Sixteen patients with a femoral fracture treated with antegrade nailing. Femoral neck fracture dr francis deng and assoc prof frank gaillard et al. It typically takes a major force to cause this type of broken leg. Femur shaft fractures broken thighbone related media. The fracture within this age range 2565 years, is only 1 in 10,000. Only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in. However, associated injuries may have some influence on method used together with the type of fracture, apart from the experience of the surgeon. The pattern of the fracture, such as the fracture of the femoral shaft can occur in different directions, e. In this type of fracture of the femoral shaft, the bone is fractured such that the fragments of the bone stick out or pierce through the skin or there is a wound that penetrates down to the fractured bone. Apr 20, 2016 fracture shaft of femur a femoral shaft fracture is a fracture of the femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle 6. Management of femoral shaft fractures acta chirurgiae. It is a fracture of femoral diaphysis occurring between 5cm distal to lesser trochanter and 5cm proximal to adductor tubercle. Femur shaft fracture an overview sciencedirect topics.
Comminuted fracture the bone has broken into three or more pieces. May 08, 2012 humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. Fracture of shaft of femur 1 fracture of shaft of femur 2. In this prospective cohort study, we evaluated clinical and radiological longterm results after operative treatment using several surgical strategies. Rti ratio may be a valid tool for estimating femur. Epidemiology, fracture patterns, nonunions, and fatigue fractures a clinical study sari salminen academic dissertation to be presented with the permission of. Femur fracture reaming reaming of the femoral shaft fracture only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in acute femur fracture patients with pulmonary trauma in both a retrospective analysis and multiple animal studies pape, j trauma 1992. The vast majority of these fractures are due to major trauma. An assessment in children younger than 3 years old article pdf available in acta ortopedica brasileira 152 december 2006 with 71 reads how we measure reads. The most common fracture type of the femoral shaft is a noncomminuted simple ao type a, most of which, in traumatic fractures, are purely transverse and located in the middle third of the femur. Fracture mechanisms and injuries causing traumatic femoral shaft fractures.
Spiral fracture the fracture line encircles the shaft like the stripes on a candy cane. Usually occur in young men after high energy trauma and elderly women even after a low energy fall. Your thighbone femur is the longest and strongest bone in your body. Stabilization of fracture fragments using open surgical procedures to place devices, such as plateandscrew, intramedullary rods, wires, and pins and nails to reduce displacement and promote healing. Highspeed movies recorded knee joint compression, femoral displacements and deformation, and fracture initiation. The rate of associated femoral neck fracture with an established femoral shaft fracture ranges from 25% to 6% of these, up to 33% will be missed on initial injury radiographs. Because the femur is a major loadbearing bone and is the biggest in the body, untreated or inappropriately treated fractures may cause lifelong morbidity and.
Femoral shaft fractures should be put into skin traction 10% of body weight to help with pain management. Nonoperative treatment of femoral shaft fractures in adults is an exception 3. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. Injuries associated with femoral shaft fractures were very frequent 46. The burden of femoral shaft fractures in tanzania injury. The winquist classification is based on the amount of comminution. Abstract mechanisms of femoral fracture of the condyles and shaft were experimentally investigated through controlled knee impact ofdenuded femurs in six human cadavers. Injudicious rotation of the femur without properly releasing. Fracture of shaft and distal part of femoral bone prepared by. The femur is the longest and strongest bone in the body, and it takes a great deal of force to break it. This type of fracture is known as an open or compound fracture and these types of fractures commonly are associated with increased damage to the surrounding.
Femoral shaft fractures are emergent injuries that are typically a result of high energy forces or low energy falls in the elderly and are commonly associated with multisystem trauma. Insofar as no operative technique had yielded consistently better results than casting, nonsurgical treatment continues to be the preferred and most costeffective form of. Tano a, oh y, fukushima k, kurosa y, wakabayashi y, fujita k, et al. They were divided according to therapeutic approach. Femoral shaft fractures in adults article pdf available in orthopaedics and trauma 275. Surgical treatment of ipsilateral multilevel femoral fractures. Children that sustain femur fractures prior to walking age should be screened for nonaccidental. Hence management of femoral shaft fractures is often directed by comorbidities, additional injuries and the medical condition of the patient. Femoral shaft fractures are commonly thought to be primarily associated with severe trauma in young persons. Subsequent imaging in the trauma bay demonstrates a bifrontal cerebral contusion, an l4 burst fracture, multiple rib fractures, an lc1 type pelvic ring injury, a femoral shaft fracture, and an open ipsilateral tibial shaft fracture.
A lowenergy femoral shaft fracture from performing a. Ipsilateral displaced acetabular and femoral shaft fractures represent a. Because the femur is so strong, it usually takes a lot of force to break it. Fracture shaft femur surgical specialties musculoskeletal. There is a bimodal distribution with peaks primarily in young male patients, 2 years of age, and a larger peak in older females from 6080 years of age 4. Adults with a femur fracture are best treated with immediate operative fixation, typically intramedullary nailing.
With an ipsilateral femoral shaft fracture, rotating the lower leg will not change the proximal femur orientation until fixation of the shaft component is achieved. Thus it is the most commonly fractured long bone in the body. Femoral shaft fractures can be classified with the winquist classification or the aoota classification. It is noted that 3 in 10,000 individuals per year, who are younger than 25 years or older than 65 years, experience a femoral shaft fracture.
Oblique fracture the fracture has an angled line across the shaft. Femoral shaft fractures are typically an emergency. Potential bone fragility of mid shaft atypical femoral fracture. Femoral shaft fracture is a serious complication related to removal of a femoral stem. Femoral shaft fractures can also result in major physical impairment due to potential fracture shortening, malalignment, or prolonged immobilization of the extremity with casting or traction. Tibia shaft fracture is a fracture of the proximal upper third of the tibia lower leg bone. What is femoral shaft fracturetypescausestreatment. Displacement was 30% of the ulnar diameter at the fracture level on ap radiogrpah and 60% on the lateral.
