Femur fracture shaft

0
2136

Femur fracture shaft

Shaft of femur fracture

      • A fracture of the shaft of the femur is usually sustained by a severe violence, as may occur in a road accident.
      • The force causing the fracture may be
        • indirectas in twisting or bending force
        • directas in traffic accidents
      • fracture is almost equally common in the upper, middle and lower thirds of the shaft.
      • Displacements:
        • In adults, there is marked displacement ,unlike in children
        • The proximal fragment is flexed, abducted and externally rotated by the pull of the muscles attached to it (MCQ)
        • The distal fragment is adducted because of attachment of adductor muscles(MCQ)
        • The unsupported fracture end of the distal fragment sags because of the gravity. There is proximal migration (overriding) of this fragment because of the pull by the muscles going across the fracture.
      • commonassociated injury is present in the pelvis.
      • Treatment
        • Conservative methods
          • Traction:
            • A fracture of the shaft of the femur can be treated by traction, with or without a splint.
            • Usually a Thomas splint is used. (A frequently asked MCQ in PG Medical Entrance)
            • Skin traction is sufficient in children, but skeletal traction is required in adults. Skeletal traction is given by a Stienmann pin passed through the upper-end of tibia. (A frequently asked MCQ in PG Medical Entrance)
          • Hip spica: (MCQ)
            • This is a plaster cast incorporating  part of the trunk and the limb.
            • It can be safely used for immobilising these fractures in children.
            • It may also be used for treating fractures in young adults, once the fracture becomes ‘sticky’.
        • Operative methods:
          • Intra-medullary nailing is the preferred method of choice.(MCQ)
          • Plating is preferred in cases where good hold is not possible by a nail.
          • 2 commonly usedmethods of operative treatment
            • Closed Interlock nailing: (MCQ)
              • This is the preferred method of treatment of most femoral shaft fractures. (MCQ)
              • In this, the fracture is reduced under X-ray control (Image intensifier), without opening it. 
              • The nail  (a kind of rod)  is introduced into the medullary canal from the greater trochanter under monitoring by image intensifier. This is called dosed nailing.
              • It is a minimally invasive counterpart of conventional nailing done by opening the fracture (open nailing).
              • interlock nailing is advanced form of closed nailing
              • In this, two horizontal screws are passed through two holes at the ends of the nail. This locks the nail in place.
            • Kuntscher’s clover leaf intra-medullary nail (K-nail):(MCQ)
              • At places where facility of image intensifier is not available, open K-nailing, used judiciously, gives good results
              • It is most suited   for a transverse or a short oblique fracture at the junction of the upper and middle-third of the femur (the isthmus).
              • It is not preferred for
                • comminuted fractures
                • fracturesin the distal-third of the shaft
            • Plating (fixing with a thick strip of metal):(MCQ)
              • Plating – Indications
                • fractures where medullary canal is too wide for a nail to provide a good hold
                • for a comminuted fracture
              • there is a trend towards interlock nailing the fractures of the shaft of the femur rather than plating.
        • What is the best treatment plan ?
          • The treatment depends primarily upon the
            • ageof the patient
            • locationof the fracture
            • type of the fracture (transverse, oblique etc.)
            • presence of a wound.
