Lars Rehnberg

Subchondral screw fixation for femoral neck fractures

We describe a method of internal fixation for femoral neck fractures which has been newly developed to reduce the frequency of early complications. Two cannulated screws are inserted in the axis of the femoral neck to reach into the subchondral bone of the femoral head. The screws are inserted over guide pins and the tip of the screw is self-tapping and designed to provide good anchorage in the femoral head. We used this method in 44 consecutive patients in a prospective study with no exclusions, followed for a minimum of 24 months. All fractures healed within 12 months, and there were no cases of early loosening or nonunion. In four cases, late segmental collapse had developed during the mean follow-up period of 30 months.

External fixation of displaced femoral shaft fractures in children: a consecutive study of 98 fractures.

Objective To evaluate unilateral external fixation when applied as the standard treatment of children with displaced femoral shaft fractures. Setting Two county hospitals in central Sweden. Design A consecutive and prospective study including all children aged 3 to 15 years with displaced femoral fractures admitted to either of the two hospitals. Patients were followed clinically and radiographically until healing and at 1 year. Results A total of 96 children with 98 fractures were treated with the same kind of external fixator during the period 1993–2000. The mean age was 8.1 years (range 3–15 years). Average hospital stay was 8.7 days (median 7 days). Average time of external fixation was 61 days (range 37–127 days; median 56 days). Minor complications included pin track inflammation/infection in 36 of 98 (37%) fractures. In 18 of 36 fractures, a short treatment with oral antibiotics was given. Other minor complications were one heterotopic ossification, one patient with two rereductions, nine cases of clinically insignificant malunion (varus = valgus > 5° or procurvatum > 10°), and one leg-length discrepancy greater than 2 cm. Major complications (6%) included two refractures, one through a pinhole and one at the fracture site, both after significant trauma. Three of the older children with transverse fractures after high-energy injury developed a bending due to premature removal of the fixator prior to healing and required corrective osteotomies. One boy had a third rereduction because of displacement after a fall. Conclusions The use of external fixation as a standard treatment of uncomplicated displaced femoral shaft fractures in children gave satisfactory results. The surgical learning curve was short, and the advantages compared with nonsurgical treatment included shorter hospital stay, early mobilization, and fewer days out of school for the patient and out of work for the caregiver. We believe that the advantages far outweigh the complications, many of which can be avoided.

Fixation of femoral neck fractures: comparison of the Uppsala and von Bahr screws

In a prospective randomized study, a newly developed so-called Uppsala technique for internal fixation of femoral neck fractures was compared with the von Bahr technique. The series consisted of 222 consecutive patients, 167 women and 55 men, with a mean age of 80 years. Half of the patients were randomized to each treatment group. During the first postoperative year, 18 failures occurred in the Uppsala group, compared with 39 in the von Bahr group (P less than 0.01). Of 128 patients without pain at 4 months, 9 developed failures, compared with 29 of the 37 that had pain at this time (P less than 0.001). We conclude that the new technique gives better results during the first postoperative year and that most failures occur among those with pain at 4 months. Follow-up radiography is indicated only in patients with pain at 4 months.

Treatment of intertrochanteric fractures: comparison of Ender nails and sliding screw plates.

The results of two fixation devices for the treatment of intertrochanteric fractures were compared in 220 patients 163 women and 57 men with a mean age of 81 ± 10 years. One hundred and one patients were randomized to Ender nailing and 119 to fixation with a sliding screw plate (SSP). The two treatment groups were equal with respect to important preinjury variables. The two methods did not differ in operating time or perioperative blood loss. The proportions of good reduction of the fractures and of good positioning of the internal fixation devices were equal in the two groups. But the complication rate and the reoperation rate were more than twice as high in the Ender group than in the SSP group. The outcome at 1-year follow-up was approximately equal in the two groups.

The stability of femoral neck fractures and its influence on healing.

We measured the stability of fixation in femoral neck fractures treated with von Bahr screws, investigated the influence of impaction and correlated peroperative stability with the clinical results. Stability was measured at operation using a metal probe fitted with strain gauges. Its tip was anchored in the subchondral bone of the femoral head and its lateral end was fixed in the lateral femoral cortex. The shearing force produced by longitudinal compression applied to the foot of the operated leg was recorded. The results in 41 consecutive patients all followed for 30 months, showed that fractures with early loosening or nonunion had all had significantly poorer stability than the fractures that had healed. Impaction improved stability in only 23 out of the 41 fractures; in the others stability had deteriorated or was unchanged.

Incidence of hip fractures in the elderly: Uppsala County 1980–1987

The age-, sex-, and fracture-type-specific annual incidence of hip fracture in patients over 55 years of age in Uppsala County were computed for the years 1980 to 1987. The number of fractures increased by less than 2 percent annually. The increase was mainly due to age changes in the population. The overall increase in specific incidence rates was approximately 1 percent; and most age, sex, and fracture-type groups demonstrated an unaltered incidence. Cervical fractures in women 55 to 64 and 75 to 84 years of age decreased in specific incidence.

Uppsala screw fixation versus the von Bahr technique in displaced cervical hip fractures: preliminary report.

A study of 75 patients with displaced cervical hip fractures was done utilizing two different multiple pinning techniques with threaded screws. One was the refined method of internal fixation by which the strongest bone of the femoral head was utilized to increase the stability of the fracture, and the other was the von Bahr method. As much as possible, other factors influencing healing were standardized in both groups. Forty-three of the patients were treated with the refined method and 32 with the von Bahr method. Complications occurred in 5 of 43 patients in the group treated with the new method, compared with 12 of 32 patients in the von Bahr group. Early redisplacement and nonunion were more common in the von Bahr group. Late segmental collapse was the same in both groups. In our opinion the early complications of redisplacement and nonunion are due to poor stability of the fracture. With the new, refined method, it is possible to reduce these complications.

Back pain and arthralgia before and after leg lengthening: 75 patients questioned after 6 (1-11) years

We performed 100 lengthenings of the lower extremities in 85 patients from 1980 to 1991, using three different surgical techniques. 6 (1-11) years after lengthening 75 of these patients with a preoperative leg length inequality of 6 (3-14) cm were clinically and radiographically assessed, and replied to a questionnaire on pre- and postoperative complaints of low back pain and pain from the joints of the lower extremities. Patients 15 years of age or younger at surgery had few complaints. Before lengthening, 18 patients suffered from severe low back pain compared with 6 at follow-up. Complaints from the joints of the lower extremities were less common and the effect of lengthening on these symptoms was minor. The ability to work, walk and to perform recreational activities was improved. 60 patients were satisfied with the result of the lengthening.

Oral cefadroxil prophylaxis in hip fracture surgery: Serum concentrations studied in 17 patients

Serum concentration-time curves were determined in seventeen 82 (60-90) year-old patients undergoing trochanteric hip fracture surgery after receiving 1 g of cefadroxil per os. All the patients attained a serum level of antibiotic high enough to inhibit the growth of Staphylococcus aureus and S. epidermidis. When orally administered, cefadroxil should be given within 2 hours before surgery.

Arthrography in Legg-Calvé-Perthes Disease: Evaluation of Lateral Subluxations

Plain radiographs and arthrograms were taken of 76 hips with Legg-Calvé-Perthes disease. The occurrence of lateral subluxation as seen in the plain radiographs was compared with that found at arthrography. In 43 of the 76 hips, the femoral head was found to be subluxated in both plain radiographs and at arthrography. In the remaining 33 hips, plain radiographs could not verify any subluxation, but arthrography showed subluxation in 32 of these 33 hips.