In contrast an indirect trauma mechanism can lead to a complex femoral shaft fracture especially in elderly patients with minor bone stock quality. Femoral shaft fractures reportedly occur at a rate of approximately 20100,000 children in the usa, representing 1. In multiple injured patients femoral fractures account for up to 30%, with open femoral fractures found. What is femoral shaft fracturetypescausestreatmenthealing.
Additional and relevant useful information for fracture of the femoral shaft. Delayed recognition of an ipsilateral femoral neck and shaft fracture. Interprosthetic fracture of the femoral shaft sciencedirect. Biomechanical analysis by a ctbased nonlinear finite element method. Open reduction and internal fixation was a poor prognostic factor of nonunion in these fractures. Femoral shaft fractures musculoskeletal medicine for. The long, straight part of the femur is called the femoral shaft. In adolescents, the most common mechanism is a highenergy injury such as a motor vehicle collision. Femoral nerve blocks are effective for pain management and have less side effects than systemic analgesics. The mean age of presentation is 34 years old and is usually seen in high energy injuries 8. Femoral shaft fractures are commonly associated with multisystem trauma.
Nov, 2019 apply wet sterile dressings over an open fracture. Fracture, femoral shaft childrens hospital colorado. Timing of fracture stabilization is depended on the overall medical condition of the patient, but. Fracture of the femoral shaft in the region of a functioning arthroplasty poses a difficult manage ment problem. The incidence of osteonecrosis in ipsilateral femoral neck and shaft fractures is also less than that. Motor vehicle collisions, for example, are the number one cause of femur fractures. Splintage of the femoral fracture, initially in the form of. Intramedullary nailing intramedullary nailing imn is the goldstandard in treating patients with femoral shaft fractures figs 1 and 2. The long, straight part of the femur thighbone is called the femoral shaft. Femoral shaft fracture a fracture of the shaft of the femur is usually sustained by a severe violence,as may occur in a road accident. Research article injuries associated with femoral shaft. The concomitant shaft fracture is often comminuted and or open and is thought to absorb the majority of the force decreasing the forces across the neck explaining the less likelihood of displacement versus isolated neck of femur fractures 4. Due to the location of the tibia, it is frequently injured.
Scribd is the worlds largest social reading and publishing site. Neck of femur fractures nof are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture. Antegrade femoral nailing in acetabular fractures requiring a. Femoral shaft fracture, spica, traction, casting, flexible nails, plating, antegrade trochanteric nail, external fixation, children introduction femoral shaft fractures, typically caused by blunt trauma, are the most common major pediatric injuries treated by the orthopedic surgeon.
A femoral fracture is a bone fracture that involves the femur. Fracture shaft femur free download as powerpoint presentation. Femoral shaft fractures in emergency medicine clinical. Type i represents a femoral shaft fracture with no comminution or a small butterfly fragment less than 25% of the bone. A young adult sustained a closed, shortened fracture of the distal ulnar shaft. With the available surgical stabilization techniques, numerous studies support the advan tage of surgical therapy in terms of morbidity, mortality and functional outcome. Isbn 9521025239 pdf helsinki university printing house helsinki 2005. The femoral shaft is rarely the site of a lowenergy fracture in a healthy individual. Femoral shaft fractures orthopaedic trauma association. Low energy violence as a cause of these fractures, especially among the elderly, has been mentioned only sporadically in epidemiologic studies. Pdf fracture shaft of femur in children with newly designed. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture.
If the wound is grossly contaminated, sterile saline irrigation may be used to remove large contaminants. Associated injuries, diaphysis, femur, fracture, treatment dintroduction. Ppt fracture of shaft of femur powerpoint presentation. Ap and lateral radiographs of the thigh showing displaced oblique femoral mid shaft fracture. Spiral fractures that are related to low energy trauma situate in the middle third of. Fractures of the femoral shaft are highenergy injuries often associated with. A twisting force to the thigh causes this type of fracture. The common femoral shaft fracture incidence is 21100,000 personyears 2. Ipsilateral femoral neck and shaft fracture was first reported in the literature by delaney and street 7. Always remember to complete a thorough trauma evaluation.
Dec 07, 2017 the fracture location, as the femur is divided into 3 parts. A tibial shaft fracture occurs along the length of the tibia shinbone, below the knee and above the ankle. Femoral shaft fractures are an emergency indication and should be promptly stabilized as delayed stabilization is associated with increased morbidity, particularly in the lungs and a longer hospital stay 9. Pdf femoral shaft fractures in adults researchgate. Jan 24, 2015 concurrent ipsilateral fractures of the proximal and shaft of the femur are rare complex fracture combinations. Multiple injured 25yearold man, who sustained a blunt thoracic injury, a pelvic fracture, a multifragmentary fracture of the lower leg with a compartment syndrome and. Nonoperative treatment of femoral shaft fractures in adults is an exception. The femur is a strong, weightbearing bone that resists fracture except in cases of. Traditionally, the treatment for closed femoral shaft fractures in children was a period of skeletal traction until signs of healing were. Epidemiology common injury due to major violent trauma 1 femur fracture 10,000 people more common in people 65 yr motor vehicle. Initial radiographic and ct scan evaluation revealed a displaced femoral shaft fracture but no other femoral fractures were detected. If the patient is to be transferred to another hospital, the leg should be immobilised in a thomas type splint if available or a backslab. Femur shaft fractures broken thighbone orthoinfo aaos. Femoral shaft fractures are typically an emergency indication as delayed fracture stabilization is associated with an increased morbidity, and a.