Aims. The impact of concomitant injuries in patients with proximal
Aims. The prevalence of ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is rising in concert with life expectancy, putting more patients at risk for interprosthetic
Aims. Current American Academy of Orthopaedic Surgeons (AAOS) guidelines for treating
Aims. Periprosthetic proximal
Aims. The incidence of atypical
Aims. Treatment guidelines for atypical
Aims. Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical
An atypical
Peri-prosthetic
The results of the treatment of 31 open
We evaluated the cost and consequences of proximal
Aims. The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric
A medical and engineering study was made of 1074 car accidents involving 2520 vehicle occupants. The injuries they sustained were correlated with details of the crash and with contact points inside the cars. Where possible the forces which were generated in the crash were estimated and related to the injuries. In all, 39 car occupants suffered femoral shaft fracture, with an incidence of 1.7% and 0.8% for front and rear seat occupants respectively. Of these, 31 had associated injuries to other regions of the body; these were the cause of 13 of the 14 deaths in this group. Associated injuries were more severe in car occupants who were not wearing seat belts but the incidence of
Benefits of early stabilization of femoral shaft fractures, in mitigation of pulmonary and other complications, have been recognized over the past decades. Investigation into the appropriate level of resuscitation, and other measures of readiness for definitive fixation, versus a damage control strategy have been ongoing. These principles are now being applied to fractures of the thoracolumbar spine, pelvis, and acetabulum. Systems of trauma care are evolving to encompass attention to expeditious and safe management of not only multiply injured patients with these major fractures, but also definitive care for hip and periprosthetic fractures, which pose a similar burden of patient recumbency until stabilized. Future directions regarding refinement of patient resuscitation, assessment, and treatment are anticipated, as is the potential for data sharing and registries in enhancing trauma system functionality. Cite this article:
An 81-year-old woman presented with a fracture
in the left femur. She had well-fixed bilateral hip replacements
and had received long-term bisphosphonate treatment. Prolonged bisphosphonate
use has been recently linked with atypical subtrochanteric and diaphyseal
femoral fractures. While the current definition of an atypical fracture
of the femur excludes peri-prosthetic fractures, this case suggests
that they do occur and should be considered in patients with severe
osteopenia. Union of the fracture followed cessation of bisphosphonates
and treatment with teriparatide. Thus, this case calls into question
whether prophylactic intramedullary nailing is sufficient alone
to treat early or completed atypical
The outcome of various types of treatment for
We have attempted to describe the epidemiology of
We performed a retrospective review of all patients
admitted to two large University Hospitals in the United Kingdom
over a 24-month period from January 2008 to January 2010 to identify
the incidence of atypical subtrochanteric and femoral shaft fractures
and their relationship to bisphosphonate treatment. Of the 3515 patients
with a fracture of the proximal femur, 156 fractures were in the
subtrochanteric region. There were 251 femoral shaft fractures.
The atypical fracture pattern was seen in 27 patients (7%) with
29 femoral shaft or subtrochanteric fractures. A total of 22 patients
with 24 atypical fractures were receiving bisphosphonate treatment at
the time of fracture. Prodromal pain was present in nine patients
(11 fractures); 11 (50%) of the patients on bisphosphonates suffered
12 spontaneous fractures, and healing of these fractures was delayed
in a number of patients. This large dual-centre review has established
the incidence of atypical
A consecutive series is reported of 17 patients who underwent early surgical treatment for acetabular or unstable pelvic fractures associated with ipsilateral fractures of the femur. Treatment included external and internal fixation, and required careful consideration of the surgical approach and the positioning of the patient. The multiple injuries sustained by these patients required simultaneous procedures by several surgical teams. All the