FRACTURE SHAFT OF FEMUR

Hip Spica in abduction and internal rotation REF: Tachidjian’s pediatrics orthopedics 3ed p. 2286-300

“Hip spica is used in all patients after internal fixation under 10 year age for 6-12 weeks”

Delbet and Colonna classification of hip fractures in children

D i.e. Fat embolism is common

C i.e. Gallow’s traction

A i.e. Hip Spica and if necessary internal fixation

A i.e. Intramedullary nail fixation

A i.e. A transverse fracture

D i.e. Compression plating with bone grafting 

C i.e. Bone grafting with internal fixation with K-Nail

C i.e. 3-4 months

It is said that a fractured shaft femur should unite in 100 days, plus minus 20 (3 – 4 rnonths)Q. But nonunion is probably best defined by a lack of progression of healing combined with clinical symptoms of discomfort at a minimum of 6 months from the time of treatment. Further, a nonunion implies that healing is considered unlikely without further intervention.

Ans. is ‘a’ i.e., Femur

• Thomas splint most commonly used for fractures of the femur 

Splints

• Any material which is used to support a fracture is called splint.
• Splints are used for immobilizing fractures; either temporarily during transportation or for definitive treatment.
• The most commonly employed splints is plaster of paris (POP) splint. Various POP splints are:-

1) Casts : – Here the POP roll completely encircles the limb.

2) Slab : – It is not completely encircles the limb, but only one half or one third circumference.

3) Spica : – This encircles a part of the body; e.g., hip spica for fractures around hip.

Ans. is ‘b’ i.e., Russel traction

In children, conservative treatment is given by:-

• 0-2 yeas:- Plaster spica or modified Bryant or Gallov/s traction or pavllic harness (< 6 month of age).
• 2-10 years:- Split Russel traction.
• 10-15 years:- 90-90′ femoral skeletal traction

Ans. is ‘c’ i.e., Fat embolism

This patient in question has femur fracture has developed classical triad of fat embolism :-

1. Respiratory symptom :- Tachypnea
2. Neurological symptom :- Disorientation
3. Petechial rash :- Conjunctivalpetechiae

• So, the most probable diagnosis is fat embolism syndrome.

• A hip spica cast is a sort of orthopedic cast used to immobilize the hip or thigh. It is used to facilitate the healing of injured hip joints or fractured femurs. A hip spica includes the trunk of the body and one or both legs.
• A hip spica that covers only one leg to the ankle or foot may be referred to as a single hip spica, while one which covers both legs is called a double hip spica.
• A one-and-a-half hip spica encases one leg to the ankle or foot and the other to just above the knee. The extent to which the hip spica covers the trunk depends greatly on the injury and the surgeon; the spica may extend only to the navel, allowing mobility of the spine and the possibility of walking with the aid of crutches or may extend to the rib cage or even to the armpits in some rare cases. Hip spicas were formerly common in reducing femoral fractures, but today is rarely used except for congenital hip dislocations, and then mostly while the child is still an infant

Ans. c. Intubation

Thefirst priority in management of a case of head injury with openfracture of shaft of femur is Intubation.
“Ensuring an adequate airway is thefitst priority in the primary sarvey of trauma

Ans. c. Fracture shaft of femur

Russel’s traction or Thomas splint is used for fracture shaft femur in older children.

Gallow’s Traction

• Gallow’s traction is used for treatment of fracture shaft of femur, in infants and children <2 years of ageQ.
• Weight must not be >12 kgs
• Both the fractured and the normal femur are placed in skin traction and infant is suspended by these from a special frame. The buttocks should be lifted just off the bed so that the weight of the body provides counter traction and the fracture is reduced.