Download PDF
Semin Musculoskelet Radiol 2019; 23(02): e1-e19
DOI: 10.1055/s-0039-1681048
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Hatice Tuba Sanal
1   Department of Radiology, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
,
Christina Boulton
2   Department of Orthopaedics, Banner Health and the University of Arizona-Tucson, Tucson, Arizona
,
Cagri Neyisci
3   Department of Orthopedics and Traumatology, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
,
Yusuf Erdem
3   Department of Orthopedics and Traumatology, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
,
Jason Lowe
2   Department of Orthopaedics, Banner Health and the University of Arizona-Tucson, Tucson, Arizona
› Author Affiliations
Further Information

Publication History

Publication Date:
29 March 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Good outcomes following treatment of pelvic ring injuries, acetabular fractures, and femur fractures rely on restoration of native pelvic or limb alignment, anatomical reduction and rigid stability of articular fractures, and early postoperative mobilization. Multiple surgical approaches, reduction aids, and orthopaedic implants are available to stabilize these fractures. Despite best practices, complications including hardware failure, nonunions, malunions, and infections occur. This article discusses common fracture classification systems, implants, and imaging findings associated with unwanted complications in fractures of the pelvis, acetabulum, and femur.

Keywords

pelvis - acetabulum fracture - femur fracture - external fixation - internal fixation
 

  • References

  • 1 Taljanovic MS, Jones MD, Ruth JT, Benjamin JB, Sheppard JE, Hunter TB. Fracture fixation. Radiographics 2003; 23 (06) 1569-1590
    CrossrefPubMedGoogle Scholar
  • 2 Wong JM, Bucknill A. Fractures of the pelvic ring. Injury 2017; 48 (04) 795-802
    CrossrefPubMedGoogle Scholar
  • 3 Gabbe BJ, de Steiger R, Esser M, Bucknill A, Russ MK, Cameron PA. Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury 2011; 42 (10) 985-991
    CrossrefPubMedGoogle Scholar
  • 4 Dalal SA, Burgess AR, Siegel JH. , et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989; 29 (07) 981-1000 ; discussion 1000–1002
    CrossrefPubMedGoogle Scholar
  • 5 Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986; 160 (02) 445-451
    CrossrefPubMedGoogle Scholar
  • 6 Alton TB, Gee AO. Classifications in brief: Young and Burgess classification of pelvic ring injuries. Clin Orthop Relat Res 2014; 472 (08) 2338-2342
    CrossrefPubMedGoogle Scholar
  • 7 Ben-Menachem Y. Delayed, exsanguinating pelvic hemorrhage after blunt trauma without bony fracture: case report. J Trauma 1991; 31 (07) 1018
    CrossrefPubMedGoogle Scholar
  • 8 Heetveld MJ, Harris I, Schlaphoff G, Balogh Z, D'Amours SK, Sugrue M. Hemodynamically unstable pelvic fractures: recent care and new guidelines. World J Surg 2004; 28 (09) 904-909
    CrossrefPubMedGoogle Scholar
  • 9 Borrelli Jr J, Koval KJ, Helfet DL. Operative stabilization of fracture dislocations of the sacroiliac joint. Clin Orthop Relat Res 1996; (329) 141-146
    PubMedGoogle Scholar
  • 10 Tile M, Hearn T, Vrahas MS. Biomechanics. In: Fractures of the Pelvis and Acetabulum. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003: 32-45
    Google Scholar
  • 11 McMurtry R, Walton D, Dickinson D, Kellam J, Tile M. Pelvic disruption in the polytraumatized patient: a management protocol. Clin Orthop Relat Res 1980; (151) 22-30
    PubMedGoogle Scholar
  • 12 Khurana B, Sheehan SE, Sodickson AD, Weaver MJ. Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics 2014; 34 (05) 1317-1333
    CrossrefPubMedGoogle Scholar
  • 13 Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol 2008; 191 (04) 995-1001
    CrossrefPubMedGoogle Scholar
  • 14 Gardner MJ, Routt Jr ML. Transiliac-transsacral screws for posterior pelvic stabilization. J Orthop Trauma 2011; 25 (06) 378-384
    CrossrefPubMedGoogle Scholar
