Beruflich Dokumente
Kultur Dokumente
Femur Fracture
Common injury due to major violent
trauma
More common in people < 25 yo or
>65 yo
Mechanism traumatic
high-energy
Femur Fracture
Classification
AO/OTA Femur Diaphysis - Bone segment
32
Femur Fracture
Classification
Winquist and Hansen
Classification
Type 0 - No comminution
Type 1 - Insignificant butterfly fragment
Clinicaly
Symptoms pain in thigh,NWB
Physical exam inspection
tense, swollen ,deformated thigh
affected leg often shortened
External rotated,abducted
must record and document distal
neurovascular status
Femur Fracture
Management
Initial traction with portable traction splint or
Femur Fracture
Management
Diaphyseal fractures are
managed by intramedullary
nailing through an antegrade
or retrograde insertion site
Proximal or distal 1/3
fractures may be managed
best with a plate or an
intramedullary nail depending
on the location and
morphology of the fracture
standard
Highest union rates with reamed nails
Extraarticular starting point
improved rehabilitation
injured patients
not indicated for use with ipsilateral
femoral neck fracture
starting point
Better for combined fracture patterns
(ipsilateral femoral neck,
tibia,acetabulum)
Union approaching antegrade nails
when reamed
pole of patella
medial parapatellar
transtendinous approaches
antegrade nailing
no increased rate of septic knee with
retrograde nailing of open femur fractures
Cons
knee pain
increased rate of interlocking screw
irritation
cartilage injury
cruciate ligament injury with improper
starting point
Obese
Non-Obese
BMI >30 BMI <30
Ante OR Time
94
62
P<.003
Retro OR Time
67
62
nss
Ante Fluoro
247
135
P<.03
Retro Fluoro
76
63
nss
Outcomes
infection
nonunion
hardware failure
fracture
Dirty open fracture
Vascular injury
Femur Fracture
Complications Non union
Incidence <10%
Risk factors
-postoperative use of nonsteroidal
anti-inflammatory drugs
-smoking is known to decrease bone
healing
Femur Fracture
Complications
Hardware failure
Malunion - shortening, malrotation, angulation
Infection < 1%
Neurologic, vascular injury,
Heterotopic ossification
Thank You