Articles: femoral-fractures-complications.
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J Trauma Acute Care Surg · Oct 2012
Multicenter Study Comparative StudyPediatric obesity and traumatic lower-extremity long-bone fracture outcomes.
Pediatric obesity is associated with lower-extremity injuries and poor outcomes after blunt trauma. Our aim was to determine if obese pediatric patients with femur and tibia fractures have more severe injury patterns and worse outcomes compared with those of nonobese patients. ⋯ Epidemiologic study, level III.
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Multicenter Study
A national survey of acute hospitals in England on their current practice in the use of femoral nerve blocks when splinting femoral fractures.
Missed compartment syndrome can have devastating long-term impact on a patient's function. Femoral fracture has been reported in 52-58% of acute thigh compartment syndromes in the existing literature. Time to diagnosis of compartment syndrome is cited as a key determinant of outcome. Use of femoral nerve blocks in splinting of femoral fractures may mask signs of early compartment syndrome. We present the attitudes of emergency department and orthopaedic staff in NHS trusts in England with regard to this issue. ⋯ Femoral nerve block is an under-utilised, effective mode of analgesia following femoral fractures. There is a low risk of associated compartment syndrome, but clinicians should be especially vigilant in high-energy injuries. We recommend that all acute trusts receiving trauma should have a protocol for the use of femoral nerve blocks agreed by the emergency and orthopaedic departments.
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Emerg Med Australas · Jun 2009
Multicenter StudyPain management practices in paediatric emergency departments in Australia and New Zealand: a clinical and organizational audit by National Health and Medical Research Council's National Institute of Clinical Studies and Paediatric Research in Emergency Departments International Collaborative.
To audit pain management practices and organization in paediatric ED across Australia and New Zealand. ⋯ We found a notable lack of pain assessment documentation and delays to analgesia. There is a need to improve pain assessment and management, although a majority of paediatric ED surveyed had important organizational and educational structures in place. Issues to explore include use of opioids in migraine and the underuse of femoral nerve blocks.
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Multicenter Study Comparative Study Clinical Trial
Results of femoral intramedullary nailing in patients who are obese versus those who are not obese: a prospective multicenter comparison study.
Antegrade femoral nailing through a piriformis fossa starting point in patients who are obese has been demonstrated to be problematic. Retrograde femoral nailing therefore has been advocated in this patient population, but little data exist to support such a recommendation. The purpose of this study was to evaluate and compare antegrade and retrograde femoral nailing technique in both patients who are and are not obese. ⋯ This study provides evidence, in the form of decreased operative and radiation exposure times, to support the use of retrograde nailing technique for the treatment of femoral shaft fractures in patients who are obese. Also, antegrade nailing was found to require significantly more operative and radiation exposure time in the patient who is obese as opposed to the patients who is not obese. Although having similar baseline functional scores, patients who are obese recovered at a slower rate and more incompletely than patients who are not obese.
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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.