          • In general, an open fracture is treated conservatively; in bad cases an external fixator may be used. (MCQ)
          • In children, treatment is mostly by non-operative methods.
            • From birth to 2 years(MCQ)
              • These fractures are treated by Gallow’s traction(MCQ)
              • In this, the legs of the child are tied to a overhead beam
              • The hips are kept a little raised from the bed so that the weight of the body provides counter-traction and the fracture is reduced.
              • This is continued till sufficient callus forms(3-6 weeks).
            • From 2 years to 16 years:
              • The treatment at this age is essentially conservative
              • Different methods of traction are used to keep fragments in proper alignment.
              • Once the fracture becomes ‘sticky’, further immobilisation can be provided in a hip spica(MCQ)
              • Older the child, more difficult it becomes to keep the fracture reduced for required period.
              • It is therefore, sometimes preferred to internally fix the fracture in older children (more than 10 yrs. of age).
              • TENS (Titanium Elastic Nail System) nails are used for this. (MCQ)      
        • In adults and in the elderly,
            • treatment of choice for these fractures is by operation
      • Complication
        • Early complications
            • Shock:
              • In a closed fracture of the shaft of the femur, on an average, 1000-1500 ml of blood is lost.   (A commonly asked MCQ)
            • Fat embolism:
              • Patient shows signs and symptoms of fat embolism after 24-48 hours of the fracture. (MCQ)
              • Frequent shifting of the patient without proper splintage of the fracture should be avoided.
            • Injury to femoral artery:
              • occurs most commonly in  fractures  at  the junction  of middle and distal-third of the femoral shaft. (MCQ)
            • Injury to sciatic nerve: (MCQ)
            • Infection
        • Late complications
          • Delayed union(MCQ)
            • if union is still insufficient to allow unprotected weight bearing after 5 months, it is considered delayed. (MCQ)
            • Treatment:bone grafting, especially in an elderly person.
          • Non-union: (MCQ)
            • It occurs when the fracture surfaces become rounded and sclerotic.
            • A persistent mobility at the fracture site in a fracture fixed internally, not yet united, sometimes leads to fatigue fractures of the plate or nail (implant failure).
            •  Clinically, there may be frank mobility, pain on stressing or tenderness at the fracture site.
            • Treatment is by internal fixation and bone grafting.
            • A nail or a plate may be used for fixation.
          • Malunion:(MCQ)
            • The deformity is generally lateral angulation and external rotation.
            • There may be significant shortening due to overlap of the fragments.
            • Treatment:
              • In an elderly patient, if the disability is not much, tendency is toward accepting the deformity
              • Shortening may be compensated by giving a shoe raise
              • In younger patients, correction of the deformity is done by operative means.
                • After redoing the fracture or by osteotomy, the deformities are corrected and the fracture fixed with internal fixation devices. Bone grafting is done in addition
          • Knee stiffness:
              • Causes of persistent stiffness
                • intra-articular and peri-articular adhesions
                • quadriceps adhering to the fracture site
                • an associated, often undetected, knee injury.
              • Treatment:
                • Intra-articular adhesions can be released by arthroscopic technique (arthrolysis
                • Quadriceps adhesion may require release
                • Quadricepsplasty – contracted quadriceps may need to be ‘lengthened’ .(MCQ)