  • 15 Routt Jr ML, Simonian PT, Swiontkowski MF. Stabilization of pelvic ring disruptions. Orthop Clin North Am 1997; 28 (03) 369-388
    PubMedGoogle Scholar
  • 16 Routt Jr ML, Kregor PJ, Simonian PT, Mayo KA. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma 1995; 9 (03) 207-214
    CrossrefPubMedGoogle Scholar
  • 17 Lucas JF, Routt Jr ML, Eastman JG. A useful preoperative planning technique for transiliac-transsacral screws. J Orthop Trauma 2017; 31 (01) e25-e31
    CrossrefPubMedGoogle Scholar
  • 18 Eastman JG, Krieg JC, Routt Jr ML. Early failure of symphysis pubis plating. Injury 2016; 47 (08) 1707-1712
    CrossrefPubMedGoogle Scholar
  • 19 Starr AJ, Nakatani T, Reinert CM, Cederberg K. Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure?. J Orthop Trauma 2008; 22 (02) 81-87
    CrossrefPubMedGoogle Scholar
  • 20 Vaidya R, Woodbury D, Nasr K. Anterior subcutaneous internal pelvic fixation/INFIX: a systemic review. J Orthop Trauma 2018; 32 (Suppl. 06) S24-S30
    PubMedGoogle Scholar
  • 21 Vaidya R, Kubiak EN, Bergin PF. , et al. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res 2012; 470 (08) 2124-2131
    CrossrefPubMedGoogle Scholar
  • 22 Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury 2004; 35 (07) 671-677
    CrossrefPubMedGoogle Scholar
  • 23 Tucker MC, Nork SE, Simonian PT, Routt Jr ML. Simple anterior pelvic external fixation. J Trauma 2000; 49 (06) 989-994
    CrossrefPubMedGoogle Scholar
  • 24 Lee C, Sciadini M. The use of external fixation for the management of the unstable anterior pelvic ring. J Orthop Trauma 2018; 32 (Suppl. 06) S14-S17
    PubMedGoogle Scholar
  • 25 Collinge C, Coons D, Aschenbrenner J. Risks to the superior gluteal neurovascular bundle during percutaneous iliosacral screw insertion: an anatomical cadaver study. J Orthop Trauma 2005; 19 (02) 96-101
    CrossrefPubMedGoogle Scholar
  • 26 Mason WT, Khan SN, James CL, Chesser TJ, Ward AJ. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury 2005; 36 (05) 599-604
    CrossrefPubMedGoogle Scholar
  • 27 Kim WY, Hearn TC, Seleem O, Mahalingam E, Stephen D, Tile M. Effect of pin location on stability of pelvic external fixation. Clin Orthop Relat Res 1999; (361) 237-244
    PubMedGoogle Scholar
  • 28 Mendel T, Radetzki F, Wohlrab D, Stock K, Hofmann GO, Noser H. CT-based 3-D visualisation of secure bone corridors and optimal trajectories for sacroiliac screws. Injury 2013; 44 (07) 957-963
    CrossrefPubMedGoogle Scholar
  • 29 Mendel T, Noser H, Kuervers J, Goehre F, Hofmann GO, Radetzki F. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation. Injury 2013; 44 (12) 1773-1779
    CrossrefPubMedGoogle Scholar
  • 30 Reilly MC, Bono CM, Litkouhi B, Sirkin M, Behrens FF. The effect of sacral fracture malreduction on the safe placement of iliosacral screws. J Orthop Trauma 2003; 17 (02) 88-94
    CrossrefPubMedGoogle Scholar
  • 31 Miller AN, Krieg JC, Chip Routt Jr ML. Lateral sacral imaging in the morbidly obese. J Orthop Trauma 2013; 27 (05) e122-e124
    CrossrefPubMedGoogle Scholar
  • 32 Herman A, Keener E, Dubose C, Lowe JA. Simple mathematical model of sacroiliac screws safe-zone-Easy to implement by pelvic inlet and outlet views. J Orthop Res 2017; 35 (07) 1478-1484
    CrossrefPubMedGoogle Scholar
  • 33 Morris SAC, Loveridge J, Smart DKA, Ward AJ, Chesser TJ. Is fixation failure after plate fixation of the symphysis pubis clinically important?. Clin Orthop Relat Res 2012; 470 (08) 2154-2160
    CrossrefPubMedGoogle Scholar
  • 34 Metz RM, Bledsoe JG, Moed BR. Does posterior fixation of partially unstable open-book pelvic ring injuries decrease symphyseal plate failure? A biomechanical study. J Orthop Trauma 2018; 32 (Suppl. 01) S18-S24
    PubMedGoogle Scholar
  • 35 Kim JW, Oh CW, Oh JK. , et al. The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury. Arch Orthop Trauma Surg 2016; 136 (07) 921-927
    CrossrefPubMedGoogle Scholar
