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A - MSRA MSK [11] > [38] Femoral Shaft Fracture > Flashcards

[38] Femoral Shaft Fracture Flashcards

1
Q

Why are femoral shaft fractures so serious?

A

Because the femur is a highly vascularised bone, so large volumes of blood (up to 1500ml) can be lost when fractured

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2
Q

Why is the femur a highly vascularised bone?

A

Due to its role in haematopoiesis

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3
Q

What is the blood supply to the femoral shaft?

A

Penetrating branches of profunda femoris artery

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4
Q

How might femoral shaft fractures be further complicated?

A
  • Open

- Associated with neurovascular injury

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5
Q

In what settings are femoral shaft fractures most commonly seen?

A
  • High-energy trauma
  • Fragility fractures
  • Pathological fractures
  • Bisphosphonate-related fractures
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6
Q

What is the classic bisphosphonate related fracture of the femoral shaft?

A

A transverse fracture in the proximal femur

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7
Q

How will a patient with femoral shaft fracture present?

A
  • Pain in the thigh and/or hip/knee pain
  • Unable to weight bear
  • In severe cases, obvious deformity
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8
Q

What do you need to assess with femoral shaft fracture?

A
  • Skin
  • Neurovascular examination
  • Secondary survey
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9
Q

Why is it important to assess the skin with femoral shaft fractures?

A

May be open or threatened

The proximal fragment is invariably pulled into flexion and external rotation, which can further tent the skin

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10
Q

What are the signs that the skin is threatened with femoral shaft fracture?

A
  • Tethered
  • White
  • Non-blanching
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11
Q

How should patients presenting following major trauma be investigated and managed?

A

As per ATLS protocol

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12
Q

What investigations are included in the ATLS protocol?

A

Routine urgent bloods, including coagulation and G&S

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13
Q

What further bloods may be sent in femoral shaft fracture?

A

When pathological cause is suspected, further work up bloods such as serum calcium may be needed

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14
Q

What imaging may be done in femoral shaft fracture?

A
  • Plain film radiograph

- CT scanning

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15
Q

What x-ray views are required with femoral shaft fracture?

A

AP and lateral view of entire femur, including hip and knee

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16
Q

When might further imaging via CT scanning be done in femoral shaft fracture?

A

If polytrauma is suspected

17
Q

What is the first priority in managing patients with femoral shaft fractures?

A

As per ATLS guidelines, A-E assessment, stabilise patient, ensure appropriate fluid resuscitation

18
Q

What pain relief may be required for femoral shaft fracture?

A

Often opioid analgesia +/- regional blockade, e.g. fascia iliac block

19
Q

What management do femoral shaft fractures require for the actual bone?

A

Immediate reduction and immobilisation

20
Q

Why is reducing the fracture to near anatomical alignment important in femoral shaft fractures?

A

Will ensure appropriate haematoma formation, as well as reducing pain

21
Q

How is reduction and immobilisation of femoral shaft fracture achieved?

A

In-line traction

22
Q

Give an example of a traction splint

A

Kendrick traction splint

23
Q

When are Kendrick traction splints used in femoral shaft fractures?

A

In suspected or isolated fractures of mid-shaft femur

24
Q

What are the contraindications to traction splinting for femoral shaft fractures?

A
  • Hip or pelvic fractures
  • Supracondylar fractures
  • Fractures of ankle or foot
  • Partial amputation
25
Q

What definitive management do most femoral shaft fractures require?

A

Surgery

26
Q

When might femoral shaft fractures not require surgery?

A

In undisplayed femoral shaft fractures in patients with significant co-morbidities

27
Q

What may be used in undisplayed femoral shaft fractures in patients with significant co-morbidities?

A

Long-leg casts

28
Q

How soon should femoral fractures be surgically fixed?

A

Within 24-49 hours (sooner id open)

29
Q

How can most isolated cases of femoral shaft fractures be managed?

A

Integrate intramedullary nail

30
Q

What may be required for femoral shaft fracture in unstable polytrauma or open fractures?

A

External fixation, with subsequent delayed conversion to intramedullary nail

31
Q

What are the common complications of a femoral shaft fracture?

A
  • Nerve or vascular injury
  • Malunion, delayed union, or non-union
  • Infection
  • Fat embolism
32
Q

What nerves may be injured in femoral shaft fractures?

A
  • Pudendal (around 10%)

- Femoral

33
Q

What increases the risk of non-union of femoral shaft fractures?

A
  • Smoking

- Increased post-op use of NSAIDs

34
Q

What are the more long-term complications of femoral shaft fracture?

A
  • Hip flexor or knee extensor weakness
  • Limb stiffness
  • Re-fracture
35
Q

What reduces the complications of femoral shaft fracture?

A

Early mobilisation following intra-medullary nailing

A - MSRA MSK [11] (38 decks)

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