Post on 08-Sep-2015
description
Anatomy
Long tubular bone, anterior bow, flair at femoral condyles.The longest and strongest bone.Blood supplyMetaphyseal vesselsnutrient artery medullary arteries in intramedullary canalFemur Fracture
Common injury due to major violent traumaMore common in people < 25 yo or >65 yoMechanism traumatic high-energy most common in younger populationresult of high-speed RTAlow-energy more common in elderly often a result of a fallFemur Fracture
Classification
Femur Fracture
Classification
Winquist and Hansen Classification
Type 0 - No comminutionType 1 - Insignificant butterfly fragment with transverse or short oblique fractureType 2 - Large butterfly of less than 50% of the bony width, > 50% of cortex intactType 3 - Larger butterfly leaving less than 50% of the cortex in contactType 4 - Segmental comminution-Clinicaly
Symptoms pain in thigh,NWBPhysical exam inspection tense, swollen ,deformated thighaffected leg often shortenedExternal rotated,abductedmust record and document distal neurovascular statusFemur Fracture Management
Initial traction with portable traction splint or transosseous pin and balanced suspensionTiming of surgery is dependent on:Resuscitation of patientOther injuries - abdomen, chest, brainIsolated femur fractureFemur Fracture Management
Diaphyseal fractures are managed by intramedullary nailing through an antegrade or retrograde insertion siteProximal or distal 1/3 fractures may be managed best with a plate or an intramedullary nail depending on the location and morphology of the fractureFemur Fracture Antegrade Nailing
Antegrade nailing gold standardHighest union rates with reamed nailsExtraarticular starting pointimproved rehabilitationAntegrade nailing problems:Varus alignment of proximal fracturesCan be difficult with obese or multiply injured patientsnot indicated for use with ipsilateral femoral neck fractureFemur Fracture Antegrade Nailing
Antegrade nailingapproach 3 cm incision proximal to the greater trochanter in line with the femoral canal
Femur Fracture Antegrade Nailing
Femur Fracture Antegrade Nailing
Femur Fracture Retrograde Nailing
Retrograde nailing advantagesEasier in large patients to find starting pointBetter for combined fracture patterns (ipsilateral femoral neck, tibia,acetabulum)Union approaching antegrade nails when reamedRetrograde nailing problems:Union rates are slightly lower, more dynamizing with small diameter nailsIntra-articular starting pointFemur Fracture Retrograde Nailing
Approach2 cm incision starting at distal pole of patellamedial parapatellartranstendinous approachesFemur Fracture Retrograde Nailing
Entry point:
center of intercondylar notch on AP viewextension of Blumensaat's line on lateralFemur Fracture Retrograde Nailing
Prostechnically easierunion rates comparableto those of antegrade nailingno increased rate of septic knee with retrograde nailing of open femur fracturesConsknee painincreased rate of interlocking screw irritationcartilage injurycruciate ligament injury with improper starting pointAntegrade v Retrograde Comparisons
Equal union rates
Tornetta, JBJS (B), 2000
Ricci, JOT, 2001
Ostrum, JOT, 2000
Tucker M. JOT 2007
ObeseBMI >30Non-ObeseBMIORIF With Plate
External Fixator for Femoral Shaft Fracture
Multiply injured patientComplex distal femur fractureDirty open fracture Vascular injuryFemur Fracture
Complications Non union
Incidence
Femur Fracture
Complications
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