Articles: femoral-fractures-complications.
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Femoral fracture may predispose the knee to the development of post-traumatic arthritis by either a direct intra-articular injury or residual limb malalignment. Malunion, intra-articular osseous defects, limb malalignment, retained internal fixation devices, and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) in these patients. The aim of our study was to evaluate the result of TKA in patients with previous distal femoral fracture. ⋯ Significant improvement in function and relief of pain is seen in the vast majority of patients with previous distal femoral fractures undergoing subsequent TKA. However, these patients are at increased risk for restricted motion and perioperative complications following TKA. Special efforts to preserve the vascularity of the skin and subcutaneous tissues, restore limb alignment, ensure correct component positioning, and achieve soft tissue balance may help minimize the problems identified in this study.
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Exp. Toxicol. Pathol. · Nov 2002
Polymicrobial sepsis induces organ changes due to granulocyte adhesion in a murine two hit model of trauma.
Polytrauma patients, who develop organ dysfunction, have often undergone multiple subsequent insults ("hits"). The sequence of organs that show a dysfunction mostly is lung, liver, kidney and heart. The aim of the present study was to investigate whether a second hit after trauma induces organ changes. Furthermore, it was of interest to identify possible pathogenic mediators such as polymorphonuclear granulocytes (PMN) and cytokines. For this purpose, a two hit model of systemic damage in mice was developed. Sepsis was induced by caecal ligation and puncture (CLP), which was preceded 48 hours by a femur fracture, the most common fracture of long bones in trauma patients. This fracture was combined with a haemorrhagic shock. ⋯ A new rodent model mimicking the situation in the polytraumatized patient was developed. Although the animals showed minimal organ manifestation, a high percentage died probably due to cytokinemia. Furthermore, the increased TNF-alpha levels may lead to increased adhesion of PMN in the lung venules. This adhesion developed four days after the second hit. This might be the initial step for the development of extensive lung lesions in later phases. This model represents the SIRS more than MODS. This is a model for devolopment of posttraumatic disease due to cytokinemia and less for chronic multiple organ dysfunction and failure.
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The purpose of this study is to identify and characterize the nature of internal knee derangement associated with ipsilateral femur fractures. ⋯ Given the large number of soft tissue injuries about the knee, it would be prudent to emphasize the importance of a thorough intraoperative examination once the femur fracture has been stabilized. Additionally, there should be a low threshold to obtain an MRI if the postoperative clinical examination suggests an associated knee injury. Bone bruises, which can only be identified by MRI studies, are increasingly being acknowledged as a source of persistent symptoms.
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Pudendal nerve trauma is a rare complication of orthopaedic and traumatological surgery, which occurs after traction of the pelvis on an orthopaedic table fitted with a pelvic support. This trauma is generally due to crushing of the nerve against the central part of the table or stretching of the pudendal nerve due to excessive traction during fractures of the femur. the urological consequences of this neurological trauma present in the form of disorders of perineal sensitivity, which usually rapidly resolve spontaneously, or vesicosphincteric and/or erectile disorders, which have a more pejorative course and which can sometimes persist. ⋯ Surgical decompression, rarely indicated, can be necessary in the case of serious and persistent sensory or motor lesions. Patients must be clearly informed about this possible neurological complication before an operation on the orthopaedic table as part of good surgical practice.
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Pneumonol Alergol Pol · Jan 2002
Case Reports[Pulmonary embolism in course of deep vein thrombosis of lower extremities in patient wit bilateral femoral bone fracture after car accident injuries].
The incidence of deep vein thrombosis in Western World is estimated at about 1 case/1000/year and of pulmonary embolism at 0.5 case/1000/year. Mortality in untreated pulmonary embolism is 30%. With adequate treatment (anticoagulation) it can be decreased to 2-8%. ⋯ When surgery has to be performed in patient with high risk of pulmonary embolism, anticoagulant prophylaxis should be performed. Venous thromboembolic disease is the most important cause of mortality in trauma patients. We present a case of 46 years old man with bilateral fracture of femoral bone after car accident injury in whom signs of deep venous thrombosis and pulmonary embolism were observed despite the use of anticoagulant prophylaxis.