Cases reported "Femoral Fractures"

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1/49. Operative treatment of a unilateral bicondylar fracture of the femur.

    A case of isolated tangential fracture of the dorsal part of both condyles of the femur (bicondylar Hoffa fracture) is described. After open reduction, four lag screws were introduced through the fractured condyles to fix the fragments. A plaster cast was applied for a period of four weeks. Full weight-bearing was authorized after six weeks. Full range of motion of the knee was observed as early as after three months, as well as after twenty-one months. The mechanism and therapeutic implications are discussed and the literature is reviewed.
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2/49. Primary total knee arthroplasty for supracondylar/condylar femoral fracture in osteoarthritic knees.

    Supracondylar or condylar femoral fractures require extended treatment and often result in loss of knee range of motion. We present 3 cases in which femoral fractures and preexisting painful knees secondary to osteoarthritis were treated using total knee arthroplasty with a stemmed femoral implant. The patients were all women aged 83, 84, and 87 years old. All fractures united within 3 months, and the patients could walk with 1 cane within 2 months. Primary total knee arthroplasty should be considered as a treatment for supracondylar/condylar femoral fractures in osteoarthritic knees.
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3/49. femur fracture in infants: a possible accidental etiology.

    femoral fractures in nonambulating infants are generally felt to be attributable to abuse in the absence of significant trauma or underlying organic pathology. The investigation of such fractures includes a report to appropriate social service and law enforcement agencies, and legal involvement. This paper describes 2 nonambulatory infants who sustained identical oblique distal femoral metaphyseal fractures extending through the growth plate after playing in an infant stationary activity center called an Exersaucer. It is possible that the twisting motion provided by the Exersaucer (Evenflo, Picqua, OH) might be consistent with the generation of forces necessary to cause these fractures.
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4/49. Supracondylar distal femoral nonunions treated with a megaprosthesis in elderly patients: a report of two cases.

    The purpose of this paper is to report the use of total knee arthroplasty, a megaprosthesis, as a treatment in elderly patients who have a persistent nonunion of a supracondylar femur fracture. This case report includes two elderly patients who sustained supracondylar femur fractures that failed to unite with standard operative fixation methods. Despite multiple procedures during a long period, patients had a persistent nonunion. Both patients underwent total arthroplasty with a cemented kinematic rotating hinge and had significant clinical improvement. The Hospital for Special Surgery (HSS) knee scores increased from fifty-four points to seventy points in one patient and forty-two points to seventy-three points after surgery in the other patient. Both patients had excellent range of motion after surgery. A cemented megaprosthesis appears to be a viable treatment option for persistent nonunions of supracondylar femur fractures in elderly patients. It is well tolerated and permits early ambulation and return to activities of daily living.
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5/49. Intra-articular fracture of the knee with spondyloepiphyseal dysplasia congenita: successful result of open reduction and internal fixation.

    In spondyloepiphyseal dysplasia congenita (SEDC), since the cartilage is congenitally abnormal, functional recovery of an intra-articular fracture is uncertain even with surgical treatment. We report a 29-year-old Japanese woman with SEDC whose left knee injury (intercondylar femur fracture and tibial plateau fracture) was surgically reduced and fixed. Although special care was required during the operation for associated atlantoaxial instability and cardiopulmonary suppression due to severe thoracolumbar kyphoscoliosis as well as osteopenia, she had neither restriction of knee motion nor pain at follow-up 2 years and 4 months after surgery. Therefore, although the situation involving fractures in a patient with SEDC is complicated, we believe the main problem to be solved is whether the risk-related kyphoscoliosis and atlantoaxial instability can be managed or not. Fractures themselves can be treated based on the principles used for patients without SEDC.
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6/49. Fracture after arthrodesis of the hip and knee.

    In 27 cases of fracture after arthrodesis of the hip and knee, there was a characteristic location and appearance which depended upon whether or not metal implant was present. fracture healing and preservation of motion of adjacent joints was achieved in all cases with internal fixation using the plating techniques described by the A-O group. There is also always the opportunity to decorticate and add supplementary bone grafts for an arthrodesis that had failed before the time of fracture. Metal implants should be removed when there is evidence of consolidation and maturation of bone at both the arthrodesis and fracture sites.
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7/49. Ender nailing for supracondylar fracture of the femur after total knee arthroplasty: five case reports.

    We studied 5 women with supracondylar fractures after total knee arthroplasty (TKA). The mean age at fracture was 67.4 years. Four patients had chronic rheumatoid arthritis, and 1 had osteoarthritis. The range of motion, knee score, femorotibial angle, and component alignment were investigated. Flexion was slightly decreased after Ender nailing, but extension only changed in 1 patient. The knee score decreased, but all patients were ambulatory. The femorotibial angle changed in all patients. Measurement of femoral component alignment showed a postoperative change of angle alpha (1 degrees to 11 degrees ) and angle gamma (0 degrees to 9 degrees ). Union was achieved in all patients. Ender nailing is an acceptable method of treatment for supracondylar fractures of the femur after TKA if the nails can be inserted deeply into the femoral condyles.
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8/49. Delayed treatment of a malreduced distal femoral epiphyseal plate fracture.

    Fractures of the epiphyseal plate are considered rare when compared with the more prevalent injuries found in competitive sports, but the complications associated with this type of trauma are a major concern. The factors affecting the success or failure of healing include the severity of injury, patient age, and the type and expedience of treatment. This case study examines the clinical presentation and treatment of a 15-yr-old high school football player who sustained a displaced, distal femoral epiphyseal Salter II fracture. Primary treatment consisted of nonmanipulative, nonweight bearing knee immobilization. The treatment resulted in malunion, pain, decreased range of motion and physical deformity; therefore, the patient sought a second opinion. On physical exam, the displacement and rotational deformity of the fracture site were unacceptable. The fracture was treated 20 days post-injury via open reduction with internal fixation. On follow-up, the athlete demonstrated radiographic healing, normal physical exam, and no significant leg length discrepancy or deformity. The athlete successfully returned to full competitive sport activity.
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9/49. Operative treatment of unilateral bicondylar Hoffa fractures.

    A rare case of unilateral bicondylar fractures of the femoral condyles is presented. Internal fixation of the fragments was achieved by three cancellous lag screws, followed by a short period of cast immobilization and intensive physiotherapy. Full weight bearing was allowed 3 months postoperatively. Full range of motion of the knee and no presence of articular defects on femoral condyles were observed 2 years after hardware and heterotopic ossification removal.
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10/49. Retrograde tibial nail for femoral shaft fracture with severe degloving injury.

    We report an unusual case involving a motorcycle-vehicle collision, in which a 21-year-old woman sustained severe bilateral lower extremity degloving injuries and an associated right femoral shaft fracture. The trauma team was consulted to treat this disastrous event. Due to extensive contamination of the open wound around the entry site, retrograde intramedullary nailing was chosen to fix the fractured femoral shaft in preference to antegrade intramedullary nailing. A tibial interlocking nail was used as a substitute for immediate bony stabilization to facilitate soft tissue debridement and subsequent reconstruction. The excellent range of motion achieved in the right knee joint, without infection, limb-length discrepancy, rotational instability or angular malalignment, was encouraging.
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