Femoral shaft fractures musculoskeletal medicine for. Intramedullary nailing for femoral shaft fractures in adults. 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. Several studies have indicated that early surgical stabilisation is associated with a reduction of complications and mortality fakhry 1994. The femur is the longest and strongest bone in the body, and it takes a great deal of force to break it. Femoral overgrowth following femoral shaft fracture in children less than years old has been documented by orthoroentgenogram in 74 patients from the time of healing 3 months following fracture until skeletal maturity. Her prescription history confirmed that she was on aspirin and a 70 milligram tablet of alendronate every seven days from september 2018 through june 2019. The greatest advantage of operative treatment of a fractured femur is that it allows the patient. Fractures elsewhere in the femur or acetabulum, including femoral neck fractures, should be suspected and investigated. Associated injuries, diaphysis, femur, fracture, treatment. Two to six percent of femoral shaft fractures also have femoral neck fractures.
The initial evaluation of a trauma patient with a femur fracture should include radiographs of the chest, ap pelvis, hip, and knee. The art of femoral fracture care involves a balancing act between anatomic alignment and early functional rehabilitation of the limb. Delaney wm, street dm 1953 fracture of femoral shaft with fracture of neck of same femur. 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. Only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in. Pdf femoral shaft fractures in adults researchgate. In up to 9% of femoral shaft fractures, there is an associated ipsilateral femoral neck fracture. We found no reports of an isolated association between a hoffa fracture and a femoral shaft fracture in our search of the englishlanguage literature. In the setting of distal third pediatric femoral shaft fractures, in. A femoral fracture is a fracture of the femur thigh bone. Management of femoral shaft fractures acta chirurgiae. Treatment of the fracture is dependent on the patients age, weight, fracture configuration, softtissue injury, presence of. A femoral shaft fracture is defined as any fracture occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle.
Summaryintramedullary nails were placed prospectively in 25 acute femoral shaft fractures in 25 patients without the use of a fracture table. Pediatric femoral shaft fractures account for less than 2% of all fractures in children. There are ipsilateral knee injuries in 20%40% of patients and ipsilateral tibial fractures in approximately 10% of cases. Prior to injury, the patient was a manual laborer whose job demanded prolonged standing on concrete surfaces, squatting, and heavy lifting. Low energy violence as a cause of these fractures, especially among the elderly, has been mentioned only sporadically in epidemiologic studies. A femoral shaft fracture is defined as a fracture of the diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle occurs by chronic, repetitive activity that is common to runners and military. Timing of femoral shaft fracture fixation affects length of hospital. Bisphosphonate use and atypical fractures of the femoral shaft. Alho a 1997 concurrent ipsilateral fractures of the hip and shaft of the femur.
Biomechanical analysis by a ctbased nonlinear finite element method. He is intubated and an intracranial pressure monitor is placed which consistently measures 30mm hg. Femoral and tibial growth following femoral shaft fracture in childhood. Demographics, mechanism of injury, aoota fracture classification and management were. Pediatric femoral fractures may involve the proximal femur, the femoral shaft, or the distal femur. Org volume 88a number 10 october 2006 hoffa fragment associated with a femoral shaft fracture finitive fixation of the left femoral fractures. The fracture may be classed as open, which occurs when the bone fragments protrude through the skin, or there is an overlying wound which penetrates to the bone.
Children under the age of 2 years should be evaluated for evidence of nonaccidental trauma child abuse. Most reports on this subjectincluding all those from denmark madsen. Chapter 53 fractures of the distal femur china quad diaries. As with other fractures, the injury should be characterized by its location, angulation, distraction or overriding of fracture fragments, comminution, plane of fracture lines, involvement of articular surfaces, and evidence of open fracture or foreign body see table 143. A radiograph of the femur revealed an acute mid femoralshaft fracture with characteristic lateral cortex breaking consistent with biphosphonate fracture images 1 and and2 2. Fractures of the femoral shaft in children the overgrowth phenomenon frederic shapiro department of orthopaedic surgery, childrens hospital medical center, harvard medical school, boston, massachusetts, usa femoral overgrowth following femoral shaft fracture in children less than years. However, these are the most common pediatric fractures necessitating hospitalization and are associated with prolonged hospital stay, prolonged immobilization and impose a significant burden on the healthcare system as well as caregivers. Femoral shaft fractures are typically an emergency indication as delayed fracture stabilization is associated with an increased morbidity, and a longer hospitalization time 9. In 1980, winquist proposed a classification for femoral shaft fractures based on fracture comminution. Treatment depends on the age, fracture pattern, and weight of the patient. Diaphyseal femur fractures are mostly the result of highenergy trauma, for.