  • 36 Collinge C, Archdeacon MT, Dulaney-Cripe E, Moed BR. Radiographic changes of implant failure after plating for pubic symphysis diastasis: an underappreciated reality?. Clin Orthop Relat Res 2012; 470 (08) 2148-2153
    CrossrefPubMedGoogle Scholar
  • 37 Scheinfeld MH, Dym AA, Spektor M, Avery LL, Dym RJ, Amanatullah DF. Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics 2015; 35 (02) 555-577
    CrossrefPubMedGoogle Scholar
  • 38 Vrahas MS, Widding KK, Thomas KA. The effects of simulated transverse, anterior column, and posterior column fractures of the acetabulum on the stability of the hip joint. J Bone Joint Surg Am 1999; 81 (07) 966-974
    CrossrefPubMedGoogle Scholar
  • 39 McNamara AR, Boudreau JA, Moed BR. Nonoperative treatment of posterior wall acetabular fractures after dynamic stress examination under anesthesia: revisited. J Orthop Trauma 2015; 29 (08) 359-364
    CrossrefPubMedGoogle Scholar
  • 40 Moed BR, Ajibade DA, Israel H. Computed tomography as a predictor of hip stability status in posterior wall fractures of the acetabulum. J Orthop Trauma 2009; 23 (01) 7-15
    CrossrefPubMedGoogle Scholar
  • 41 Ohashi K, El-Khoury GY, Abu-Zahra KW, Berbaum KS. Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary?. Radiology 2006; 241 (02) 386-391
    CrossrefPubMedGoogle Scholar
  • 42 Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res 1980; (151) 81-106
    PubMedGoogle Scholar
  • 43 Firoozabadi R, Hamilton B, Toogood P, Routt MC, Shearer D. Risk factors for conversion to total hip arthroplasty after acetabular fractures involving the posterior wall. J Orthop Trauma 2018; 32 (12) 607-611
    CrossrefPubMedGoogle Scholar
  • 44 Gavaskar AS, Gopalan H, Karthik B, Srinivasan P, Tummala NC. Delayed total hip arthroplasty for failed acetabular fractures: the influence of initial fracture management on outcome after arthroplasty. J Arthroplasty 2017; 32 (03) 872-876
    CrossrefPubMedGoogle Scholar
  • 45 Moed BR. The modified Gibson posterior surgical approach to the acetabulum. J Orthop Trauma 2010; 24 (05) 315-322
    CrossrefPubMedGoogle Scholar
  • 46 Tannast M, Najibi S, Matta JM. Two- to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am 2012; 94 (17) 1559-1567
    CrossrefPubMedGoogle Scholar
  • 47 Firoozabadi R, Cross WW, Krieg JC, Routt MLC. Acetabular fractures in the senior population—epidemiology, mortality and treatments. Arch Bone Jt Surg 2017; 5 (02) 96-102
    PubMedGoogle Scholar
  • 48 Yue JJ, Sontich JK, Miron SD. , et al. Blood flow changes to the femoral head after acetabular fracture or dislocation in the acute injury and perioperative periods. J Orthop Trauma 2001; 15 (03) 170-176
    CrossrefPubMedGoogle Scholar
  • 49 Sagi HC, Dziadosz D, Mir H, Virani N, Olson C. Obesity, leukocytosis, embolization, and injury severity increase the risk for deep postoperative wound infection after pelvic and acetabular surgery. J Orthop Trauma 2013; 27 (01) 6-10
    CrossrefPubMedGoogle Scholar
  • 50 Owen MT, Keener EM, Hyde ZB. , et al. Intraoperative topical antibiotics for infection prophylaxis in pelvic and acetabular surgery. J Orthop Trauma 2017; 31 (11) 589-594
    CrossrefPubMedGoogle Scholar
  • 51 Kellam P, Ostrum RF. Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma 2016; 30 (01) 10-16
    CrossrefPubMedGoogle Scholar
  • 52 Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am 1951; 33-A (03) 746-778 , passim
    PubMedGoogle Scholar
  • 53 Hougaard K, Thomsen PB. Traumatic posterior dislocation of the hip—prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orthop Trauma Surg 1986; 106 (01) 32-35
    CrossrefPubMedGoogle Scholar
  • 54 Beebe MJ, Bauer JM, Mir HR. Treatment of hip dislocations and associated injuries: current state of care. Orthop Clin North Am 2016; 47 (03) 527-549
    CrossrefPubMedGoogle Scholar
  • 55 Epstein HC. Traumatic dislocations of the hip. Clin Orthop Relat Res 1973; (92) 116-142
    PubMedGoogle Scholar
  • 56 Pipkin G. Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am 1957; 39-A (05) 1027-1042 , passim
