and cardiovascular diseases (40.6%). Surgical interventions were categorized as intramedullary nailing (40.6%), partial hip replacement (37.7%), and dynamic hip screw (21.7%). Postoperative pneumonia was associated with older age (AOR = 1.053, 95% CI 1.020 to 1.087, p = 0.002), ICU admission (AOR = 2.283, 95% CI 1.256 to 4.148, p = 0.007), and longer length of hospital stay (AOR = 1.079, 95% CI 1.030 to 1.130, p = 0.001). The presence of pneumonia was associated with a 2.621-day increase in hospitalization after adjusting for other variables (p

Purpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss – all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery. Methods: According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients. Results: There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 – 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19–2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51–1.85; P = 0.92). Conclusion: No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon’s experience.

Background: Femoral fractures significantly contribute to disability, predominantly in the elderly. Despite this, data on postoperative pneumonia following femoral fracture surgeries remains sparse. Our study sought to explore the incidence and impact of postoperative pneumonia on outcomes following such surgeries. Methods: A retrospective study analyzed femoral fracture patients hospitalized from 2016 to 2022. We scrutinized postoperative outcomes, including pneumonia, hospital stay duration, intensive care unit (ICU) admissions, and in-hospital mortality. We established stringent diagnostic criteria for postoperative pneumonia, incorporating both clinical signs and radiological evidence, excluding patients with prior infections or those discharged within 24 h post-surgery. Statistical analyses involved Chi-square and t-tests, linear regression, and logestic regression using SPSS. Results: Out of 636 patients, 10.8% were diagnosed with postoperative pneumonia. The average age was 79.55 ± 8.57 years, with a male prevalence of 47.8%. Common comorbidities were hypertension (78.3%), diabetes (60.9%), and cardiovascular diseases (40.6%). Surgical interventions were categorized as intramedullary nailing (40.6%), partial hip replacement (37.7%), and dynamic hip screw (21.7%). Postoperative pneumonia was associated with older age (AOR = 1.053, 95% CI 1.020 to 1.087, p = 0.002), ICU admission (AOR = 2.283, 95% CI 1.256 to 4.148, p = 0.007), and longer length of hospital stay (AOR = 1.079, 95% CI 1.030 to 1.130, p = 0.001). The presence of pneumonia was associated with a 2.621-day increase in hospitalization after adjusting for other variables (p < 0.001, 95% CI: 1.454 to 3.789). Conclusion: This study accentuates the clinical significance of postoperative pneumonia in femoral fracture patients, with a noted incidence of 10.8%. A notable association with older age, prolonged hospital stays, and ICU admissions was observed, underscoring the necessity of addressing this complication to improve patient outcomes and healthcare resource allocation. [ABSTRACT FROM AUTHOR]

Summary: Number and age-standardized incidences of femoral fractures by sex and localization were determined annually between 1998 and 2021 in subjects aged 45 years or older living in Switzerland. The number and incidences of femoral neck, pertrochanteric, subtrochanteric, and femoral shaft fractures followed distinct unexpected trend patterns. Introduction: Long-term incidence trends for femoral fractures by individual localizations are unknown. Methods: Annual absolute number of hospitalizations and median age at hospital admission between 1998 and 2021 were extracted from the medical database of the Swiss Federal Office of Statistics by sex and 10-year age groups for the following 10th International Classification of Diseases (ICD-10) codes: femoral neck (ICD-10 S72.0), pertrochanteric (S72.1), subtrochanteric (S72.2), and femoral shaft fractures (S72.3). Age-standardized incidence rates (ASI) and corresponding trends were calculated. Results: Over 24 years, the number of femoral neck fractures increased in men (+ 45%) but decreased in women (− 7%) with ASI significantly decreasing by 20% and 37% (p < 0.001 for trend for both), respectively. By contrast, the number of pertrochanteric fractures increased by 67% and 45% in men and women, respectively, corresponding to a horizontal ASI-trend in men (n.s.) and a modest significant decreasing ASI-trend in women (p < 0.001). The number of subtrochanteric fractures increased in both sexes with corresponding modest significant reductions in ASI-trends (p = 0.015 and 0.002, respectively). Femoral shaft fractures almost doubled in men (+ 71%) and doubled in women (+ 100%) with corresponding significant increases in ASI-trends (p = 0.001 and p < 0.001, respectively). Age at admission increased for all fracture localizations, more so in men than in women and more so for subtrochanteric and shaft fractures than for "typical" hip fractures. Conclusion: Incidence changes of pertrochanteric fractures and femoral shaft fractures deserve increased attention, especially in men. Pooling diagnostic codes for defining hip fractures may hide differing patterns by localization and sex. [ABSTRACT FROM AUTHOR]

Introduction: Disproportionate emphasis has been attributed to hip fracture over other femoral fractures through implementation of Best Practice Tariff (BPT). This retrospective comparative observational cohort study aimed to evaluate the epidemiology of native and periprosthetic femoral fractures and establish any disparities in their management relative to hip fractures. Methods: All patients ⩾60 years admitted with a native or periprosthetic femoral fracture during July 2016–June 2018 were identified using our hospital database. Results were compared to National Hip Fracture Database data over the same period. Results: 58 native femoral, 87 periprosthetic and 1032 hip fractures were identified. (46/58) 79% and 76/87 (89%) of native and periprosthetic femoral fractures were managed operatively. Surgery was performed <36 hours for 34/46 (74%) of native femoral and 33/76 (43%) of periprosthetic fractures compared to 826/1032 (80%) for hips. Median time to surgery was longer in periprosthetic femoral than hip fracture patients (44.7 vs. 21.6 hours; p < 0.0001). Orthogeriatrician review occurred in 24/58 (41%) and 48/87 (55%) of native and periprosthetic fractures compared to 1017/1032 (99%) for hips (p < 0.0001). One year mortality was 35%, 20% and 26% for native femoral, periprosthetic and hip fracture patients. Cox proportional hazard ratio was higher for native femoral than hip fracture patients (1.75; 95% CI, 1.12–2.73). Conclusions: This study demonstrates large disparities in management of other femoral and periprosthetic fractures compared to hip fractures, specifically time to surgery and orthogeriatrician review. This may have resulted in the comparatively higher mortality rate of native femoral fracture patients. Expansion of the BPT to include the whole femur is likely to improve outcomes. [ABSTRACT FROM AUTHOR]

