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Chapter: Orthopaedics

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Orthopaedics: Femur

1. Femoral Diaphysis Fracture 2. Distal Femoral Fracture

Femur

 

Femoral Diaphysis Fracture

 

Mechanism

·                 high energy trauma (MVA, fall from height, gunshot wound)

·                 in children, can result from low energy trauma (spiral fracture)

 

Clinical Features

·                 shortened, externally rotated leg (if fracture displaced)

·                 inability to weight-bear

·                 often open injury, always a Gustilo III

 

Investigations

·                 AP pelvis, AP/lateral hip, femur, knee

 

Specific Complications

·                 hemorrhage requiring transfusion

·                 fat embolism leading to ARDS

·                 extensive soft tissue damage

·                 ipsilateral hip dislocation/fracture

·                 nerve injury

 

Treatment

·                 stabilize patient

·                 immobilize leg

·                 ORIF with intramedullary nail, external fixator, or plate and screws within 24 hours

·                 early mobilization and strengthening

 

Distal Femoral Fracture

 

Mechanism

·                 direct high energy force or axial loading

·                 three types (Figure 37)

 

Clinical Features

·                 direct high energy force or axial loading

·                 extreme pain

·                 knee effusion (hemarthrosis)

·                 shortened, externally rotated leg ifdisplaced

 

Treatment

·                 ORIF

·                 early mobilization and strengthening

 

Complications (see General Fracture Complications)

·                 femoral artery tear

·                 nerve injury

·                 eDensl.ve soft tissue injury

·                 angulation deformities

 

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