Orthopaedics: Femur

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