Articles: femoral-fractures-complications.
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Multicenter Study Clinical Trial
Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures.
A series of 110 patients with 114 fractures of the femur were reviewed an average of 3.9 years after injury. Demonstrable knee ligament laxity was present in 31 (27 per cent) of these patients, while 13 (11 per cent) complained of instability. Thirty-three patients with 34 ipsilateral femoral and tibial shaft fractures were examined an average of 3.7 years after injury. ⋯ Most of the patients with instability had a rupture of the anterior cruciate ligament with or without damage to other ligaments. We conclude that knee ligament injury is more common with ipsilateral fracture of the femur and tibia than with just a single ipsilateral femoral fracture. We advocate careful assessment of the knee in all cases of fracture of the femur.
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Comparative Study
Fat embolism in patients with an isolated fracture of the femoral shaft.
Analysis of basic pathophysiologic variables in fat embolism patients is often restricted by the complexity of the different injuries present in each individual patient. To avoid this problem we investigated the presence of the fat embolism syndrome in patients with an 'isolated' fracture of the femoral shaft. ⋯ They showed significantly higher initial temperatures, lower pulse rates, a progressive hemoglobin decrease, and a fracture localization more proximal (p less than 0.025) than the other patients in the nondecompressed group; they also showed significantly different pathophysiologic patterns from the patients in the decompressed group. Although the pathophysiologic mechanism of the onset of clinical fat embolism remains unclear, initial temperature elevations in combination with 'typical' fracture localization and fracture type appear to have a predictive value.
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A seventeen year old boy sustained pelvic, femoral shaft and malleolar fractures in a road traffic accident. Six hours after admission, the patient became comatose (Glasgow coma score = 7); the coma worsened such that, 24 h later, the coma score was 4. Petechiae were present on the conjunctiva and anterior chest wall. ⋯ Ten months after the accident, magnetic resonance imaging showed a small ventricular dilatation due to subcortical atrophy. Residual ischaemic lesions and demyelination could be seen in the right centrum ovale and temporal lobe. The cerebral lesions contrast with the reversibility of the clinical state.
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Twenty five adults and children with fractured shaft of femur were given femoral nerve block for pain relief. The block was found to be useful for purposes of transportation and immobilization. The pain relief was complete if the fracture site was in the middle third of the femoral shaft. The block is easy, safe, economical and most useful in emergency and poor risk patients.