Fractures of the distal femur revisited

The treatment of supracondylar fractures is presented, including the most recent developments. The author uses the comprehensive classification of these fractures and explains the method of this classification scheme as a guide to treatment. New surgical approaches and a discussion of the surgical anatomy are presented in detail. The traditional and contemporary methods of reduction and fixation are discussed, and how the need to preserve the blood supply to the soft tissues and bone has led to the development of the modern methods. The biologic and biomechanical reasons for absolutely stable fixation for simple fractures and splinting with bridging plates, the so called bridge plating of multifragmentary fractures are explained as are the technical details of fixation. Discussed in detail are specific variations in treatment methods for the particularly difficult problem of open fractures, fractures above total knee arthroplasty, and fractures in osteoporotic bone.     

Treatment of distal femoral fractures in the elderly. Results with the retrograde intramedullary supracondylar nail

The incidence of neural tube defects including myelomeningocele, which is one of the most common causes of infant and childhood disability, can be substantially reduced by folic acid supplementation to the diet of women before and during the early stages of pregnancy. All females of childbearing age should be taking folic acid supplements of 0.4 mg/day (400 micrograms/day) and consuming a diet rich in folate. Because many pregnancies are unplanned, supplementation should not await plans for pregnancy. Because pediatric nurse practitioners are in frequent contact with both adolescent patients and patients whose mothers are of childbearing age, and because pediatric nurse practitioners have an interest in preventing neural tube defects in future pediatric patients, they are in a good position to provide the necessary anticipatory guidance regarding the critical need for adequate folic acid intake by females of childbearing age. This article discusses and includes guidelines for providing this anticipatory guidance.     

锁定钢板内固定治疗股骨远端骨折42例临床分析

目的 探讨股骨远端骨折锁定钢板内固定治疗的临床方法及疗效分析.方法 回顾我院其中2004年4月～2009年7月股骨远端骨折42例,采用股骨远端锁定钢板内固定.结果 42例随访11个月～3年,平均18个月,骨折愈合40例,不愈合2例.膝关节功能按Karlstrom标准评价:优良率90.47%.结论 锁定钢板治疗股骨远端骨折,螺钉、钢板匹配相合,锁定在一起,互为一体,固定坚固,有利于骨折的愈合及软组织的修复,是目前众多治疗股骨远端骨折较为有效的方法之一.     

The retrograde intramedullary supracondylar nail: an alternative in the treatment of distal femoral fractures in the elderly?

To find out whether retrograde nailing of distal femoral fractures is beneficial for the aged patient, we performed a prospective study of consecutive patients 65 years or older with distal femoral fracture treated with a retrograde femoral nail between 1 March 1993 and 30 April 1996 in our department. In total, 26 patients with unilateral distal femoral fractures had been treated in our department, and 24 patients had been followed up for more than 12 months. All fractures had healed. Six patients did not walk before the injury. According to the Neerscore we counted 10/18 excellent results (> or = 85 points), 6/18 good results (> or = 70 points), 2/18 fair results (> or = 55 points) and no failures (< 55 points). Retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Even in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult proximal locking are the two major technical problems encountered with this implant. Early weight-bearing is not advisable.     

Intraindividual element distribution in the distal femur

Elemental analysis of archaeological bone is a useful tool for intra- and inter-population research. Possibly an intraindividual elemental analysis could also reveal individual influences from the personal life history. The distal part of an archaeological femur was prepared in 48 samples (6 heights, 4 locations, compact/spongious bone). The elements Ca, P, Pb, Sr and Zn were measured by atomic-absorption-spectrometry and photometry. Statistical tests were used to study similarities and differences. In addition, a sample was taken from the middle of the diaphysis to compare these results with the concentrations of the distal part of the femur. The results show a specific distribution for each element. Similarities were only found between Ca and P. A likely interpretation of intraindividual element data is not yet possible due to the lack of the knowledge of the intraindividual element distribution. More intraindividual studies like this one are recommended.     

