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FRACTURE SHAFT OF FEMUR

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FRACTURE SHAFT OF FEMUR

FRACTURE SHAFT OF FEMUR

  • One of the major long bone fractures.
  • The narrowest portion of the shaft is known as isthmus.
  • The bone is highly vascular.
  • Surrounded all round by strong muscles of the thigh.
  • Heavy blood loss up to 1.5 liters can occur.
  • Patient may go in for hypovolemic shock. 

Mechanism of Injury

  • May occur in a road accident.
  • The force causing the fracture may be:
  1. Indirect (twisting or bending force) or
  2. Direct (traffic accidents)

PATHOANATOMY

  • The fracture may occur at any site.
  • Common in the upper, middle and lower thirds of the shaft.
  • Types of Fracture Femur
  1. Transverse fracture
  2. Oblique fracture
  3. Spiral fracture
  4. Comminuted fracture
  5. Segmental fracture

Clinical features:

  • History of severe violence.
  • Classic signs of fracture in the region of the thigh:
  1. Pain
  2. swelling
  3. Deformity
  4. abnormal mobility etc
  • Diagnosis is not difficult.

Radiological examination:

  • X-rays done for a femoral shaft fracture must include the whole femur.
  • In addition, an X-ray of the pelvis should be done.
  • X-rays help in identifying the type and level of fracture
  • As well as the diameter of the medullary canal.

Investigations

  1. Hb%,
  2. PCV and
  3. blood grouping and cross-matching is a must

TREATMENT

Conservative methods:

1. Traction

  • Treated by traction, with or without a splint.
  • Usually a Thomas splint is used.

2. Hip spica

  • This is a plaster cast incorporating part of the trunk and the limb.
  • It may be a single spica or one-and-a-half. 

Operative methods:

  • Intra-medullary nailing is the preferred method. 

  • The fracture may be reduced by closed or open methods.
  1. Closed Interlock nailing
  2. Plating (fixing with a thick strip of metal) 

DECIDING TREATMENT PLAN

  • In children, treatment is mostly by non-operative methods.
  • The technique of traction varies in different age groups.
1. From birth to 2 years:
  • Treated by Gallow’s traction.  

2. From 2 years to 16 years:
  • Conservative treatment.
  • Different methods of traction are used (Russel traction).
  • In older children (more than 10 yrs. of age), TENS (Titanium Elastic Nail System) nails are used.

COMPLICATIONS

EARLY COMPLICATIONS:

  1. Shock
  2. Fat embolism
  3. Injury to femoral artery
  4. Injury to sciatic nerve
  5. Infection

LATE COMPLICATIONS:

  1. Delayed union
  2. Non-union
  3. Malunion
  4. Knee stiffness

Exam Important

  • Thomas splint is used for immobilizing fractures of Femur.
  • Fracture shaft of femur in adult unites by 3 to 4 months.
  • Fracture shaft of femur in children of less than 2 years old is treated by Gallow’s traction.
  • Best way to treat a fracture neck of femur in a child is Hip Spica in abduction and internal rotation.
  • Treatment of shaft femur fracture in a 3 years old boy by Russel traction.
  • Best treatment of 3 weeks old, fracture shaft femur with nonunion is Bone graft with internal fixation.
  • Treatment of Non-union of # shaft femur Bone grafting with internal fixation with K-Nail.
  • Treatment of choice for old non-united fracture of shaft of femur is Compression plating with bone grafting.
  • Intramedullary fixation is ideal in a case of fracture of shaft of femur when there is A transverse fracture.
  • Fracture of femur at the level of isthmus is best treated by Intramedullary nail fixation.
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