Femoral shaft fracture + quadriceps tendon rupture Flashcards
Mechanism of injury
High-energy trauma
Fragility fractures in the elderly (low-energy trauma)
Pathological fractures (e.g. metastatic deposits, osteomalacia)
Bisphosphonate-related fractures*
Clinical features
Pain in the thigh Radiates to hip or knee Unable to weight bear Deformity Flexed and externally rotated
Mx
ATLS Analgesia Admit Xray Haematoma block Immediate reduction and immobilisation - in line traction Splint Surgery
Open fracture:
- abx within 3 hours
- up to date tetanus vaccination
- remove debris and take picture
- cover with saline dressing
- debridement
Ix
Routine urgent bloods and Xray - including coagulation. Group + save and X mismatch
Surgery
Surgically internally fixed within 24-48 hours - Antegrade intramedullary nail
External fixation - open fracture for optimisation before internal fixation
Complications
Nerve injury - common peroneal injury - foot drop
Pudendal nerve injury or femoral nerve injury (rare)
Mal-union (or rotational mal-alignment)
Delayed union, or non-union
Infection - open fractures
Fat embolism
Risk factors for quadriceps tendon rupture
Increasing age Chronic kidney disease Diabetes mellitus Rheumatoid arthritis Medication - corticosteroids and fluoroquinolones
Clinical features of quadriceps tendon rupture
Hear a pop
Tearing sensation
Pain in the anterior knee
Difficulty weight bearing
Localised swelling
Tender palpable defect
Complete tear:
Inability to straight leg raise and loss of knee extension
Mechanism of injury for quadriceps tendon rupture
Sudden and excessive loading - landing from a jump
Ix for quadriceps tendon rupture
Clinical diagnosis
Xray - lateral, skyline, AP
USS - degree of rupture
Mx of quadriceps tendon rupture
Partial tear - conservative (if knee extension intact)
- immobilisation of the knee joint - brace
- intensive rehab
Complete tear and when no knee extension - surgery
Surgery to fix quadriceps tendon
Tears at the point of insertion - longitudinal drill holes or suture anchors
Intra-tendinous tears - end-to-end sutures.
Quadriceps tendon rupture post op
Knee is immobilised in a brace
6 weeks post repair - progressive strength and flexibility exercises
