Fracture Femur

The past medical history was significant for a dislocated left elbow at 6 months of age that resolved spontaneously, left femur fracture at 16 months of age that occurred while she was trying to pull up to stand, and chronic sinusitis due to an underdeveloped ethmoidal-sphenoid sinus (air-filled cavity in the skull behind the bridge of the nose). Her psychosocial development appeared normal. She was able to crawl and scoot but could not cruise yet. 

Sgadari A, Lapane KL, Mor V, Landi F, Bernabei R, Gambassi G. Oxidative and nonoxidative benzodiazepines and the risk of femur fracture. The Systematic Assessment of Geriatric Drug Use Via Epidemiology Study Group. J Clin Psychopharmacol 2000 20(2) 234-9. 

The hip (specifically the bone called the femur) is another extremely common location for an osteoporotic fracture. In fact, while it was initially thought that an individual falling resulted in a broken femur, it now believed that some femur fractures occur som hat spontaneously, and the already broken hip then causes the individual to fall. 

Distinction between the effects of injury on protein metabolism and the effects of corticoid on protein metabolism has been made by Munro (M17, MIS) who has found a marked gain in liver nitrogen content following cortisone administration to the rat, but not after femur fracture. He also notes that cortisone has a constant action on nitrogen balance at all levels of protein intake whereas the effect of injury is obliterated by prior protein depletion. 

Priority I—Patients with correctable life-threatening illnesses or injuries such as respiratory arrest or obstruction, open chest or abdomen wounds, femur fractures, or critical or complicated bums. Priority II—Patients with serious but nonlife-threatening illnesses or injuries such as moderate blood loss, open or multiple fractures (open increases priority), or eye injuries. 

Fig. 8.5. Transverse fracture of the midshaft of the femur. Fracture reduced by traction in Thomas splint...

Scherl SA, Miller L, Lively N et al (2000) Accidental and nonaccidental femur fractures in children. Clin Orthop 376 96-105... 

Proximal femur fractures were studied as well through the use of a PPF composite consisting of PPF, MMA, tricalcium phosphate and calcium phosphate (Witschger et al., 1991). Dynamic hip screws were placed in cadaveric proximal femora and fixed in place with the PPF composite mixture. The yield load when placed under mechanical testing was 1130 N, just slighly under 1750 N corresponding to the use of MMA alone. 

Witschger, P., Gerhart, T, Goldman, J., Edsberg, L. and Hayes, W. (1991) Biomechanical Evaluation of a Biodegradable Composite as an Adjunct to Internal Fixation of Proximal Femur Fractures, /. Orthop. Res., 9, 48-5.3. 

Fig. 3S.16a,b. A 51-year-old female with a large osteolysis of the right intertrochanteric region. The cortex is destructed on the medial side (arrow). (High risk for fracture ) c 1 week after the first examination, the femur fractured while the patient was hospitalized... 

The most common osteoporosis-related fractures involve the vertebrae, proximal femur, and distal radius (wrist or Colies fracture). Two-thirds of patients with vertebral fractures are asymptomatic the remainder present with moderate to severe back pain that radiates down a leg after a new vertebral fracture. The pain usually subsides significantly after 2 to 4 weeks, but residual, chronic, low-back pain may persist. Multiple vertebral fractures decrease height and sometimes curve the spine (kyphosis or lordosis) with or without significant back pain. 

Daily doses studied have ranged from 9 to 22.6 mg of fluoride over time periods of 1-4 years [98]. These trials were particularly concerned with the use of slow-release NaF [112,113] or sodium monofluorophosphate preparations [114,115], and they generally led to reductions in the incidence of bone fracture, as shown in Table 3. In addition, they typically caused increased bone density at the neck of the femur, the femoral condyle and the lower spine [98] (Table 3). 

Bone fractures, especially of the femur Parenteral. Metallic, altered taste Rare... 

On direct contact, one test resulted in a fractured femur. In another, over the chest, the rabbit was killed. The wad in the cartridge was the cause of the damage. 

Blumenthal I, Lealman GT, Franklyn PP (1980) Fracture of the femur, fish odour and copper deficiency in a preterm infant. Arch Dis Child 55 229-231... 

A seven-month-old child "fell over" while crawling, and now presents with a swollen leg. At age one month, the infant has multiple fractures in various states of healing (right clavicle, right humerus, right radius). At age seven months, the infant has a fracture of a bowed femur, secondary to minor trauma (see x-ray below). The bones are thin, have few trabecula, and thin cortices. A careful family history ruled out nonaccidental trauma (child abuse) as a cause of the bone fractures. The child is most likely to have a defect in ... 

Brown KM, Saunders MM, Kirsch T, Donahue HJ, Reid JS. Effect of COX-2-specific inhibition on fracture-healing in the rat femur. J Bone Joint Surg Am. 2004 86-A l 16-123. 

Ouyang, H, Sherman, P. J., Paschalis, E. P., Boskey, A. L. and Mendelsohn, R. (2004) Fourier transform infrared microscopic imaging effects of estrogen and estrogen deficiency on fracture healing in rat femurs. Appl. Spectrosc. 58, 1-9. 

Her x-ray series revealed generalized under-mineralization throughout the bony structures. Her ribs were thin, and the spine showed the presence of multiple compression fractures at the thoracolumbar level. There was marked bowing of all extremities with evidence of old fractures in femurs, humerus, and left ulna. A bone mineral density study of the lumbar vertebral bodies (L1-L4) performed at 5 years of age revealed a value of 6.57 standard deviations below the mean for children of the same age. 

The cost to the health economy of managing a fall with a major fracture such as neck of femur is great. 

In the 1930s a special nail was developed to hold bone fragments together to allow them to heal better. A few years later a metal device was invented to replace the head of a femur (thigh bone), which formed part of the hip joint and often would not heal after being fractured. A total hip joint was later invented and it continues to be revised and improved to allow the patient maximum use and flexibility of the leg. 

Ideally, diagnosis of osteoporosis should be made prior to the occurrence of symptom-causing fractures. Various radiologic techniques are available to measure the density (solidity) of bone, and include x ray and CT (computed tomography) examinations of the spine, femur, and wrist bones. 

INR 2.0-2.5 Prophylaxis of deep vein thrombosis including surgery on high-risk patients (2.0-3.0 for hip surgery and fractured femur operations). 

The effects of injury and corticoid administration on protein metabolism differ significantly in animals. The content of liver nitrogen is increased by giving cortisone to rats but fracture of the femur does not have this effect in spite of increased levels of cortisol in the blood (M13). The administration of cortisone has a constant effect on nitrogen balance at all levels of nitrogen intake whereas the catabolic response to injury is reduced or even abolished by diminished protein intake and weight loss prior to injury (M12). 

Vitamin D deficiency in adults cannot affect the epiphyseal plate, as it has disappeaced, but it can prevent normal mineralization of the osteoid layer in bone that turns over. In vitamin D deficiency the osteoclasts continue to create tunnels and pits in the bone. The osteoblasts continue to synthesize the protein matrix however, complete mineralization of the osteoid may not occur. The result is osteomalacia - This disease may present as bone pain about the hips. Osteomalacia can be diagnosed using a bone biopsy, A sample is taken from the iliac crest — the hip bone. An abnormally wide osteoid is indicative of the disease. X-rays can also be used to diagnose osteomalacia, which is characterized by arrays or zones of tiny fractures in sucli bones as the pelvis and femur. 

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