Other common complication is avascular necrosis avn of the femoral head with most reported incidences being femur dr. Ein bruch fraktur im oberen, dem huftgelenk zugewandten teil des. Although the tibia and femur have significantly different physical and biologic healing environments, dynamization is a firstline treatment for delayed union or nonunion of both, and dynamization. Orth, frcs, facs pro chancellor, nitte university abstract how the saga of non union has changed in the last 50 years from the classification to the causes of delayed and non union to diagnosis and even the management is amazing. Proximal femoral nail antirotation pfna this is a device used to align and stabilise the fracture to aid healing. The pfna augmented in revision surgery of proximal femur. Some coexisting problems usually complicate the nonunion including persistent infection, bone and soft tissue loss, limblength inequalities, deformity, and joint stiffness 1,2. Closed intramedullary nailing for femoral and tibial shaft fractures 19 outline of tibia fractures including one bilateral patient, there were 83 males and 22 females aged 15 to 75 average age 42, ofwhich 38 cases were caused by traffic accidents, 35 by laboraccidents, 16 by sports accidents, 8 by a fall, and 8 cases by other reasons. Neck of femur fractures nof are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral. Slight abductionadduction deviations in femur positioning. Jul 10, 2015 non union fracture femoral neck is one of the common complication of intra capsular fracture neck of femur in children as well as in adults and it is the most challenging problem to treat if femoral head salvage is attempted. Several nonmetric traits have been distinguished so far. A case report d dhar, ms ortho department of orthopaedics, regional referral hospital, nizwa, oman corresponding author. Dynamic compression plate and cancellous bone graft for.
This variant is found in close association, but not correlated with. It is inserted into the middle of the thigh bone for support. Now after 4 months my femur fracture is united, i went thru a mri test, it. Concomitant ipsilateral subcapital and intertrochanteric. Fragomen, md published outcomes of this procedure can be found at. Heretofore, there has still been a challenge for orthopedic surgeons about the treatment of infected nonunion of tibia and. Fraktur femur disebut terbuka apabila terdapat hubungan langsung antara tulang dengan udara luar.
He was having severe pain and great difficulty bearing weight, even with his crutches. Learn knee joint anatomy with free interactive flashcards. Lengthening of the femur over an existing intramedullary nail. The ankle joint is the articulation of the tibia, the fibula, and the. Touch on both introduction modern fixation techniques locking plates ss, titanium, polyaxial, far cortex locking sc specific imn minimally invasive large cancellous bone surface union rates 8497%. Oberschenkelknochens femur wird als huftgelenknahe femurfraktur. Anteroposterior a, b and lateral c, d radiographs of the same patient as. Dinesh dhar, senior specialist, department of orthopaedics, regional referral hospital, nizwa email. Neck of femur fractures nof are common injuries sustained by older patients who are both more likely. Surgical technique standard locking spiral blade locking. Trauma 101 clearwater 2016 john d wyrick md university of cincinnati introduction help preventtreat the nonunion. In five cases revision surgery was performed because of a loosening of the femoral neck implant, in two cases because of a pseudarthrosis, in two cases because of an implant failure and in one case because of a new fracture with the implant. Postmenopausale osteoporose mit pathologischer fraktur.
Roberts department of orthopaedic surgery, university of louisville school of medicine, 210 east gray street, suite 1003, louisville, ky 40202, usa keywords nonunion. Pdf asuhan keperawatan fraktur femur anggita agustina. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. On 24th july 2009, surgery was done, whereby the right femur was plated. Adjust the ruler until the distal end is at the desired nail insertion depth. Many times, people who have broken a bone have suffered a single fracture.
Rigid fixation with plate and bone graft in failures of intramedullary osteosynthesis for the treatment of diaphyseal nonunion of the femur. Nonunions of the distal femur are uncommon but difficult to manage. Management of femur shaft fractures in obese patients. To evaluate the therapeutic outcome of artificial total hip arthroplasty tha with collum femoris preserving for hip joint disease in young and.
In the case of the femur this can be accounted for entirely by differences in growth rates at the epiphyseal plates of the femur compensating for the disproportion in the distances of the foramen from the two plates. The situation now is that i am in a little pain mainly due to a 1 inch. The remotecontrolled magnetic intramedullary nail is a telescopic. T1 management of femur shaft fractures in obese patients. Fraktur femur adalah hilangnya kontinuitas tulang paha tanpa atau disertai adanya kerusakan jaringan lunak otot, kulit, jeringan saraf, dan pembuluh darah. This classification takes into account the involvement of anatomic region of the distal femur, the energy of the injury and also prognosticates the outcome. The treatment of proximal femur fractures has improved due to new implant designs in recent years 1 kraus m, krischak g, scola a, et al. Systemic factors summary nonunion of a fracture can be caused by various. Once the reducer is in the medullary canal and has captured the distal fragment, the balltipped guide rod 251160 is inserted through it with the use of the gripper into the distal femur in the. Place the reducer through the entry tool and 14 mm channel reamer to reduce the fracture figure 8. A fracture through the intra articular part of the femoral neck is usually referred to by the term femoral neck fracture. Etiologi penyebab fraktur secara fisiologis merupakan suatu.
Amongst all these, exchange nailing is the simplest and most successful technique for treating aseptic non union of femoral shaft fractures. Non union femur fracture 4 years on orthopedics medhelp. This layer produces peripheral callus the portion of the neck which is within capsuleshas essentially no cambium layer therefore healing in the femoral neck area iscompletely dependent on endosteal. N2 given the ongoing epidemic of obesity, femoral fracture management in the population affected by this condition is likely to become more frequent. Osteosynthesis in a 10 year old boy with fracture neck of. Berdasarkan bentuk garis patah dan hubbungannya dengan mekanisme trauma. Variations of the proximal part of femur specially its head and neck region have attracted anthropologists and anatomist for a long time. Recent concept for management of femoral neck fracture. With long forceps, hold the radiographic ruler 357. What is the angle of the head and neck of the femur in relation to the body of the femur 1520 degrees internally what angle must the femur and leg be rotated to place the femoral neck parallel to the ir for a true ap projection of the proximal femur. My doctor kept me under observation for 3 days and after that they operated me on 4aug, they inserted a titanium rod and 4 screws in it. The first thing is belief in your treating orthopaedician.
