Aeroembolism of Bone Marrow

Colonna, Paul

doi:10.1001/archsurg.1948.01240010166006

Cited by 14 publications

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References 7 publications

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“…They have advocated the insertion of a prosthesis or an arthrodesis of the hip. 15 patients were treated by various types of resection of the femoral head-these included Colonna's method and Wilson's modification of this procedure covering the greater trochanter by a metal cup (Colonna, 1935;Wilson, 1947).…”

Section: Review Of Cases Of Non-umon Of Femoralmentioning

confidence: 99%

Ununited Fracture of the Neck of Femur

1960

Proceedings of the Royal Society of Medicine

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Paris NON-UNION (or pseudarthrosis) of the fractured femoral neck can be divided into three main groups:(1) Those cases in which the fragments are normal, provided with an adequate blood supply.In these, non-union is due to absence of treatment, lack of reduction or lack of immobilization. Union can be obtained by simple means, i.e. adequate reduction and fixation of the fracture even if this has been delayed for six months or more.(2) Those cases where the proximal fragment is deprived by the fracture of its blood supply. Bony union can be obtained by adequate reduction and fixation but the necrotic femoral head is liable to collapse after weight-bearing even after bony union of the fracture has been obtained. This may occur many months or even years after union of the fracture.(3) Cases where a second fracture occurs after the onset of the aseptic necrosis of the femoral head. For example, a trochanteric fracture united after nailing but one year later a spontaneous subcapital fracture occurred.This second fracture occurred when the line of new blood vessels to the necrotic proximal fragment had reached the fragile subcapital region. Similarly on careful examination some radiographs of cases of non-union with displacement after treatment by nailing or screwing may show that the ununited fracture is proximal to the original one. Here one may be certain that the femoral head is necrotic and the pseudarthrosis a severe one.About half of all the fractures of the femoral neck treated by the old conservative method of plaster immobilization resulted in bony union after accurate reduction; the remainder ended in fibrous union, sometimes firm, or non-union.Operative fixation of this fracture gives successful bony union in about 55% within 3 months with a normal hip. About 20 % result in delayed union often with shortening of the femoral neck and late pain due to deformation of the femoral head. In about 10% early displacement of the fracture occurs and in 15 % late displacement occurs, generally due to a JUNE pathological fracture through the line of "creeping substitution." These last two groups of non-union are the most difficult to treat.It is possible that causes other than faulty treatment or aseptic necrosis are responsible for non-union in fractures of the femoral neck. Harrold, 1959, has shown the presence of an anticoagulant substance in synovial fluid which prevents the formation of blood clot necessary for the development of callus.Most writers consider that lack of adequate blood supply to the femoral head is the main cause of non-union in fractures of the neck of that bone. They believe that this is the chief factor influencing prognosis and the choice of operative procedure. On this assumption we have treated some cases with preservation of the femoral head and others by its removal. Results show that we have preserved some necrotic heads; possibly we have removed some living ones. REVIEW OF CASES OF NON-UmON OF FEMORALNECK FRACTURES 306 cases have been reviewed, which include all those treated in the pa...

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Section: Review Of Cases Of Non-umon Of Femoralmentioning

confidence: 99%