Femoral shaft is the elongated, straight part of the femur and any breakage or fracture along the length of this shaft is known as femoral shaft fracture. Dec 17, 2019 frontal view of the pelvis reveals acute mid femoral shaft fracture with characteristic lateral cortex beaking consistent with bisphosphonate fracture arrow. In these situations, bridge plating of the femoral shaft fracture may be considered40,41e. Tano a, oh y, fukushima k, kurosa y, wakabayashi y, fujita k, et al. Femur fractures due to running frequently appear in the femoral shaft. General anesthesia was administered, and the patient was placed supine on a radiolucent operating table. In addition, the condyles are wider posteriorly than. Fractures of the proximal femoral shaft are not well controlled with long leg splints alone. A study published in the journal of orthopedic trauma in 2011 estimated the rate of femoral shaft fractures to be between 10 and 20 per 100,000 people annually. Excellent reduction is the key to decrease the complication of femoral neck fracture in any surgical stabilizations.
A femoral distractor was used in 21 of the 25 patients to aid in obtaining and holding a reduction. Jul 17, 20 seventy percent of femoral fractures involve the shaft 1. Original article from the new england journal of medicine bisphosphonate use and atypical fractures of the femoral shaft. Do a femoral osteotomy to correct the deformity and fix it with flexible. Surgical treatment of femoral shaft fractures with an im nail is considered the standard of care with union rates between 95% and 99%, despite this success, functional limitations and impairments often persist after the injury and surgical procedure, which may result in residual disability. Femoral shaft fractures occur most commonly in young men and elderly women following highenergy trauma and lowenergy falls, respectively. Femoral shaft fractures are more common than other parts of the femur. The concept of damage control orthopaedics es pecially treating femoral fractures in polytrauma tized patients is well established, but clear indicators, which patients benefit from this approach, are mis sing.
Nov, 2019 apply wet sterile dressings over an open fracture. This type of fracture has an angled line across the shaft. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. To describe the use of traction splinting in children with femoral shaft fracture and to determine if timing of traction splinting application effects outcome. Pediatric femoral shaft fractures are one of the most common peditric orthopaedic fractures and are the most common reason for pediatric orthopaedic hospitalization. Diagnosis of femoral neck fractures in patients with a femoral shaft fracture.
An intramedullary nail is a metal rod that is inserted into the medullary cavity of a bone and across the fracture in order to provide a solid support for the fractured. Do you want to use the redesigned ao sr like an app. These injuries must be differentiated from insufficiency fractures, which, though similar in. Femur shaft fracture an overview sciencedirect topics.
The most common types of femoral shaft fractures include. Overview of the femur and pelvis fracture episode of care. To prevent a fracture of the femoral shaft, individuals should be careful and consciously aware, while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Dec 07, 2017 femoral shaft fracture, also known as broken thighbone, is the breakage of the shaft of the femur or thighbone. They are often associated injuries to the hip, pelvis, knee and other parts of the body. Injuries associated with femoral shaft fractures with special. Therefore, femoral nailing is the overall gold standard in treating femoral shaft fractures 18. Femoral shaft fractures orthopaedic trauma association. Pediatric femoral shaft fractures presented by members of posna. Some foreign materials may enter the fracture site such as. Ninetyeight fractures of the shaft of the femur were seen in one unit over the two years 1974 and 1975, and the results have been assessed in sixtynine. The journal of the international college of surgeons 193. How can fracture of the femoral shaft be prevented. Potential bone fragility of midshaft atypical femoral fracture.
Early rehabilitation following surgical fixation of a femoral. Splintage of the femoral fracture, initially in the form of. History of femur fracture during delivery treated in pavlik harness i want to a. Open subtypes 3 open subtypes 3 multifragmentary fractures. Intramedullary nailing of acute femoral shaft fractures. 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. Case reports the authors oversaw three cases of iatrogenic subtrochanteric femoral fracture during trochanteric femoral nailing. Nov, 2019 willett k, alkhateeb h, kotnis r, bouamra o, lecky f. Pdf diaphyseal femoral fractures are common and can present as isolated injuries or as part of a polytrauma situation. 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 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. Frequencyfrequency fractures of the femoral shaft arefractures of the femoral shaft are the most common fractures thatthe most common fractures that orthopedist see.
In the treatment of these injuries, it is important to keep in mind that pediatric femoral fractures differ from adult femoral fractures in several key respects, and these differences affect management. What is femoral shaft fracturetypescausestreatment. 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 incidence of femoral shaft stress fractures is not well documented. What is femoral shaft fracturetypescausestreatmenthealing. The incidence of osteonecrosis in ipsilateral femoral neck and shaft fractures is also less than that.