This could be a hairline fracture, a complete break, or something in between. What is the name of the ligament that attaches to the fovea capits. Nonmetric variation of the neck of the femur 98 int j res med. The position of the nutrient foramen in the growing tibia. Steps for closed intramedullary nailng offractures the tibial shaft. Fractured neck of femur dhs pfna cannulated hip screw. Bilateral traumatic fracture of neck of femur in a child. The region of the proximal femur extending to the lesser trochanter must be enlarged to 14mm. Mechanism of injury fractures of the femoral neck can occur following both direct and indirect mechanisms. Bone healing and infection in a femoral fracture model in histamine. The left femur had a fracture of the mid shaft, as seen above and the right femur had a fracture of the proximal third initial radiographs not available to us.
Kondisi ini secara umum disebabkan oleh trauma langsung pada paha. Nail dynamization for delayed union and nonunion in femur and. Absence of cambium layer of periosteum intracapsular vascular anatomy inaccurate reduction loss of fixation 2. The position of the nutrient foramen in the growing tibia and. I broke my right femur shaft on 31july12 along with parietal haematoma. Move the image intensifier to the proximal femur position 2, place the distal end of the ruler on the skin mark. Lengthening of the femur with a remotecontrolled magnetic. Recent concept for management of femoral neck fracture non. Is distal fixation necessary in cephalomedullary fixation. Among all the classifications described for distal femur fractures, the muller ao classification system is the most widely accepted system and is being used worldwide. Anteroposterior a, b and lateral c, d radiographs of the same patient as in figure 2 obtained.
Non union fracture neck of femur linkedin slideshare. Choose from 500 different sets of knee joint anatomy flashcards on quizlet. Infected nonunion of tibia and femur are common in clinical practice. Anterioposterior radiograph of pelvis after internal fixation of femoral neck fractures with cancellous screws. Blandaltman plots were constructed to compare the relative correlation between the standard fixed and adjustablewidth bilateral femur positioning techniques in the measurement of bmd on the left, right, and mean hip regions of interest at the femoral neck and total femura left femoral neck, b right femoral neck, c left total femur.
Unstable intertrochanteric fracture of the femur is one of the most commonly encountered orthopaedic injuries in the united states. Blandaltman plots to assess relative correlation and the associated limits of agreement bias between the 2 positioning techniques revealed. Introduction failure of fixation after femoral cephalomedullary nailing for pertrochanteric pt femur fractures is a major source of morbidity and mortality in the elderly population. There are many ways to treat aseptic nonunion of femoral shaft fractures with reported varied success rate. Non union fracture femoral neck is one of the common complication of intra capsular fracture neck of femur in children as well as in adults and it is the most challenging problem to treat if femoral head salvage is attempted. In the tibia, however, extension of the extremely oblique nutrient canal as the bone increases in girth is also involved.
This holds the ends of the bones together while they heal. Nov 29, 2016 although the tibia and femur have significantly different physical and biologic healing environments, dynamization is a firstline treatment for delayed union or nonunion of both, and dynamization. These surgeries and treatment require long term relationship between the patient and the physician and going step by step and. Lengthening of the femur with a remotecontrolled magnetic intramedullary nail antegrade technique s. Absence of cambium layer of periosteum intracapsular vascular anatomy inaccurate reduction loss of fixation. Afklemningsredskab middel til blokering pa muskler muskeltr. Lengthening of the femur over an existing intramedullary nail han jo kim, md, austin t. Intraoperative complications6 it was necessary to expose the fractured site in order to insert the reamer guide into the distal fragment in 3cases, including a femoral segmental fracture, a. Hold the radiographic ruler perpendicular to the femur. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only.
The nail design has been well proven in over 200 000 cases performed with the pfn. To the best of our knowledge, there is no previous report in the literature of these conditions as a result of high energy trauma or of the treatment used. Role of implant stability and local inflammatory responses. Anterioposterior radiograph of pelvis showing bilateral displaced fracture neck femur. Chapter 7 femur and pelvic girdle questions and study guide.
We report the case of an unusual combination of concomitant subcapital and intertrochanteric fractures of the hip in a patient after a motorcycle accident. Linear regression analysis of femoral neck left and right and left total and mean total femur bmd fig. Leg length discrepancies can occur despite successful union of femur fractures after intramedullary nailing imn. Successful treatment of these nonunions requires adherence to the proven principles for the treatment of metaphyseal nonunions. Nail dynamization for delayed union and nonunion in femur. Clinical evaluation of pfna and relationship between the tipapex distance and mechanical failure unfallchirurg 2011. Chapter 7 femur and pelvic girdle questions and study. Infected nonunion of tibia and femur treated by bone. Delayed and non union of long bone fractures case series prof. Fraktur femur adalah terputusnya kontinuitas batang femur yang bisa terjadi akibat trauma langsung kecelakaan lalu lintas, jatuh dari ketinggian. Several studies have looked at patient demographics and technical factors of fixation as predictors for blade cutout, however, none have examined. Suprakondylare extension einer pertrochantaren femurfraktur. Tfna proximal femoral nailing system surgical technique depuy synthes 11 5 determine nail diameter instrument 03. A 63yearold female sustained a highly unstable intertrochanteric fracture of the femur ota 31a 3.
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