Hongfei Qi,1,&ast; Zhong Li,1,&ast; Teng Ma,1 Yangyang Jiang,2,&ast; Cheng Ren,1,&ast; Yibo Xu,1 Qiang Huang,1 Kun Zhang,1 Yao Lu,1 Ming Li1 1Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China; 2Xi’an Medical College, Xi’an, Shaanxi, 710000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ming Li; Teng Ma, Email limingguke123@163.com; free40@126.comObjective: The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly.Patients and Methods: From February 2021 to October 2022, the elderly (> 65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups.Results: There was no statistical difference in baseline data between the two groups (P> 0.05). The intraoperative bleeding in the robot group was 68.17± 10.66 mL, the intraoperative bleeding in the traditional group was 174± 8.11mL (P< 0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P< 0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P< 0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021).Conclusion: PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.Keywords: orthopedics robot navigation, femoral fracture, older persons, intramedullary nail fixation

Purpose: The purpose of this study was to determine the incidence and trends of both hip spica casting and elastic stable intramedullary nailing in children aged 2–12 years who sustained femoral diaphyseal fracture between 1998 and 2016 in Finland. We also evaluated the actual hospital costs of both treatment methods as well as calculating the length of hospital stay. Methods: This study included all 2- to 12-year-old children with femoral diaphyseal fracture who were treated in Finland between 1998 and 2016. Data were collected from the National Hospital Discharge Register of Finland. Children were classified by age into five groups. The annual incidences per 100,000 persons were calculated using annual mid-year population census data obtained from Statistics Finland. Data on the annual actual daily hospital costs were collected from the Finnish Institute for Health and Welfare. Results: In total, 1064 patients aged 2–12 years who had sustained femoral diaphyseal fracture were treated with elastic stable intramedullary nailing or hip spica casting between 1998 and 2016. In children aged 4–5 years, the incidence of elastic stable intramedullary nailing increased during the study period from 5.4 per 100,000 persons in 1998 to 8.1 per 100,000 persons in 2016. Conclusions: The length of hospitalization in patients treated with elastic stable intramedullary nailing was shorter and, therefore, the total costs of hospital treatment were lower than in those children treated with hip spica cast. Level of evidence: level III. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups. Methods: Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12–120 months). Results: Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18–99) and 70.1 (18–100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6–48, SD 7.3) versus 28.4 (3–48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01. Conclusion: While the rate of non-union was higher in the LP group and the functional results were superior in the plating group. [ABSTRACT FROM AUTHOR]

Introduction: Due to the aging of the population, nursing processes have been adapted to these patients, who require a high level of care and guidance. Objective: Analyzing the degree of dependence on nursing care by elderly patients (65 years or older) with femur fractures. Materials and Methods: retrospective, with a quantitative approach, carried out in a private hospital from April 2021 to April 2022. According to the Patient Classification System (PCS), the sample comprehends 41 patients, analyzed epidemiological data and degree of dependence Study of nursing care during hospitalization, environment of hospitalization, and discharge. Results: Composed of 41 patients, mean age of 84 years and female predominance (75.61%). Concerning fractures, there was a greater occurrence due to falls from standing height and a predominance of neck fractures, with an average time until surgery of less than 16 hours. Systemic Arterial Hypertension and Diabetes Mellitus were predominant. The average of the PCS estimates presented 24.26 in the 1st, 26.12 in the 2nd, and 26.24 in the 3rd. The length of hospital stay was 7 days and no deaths were reported. Discussion: The findings on sociodemographic data, reasons for falls, location, comorbidities, degree of dependence, and length of hospital stay are similar to those available in databases. They differ, in better quality, under time until surgery and clinical. Conclusions: The study presents specific knowledge to carry out the care of the intrahospital nursing process, thus allowing the systematization of the team's assistance. [ABSTRACT FROM AUTHOR]

BackgroundThe management of femoral fractures in children aged two to six years is still controversial. The purpose of this study was to assess the results of closed reduction and elastic stable intramedullary nail (ESIN) fixation in completely displaced fractures of the femoral diaphysis in children in this age group.MethodsA retrospective review of all children with acute completely displaced fractures of the femoral diaphysis in children aged 2–6 years treated from 2013 to 2020 was performed. A total of 34 patients were treated who met the inclusion criteria: Group 1: 21 fractures (transverse and short oblique); Group 2: 13 fractures (long oblique and spiral) that underwent closed reduction and elastic stable intramedullary nail (ESIN) fixation. No differences existed between the 2 groups with respect to age, extremity, sex, time to treatment, mechanism of injury, or fracture displacement. Demographic characteristics and radiographs were reviewed, and the following parameters were documented: surgery time, time to union, return to activities, range of motion of knee joints, and complications. Major complications were defined as those with presumptive long-term side effects or those requiring a reoperation. No major complications were observed in the two groups. All included fractures were treated by a single senior paediatric surgeon. The mean follow-up period was 28.4 months (range 24–45 months). The level of significance was set at p

Background: The femur is the longest bone in the body. Injury or fracture in this bone strongly affects the quality of life of people.Objectives: The aim of this study was to investigate the morphometric parameters of femur proximal part and its relationship with body mass index (BMI).Methods: This descriptive-analytical study was conducted on 200 patients over 50 years of age referred to Shahid Beheshti Hospital in Kashan and Ayatollah Kashani Hospital in Isfahan during 2018-2019. The participants had radiographs in the supine position of femur proximal part. BMI and bone mineral density of patients were determined by the DXA method. Using radiographic images of the femur, the morphological features were evaluated. Also, the relationship of these characteristics with age, gender, BMI and bone mineral density was investigated.Results: The values of six morphological parameters of the femur in the patients under study were Q-angle=121.93±3.78, TW=86.06±7.65, HW=52.4±4.69, FW=37.74±4.29, HAL=118.43±10.47 and FAL=105.34±7.59 mm, which were higher in men. There was a direct and significant correlation of 23% between age and TW, which was significant according to the Pearson Correlation Test (P=0.039). Inverse correlation of 14% was observed between HAL width and BMI, which was statistically significant (P=0.042). FAL variable had a decreasing trend with decreasing BMD (P=0.031).Conclusion: Proximal femur characteristics were significantly related to factors such as gender and BMI. The morphological specifications of femur proximal were higher in men than in women. Compared to evaluations in other regions, the included characteristics are distinct from other countries, which these differences can be caused by genetic characteristics, environment, nutritional status, and lifestyle.