Shock is never the result of a single femoral shaft fracture in children look for another site of. Hoffa fragment associated with a femoral shaft fracture. The long, straight part of the femur thighbone is called the femoral shaft. The art of femoral fracture care involves a balancing act between anatomic.
Femoral shaft fractures pediatric pediatrics orthobullets. Femoral shaft fractures reportedly occur at a rate of approximately 20100,000 children in the usa 2, representing 1. Know the types, causes, signs, symptoms, treatment, healing time, risk factors and complications of femoral shaft fracture. Femoral shaft fractures in emergency medicine guidelines. Adults with a femur fracture are best treated with immediate operative fixation, typically intramedullary nailing. Shock is never the result of a single femoral shaft fracture in children look for another site of haemorrhage. Is there a standard rehabilitation protocol after femoral. Most femoral shaft fractures are treated surgically. Femoral shaft fracture, also known as broken thighbone, is the breakage of the shaft of the femur or thighbone. Femoral shaft fracture in children not yet walking must raise suspicion for nonaccidental trauma. Femoral shaft fracture is one of the typical bone fractures due to high energy trauma and may occur as an open fracture. Traction splinting of femoral shaft fractures in a. A retrospective descriptive study conducted over a five and a half year period 1 january 1996 to 1 july 2001 on children presenting with femoral shaft fracture to a paediatric trauma centre.
In this type of fracture, the break is a straight horizontal line going across the femoral shaft. Femoral shaft fracture after hip arthroplasty jsrgen steen jensen, gunnar barfod, dick hansen, eilif larsen, frank linde, henrik menck and bent olsen femoral shaft fractures after hip arthroplasties were treated in 74 noncemented hemiarthroplasties and 65 cemented arthroplasties. Femoral shaft fractures are common in pediatric age groups. Femur shaft fractures broken thighbone orthoinfo aaos.
Femoral shaft fractures are commonly thought to be primarily associated with severe trauma in young persons. The epidemiology of adult distal femoral shaft fractures in a central london major trauma centre over five years. Open subtypes 3 your digital gateway to expertise, education, and innovation. Consider nonaccidental injury in femoral shaft injuries in infants. Identification and management of 2 femoral shaft stress. In a recent analysis comparing different treatment options in femoral shaft fractures, it could be clearly stated. These types of fracture cause more damage to the surrounding tissue, are less likely to heal properly, and are at much greater risk of infection. Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures. Fractures of the femoral shaft are caused by a highenergy injury, such as a road traffic accident, unless a pathological fracture in a patient with osteoporosis or metastatic disease. These are better managed with the placement of skin traction. In contrast, a too lateral entry point can result in varus.
The prognostic value of this classification scheme lies on the rationale that the more comminuted the fracture, the more injury the bone and the soft tissue sustain and the higher the likelihood for complications with healing. Certain patients in this treatment category may have complex andor comminuted femoral shaft fractures. Ipsilateral femoral neck and shaft fractures fixation with. Reduce the fracture to it pre fracture alignment and apply a spica cast. Identification and management of 2 femoral shaft stress injuries. Reduce the fracture to anatomic alignment and apply a spica cast.
Fractures of the femoral shaft are usually readily evident on xray figure 1486. When the fracture extends far down the shaft towards the knee a plate may be used. Subtrochanteric femoral fracture during trochanteric. The current techniques may help surgeons obtain the optimal neck reduction of the challenging fracture pattern intra. Fracture, femoral shaft childrens hospital colorado. 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. 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. If the wound is grossly contaminated, sterile saline irrigation may be used to remove large contaminants.
The epidemiology of adult distal femoral shaft fractures in a. To guide pch ed staff in the assessment and management of femur fractures in children. 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. We report on three cases of subtrochanteric femoral fracture during trochanteric femoral nailing for femoral shaft fractures. Femoral shaft fracture is one of the typical bone fractures due to high energy trauma and may occur. Of these, thirtyeight were treated by skeletal traction in a thomass splint followed by skin traction, and thirtyone by skeletal traction followed by a castbrace. The fracture line encircles the shaft like the stripes on a candy cane. Apr 01, 2006 the subject was an otherwise healthy 28yearold man who had a highenergy, closed, oblique, midshaft to proximalthird shaft fracture of the left femur while involved in a headon motor vehicle accident. Pdf the castbrace treatment of femoral shaft fractures. Our goals were to determine if the technique was safe and effective for insertion of intramedullary nails in a wide spectrum of femoral fractureswith. Femoral shaft fractures treatment goals in children and adolescents are the following. Femoral shaft fractures in children are common and frequently lead to hospitalization and require anesthesia for performing an orthopaedic procedure 1.
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