406 fractures of the femur in persons younger than 17 years of age were treated at Haukeland University Hospital, Bergen, from January 1980 to December 1993. The incidence was 35/100,000 per year; 57/100,000 for boys, and 24/100,000 for girls. No significant changes in the incidence occurred during the study period. 70% of the fractures occurred in boys. 78% had an isolated fracture, while 7% had other fractures, 7% head injuries and 8% injuries of multiple organs as well. Traffic accidents accounted for 35% of the fractures. 65% of the femur fractures were treated by skeletal traction (mean hospitalisation 30 days), 21% were operated on initially (hospitalisation 12 days), and 14% were given early spica cast (hospitalisation three days). The results of the treatment were generally satisfactory. Neither anisomelia (8.5% more than 10 mm) nor malrotation (12% more than 10 degrees) of the femur was a serious problem, but the length of time the patients were hospitalized was rather long.
Among men, hip fracture is the most common outcome of osteoporosis. The aim of this study was to investigate the clinical characteristics, treatment, complications, short-term outcome and mortality of male hip fracture patients.
Operation theatre logs of all hip fracture patients operated on (1124 patients) at Kuopio University Hospital in 1989-1993 were reviewed. Medical records of the 276 male patients who underwent surgery (25 % of all patients) were studied.
233 hip fractures (86 %) in men were due to low energy trauma. Of these cases, 61 % of the fractures occurred at the femoral neck, 31 % were pertrochanteric and 8 % subtrochanteric. The vast majority (90 %) of these patients had some chronic medical condition, and in 66 % the condition influenced motory or sensory functions. Hemiarthroplasty was most often used for femoral neck fractures (64 %). Internal fixation was used for pertrochanteric (97 %) and subtrochanteric (94 %) fractures. 20 % of the men had post-operative complications during the 1.5 year follow-up. During primary hospitalisation mortality was 3 %. Within 1.5 years of the fracture 40 % of the men had died, resulting in a mortality three times higher than age matched Finnish male population.
The pathophysiology of atypical fractures is unknown. We compared characteristics of patients with atypical femoral fractures and hip fractures in typical locations of the femur. Patients with atypical fracture reported a longer duration of use of bisphosphonates, had higher body mass index, and higher total hip bone mineral density. Further studies are needed.
This study aims to describe the characteristics of patients with typical and atypical fractures of the femur assessed in a tertiary care osteoporosis center.
We abstracted clinical, laboratory, and radiographic data on subjects with a history of a low-impact fracture at the femur and/or hip (confirmed by review of radiograph and/or radiology report) from January 2008 to October 2011. Available radiographs were reviewed and fracture categorized as typical or atypical by a radiologist blinded to the original diagnosis.
Radiology reports were available for 72 subjects: 40 hip fractures in typical locations (typical fracture), 16 atypical femoral fracture (atypical fracture), and 16 were excluded. While both those with typical and atypical fractures reported taking bisphosphonates at the time of fracture, duration of use was longer with atypical fractures (104.2±42.0 months) compared with typical (71.1±62.8 months) (p=0.04). Body mass index (BMI) was higher in patients with atypical fractures (26.2±3.2 kg/m2) than in those with typical (23.1±4.3 kg/m2) (p=0.006). Total bone mineral density (BMD) was higher in patients with atypical fracture (0.795±0.102) versus typical (0.686±0.130) (p=0.003) Previous history of cancer was reported by 7 of 16 patients with atypical and 7 of 40 patients with typical fracture (p=0.04).
Compared to those with typical fractures, patients with atypical fracture report a longer duration of use of bisphosphonates, higher BMI, and higher total hip BMD. Future studies should examine if these differences contribute to the pathophysiology of atypical fractures.
For this study, all displaced fatigue fractures of the femoral shaft treated during a 20-year period at a national military hospital were analyzed. Ten previously healthy male recruits sustained displaced femoral shaft fatigue fractures, the incidence being 1.5 per 100,000 person-years in military service. The median age of the patients was 19 years (range, 18-20 years). None had any previous fatigue fractures. The median body mass index was normal. Before the fracture displacement, nine recruits experienced thigh or knee pain for 1 to 6 weeks. Six of the 10 fractures were located in the distal third of the diaphysis. Only one fracture occurred in the proximal third. Six fractures showed a noncomminuted, oblique, or oblique-transverse configuration. Five fractures were treated using an intramedullary nail, four fractures with a dynamic compression plate, and one with a dynamic condylar screw-plate. The bone at the site of fracture proved to be abnormally brittle. In six patients this resulted in additional comminution intraoperatively. Two reoperations were necessary to exchange a nail and a screw because of technical faults. The median time to solid bony union was 3.5 months (range, 3-5 months). The recruits returned to light duty military service 6 weeks postoperatively, on the average. Two were exempted from military service for 2 years. Displacement is a rare, highly undesirable consequence of fatigue osteopathy of the femoral shaft among young recruits during basic military training. Preventive methods should focus on early, effective detection of developing fatigue fractures to avoid a displaced fracture, with subsequent prolonged morbidity and possible complications. Gentle handling of the bone during the fracture fixation procedure is imperative because of the extraordinary brittleness of the fracture fragments.