Abstract Objective The implementation of more active anticoagulant prevention and treatment measures has indeed led to a significant reduction in the incidence of perioperative deep vein thrombosis (DVT) among patients with bone trauma. However, it is important to note that despite these efforts, the incidence of DVT still remains relatively high. According to the Caprini score, all patients undergoing major orthopedic surgery were defined as the high-risk group for DVT. Stratifying the risk further within high-risk groups for DVT continues to present challenges. As a result, the commonly used Caprini score during the perioperative period is not applicable to orthopedic patients. We attempt to establish a specialized model to predict postoperative DVT risk in patients with femoral fracture. Methods We collected the clinical data of 513 patients undergoing femoral fracture surgery in our hospital from May 2018 to December 2019. According to the independent risk factors of DVT obtained by univariate and multivariate logistic regression analysis, the corresponding nomogram model was established and verified internally. The discriminative capacity of nomogram was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC). The calibration curve used to verify model consistency was the fitted line between predicted and actual incidences. The clinical validity of the nomogram model was assessed using decision curve analysis (DCA) which could quantify the net benefit of different risk threshold probabilities. Bootstrap method was applied to the internal validation of the nomogram model. Furthermore, a comparison was made between the Caprini score and the developed nomogram model. Results The Caprini scores of subjects ranged from 5 to 17 points. The incidence of DVT was not positively correlated with the Caprini score. The predictors of the nomogram model included 10 risk factors such as age, hypoalbuminemia, multiple trauma, perioperative red blood cell infusion, etc. Compared with the Caprini scale (AUC = 0.571, 95% CI 0.479–0.623), the calibration accuracy and identification ability of nomogram were higher (AUC = 0.865,95% CI 0.780–0.935). The decision curve analysis (DCA) indicated the clinical effectiveness of nomogram was higher than the Caprini score. Conclusions The nomogram was established to effectively predict postoperative DVT in patients with femoral fracture. To further reduce the incidence, more specialized risk assessment models for DVT should take into account the unique risk factors and characteristics associated with specific patient populations.

ObjectiveThe aim of this study is to summarize and demonstrate the different sterilization methods and surgical techniques for open fractures with impacted bone segments in the lower limbs.MethodsA retrospective analysis was conducted on the clinical characteristics, treatment methods, and outcomes of a case involving a 10.5 cm extruded segment of the femur in a 9-year-old male with a right femoral comminuted fracture treated at our center. Additionally, a retrospective review and summary were conducted on all reported cases of open fractures with impacted bone segments in the lower limbs.ResultsOur center treated a 9-year and 11-month-old male child who presented with a Gustilo type IIIB open fracture of the femur along with a large segment of the femur being ejected as a result of a car accident. The child was resuscitated to correct hypovolemic shock, underwent emergency wound debridement, and had Ilizarov external fixation of the femur. The ejected femur segment was sterilized using ethylene oxide and re-implanted four days after the injury. A literature review showed that out of the cases of open fractures with impacted bone segments in the lower limbs, there were 14 cases involving the femur and 5 cases involving the tibia. Among them, sterilization was performed using povidone-iodine in 6 cases, high-pressure steam sterilization in 3 cases, and other methods including gamma-ray irradiation and soaking in antibacterial solution were used in the remaining cases. In terms of surgical methods, 7 cases were fixed with locking plates, 3 cases were fixed with external fixation devices, 1 case was immobilized in a cast, 1 case was fixed with an intramedullary rod, and 4 cases involved a combination of external fixation and internal fixation. The average time for re-implantation was 7.6 days after the injury. There were no serious complications such as infection or non-union observed in any of the cases during follow-up.ConclusionEthylene oxide can be considered a reliable choice for the reimplantation of displaced bone segments in open fractures after sterilization.

Introduction: Due to the aging of the population, nursing processes have been adapted to these patients, who require a high level of care and guidance. Objective: Analyzing the degree of dependence on nursing care by elderly patients (65 years or older) with femur fractures. Materials and Methods: retrospective, with a quantitative approach, carried out in a private hospital from April 2021 to April 2022. The sample comprehends 41 patients, analyzed epidemiological data and degree of dependence Study of nursing care during hospitalization, environment of hospitalization and discharge, according to the SCP. Results: Composed of 41 patients, mean age of 84 years and female predominance (75.61%). With regard to fractures, there was a greater occurrence due to falls from standing height and predominance of neck fractures, with an average time until surgery of less than 16 hours. Systemic Arterial Hypertension and Diabetes Mellitus were predominant. The average of the SCP estimates presented 24.26 in the 1st, 26.12 in the 2nd and 26.24 in the 3rd. The length of hospital stay was 7 days and no deaths were reported. Discussion: The findings on sociodemographic data, reasons for falls, location, comorbidities, degree of dependence and length of hospital stay are similar to those available in databases. They differ, in better quality, under time until surgery and clinical. Conclusions: The study presents specific knowledge to carry out the care of the intra-hospital nursing process, thus allowing the systematization of the team's assistance.

Introduction: Well leg compartment syndrome is a rare complication of orthopaedic surgery, especially in paediatric patients. The aim of this study is to present a single case of this disease and to provide recommendations for its management. Case presentation: A 16-year-old male semi-professional footballer sustained a midshaft femoral fracture on the field and subsequently underwent fracture fixation with an intramedullary nail. Following surgery, the patient complained of severe pain in the opposite (well) leg and displayed neurological deficits on examination. He was clinically diagnosed with acute compartment syndrome and underwent emergent two-compartment fasciotomy. The postoperative course was complicated by a persistent foot drop, wound infection, residual compartment swelling preventing direct wound closure, and status epilepticus necessitating intensive care admission. At three-month follow up the patient had a residual foot drop. Conclusion: Well leg compartment syndrome is a rare complication of orthopaedic surgery; however, it can have devastating consequences, particularly in the paediatric population. We recommend intraoperative mobilization of the well leg every 2 h for long operations, normotensive blood pressure control to ensure adequate tissue perfusion, and minimal elevation of the well leg. Frequent postoperative examinations may facilitate early diagnosis and management.

