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Augmentation of fracture fixation
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Peter V. Giannoudis, Panagiotis Douras
Surgical treatment is the method of choice in managing proximal femoral fractures except when certain reasons or comorbidities recommend a different approach. When dealing with trochanteric hip fracture, certain parameters have to be taken into consideration: age of patient, mobility status, integrity of lateral and medial proximal femoral cortex, and degree of comminution. The goal of treatment is to give the patient the chance to mobilize as quickly as possible, avoiding risks of prolonged bed rest, or deterioration of comorbidities. Stable fracture patterns do not usually present any difficulties, whereas multifragmentary or unstable fractures remain a challenging task. When the lateral cortex is intact, fixation can be performed with the use of a dynamic hip screw (DHS).
Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Femoral fractures result from direct or indirect force applied to the bone. Given the strength of this bone, the forces involved are usually large and a search for other associated injuries should be made. The patient will usually complain of severe thigh pain, and swelling and deformity are usually obvious. The patient will not be able to bear weight. Femoral fractures are associated with significant blood loss into the leg itself, which may not be visible. Open femoral fractures should be treated aggressively to prevent circulatory shock.
Advances in Avascular Necrosis of the Hip joint
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Femoral fracture may happen during or after the surgery. The incidence rate used to be 2.5% in the past, which is now reduced to less than 1% [112]. The reason of fracture is technical and in case the entrance of the core is above the lesser trochanter it can reduce significantly.
Fatal bone marrow embolism
Published in Baylor University Medical Center Proceedings, 2022
Rasmey Thach, Alexandra Cina, Lorenzo Gitto
Due to the history of drug abuse and the lack of information regarding the traumatic fracture, a medicolegal autopsy was ordered. External examination revealed multiple stage III and IV pressure ulcers localized to the sacrum, left gluteal fold, and right gluteus. The right lower extremity was in an externally rotated position and shorter in length than the left. There was no evidence of rib fractures. Dissection of the right thigh revealed a displaced femoral fracture, surrounded by dark brown to black-colored necrotic soft tissues, consistent with a fracture that occurred several days before the examination. Microscopic examination of lung tissue revealed focal areas of hyaline membranes and alveolar hemorrhage, suggestive of early stage acute respiratory distress syndrome. Fragments of mature bone marrow particles showing myeloid and lymphoid precursors surrounded by adipose tissue were present in the lumen of multiple pulmonary vessels, consistent with widespread pulmonary BME. Adipose cells with admixed scattered immature myeloid and lymphoid elements were also present in small vessels of the heart and liver (Figure 1). Blood cultures drawn at admission returned negative.
A finite element analysis study based on valgus impacted femoral neck fracture under diverse stances
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Haowei Zhang, Xinsheng Xu, Shenghui Wu, Ying Liu, Jiong Mei
Chaudhry et al. (2020) analyzed the hip joint and focused on the fracture of the hip joint and found that: proximal hip joint fractures mostly occur in the elderly, and most occur in the femoral shaft under the same boundary conditions. With age, the possibility of hip fractures increases, and fractures tend to be more likely to be femoral heads. In the analysis of normal femoral gait, Gao et al. (2019) analyzed the force of the hip joint by anybody and found that the stress distribution is mainly distributed in the femur during the gait, and the stress peak value in the hip joint area is 1.2 MPa. Bai and Shang (2010) concluded that femoral fractures usually occur in the middle of the femoral shaft and at the femoral neck, which is basically same in this article. The stress is usually greater and the stress distribution is uneven, which will lead to a worse mechanical environment after the fracture, and secondary fractures may occur at these stress-concentrated parts (Xu 2014), especially the middle and lower part of the femoral neck. Future research will further study the relationship between implant-associated complications and the mechanical environment of the femoral neck fractures (Hrubina et al. 2013). Therefore, from the simulation results, the results are feasible
Repurposing denosumab in lung cancer beyond counteracting the skeletal related events: an intriguing perspective
Published in Expert Opinion on Biological Therapy, 2020
Maria V. Deligiorgi, Dimitrios T. Trafalis
Atypical femoral fractures (AFFs) have been related, though rarely, with denosumab, most commonly after minimal or no trauma. Most information is derived from patients receiving denosumab for osteoporosis. In the extension of FREEDOM trial, yearly exposure-adjusted subject incidence of AFFs was 5.6 per 10,000 subject-years for long-term denosumab participants during year 7, while no AFF was reported during years 1–6 and during year 8. No confirmed atypical femoral fracture was recorded in the ABCSG-18 study [76]. The pathophysiology of denosumab-related AFFs remains unknown, likely implicating inhibition of bone turnover, impeding the repair of microdamage of skeleton [77]. Seven cases of AFFs related to denosumab administered for bone metastases were reported in a systematic review, with half cases being exposed to denosumab for more than 42 months and more than half cases being previously treated with BP. Evidence-based recommendations regarding diagnosis and management of AFFs are still lacking, indicating the need for further research [78].