Fracture of the Femur and its fixation – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video show an example of a femoral shaft fracture and fixation with IM nail.
Fractures Of The Femur Shaft Winquist & Hansen – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing Winquist and Hansen classification of the femur.
Femur – Shaft Fractures – Thomas Splint
Ipsilateral Femoral Neck & Shaft Fractures – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing ipsilateral femoral neck and shaft fractures of the femur
Orthopaedic Trauma Lecture: Femoral Shaft Fractures
Upper Chesapeake Medical Center Orthopaedic Trauma Conference on fractures of the femur given on March 7th, 2012 in Bel Air, Maryland. Moderator Spiro Antoniades, M.D.
Titanium Elastic Nailing in Fracture Shaft of Femur in Children…
Titanium Elastic Nailing in Fracture Shaft of Femur in Children.
Fracture of the femoral shaft
EMS TRACTION SPLINTING OF A MID-SHAFT FEMUR FRACTURE
Paramedic 1, Managment of a fractures shaft of femur
Paramedic management of a fractured shaft of femur.
Femur Shaft Fractures (Broken Thighbone) Comminuted Rehab Recovery
Your thighbone (femur) is the longest and strongest bone in your body. Because the femur is so strong, it usually takes a lot of force to break it. Car crashes, for example, are the number one cause of femur fractures.
The long, straight part of the femur is called the femoral shaft. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. In this type of fracture, the bone has broken into three or more pieces. In most cases, the number of bone fragments corresponds with the amount of force required to break the bone.
onlay graft of femoral shaft fracture( non union )by dr Auday Hussain
Fracture Shaft Femur Mipo 2
Fracture Shaft Femur Mipo – 1
Fracture Shaft Femur Mipo 3
Osteoporosis | elderly women at risk for femoral fracture
What devastating problem can occur with osteoporosis treatment… coming up next…
Elderly Women Who Take Bisphosphonates Long-Term May Have Increased Risk Of Atypical Femur Shaft Fractures.
Nicola Garrett writing in Rheumatology Update reported that research published in Osteoporosis International indicated that “elderly women who take bisphosphonates long-term have an increased risk of atypical femur shaft fractures…but the overall benefits of treatment still outweigh the risks.” Researchers “found that each additional year of bisphosphonate treatment showed a progressive increase in subtrochanteric/femoral shaft fractures.”
Subtrochanteric Femur Fractures – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing subtrochanteric fractures.
Intramedullary Nailing of Right Femur Fracture
This 3D medical animation features a dramatic surgical overview during the operative placement of an intramedullary nail into the right leg to secure a comminuted femur fracture.
Multiple femur fractures
A patient taking her first steps after being admitted into Shanti Bhavan Medical Center with multiple femur fractures. Dr. Minz and his surgical team successfully realigned her femoral shaft. She is now able to utilize a walker, bearing minimal weight, to start the recovery process.
Commminuted Right Femur Fracture
This 3D medical animation features a dynamic overview of the bony anatomy associated with a typical mid-shaft comminuted right femur fracture.
The animation begins a view of a male body lying on a hospital gurney. The camera zooms-in and the superficial tissues dissolve away revealing an isolated view of a comminuted right femur fracture.
Leg Surgery: Indirect Reduction Techniques for the Treatment of Periprosthetic Femoral Fractures
This presentation, featuring William M. Ricci, MD, covers Indications/Contraindications, Pearls on Exposure, Newer Fixation Options, Benefits of Indirect Reduction, Avoiding Complications and Postoperative Protocol.
As the prevalence of periprosthetic femoral fractures has increased over the last decade, the complications associated with their treatment have been increasingly recognized. However, optimal management strategies remain unclear. The difficulty involved in the management of these fractures is evidenced by the array of treatment options described in the literature without a clear consensus regarding the most appropriate method. Contemporary fracture-fixation techniques that have focused on minimizing soft-tissue disruption and periosteal stripping have reduced the need for supplemental bone-grafting. In this video supplement to the JBJS article, William M. Ricci, M.D., of Washington University School of Medicine in St. Louis, MO., discusses and demonstrates his surgical technique of indirect fracture-reduction combined with fixation with a single lateral plate without the use of structural allograft, for the treatment of periprosthetic femoral shaft fracture about a stable intramedullary implant.
Osteoporosis | bisphosphonates femur fractures
What devastating problem can occur with osteoporosis treatment… coming up next…
Elderly Women Who Take Bisphosphonates Long-Term May Have Increased Risk Of Atypical Femur Shaft Fractures
Nicola Garrett writing in Rheumatology Update reported that research published in Osteoporosis International indicated that “elderly women who take bisphosphonates long-term have an increased risk of atypical femur shaft fractures…but the overall benefits of treatment still outweigh the risks.” Researchers “found that each additional year of bisphosphonate treatment showed a progressive increase in subtrochanteric/femoral shaft fractures.”
Comment: While this is not new news, it underscores the need to be vigilant and probably have patients go on a drug holiday- meaning taking a year off the medicine- if they have been on medication for more than 5-7 years or so.
percutaneous plating of Distal Femoral Fracture 08
percutaneous plating of Distal Femoral Fracture
Femoral fracture repair.wmv
Repair of a femoral fracture in a puppy using 2 rush pins.
Fracture Femur Types – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describe fracture types of the femur.
Interpreting X-Rays of the Pelvis, Hip Joint and Femur
A video tutorial in interpreting radiographs of the pelvis, hip joint and femur. This is the fourth video in a series of five by TeachMeAnatomy — have a look at the rest at www.teachmeanatomy.info.
Distal Femur Fracture Periprosthetic – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing periprosthetic fractures.
Bisphosphonates and Femoral Fractures
Bisphospohnate use over an extended period can lead to increased risk of femoral shaft fractures in older women according to a recent study published in the Journal of the American Medical Association (JAMA). The study results are explained in this video.
Distal Femur Fractures
Closed Reduction Internal Fixation of Femur Fracture.wmv
Video shows how to fix the fracture of femur by closed reduction and internal fixation, watch out all surgical steps
Femur Fracture, Periprosthetic fracture – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing the periporsthetic fracture of the femur.