Background: Restricted weight-bearing is still used after lower extremity fracture surgery in elderly patients. The long-term effect on gait recovery in elderly patients with distal femur fractures (DFF) and their ability to comply with the restrictive weight-bearing regime is unknown. This study aimed to investigate the effect of restricted postoperative weight-bearing on gait recovery (actual weight-bearing and cadence) during a 1-year follow-up. Methods: This study evaluated secondary outcomes from a randomized controlled trial (32 patients ≥65 years, with a traumatic DFF). Internal fixation was achieved using an anatomical lateral plate. Patients were allocated to either immediate full weight-bearing (FWB) or partial weight-bearing (PWB) (30% of body weight) for 8 weeks. Pressure-sensitive sensors (F-scan™ system, Tekscan, Massachusetts, USA) were used to measure weight-bearing and cadence postoperatively and at 8-, 16-, and 52-week follow-ups. Twenty-six patients with at least 1 measurement were included. Results: There was a statistically significant difference in actual weight-bearing between the PWB and FWB groups postoperatively of 32.3% (95% confidence interval CI, −50.0; −13.0, P <.001) and at the 8-week follow-up of 36.8% (95% CI −61.0; −18.0, P =.01), but not at later follow-ups. The PWB group presented a consistently lower cadence compared to the FWB group, which was statistically significant at the 16-week follow-up with 9.0 steps/min (95% CI -16.2; −1.1, P =.047) and 52-week follow-up with 9.3 steps/min (95% CI −18.0; −3.9, P =.009). Conclusions: Restricting postoperative weight-bearing in elderly patients with a DFF had a significant effect on postoperative weight-bearing. The effect lingered with a delayed return to FWB and persistent significantly lower cadence in the PWB group. These findings suggest that even temporary weight-bearing restrictions most likely have negative long-term effects on gait function at 1 year and, therefore, cannot be recommended. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to describe services available to patients with periprosthetic femoral fracture (PPFF) in England and Wales, with focus on variation between centres and areas for care improvement. Methods: This work used data freely available from the National Hip Fracture Database (NHFD) facilities survey in 2021, which asked 21 questions about the care of patients with PPFFs, and nine relating to clinical decision-making around a hypothetical case. Results: Of 174 centres contributing data to the NHFD, 161 provided full responses and 139 submitted data on PPFF. Lack of resources was cited as the main reason for not submitting data. Surgeon (44.6%) and theatre (29.7%) availability were reported as the primary reasons for surgical delay beyond 36 hours. Less than half had a formal process for a specialist surgeon to operate on PPFF at least every other day. The median number of specialist surgeons at each centre was four (interquartile range (IQR) 3 to 6) for PPFF around both hips and knees. Around one-third of centres reported having one dedicated theatre list per week. The routine discussion of patients with PPFF at local and regional multidisciplinary team meetings was lower than that for all-cause revision arthroplasties. Six centres reported transferring all patients with PPFF around a hip joint to another centre for surgery, and this was an occasional practice for a further 34. The management of the hypothetical clinical scenario was varied, with 75 centres proposing ORIF, 35 suggested revision surgery and 48 proposed a combination of both revision and fixation. Conclusion: There is considerable variation in both the organization of PPFF services England and Wales, and in the approach taken to an individual case. The rising incidence of PPFF and complexity of these patients highlight the need for pathway development. The adoption of networks may reduce variability and improve outcomes for patients with PPFF. Cite this article: Bone Jt Open 2023;4(5):378–384.

Abstract Background The traction table is generally used in femoral intramedullary nailing surgery. Recently, some published studies have shown that the same or better treatment effects can be gotten without a traction table. It remains no consensus on this issue. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was applied in this study. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for eligible studies. The random-effect model was used to calculate the standardized mean difference (SMD) and risk ratios with 95% CIs. Trial sequential analysis (TSA) was performed to verify the results. Results The pooled estimates of seven studies, including 266 cases each in the manual traction group and traction table group, indicated that manual traction could shorten operative time [SMD, − 0.77; 95% CI (− 0.98, − 0.55); P

OBJECTIVE: To compare the radiological healing in elderly patients with hip fractures fixed with intramedullary versus extramedullary implants at 3 months by using Radiological Union Score for Hip (RUSH score). METHODS: This quasi-experimental study was conducted at Lady Reading Hospital, Peshawar from September 2020 to March 2021, in elderly patients (50-80 years) with hip fractures. Out of 238 patients, 119 were non-randomly assigned to Group-A undergoing intra- medullary implants and 119 to Group-B undergoing fixation with an extra-medullary implant. After the surgery, the patients were followed up periodically at 2nd week, 6th week and 12th week after surgery and assessed for radiological healing through RUSH score. The data was analyzed using SPSS version 23. RESULTS: Out of 238 patients, 96 were males and 142 were females. In Group-A, 51 (42.9%) were males and 68 (57.1%) were females. In Group-B, 45 (37.8%) were males and 74 (62.2%) were females. Majority (n=135/238: 56.72%) were aging from 50-60 years. Mean±SD of age was 63.1±8.8 years and 61.7±8.1 years in Group-A & Group-B respectively. Mean±SD of RUSH score in Group-A & Group-B was 19.50±6.92 and 22.51±5.60 respectively. Mean RUSH score for males in Group-A and Group-B was 21.52±6.39 and 22.33±6.99 (p=0.354) and for females in Group-A and Group-B was 19.36±7.33 and 22.18±5.75 (p=0.025) respectively. Median and IQR of RUSH score in Group-A & Group-B was 21±10 and 23±8 respectively (p=0.069). CONCLUSION: There was statistically insignificant difference in median RUSH score with use of either intramedullary or extramedullary implants in the management of hip fractures.