    PubMedGoogle Scholar
  • 57 Goddard NJ. Classification of traumatic hip dislocation. Clin Orthop Relat Res 2000; (377) 11-14
    PubMedGoogle Scholar
  • 58 Mandell JC, Marshall RA, Weaver MJ, Harris MB, Sodickson AD, Khurana B. Traumatic hip dislocation: what the orthopedic surgeon wants to know. Radiographics 2017; 37 (07) 2181-2201
    CrossrefPubMedGoogle Scholar
  • 59 Uzel AP, Bertino R, Daculsi G, Laflamme GY. Irreducible traumatic posterior hip dislocation with entrapment and a buttonhole effect. Chin J Traumatol 2011; 14 (06) 367-370
    PubMedGoogle Scholar
  • 60 Mehta S, Routt Jr ML. Irreducible fracture-dislocations of the femoral head without posterior wall acetabular fractures. J Orthop Trauma 2008; 22 (10) 686-692
    CrossrefPubMedGoogle Scholar
  • 61 Cornwall R, Radomisli TE. Nerve injury in traumatic dislocation of the hip. Clin Orthop Relat Res 2000; (377) 84-91
    PubMedGoogle Scholar
  • 62 Mittal R, Banerjee S. Proximal femoral fractures: principles of management and review of literature. J Clin Orthop Trauma 2012; 3 (01) 15-23
    PubMedGoogle Scholar
  • 63 Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med 2017; 377 (21) 2053-2062
    CrossrefPubMedGoogle Scholar
  • 64 Sheehan SE, Shyu JY, Weaver MJ, Sodickson AD, Khurana B. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics 2015; 35 (05) 1563-1584
    CrossrefPubMedGoogle Scholar
  • 65 Koval KJ, Zuckerman JD. Hip fractures: I. Overview and evaluation and treatment of femoral-neck fractures. J Am Acad Orthop Surg 1994; 2 (03) 141-149
    CrossrefPubMedGoogle Scholar
  • 66 Koval KJ, Zuckerman JD. Hip fractures: II. Evaluation and treatment of intertrochanteric fractures. J Am Acad Orthop Surg 1994; 2 (03) 150-156
    CrossrefPubMedGoogle Scholar
  • 67 Garden RS. Stability and union in subcapital fractures of the femur. J Bone Joint Surg Br 1964; 46: 630-647
    PubMedGoogle Scholar
  • 68 Bartonícek J. Pauwels' classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 2001; 15 (05) 358-360
    CrossrefPubMedGoogle Scholar
  • 69 Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br 1949; 31B (02) 190-203
    PubMedGoogle Scholar
  • 70 Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand 1980; 51 (05) 803-810
    CrossrefPubMedGoogle Scholar
  • 71 Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am 2004; 35 (04) 473-483
    CrossrefPubMedGoogle Scholar
  • 72 Balach T, Baldwin PC, Intravia J. Atypical femur fractures associated with diphosphonate use. J Am Acad Orthop Surg 2015; 23 (09) 550-557
    CrossrefPubMedGoogle Scholar
  • 73 Craig JG, Moed BR, Eyler WR, van Holsbeeck M. Fractures of the greater trochanter: intertrochanteric extension shown by MR imaging. Skeletal Radiol 2000; 29 (10) 572-576
    CrossrefPubMedGoogle Scholar
  • 74 Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J 2017; 99-B (01) 128-133
    CrossrefPubMedGoogle Scholar
  • 75 Bhandari M, Devereaux PJ, Swiontkowski MF. , et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am 2003; 85-A (09) 1673-1681
    PubMedGoogle Scholar
  • 76 Bhandari M, Schemitsch E, Jönsson A, Zlowodzki M, Haidukewych GJ. Gamma nails revisited: gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: a meta-analysis. J Orthop Trauma 2009; 23 (06) 460-464
    CrossrefPubMedGoogle Scholar
  • 77 Kuzyk PR, Bhandari M, McKee MD, Russell TA, Schemitsch EH. Intramedullary versus extramedullary fixation for subtrochanteric femur fractures. J Orthop Trauma 2009; 23 (06) 465-470
    CrossrefPubMedGoogle Scholar
  • 78 Bhandari M, Tornetta III P, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws?. J Orthop Trauma 2009; 23 (06) 403-407
    CrossrefPubMedGoogle Scholar
  • 79 Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD. , et al. Complications after hip nailing for fractures. Orthopedics 2016; 39 (01) e108-e116
    CrossrefPubMedGoogle Scholar
