Femur

Question 1

Femoral diaphysis fracture mechanism

Answer 1

• high energy trauma (MVC, fall from height, gunshot wound)
■ pathologic as a result of malignancy, osteoporosis, bisphosphonate use

• in children, can result from low energy t auma (spiral fracture)

Question 2

Femoral diaphysis fracture clinical features

Answer 2

• shortened, externally rotated leg (if fracture displaced)
• inability to weight-bear
• often open injury, always a Gustilo III
• Winquist and Hansen classification

Question 3

Femoral diaphysis fracture investigations

Answer 3

• X-ray: AP pelvs, AP/lateral hip, femur, knee

Question 4

Femoral diaphysis fracture tx

Answer 4

• non-operative (uncommon)
■ indication: non-displaced femoral shaft fractures in co-morbid patients
■ long leg cast

• operative
■ ORIF with anterograde IM nail (most common) or retrograde IM nail; external fixator for unstable patients, open fractures, or highly vascular areas; or plate and screws for open growth plates within 24 h
■ early mobilization and strengthening

Question 5

Femoral diaphysis fracture complications

Answer 5

• blood loss
• fat embolism leading to ARDS
• extensive soft tissue damage
• ipsilateral hip dislocation/fracture (2-6%)
• nerve injury

Question 6

Femoral diaphysis fracture what should be ruled out

Answer 6

It is important to rule out ipsilateral femoral neck fracture, as they occur in 2-6% of femoral diaphysis fractures and are reportedly missed in 19-31% of cases

Question 7

Distal femoral fracture definition

Answer 7

fractures from articular surface to 5 cm above metaphyseal flare

Question 8

Distal femoral fracture mechanism

Answer 8

• direct high energy force or axial loading
• three types: extra articular, partial articular, complete articula

or

supracondylar
condylar
intercondylar

Question 9

Distal femoral fracture clinical features

Answer 9

• extreme pain
• knee effusion (hemarthrosis)
• neurovascular deficits can occur with displaced fracture

Question 10

Distal femoral fracture investigations

Answer 10

• X-ray: AP, lateral

* CT, angiography if diminished pulses

Question 11

Distal femoral fracture treatment

Answer 11

• non-operative (uncommon)
■ indication non-displaced extra-articular fracture
◆ hinged knee brace

• operative
■ indication: displaced fracture, intra-articular fracture, non-union
◆ ORIF or retrograde IM nail if supracondylar and non-comminuted
◆ early mobilization and strengthening

Question 12

Distal femoral fracture specific complications

Answer 12

• femoral artery tear
• popliteal artery injury
• nerve injury
• extensive soft tissue injury
• angulation deformities