Background: Segmental bone defects are defined as bone discontinuities with or without soft tissue defects, extending across the width of the bone. When this defect is 2–2.5 times larger than the diameter of the damaged bone, it is considered a critical segmental bone defect. What has been considered over the past 5 decades is that, based on clinical evidence, the presence of traumatic brain injury accelerates bone healing in patients with long-bone fractures. Method: Here, we report an exuberant callus formation in two cases who suffered from an open femoral shaft fracture with a segmental bone defect. The patients had a traumatic brain injury (TBI) at the scene of the accident and were treated with intramedullary nail (IMN) and masquelet procedures, respectively. Results: After 4 weeks the onset of the callus formation was noted and no additional procedure was needed. Conclusion: The segmental bone defect of the lower limb is one of the challenges of the orthopaedics. However, the faster healing process and callus formation of bone defects in TBI patients was impressive. In the same cases, using additional procedures due to enhance callus formation might not be necessary.

Summary: This review aimed to describe the methods and results from recent Irish research about post-acute hip fracture outcomes. Meta-analyses estimate the 30-day and 1-year mortality rate at 5% and 24% respectively. There is a need for standardised recommendations about which data should be recorded to aid national and international comparisons. Purpose: Over 3700 older adults experience hip fracture in Ireland annually. The Irish Hip Fracture Database national audit records acute hospital data but lacks longer-term outcomes. This systematic review aimed to summarise and appraise recent Irish studies that collected long-term hip fracture outcomes and to generate pooled estimates where appropriate. Methods: Electronic databases and grey literature were searched in April 2022 for articles, abstracts, and theses published from 2005 to 2022. Eligible studies were appraised by two authors and outcome collection details summarised. Meta-analyses of studies with common outcomes were conducted where the sample was generalisable to the broad hip fracture population. Results: In total, 84 studies were identified from 20 clinical sites. Outcomes commonly recorded were mortality (n = 48 studies; 57%), function (n = 24; 29%), residence (n = 20; 24%), bone-related outcomes (n = 20; 24%), and mobility (n = 17; 20%). One year post-fracture was the most frequent time point, and patient telephone contact was the most common collection method used. Most studies did not report follow-up rates. Two meta-analyses were performed. The pooled estimate for one-year mortality was 24.2% (95% CI = 19.1–29.8%, I2 = 93.8%, n = 12 studies, n = 4220 patients), and for 30-day mortality was 4.7% (95% CI = 3.6–5.9%, I2 = 31.3%, n = 7 studies, n = 2092 patients). Reports of non-mortality outcomes were deemed inappropriate for meta-analysis. Conclusion: Hip fracture long-term outcomes collected in Irish research are broadly in line with international recommendations. Heterogeneity of measures and poor reporting of methods and findings limits collation of results. Recommendations for standard outcome definitions nationally are warranted. Further research should explore the feasibility of recording long-term outcomes during routine hip fracture care in Ireland to enhance national audit. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intramedullary nail is the “gold standard” for the treatment of femoral shaft fractures, but the placement of distal locking of the femoral intramedullary nail has always been a difficult problem. OBJECTIVE: To compare the effectiveness between unarmed and vernier device support groups for distal interlocking screws in femoral nails. METHODS: Totally 63 patients with femoral shaft and trochanteric fractures (64 sides) were enrolled from Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital from 2017 to 2021. They were randomly divided into two groups. In the vernier device support group (32 cases), unarmed femoral intramedullary nail placement and internal fixation were conducted with vernier device support. In the unarmed group (32 cases), unarmed femoral intramedullary nail distal locking screw placement and internal fixation were conducted. The operation time and X-ray count for a perfect circle image, the time and the number of fluoroscopy when the nail was successfully placed, and the total time of the locking nail insertion were compared between unarmed and vernier device support groups. RESULTS AND CONCLUSION: The operation time and X-ray count for a perfect circle image of the vernier device support group were less than those in the unarmed group (P < 0.001). The time and the number of fluoroscopy when the nail was successfully placed of the vernier device support group were less than those in the unarmed group (P < 0.001). The total time of the locking nail insertion of the vernier device support group was less than that in the unarmed group (P < 0.001). The results show that, compared with the unarmed nail placement, the vernier device support placement has faster locking speed, less indirect radiation, no direct radiation exposure, and no need for a specially designed device. It is a locking nail technology worthy of promotion. [ABSTRACT FROM AUTHOR]

Objective: The implementation of more active anticoagulant prevention and treatment measures has indeed led to a significant reduction in the incidence of perioperative deep vein thrombosis (DVT) among patients with bone trauma. However, it is important to note that despite these efforts, the incidence of DVT still remains relatively high. According to the Caprini score, all patients undergoing major orthopedic surgery were defined as the high-risk group for DVT. Stratifying the risk further within high-risk groups for DVT continues to present challenges. As a result, the commonly used Caprini score during the perioperative period is not applicable to orthopedic patients. We attempt to establish a specialized model to predict postoperative DVT risk in patients with femoral fracture. Methods: We collected the clinical data of 513 patients undergoing femoral fracture surgery in our hospital from May 2018 to December 2019. According to the independent risk factors of DVT obtained by univariate and multivariate logistic regression analysis, the corresponding nomogram model was established and verified internally. The discriminative capacity of nomogram was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC). The calibration curve used to verify model consistency was the fitted line between predicted and actual incidences. The clinical validity of the nomogram model was assessed using decision curve analysis (DCA) which could quantify the net benefit of different risk threshold probabilities. Bootstrap method was applied to the internal validation of the nomogram model. Furthermore, a comparison was made between the Caprini score and the developed nomogram model. Results: The Caprini scores of subjects ranged from 5 to 17 points. The incidence of DVT was not positively correlated with the Caprini score. The predictors of the nomogram model included 10 risk factors such as age, hypoalbuminemia, multiple trauma, perioperative red blood cell infusion, etc. Compared with the Caprini scale (AUC = 0.571, 95% CI 0.479–0.623), the calibration accuracy and identification ability of nomogram were higher (AUC = 0.865,95% CI 0.780–0.935). The decision curve analysis (DCA) indicated the clinical effectiveness of nomogram was higher than the Caprini score. Conclusions: The nomogram was established to effectively predict postoperative DVT in patients with femoral fracture. To further reduce the incidence, more specialized risk assessment models for DVT should take into account the unique risk factors and characteristics associated with specific patient populations. [ABSTRACT FROM AUTHOR]