  • 80 Babcock S, Kellam JF. Hip fracture nonunions: diagnosis, treatment, and special considerations in elderly patients. Adv Orthop 2018; 2018: 1912762
    PubMedGoogle Scholar
  • 81 Arneson TJ, Melton III LJI, Lewallen DG, O'Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965–1984. Clin Orthop Relat Res 1988; (234) 188-194
    PubMedGoogle Scholar
  • 82 Winquist RA, Hansen Jr ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 1984; 66 (04) 529-539
    CrossrefPubMedGoogle Scholar
  • 83 Tornetta III P, Kain MS, Creevy WR. Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol. J Bone Joint Surg Am 2007; 89 (01) 39-43
    CrossrefPubMedGoogle Scholar
  • 84 Swiontkowski MF, Hansen Jr ST, Kellam J. Ipsilateral fractures of the femoral neck and shaft. A treatment protocol. J Bone Joint Surg Am 1984; 66 (02) 260-268
    CrossrefPubMedGoogle Scholar
  • 85 Wolinsky PR, Johnson KD. Ipsilateral femoral neck and shaft fractures. Clin Orthop Relat Res 1995; (318) 81-90
    PubMedGoogle Scholar
  • 86 Brumback RJ, Ellison Jr PS, Poka A, Lakatos R, Bathon GH, Burgess AR. Intramedullary nailing of open fractures of the femoral shaft. J Bone Joint Surg Am 1989; 71 (09) 1324-1331
    CrossrefPubMedGoogle Scholar
  • 87 Pape HC, Hildebrand F, Pertschy S. , et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma 2002; 53 (03) 452-461 ; discussion 461–462
    CrossrefPubMedGoogle Scholar
  • 88 Pape HC, Rixen D, Morley J. , et al; EPOFF Study Group. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg 2007; 246 (03) 491-499 ; discussion 499–501
    CrossrefPubMedGoogle Scholar
  • 89 Tornetta III P, Tiburzi D. Antegrade or retrograde reamed femoral nailing. A prospective, randomised trial. J Bone Joint Surg Br 2000; 82 (05) 652-654
    PubMedGoogle Scholar
  • 90 Ricci WM, Bellabarba C, Evanoff B, Herscovici D, DiPasquale T, Sanders R. Retrograde versus antegrade nailing of femoral shaft fractures. J Orthop Trauma 2001; 15 (03) 161-169
    CrossrefPubMedGoogle Scholar
  • 91 Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am 2000; 82 (06) 781-788
    PubMedGoogle Scholar
  • 92 Bucholz RW, Jones A. Fractures of the shaft of the femur. J Bone Joint Surg Am 1991; 73 (10) 1561-1566
    CrossrefPubMedGoogle Scholar
  • 93 Brumback RJ, Ellison TS, Molligan H, Molligan DJ, Mahaffey S, Schmidhauser C. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am 1992; 74 (10) 1450-1455
    CrossrefPubMedGoogle Scholar
  • 94 Ricci WM, Gallagher B, Haidukewych GJ. Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 2009; 17 (05) 296-305
    CrossrefPubMedGoogle Scholar
  • 95 Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res 2013; 99 (03) 353-360
    CrossrefPubMedGoogle Scholar
  • 96 Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37 (08) 691-697
    CrossrefPubMedGoogle Scholar
  • 97 Train JS, Hermann G. Lipohemarthrosis: its occurrence with occult cortical fracture of the knee. Orthopedics 1980; 3 (05) 416-418
    PubMedGoogle Scholar
  • 98 Ehlinger M, Adam P, Arlettaz Y. , et al. Minimally-invasive fixation of distal extra-articular femur fractures with locking plates: limitations and failures. Orthop Traumatol Surg Res 2011; 97 (06) 668-674
    CrossrefPubMedGoogle Scholar
  • 99 Acharya KN, Rao MR. Retrograde nailing for distal third femoral shaft fractures: a prospective study. J Orthop Surg (Hong Kong) 2006; 14 (03) 253-258
    CrossrefPubMedGoogle Scholar
  • 100 Virkus WW, Kempton LB, Sorkin AT, Gaski GE. Intramedullary nailing of periarticular fractures. J Am Acad Orthop Surg 2018; 26 (18) 629-639
    CrossrefPubMedGoogle Scholar
  • 101 Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma 2010; 24 (03) 156-162
    CrossrefPubMedGoogle Scholar
  • 102 Parekh AA, Smith WR, Silva S. , et al. Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation. J Trauma 2008; 64 (03) 736-739
    CrossrefPubMedGoogle Scholar
  • 103 Rodriguez EK, Boulton C, Weaver MJ. , et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury 2014; 45 (03) 554-559
    CrossrefPubMedGoogle Scholar