Design and biomechanics of a plate for the distal radius

A dorsal plate for the distal radius was designed to provide rigid fixation and thus allow early motion. It functions as a blade plate, lessening the role of metaphyseal screws, and providing internal neutralization rather than compression. The rigidity and strength of the plate were compared to the existing T-plate in an unstable, extra-articular fracture model in paired, fresh-cadaver, axially loaded radii. The dorsal plate construct was significantly stronger and more rigid than the T-plate construct. The failure mode was similar for both plate types; 8 of 10 constructs failed with plate bending and screw loosening, while the oldest specimen pair showed primary bone failure. Compared to the T-plate, the dorsal plate transmitted a greater single axial load from the articular surface to the shaft.     

Double level fractures of the femur treated with closed intramedullary nailing

Breast cancer patients receiving tamoxifen (Tam) are at an increased risk for developing endometrial carcinomas, possibly due to the partial estrogenic effect of Tam on endometrial cells. Progestational therapy has not routinely been included in Tam regimens. It was our aim to determine the presence of estrogen receptors (ERs) and progesterone receptors (PRs) in normal and abnormal endometria from postmenopausal women with breast cancer who were treated with Tam. Standard immunohistochemical staining of ERs and PRs was performed on paraffin sections from formalin-fixed uterine curettings or hysterectomy specimens from 40 patients who had received 20-40 mg of Tam daily for a minimum of 3 months. For comparison, normal endometria from 20 women who had not received Tam (11 premenopausal, 9 postmenopausal) were also studied for ER and PR expression. Staining was evaluated using semiquantitative immunoreactivity scores (IRS) ranging from 0 (negative) to 12 (strongly positive). In the group of patients receiving Tam, ERs and PRs were detected in the nuclei of glandular cells in 24/24 cases of endometrial atrophy (ER/PR-IRS, 2-12), in 8/8 endometrial polyps (ER-IRS, 6-12; PR-IRS, 4-12), in 4/4 adenomatous endometrial hyperplasias (ER-IRS, 3-8; PR-IRS, 1-12), and in 4/4 well-differentiated endometrioid adenocarcinomas (ER-IRS, 2-12; PR-IRS, 6-8). Of the 11 endometria from premenopausal patients who had not received Tam, 8 were ER+/PR+ (ER-IRS, 1-12; PR-IRS, 1-12), 1 was ER+/PR- (ER-IRS, 3; PR-IRS, 0), 1 was ER-/PR+ (ER-IRS, 0; PR-IRS, 2), and 1 was ER-/PR- (ER/PR-IRS, 0). Among 9 atrophic endometria from women not treated with Tam, 6 were ER+/PR+ (ER-IRS, 4-12; PR-IRS, 3-6), 1 was ER+/PR- (ER-IRS, 4; PR-IRS, 0), and 2 were ER-/PR- (ER/PR-IRS, 0). The consistent finding of ER and PR expression in endometria from postmenopausal women receiving Tam further supports the suspected estrogenic effect exerted by Tam on endometrial cells. Progestational therapy could be beneficial in the prevention of Tam-induced abnormal endometrial proliferations.     

Malignant giant cell tumour of the distal femur treated by excision, allografting and ligamentous reconstruction: an 18-year follow-up

Technical progress made in neuroradiology, and focal external and internal radiation therapy, have allowed the development of a series of local therapeutic modalities both in primary and in metastatic brain tumours. Eligibility criteria and results obtained with these new techniques are compared. Experimental studies with implications for radiation therapy, particularly boron neutron capture therapy, and for chemotherapy are reviewed. The possible use of chemotherapy as first-line treatment in non-Hodgkins lymphomas of central nervous system is stressed.     

Fractures following accidental falls among the elderly in the county of Aarhus

The incidence rates of common fall-related fractures were investigated in a Danish population of elderly people (> 64 years). One thousand one hundred and eighty fractures in 1016 patients were observed. About 26/1000 suffered a fracture per year, 47% being hip fractures, and 33% fractures of the wrist. Incidence rates increased with age, most markedly for fractures in the weight-bearing skeleton (hip, pelvis and vertebral column). Patients with a fall-related fracture had a four times higher risk of getting a new fracture. Increased mortality, adjusted for age and sex, ranged from 10 to 30 percent in the first year; except for fractures of the wrist, which were not associated with increased mortality.     