• Despite much focus on quality-improvement, there has been little change in time to hip fracture surgery in Ireland over the last five years. • Patient comorbidity, procedure type and timing/ route of hospital presentation are key factors associated with time to surgery in the country. • Low surgical capacity locally and nationally may also be contributing to delays. • Further exploration of interventions to improve this quality indicator is needed. In hip fracture care, time to surgery (TTS) is a commonly used quality indicator associated with patient outcomes including mortality. This study aimed to identify patient and hospital-level characteristics associated with TTS in Ireland. National data from the Irish Hip Fracture Database (IHFD) (2016–2020) were analysed along with hospital-level characteristics obtained from a 2020 organisational survey. Generalised linear model regression was used to explore the association of TTS with case-mix, surgical details, hospital-level staffing and specific protocols recommended to expedite surgery. A total of 14,951 patients with surgically treated hip fracture from 16 hospitals were included (Mean age= 80.6 years (SD=8.8), 70.4% female). Mean TTS was 40.9 h (SD=60.3 h). Case-mix factors associated with longer TTS were male sex and higher American Society of Anaesthesiologists (ASA) grade. Other factors found to be associated with longer TTS included low pre-morbid mobility, inter-hospital transfer, weekday presentation, pre-operative medical physician assessment, intracapsular fracture type, arthroplasty surgery, general anaesthesia, consultant grade of surgeon and lower hospital-level orthopaedic surgical capacity. The oldest age-group and pre-fracture nursing home residence were associated with shorter TTS when adjusted for other case-mix factors. None of four explored protocols for expediting surgery were associated with TTS. Patients with more comorbidity experience longer surgical delay after hip fracture in Ireland, in line with international research. Low availability of senior orthopaedic surgeons in Ireland may be delaying hip fracture surgery. Pathway of presentation, including via inter-hospital transfer or hospital bypass, is an important factor that requires further exploration. Further research is required to identify successful system-level protocols and interventions that may expedite hip fracture surgery within this setting. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU® to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI. [ABSTRACT FROM AUTHOR]

Simple Summary: This study addressed the complexities of nonunion in small animal orthopedics and highlighted the potential of autogenous corticocancellous bone grafts to facilitate bone healing. Autogenous cancellous bone grafting has proven to be the most effective means of stimulating fracture healing in orthopedics; however, filling large bone defects with cancellous bone can be challenging. In these cases, cortical bone grafts may provide mechanical stability to the defective area. This case study investigated the use of the coccygeal bone as an autogenous bone graft to fill a large femoral defect. To prevent fixation failure, rigid fixation was achieved between the coccygeal and femoral bone fragments using orthogonal locking plates and screws, strengthening the mechanical structure. Harvesting was performed immediately before transplantation to increase the viability of the grafted bone. Various methods can be employed to enhance osteoinductivity and osteoconductivity to promote successful engraftment, including the use of platelet-rich plasma and active rehabilitation to improve the blood supply and increase biological activity. Although coccygeal bone grafting has been reported in the radius and tibia, this is the first instance of the coccygeal bone being used as an autogenous bone graft in femoral fracture nonunion. An 11-month-old castrated male Pomeranian presented with nonunion following a femoral fracture that occurred after femoral head and neck osteotomy. Radiography and computed tomography revealed severe atrophy of the proximal bone fragment and retardation of the ipsilateral distal fragment and tibia. An autogenous bone graft using coccygeal bone was performed, in which three and a half coccyges were placed in succession and fixed using an orthogonal locking plate. To promote bone healing and facilitate proper weight bearing and ambulation, bone morphogenetic proteins, biphasic calcium phosphate, platelet-rich plasma, passive-range-of-motion exercises, transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and low-level laser therapy were applied. During the four-year follow-up, it was observed that the previously engrafted bone healed well and maintained stability over a prolonged period, resulting in the patient being able to walk comfortably with good outcomes. However, some degree of lameness was noted in the dog when running owing to limb shortening and joint contracture. [ABSTRACT FROM AUTHOR]

Background: The risk of bone fractures, particularly hip fractures is increasing in the elderly. One of the known factors for predicting fractures is body mass index (BMI) and abdominal obesity. Thus, this study aimed to determine the association between obesity (general and abdominal) with femoral and hip fractures according to gender and age. Methods: In this descriptive cross-sectional study, 100 patients with femoral or hip fractures admitted to the orthopedic ward of Khatam Al-Anbia Hospital in Zahedan were selected between March 2018 and May 2019. Waist circumference (WC), wrist circumference, BMI, and body size were measured. A P-value of 167 cm) (P < 0.0001). The risk of fractures decreased with increasing WC (P < 0.01). Approximately half of those with hip fractures (52.4%) and femoral fractures (51.9%) had small size. Conclusion: On the basis of our findings, taller height, lower BMI and smaller body size have been suggested as potential contributions to the risk of femoral and hip fractures. It is suggested that abdominal fat may be protective against the risk of hip and femoral fractures at older ages, which requires further research.

Introduction: The present study set out to compare the effects of midazolam, dexamethasone, ondansetron and propofol on the prevention and control of opioid-induced pruritus after spinal anaesthesia with bupivacaine and fentanyl as adjuvants in femoral fracture surgery. Materials and Methods: This double-blind clinical trial study was conducted on 136 patients who were scheduled for orthopaedic surgery in Valiasr Hospital of Arak. The patients were randomly divided into four groups (ondansetron, midazolam, dexamethasone and propofol) with a block randomisation pattern. Blood pressure, heart rate, oxygen saturation, the incidence of pruritus, nausea, vomiting and sedation level were monitored and recorded intraoperatively and postoperatively in recovery and every 2 h until 12 h postoperatively. Data were then analysed with SPSS 20. Results: From 10 min to 60 min, blood pressure was lower in the midazolam group, while it was lower in the propofol group from 60 min to 105 min. In general, blood pressure in the midazolam group was lower than that in the other groups (P = 0.001). Furthermore, pruritus was observed less in the midazolam group than in the other groups (P < 0.05). Sedation level was higher in the midazolam group than in the other groups (P < 0.05). Conclusion: Midazolam reduced pruritus and increased sedation in patients. On the other hand, a decrease in blood pressure was observed in the midazolam group, which did not require any special treatment. According to the results of the present study, after midazolam, propofol and dexamethasone, and finally ondansetron, respectively, were effective in controlling pruritus after spinal anaesthesia, but the efficacy and effectiveness of midazolam were higher than that in the other groups. As such, this drug is recommended to be used in such procedures. Of course, it should be mentioned that the final decision depends on the patients' physical conditions and the anaesthesiologist's discretion.

