The anatomic axis of the shaft of the femur is different from the weightbearing, or mechanical, axis fig. The site of fracture varied with age and etiology with 26. A fracture is an abnormal disruption in the continuity of a bone and is often referred to as a broken bone. Fractures of the femoral shaft often result from high energy forces such as motor vehicle collisions. The bottom of the femur connects to the tibia and fibula, or shinbones, and together they form the knee. The treatment of these fractures can vary greatly depending on the age of the patient and the fracture pattern. History of femur fracture during delivery treated in pavlik harness i want to a. At the most distal end, the femoral condyles form the knee joint along with the tibia and fibula in the lower leg. We found that the early reamed intramedullary nailing was associated with low infection and nonunion rate and good range of motion.
At its most proximal end is the head of the femur, which connects to the pelvic bones. Femoral shaft fractures are an emergency indication and should be promptly stabilized as delayed stabilization is associated with increased morbidity, particularly in the lungs and a longer hospital stay 9. Clinical presentation is similar to intertrochanteric fracture. The first page of the pdf of this article appears above. Philadelphia, pennsylvania the closed reduction of fractures of the femoral shaft is difficult because of the numerous mechanical factors involved. The collum forms an angle with the shaft in about degrees.
Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter see hip fractures. Femoral shaft fractures are emergent injuries that are typically a result of high energy forces or low energy falls in the elderly and are commonly associated with multisystem trauma. Our results showed good outcome after early reamed intramedullary nailing of open grade iii fractures of femoral shaft after addressing the soft tissue injury properly. Fracture shaft femur surgical specialties musculoskeletal. Ap view of the left proximal femur demonstrating antegradeinserted im nail treatment of a femoral shaft fracture with multiple cancellous lag screws inserted around the nail to treat the femoral. The standard treatment of femoral shaft fractures in adults is an anterograde, reamed, locked intramedullary im rod. The femur thigh bone is the longest, strongest, largest and heaviest tubular bone in the human body, and one of the principal loadbearing bones in the lower extremity. Long bone fracture symptoms, diagnosis and treatment bmj. They are typically sustained in highimpact trauma, such as car crashes, due to the large amount of force needed to break the bone. Roaten jd, kelly dm, yellin jl, flynn jm, cyr m, garg s, et al.
Pediatric femoral shaft fractures presented by members of posna resident comprehensive fracture course treatment varies with age basic treatment guidelines 11 yr rigid im nail 511 yr flexible im nails 6 m5 yr spica cast 06 m pavlik harness but age isnt the only factor to consider im fixation is far from the only fixation option. The femur is the longest and strongest bone in the body, and it takes a great deal of force to break it. Your thighbone femur is the longest and strongest bone in your body. However, there are several relative indications for retrograde im rod insertion. The femur is the strongest and longest bone in our body. When the fracture extends far down the shaft towards the knee a plate may be used. Anatomy long tubular bone, anterior bowed forward and has oblique course from the neck to distal end. The thighbone, or the femur, is the largest bone in the body.
Aug 14, 2012 to characterize the recently issued femur shaft insufficiency fracture in terms of a patients own epidemiological status. In high velocity injuries ipsilateral hip dislocation and acetabular fractures have to be excluded. Femoral shaft is the elongated, straight part of the femur and any breakage or fracture along the length of this shaft is known as femoral shaft fracture. The cadaver was positioned so the femur shaft was aligned along the axis of the impact. Femur shaft fracture treatment boston medical center. Fracture, femoral shaft childrens hospital colorado. The head forms a ballandsocket joint with the hip at the acetabulum, being held in place by a ligament within the socket and by strong surrounding ligaments.
The greatest advantage of operative treatment of a fractured femur is that it allows the patient. Fracture shaft femur free download as powerpoint presentation. In the infant it is about 150 degrees and in old age reduced to 120 degrees. Femoral shaft fractures are among the most common major injuries that an orthopaedic surgeon will be required to treat. Femur fracture reaming reaming of the femoral shaft fracture only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in acute femur fracture patients with pulmonary trauma in both a retrospective analysis and multiple animal studies pape, j trauma 1992. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture.