Core decompression for avascular necrosis of the distal femur: long term followup

Seventy-nine knees (45 patients) with a diagnosis of avascular necrosis of the distal femur treated between 1978 and 1989 were evaluated. All patients had a corticosteroid association (had been treated with >30 mg of prednisone for >2 weeks predating by at least 6 months the onset of avascular necrosis). Thirty-two knees were managed with protected weightbearing and rest. Core decompression was performed at a minimum of 3 months after the onset of symptoms in another 47 knees. The knees treated with protected weightbearing had an average asymptomatic period of only 11 months and all but 6 (18%) proceeded to total knee replacement within 6 years. Core decompression yielded good or excellent results in 73% of the knees at an average followup of 11 years (range, 4-16 years). Of the 13 knees with failed core decompression, 7 were asymptomatic for greater than 5 years. A subset of 26 knees from each group was matched for age, gender, diagnosis, Ficat and Arlet Stage, and length of followup. The matched noncore group had 23% survival as compared with 74% survival in the core group. This long term followup suggests that core decompression may slow the rate of symptomatic progression of avascular necrosis of the knee. In addition, core decompression may extend the symptom free interval in certain patients and may delay the need for more extensive procedures such as total knee arthroplasty.     

Progressive genu valgum secondary to a fibrous tether at the distal aspect of the femur. A case report

We describe a technique for the treatment of hepatic encephalopathy in a cirrhotic patient with a large spontaneous splenorenal shunt. This large shunt was successfully occluded without severe complications by retrograde transrenal venous obliteration with ethanolamine oleate after balloon occlusion. This procedure may be an effective method to occlude a large spontaneous splenorenal shunt for the treatment of hepatic encephalopathy.     

Central (interior) osteophytes of the distal femur. Imaging and pathologic findings

RATIONALE AND OBJECTIVES: To characterize central osteophytes (COs) of the distal femur, imaging features that enable their differentiation from intra-articular bodies were identified, and the frequency of overlying articular cartilage abnormalities was determined. METHODS: The authors inspected 133 distal femoral specimens and retrospectively reviewed knee radiographs of 48 symptomatic patients and magnetic resonance images of 60 symptomatic patients for presence of COs. The location and imaging features of COs, and their association with marginal osteophytes (MOs), were recorded. Articular cartilage abnormalities, if any, were documented in patients who underwent magnetic resonance imaging. RESULTS: Specimen analysis showed a 41% prevalence of COs, 95% association of COs with MOs, and predominance of large COs in the medial femoral condyle (81%). Radiographic analysis revealed a 9.8% prevalence of COs in the distal femur. Magnetic resonance images demonstrated a 14.3% prevalence of COs, with the majority (73%) accompanied by an overlying cartilage that had abnormal signal intensity or morphology, or both. CONCLUSIONS: Central osteophytes are a common finding in the distal femur. Based on their location and cortical continuity with the underlying bone, most COs can be differentiated from intra-articular bodies.     

Supracondylar femoral fractures in the frail elderly. Fractures in need of treatment

The investigators of this study reviewed 112 consecutive frail elderly patients with supracondylar femoral fractures to evaluate primarily functional outcomes to optimize initial treatment of these challenging patients. A high 1-year mortality rate (22%) and significant decrease in function and quality of life occurred in frail elderly patients who sustained supracondylar femoral fractures. No statistical relationship could be found among preinjury function, age, cognitive function, type of fracture, treatment, and overall results. Nine percent of patients required late above-knee amputation in the involved extremity because of displacement of the fracture or infection or both. Optimal treatment for this type of patient remains elusive. Primary above-knee amputation may be the preferred treatment in patients who are this severely affected.