Abstract Background The stability of the Hoffa fracture fixed with a cannulated screw is limited. In the present work, we adopted two cannulated screws from anterior to posterior and posteriorly anti-gliding plate to treat 12 cases with Hoffa fracture of the lateral femoral condyle. Methods Open reduction and internal fixation were performed in 12 patients with Hoffa fractures of the lateral femoral condyle. The Hoffa fracture end was fixed with an anti-gliding steel plate based on cannulated screw fixation in the rear of the distal femur. All patients were followed for 12–24 months, with a median of 15.3 ± 4.6 months. Results All fractures were bony union, with a healing time of 3–6 months (median, 4.5 months). The Letenneur evaluation system was used to assess efficacy. Four indexes were observed, including knee range of motion (ROM), stability, pain, and dependent ambulation. The results revealed that eight cases were excellent and four cases good, with a good rate of 100%. Conclusion The surgical treatment with cannulated screws in combination with an anti-gliding steel plate could fix the end of the Hoffa fracture, which could acquire strong internal fixation and a good curative effect.

Abstract Background Intramedullary nail (IMN) is one of the key essential minimally invasive “weapons” in orthopaedic trauma, while the distal locking is still challenging for surgeons. Although there are various inventions and technologies to improve the locking procedure, there are still problems such as inaccurate positioning, excessive radiation exposure, low first success rate and long learning curve. Therefore, a new laser guiding navigation device was designed and compared with the traditional freehand (FH) technique in the distal locking of femoral IMN. Methods This randomized controlled single-blind trial recruited patients with femoral diaphyseal fracture. The self-designed laser navigation device (laser group) and freehand technique (FH group) were used in the distal locking of the IMNs. The patients enrolled were randomized into FH group and laser group, all operations were performed by two surgeons of the same level. The differences between the two groups were compared in terms of radiation exposure time, operative time, first success rate, blood loss, visual analogue score (VAS), Harris score and healing time. Results 32 patients ended the study period and 16 patients in each group. The results showed that the laser group was better than the FH group in terms of distal locking time (10(9/11) vs 19.5 (17.25/21) min, Z = 4.83, P

Objective Femoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital. Methods The records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications. Results The patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ2 = 301.699, p

OBJECTIVE: We aimed at comparing the curative effect of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of Seinsheimer type V (type V) subtrochanteric fractures with sarcopenia. PATIENTS AND METHODS: A retrospective analysis was performed on 59 patients with type V subtrochanteric fractures complicated with sarcopenia admitted to the Department of Orthopedics of the affiliated Jiangning Hospital with Nanjing Medical University from January 2016 to December 2021. Sarcopenia was diagnosed based on grip strength and skeletal muscle index (SMI). According to different surgical methods, they were divided into PFNA group (32 cases) and DHS group (27 cases). The age, gender, time from injury to operation, SMI value, incision length, operation time, intraoperative blood loss, fluoroscopy times, perioperative blood transfusion, lower limb full weight-bearing time, visual analogue scale (VAS) for pain at 3 months after operation and at the last follow-up, Harris score as well as postoperative complications were compared between the two groups. RESULTS: There were no significant differences in age, gender, time from injury to operation, and SMI between the two groups. The length of surgical incision, blood loss and blood transfusion in the PFNA group were less than those in the DHS group; however, the number of intraoperative fluoroscopies was more than that in the DHS group. The PFNA group had earlier full weight-bearing time, lower VAS score and higher Harris score at 3 months after operation, while there was no statistically significant difference in VAS score and Harris score between the two groups at the last follow-up. The incidence of complications in the PFNA group was lower than that in the DHS group, and the difference was statistically significant. CONCLUSIONS: Both PFNA and DHS are effective methods for the treatment of type V subtrochanteric fractures complicated with sarcopenia. Strikingly, PFNA is preferred because of its short surgical incision, less blood loss, faster recovery, and lower incidence of complications. [ABSTRACT FROM AUTHOR]

Background: The traction table is generally used in femoral intramedullary nailing surgery. Recently, some published studies have shown that the same or better treatment effects can be gotten without a traction table. It remains no consensus on this issue. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was applied in this study. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for eligible studies. The random-effect model was used to calculate the standardized mean difference (SMD) and risk ratios with 95% CIs. Trial sequential analysis (TSA) was performed to verify the results. Results: The pooled estimates of seven studies, including 266 cases each in the manual traction group and traction table group, indicated that manual traction could shorten operative time [SMD, − 0.77; 95% CI (− 0.98, − 0.55); P < 0.00001] and preoperative set-up time [SMD, − 2.37; 95% CI (− 3.90, − 0.84); P = 0.002], but it would not reduce intraoperative blood loss volume and fluoroscopy time. No statistical difference was found in their fracture healing time, postoperative Harris scores, and malunion rate. The use of a Traction repositor could reduce the set-up time [SMD, − 2.48; 95% CI (− 4.91, − 0.05); P < 0.00001]. Conclusions: Compared with manual traction, the traction table in femoral intramedullary nailing surgery lengthened operative time and preoperative set-up time. At the same time, it did not show significant advantages in reducing blood loss volume and fluoroscopy time, or improving prognosis. In clinical practice, the optimal surgical plan must be made on a case-by-case basis to avoid unnecessary traction table use. [ABSTRACT FROM AUTHOR]

