Dyaphiseal fractures of the femur . Flashcards
what is the cause of diaphyseal fracture ?
high energy injuries such as high speed motor cycle incident
low energy trauma common in elderly result in falling
gunshot
what is the classification used in dispahyseal fractures of the femur ?
OTA classification transverse wedge oblique segmental comminuted
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Winquest and hansen classification
type 0 - simple fracture
type 1 - insignificant amount of comminution
type 2 - greater than 50 percent cortical contact
or occupies less than 50 percent of width of bone
^—-longitudinal stability —-^
type 3 - less than 50 percent cortical contact
and occupies more than 50 percent of the width of the bone
type 4 - segmented comminution no contact between proximal and and distal fragments
why is diaphyseal fracture life threatening ?
blood loss in closed femoral shaft fractures is 1000-1500ml
in open it might be double that
fixation and stabilisation fo the fracture is associates with decreased pulmonary complications decreased thromboembolic events decreased length of stay fat embolism and DVT
what is the clinical presentation of diaphyseal femoral fracture ?
affected leg is shortened
pain in thigh
tense, swollen thigh
blood loss in closed femoral shaft fractures is 1000-1500ml
blood loss in open fractures may be double that of closed fractures
neurovascular
must record and document distal neurovascular status
what is the treatment for femoral shaft fractures ?
Advanced Trauma Life Support (ATLS) should be initiated
normal vital signs HR < 100 bpm SBP >100 mm Hg DBP >70 mm Hg normothermia (> 35° C) adequate urine output 0.5 - 1.0 mL/kg/hr (30 mL/hr) labs lactate <2.5 mmol/L base deficit within -2 and +2 IL-6 levels <500 pg/dL gastric mucosal pH >7.3
blood transfusion should be considered.
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temporary thomas splint
nonoperative
long leg cast or hip spica cast
in nondisplaced femoral shaft fractures in patients with multiple medical comorbidities
pediatric patients
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operative
antegrade (priformis fossa) intrarmeduallry nail with reaming technique
with interlocking screws
gold standard for treatment of diaphyseal femur fractures
stabilization within 24 hours is associated with
decreased pulmonary complications (ARDS)
decreased thromboembolic events
improved rehabilitation
decreased length of stay and cost of hospitalization.
reamed nailing superior to unreamed nailing, with:
increased union rates
decreased time to union
no increase in pulmonary complications
retrograde intramedullary nail
indications
ipsilateral femoral neck fracture
floating knee (ipsilateral tibial shaft fracture)
ipsilateral acetabular fracture
nail inserted with knee flexed to 30-50 degrees
external fixation with conversion to intramedullary nail within 2-3 weeks
indications
unstable polytrauma victim
vascular injury
severe open fracture
outcomes
no difference in union rates and infections rates with acute nailing
open reduction internal fixation with plate
indications :
ipsilateral neck fracture requiring screw fixation
fracture at distal metaphyseal-diaphyseal junction
inferior when compared to IM nailing due to increased rates of:
infection
nonunion
what are the complications of dispahyseal fractures ?
antegrade IM with piriformis entry causes the most significant damage to abductor muscles and tendons may result in abductor limp blood supply to the femoral head may result in AVN in pediatric patients
heterotrophic ossification -25%
Pudendal nerve injury
incidence
10% when using fracture table with traction
Femoral artery or nerve injury
nonunion
infection
what are the associated conditions in femoral shaft fractures ?
ipsilateral femoral neck fracture
ipsilateral femoral neck fracture
2-6% incidence
bilateral femur fractures
significant risk of pulmonary complications
what are the femoral characteristics ?
largest and strongest bone in the body
femur has an anterior bow
linea aspera
