Orthopaedics: Femur
Femoral Diaphysis Fracture
Mechanism
· high energy trauma (MVA, fall from height, gunshot wound)
· in children, can result from low energy trauma (spiral fracture)
Clinical Features
· shortened, externally rotated leg (if fracture displaced)
· inability to weight-bear
· often open injury, always a Gustilo III
Investigations
· AP pelvis, AP/lateral hip, femur, knee
Specific Complications
· hemorrhage requiring transfusion
· fat embolism leading to ARDS
· extensive soft tissue damage
· ipsilateral hip dislocation/fracture
· nerve injury
Treatment
· stabilize patient
· immobilize leg
· ORIF with intramedullary nail, external fixator, or plate and screws within 24 hours
· early mobilization and strengthening
Distal Femoral Fracture
Mechanism
· direct high energy force or axial loading
· three types (Figure 37)
Clinical Features
· direct high energy force or axial loading
· extreme pain
· knee effusion (hemarthrosis)
· shortened, externally rotated leg ifdisplaced
Treatment
· ORIF
· early mobilization and strengthening
Complications (see General Fracture Complications)
· femoral artery tear
· nerve injury
· eDensl.ve soft tissue injury
· angulation deformities