Objective To explore the therapeutic effect of acupuncture on bone injury in postmenopausal osteoporosis fracture rats and its possible mechanism. Methods Thirsty-six female SD rats were selected to establish the postmenopausal osteoporosis model by bilateral ovariectomy. Three weeks after the model was successfully established, the femoral fracture model was established by closed fracture method. They were randomly divided into model group, acupuncture group, acupuncture + Wnt antagonist group, and another sham operation group. Rats in the acupuncture group was treated with acupuncture. Rats in the acupuncture+Wnt antagonist group was treated with acupuncture while subcutaneously injecting 20 mg kg-1 Wnt antagonist DKK1. Rats in the sham operation group and the model group were only given routine feeding. Bone mineral density (BMD), tissue mineral density (TMD) and bone volume fraction (BV/TV), the number of trabecular bone (TB. N), trabecular bone thickness (TB.TH), and trabecular bone separation (TB.SP) of femurs in each group were measured. The levels of serum inflammatory factors and osteogenic influencing factors were detected in each group. HE staining was used to observe the histopathological changes of femurs and to evaluate the bone injury. RT-PCR and Western blotting were used to detect the secreted protein Wnt3a and β-catenin mRNA and protein expressions. Results Compared with those in the sham operation group, ALP, PINP, histopathological score of the femur, BMD, TMD, BV/TV, TB.N, TB.th, and Wnt3a and β-catenin mRNA and protein expressions decreased, the levels of TB. p, TNF- α, IL-1β, and IL-6 increased in the model group (P<0.05). Compared with those in the model group, ALP, PINP, histopathological score of the femur, BMD, TMD, BV/TV, TB. N, TB. th, and Wnt3a and β-catenin mRNA and protein expressions increased, the levels of TB.Sp, TNF-α, IL-1β, and IL-6 decreased in the acupuncture group ( P<0. 05). Compared with those in the acupuncture group, ALP, PINP, histopathological score of the femur, BMD, TMD, BV/TV, TB.N, TB.th, and Wnt3a and β-catenin mRNA and protein expressions decreased, the levels of TB.Sp, TNF-α, IL-1β and IL-6 increased in the acupuncture+ Wnt antagonist group ( P<0. 05). Conclusion Acupuncture improves BMD, reduces inflammatory reaction in vivo, and increases the level of osteogenic factors in PMOP femoral fracture rats, which may play a role by regulating Wnt signaling pathway. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of using additional locking plate-derived Poller screws to treat post-intramedullary nailing for femoral non-union was investigated. Methods: Between January 2009 and April 2012, six patients who underwent post-intramedullary nailing for femoral non-union were studied. Three, one, and two patients had femoral fractures in the proximal one-third, middle third and distal third, respectively. While the original intramedullary nails were retained, eight-to-nine hole locking plates were used for fixation and two-to-three cortical bone screws were applied to both sides of the fracture to ensure the stability of the intramedullary nail sagittal plane. One-to-two pieces of locking nails were inserted tightly next to the intramedullary nails to ensure a stable coronal plane. Autologous iliac bone grafts were performed around the fractures in all cases. Results: Follow-up evaluations were conducted between 10 and 17 months (mean, 13.8 months). The operative time was 110-160 minutes and the blood loss was 300-500 mL. Bone pain was relieved in 1 month. Continuous callus was observed after 4-6 months (mean, 4.83 months) based on imaging. There were no infections, loosening of internal fixation, or rupture. All patients were able to walk bearing weight within 3 months. Conclusion: An additional locking plate and the derived Poller screw technique effectively improved local rotation instability and is an effective and simple treatment method for femoral non-union after intramedullary nailing. [ABSTRACT FROM AUTHOR]

Intramedullary reaming has been proven to be a safe and effective method for enhancing the union rates of long bone fractures. However, there is a risk of equipment failure, which can lead to severe complications. We present two cases of reamer failure during femoral nailing which illustrate the rare occurrence of intraoperative instrument failure. Our report also underscores the importance of routinely inspecting reaming equipment and provides technical insights to reduce the risk of failure.

Abstract Background This study aims to determine whether nail size or the difference between canal and nail diameter (CN difference) affects the union rate and time of femoral shaft fracture treated with an interlocking intramedullary nail (IMN). Methods This was a retrospective review of 257 patients with femoral shaft fractures treated with IMN at a tertiary trauma medical center. All the IMN inserted were the same (Stryker T2 Femoral Nail). The patients were divided into groups based on nail size (10-, 11-, 12-, or 13-mm) and CN difference ( 2 mm), and union rate and time to union were compared. Results The 10-, 11-, 12-, and 13-mm groups based on nail size had 113, 74, 54, and 16 patients, respectively. The overall union rate was 97% (257/265). No significant differences in union rate or time to union were observed among these 4 groups. The groups based on CN differences of 2 mm comprised 143, 79, and 35 patients, respectively. Again, no significant differences were noted in union rate or mean time to union among the groups. Conclusions Similar union rate and time to union were observed, regardless of nail size or CN difference. This finding indicates that most simple femoral shaft fractures can be treated with a standard, reamed 10-mm IMN. A larger nail insertion is unnecessary and presents more risks; comparatively, the use of a small nail with less reaming is simpler, requires shorter operative times, results in less blood loss, and is less expensive.

Animal posture, limb gait, and body weight-bearing in dogs can be evaluated by limb gait score. In this study, nine adult male dogs of local breed were used to induce a complete transverse femoral mid-shaft fracture fixed internally by intramedullary pining under general anesthesia with the aseptic technique and followed for 60 days postoperative. The data were analyzed, including five degrees that indicate the correlation among animals’ posture, limbs, and body weight tolerance per day. The results demonstrated that in grade 5, the animals completely hold the affected limb during standing position 1st-3rd day postoperative. From the 4th-10th day postoperative, in grade 4, the animals supported the body weight on the affected limb in the standing position and hold it during waking. In grade 3, from 11th-21th day postoperative, the operated animals supported body weight on the affected limb in slow waking and hold it in speed waking and running. From the 22nd-28th day postoperative, in grade 2, the animals used the limb in speed walking, from the 29th-35th day postoperative. In grade1, the animals could use the limb in running from the 36th-2nd day postoperative. In grade 0, the animals used the limb normally in walking, running, and jumping until the end of experimental periods (60th day postoperative). The results indicated that limb gait scores in dogs can be used for the evaluation of the relationships among animals’ posture, limb gait, and body-weight bearing per day during bone regeneration processing of femur fracture fixed by intramedullary pining.