Fractures of the distal femur comprise 4 per cent of all femoral fractures. The records of a consecutive series, from 1969 to 1976, of 135 adult patients with 137 fractures, not caused by malignant disease, were reviewed for age, sex, previous disease, type of fracture, treatment and end-result. Eighty-four per cent of the patients were over 50 years of age, 19 per cent had other general factors predisposing them to fracture, and 42 per cent had previous or current disease of the fractured leg. Eight-three fractures were caused by moderate and 52 by severe trauma. Unicondylar fractures were separated into lateral or medial type. Ten fractures were open and 45 were operated on primarily, mostly using condylar plates, screws or Rush pins. Satisfactory results (pain-free knee without angular deformity and at least 90 degrees of motion) were achieved in two-thirds of the fractures following both non-surgical and surgical treatment. However, the surgical group was an average of 8 years younger and contained a higher proportion of bicondylar fractures than the nonsurgical group. Treatment in traction involved a mean period of 7 weeks for 47 patients. This expensive treatment is no longer used for femoral neck, trochanteric or shaft fractures. In distal femoral fractures the goal should also be early mobilization, if necessary using surgical treatment.
The goal of this study was to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1996 in Kaohsiung City, Taiwan. Kaohsiung City is the industrial and commercial center of southern Taiwan, with a population of 1,433,621 in 1996. The number of individuals over 65 years of age accounted for 6.2% of the total population. Data from the archives of reimbursement of the National Health Insurance program were used to investigate the incidence of fractures of the proximal femur. This study detected 580 cervical and trochanteric fractures (40.5 fractures per 100,000 population per year) in 261 males (35.8 fractures per 100,000 men per year) and 319 females (45.3 fractures per 100,000 women per year), with 420 (72%) of these fractures occurring in individuals over 65 years of age. The age-specific incidences of cervical and trochanteric fractures increased exponentially with age in both genders. The overall ratio of cervical to trochanteric fractures was 1:1.04. The mean ages of women with cervical or trochanteric fractures (71.6 and 74.0 years, respectively) were significantly higher than those of males (59.9 and 64.8 years, respectively; P
Fractures constitute 10% to 25% of all pediatric injuries and are more common in boys than in girls, and after age 13 or 14 years are twice as common. The results from an epidemiologic study in Malmö indicate that a child's risk of sustaining a fracture is 42% in boys and 27% in girls from birth to age 16 years. Fractures of the distal end of the radius are the most common injury, followed by fractures of the phalanges of the hand. From 1950 to 1979 there was a twofold increase in the risk of fracture, due to an increase in light-energy trauma, mainly sporting activities. Since the end of the 1970s there has been no further increase in the fracture risk. The data also indicate that preventive measures have been effective in decreasing severe accidents.
Over the 20-year period from 1965 to 1984, 370 residents of Rochester, Minnesota experienced 402 femoral fractures exclusive of the hip, giving an overall incidence rate of 37.1 per 100,000 person-years (95% confidence interval, 33.4-40.8). Of these, 54 were subtrochanteric and 210 were diaphyseal, while 123 involved the distal femur and 15 were at unspecified femoral sites. Fifty-eight percent of these fractures were caused by severe trauma. The incidence of femoral fractures due to severe trauma was greatest in young patients, especially for diaphyseal fractures, and showed a male excess. One-third of the fractures were associated with moderate trauma and were responsible for the rising incidence rates with age at all three fracture sites. These increases were greater in women. Eighty percent of patients 35 years of age or older with fractures due to moderate trauma had prior evidence of generalized osteopenia or a condition likely to cause localized osteopenia in the fractured femur. These data confirmed similar findings from Sweden, providing evidence for a relationship between osteoporosis and femoral fractures distal to the hip.
The incidence of diaphyseal femoral fracture in adults, aged 20 years and older, was determined in Stockholm County using hospital admission rates. The validity of the data was investigated by a study of the medical records of a sample of 277 cases and also by determining the incidence in a subpopulation of 139 cases using an alternative method. The incidence decreased from age 20 to middle age after which it increased into old age. The age-related increase was more pronounced in women and in fractures caused by moderate trauma. From 1972 to 1981, the incidence of diaphyseal femoral fracture caused by moderate trauma increased annually by 10 per cent in women aged 75 years and older.