It is a fracture of femoral diaphysis occurring between 5cm distal to lesser trochanter and 5cm proximal to adductor tubercle. The management of isolated femoral neck fractures in the young is geared towards head preservation and has the well. Fourteen patients were treated for insufficiency fracture from july 2002 to june 2008, excluding cases including the risk factors. Over the years, femoral nailing is the overall gold standard in treating femoral shaft fractures. Because the femur is so strong, it usually takes a lot of force to break it. For the purposes of this topic, long bones are defined as the humerus, radius, ulna, femur, tibia, and fibula. This may be representative of lower energy injury pattern and supportive of the above postulate. As the most commonly fractured long bone, it is not surprising that the femur was the first bone in which internal fixation was attempted. When there is a break along the femur, it is called a femoral shaft. Usually occur in young men after high energy trauma and elderly women even after a low energy fall. A mid shaft femur fracture in a highenergy trauma victim should prompt a careful search for an ipsilateral fracture of the femoral neck, which will be present in 5% of patients. Fracture of shaft and distal part of femoral bone prepared by.
The combination of ipsilateral femoral shaft and tibial shaft fractures, producing a floating knee, signals a high risk of multisystem injury in the patient. Motor vehicle collisions, for example, are the number one cause of femur fractures. In contrast an indirect trauma mechanism can lead to a complex femoral shaft fracture especially in elderly patients with minor bone stock quality. Morbidity and mortality of bilateral femur fractures. Immediate hip spica for fracture of shaft of femur in pediatrics jasim hasan 4 bas j surg, june, 21, 2015. Pavlik harness with immediate spica casting for femur. What is femoral shaft fracturetypescausestreatment. Femur shaft fractures broken thighbone orthoinfo aaos. The ends of broken bones are often sharp and can cut or tear surrounding blood vessels or nerves, though this is very rare.
Because the femur is a major loadbearing bone and is the biggest in the body, untreated or inappropriately treated fractures may cause lifelong morbidity and. The long, straight part of the femur thighbone is called the femoral shaft. Epidemiology, fracture patterns, nonunions, and fatigue fractures a clinical study sari salminen academic dissertation to be presented with the permission of. Jul 27, 20 in two large retrospective series of femoral shaft nonunions, the wave plate led to union after a single surgery in the vast majority of cases e. Nonoperative treatment of fractures of the shaft of the femur. Orthopedics bilateral femur fractures have been associated with frequent morbidity and mortality. Intramedullary nailing intramedullary nailing imn is the goldstandard in treating patients with femoral shaft fractures figs 1 and 2. Femoral shaft fracture a fracture of the shaft of the femur is usually sustained by a severe violence,as may occur in a road accident. A midshaft femur fracture in a highenergy trauma victim should prompt a careful search for an ipsilateral fracture of the femoral neck, which will be present in 5% of patients. Femoral shaft fractures in emergency medicine clinical. The lower leg was then pulled back melvin and stalnaker, 1975 and.
Although demographic data of the patients have been. Occurs with severe trauma or in association with pathologic bone blood loss can be substantial average loss 1l clinical features. Femur fractures can occur through the growth plate close to the knee, which is made of cartilage. Isbn 9521025239 pdf helsinki university printing house helsinki 2005. Femoral shaft fractures musculoskeletal medicine for. Associated injuries and massive hemorrhage contributed to. The body of the femur or shaft, almost cylindrical in form, is a little broader above than in the center, broadest and somewhat flattened from before backward below. Clinical analysis of femur shaft insufficiency fractures. A fracture of the femoral shaft is a break or crack that occurs anywhere in the center region along the length of the femur fractures of the femoral shaft are usually caused by direct injuriestrauma to the leg,associated with falls, participation in contact sports, or automobile accidents. Pdf clinical analysis of femur shaft insufficiency fractures. Femoral shaft fractures can cause further injury and complications.
The femur is the longest and strongest bone in the body. Fracture of shaft of femur 1 fracture of shaft of femur 2. A femoral fracture is a bone fracture that involves the femur. Reduce the fracture to anatomic alignment and apply a spica cast. The top of the femur connects to the pelvis and together they form the hip. Populationbased epidemiology of femur shaft fractures. The head of the femur is connected to the shaft through the neck or collum. In humans the neck of the femur connects the shaft and head at a 125 degree angle, which is efficient for walking. The goal in surgical treatment of femoral shaft fractures is to restore length, alignment, and rotation to the femur. It is slightly arched, so as to be convex in front, and concave behind, where it is strengthened by a prominent longitudinal ridge, the linea aspera.
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