Lower Limb: Femoral Shaft Fracture

Question 1

what type of injury usually causes a femoral shaft fracture

Answer 1

high energy injuries, as result significant risk of concomitant fracture

Question 2

describe the circumstances in which a femoral shaft stress fracture can occur

Answer 2

in osteoporotic bone, metastatic condition, Paget’s disease

Question 3

what serious complication can occur with a displaced femoral shaft fracture

Answer 3

substantial blood loss up to 1.5L

Question 4

describe what complications can arise from the damaged venous system in a femoral shaft fracture

Answer 4

fat from the medullary canal can enter damaged venous system, resulting in a fat embolism with confusion, hypoxia and risk of acute resp. distress syndrome

Question 5

describe the initial management, after initial resuscitation, of a femoral shaft fracture

Answer 5

optimising analgesia with a femoral nerve block and application of Thomas splint

Question 6

what is the benefit pf a Thomas splint in femoral shaft fracture management

Answer 6

stabilises the fracture minimising further blood loss and fat embolism

Question 7

describe the usual definitive management of femoral shaft fractures

Answer 7

closed reduction and stabilisation with an intramedullary nail

Question 8

describe the usual circumstances that lead to a distal femoral fracture

Answer 8

usually osteoporotic bone with a fall onto a flexed knee

Question 9

what different types of distal femoral fracture can occur

Answer 9

extra-articular(supracondylar) or intra-articular(intercondylar)

Question 10

what position does a distal femoral fracture usually adopt and why

Answer 10

usually a flexed position due to pull of the gastrocnemii muscles

Question 11

what treatment is usually used for distal femoral fractures, unless patient frail/not fit for surgery

Answer 11

fixed with plate and screws, because fracture position difficult to maintain in a cast