femoral shaft fracture

Femoral Shaft Fractures

Long tubular bone,

anterior bowed

forward and has

oblique course from

the neck to distal end.

ANATOMY

MUSCLE

Muscle of the thigh are arranged in three

Compartments

1-anterior compartment of thigh

Contains the sartorius and the four large

quadriceps

2-medial compartment of thigh

(gracilis ,pectineus, adductor longus, adductor

brevis, adductor magnus, and obturator externus)

3-posterior compartment of thigh

contain three large muscle termed the ‘”hamstring”

It is surrounded by massive musculature ,which

provide the femur with excellent blood supply

Femoral Shaft Fractures

* Common injury due to major violent trauma

* 1 femur fracture/ 10,000 people

* More common in people < 25 yo or >65 yo

* Femur fracture leads to reduced activity for

107 days, the average length of hospital stay

is 25 days

* Motor vehicle, motorcycle, auto-pedestrian,

aircraft, and gunshot wound accidents are

most frequent causes

CLASSIFICATIONFEMUR FRACTURE

* Type 0 - No commination

* Type 1 - Insignificant butterfly fragment with transverse or short oblique fracture

* Type 2 - Large butterfly of less than 50% of the bony width, > 50% of cortex intact

* Type 3 - Larger butterfly leaving less than 50% of the cortex in contact

* Type 4 - Segmental commination

Inquest and Hansen 66A, 1984

Axial and

rotational

stability

SYMPTOMS

Vague, diffuse pain or ache, and sometimes

tenderness and swelling in the thigh or groin.

Bleeding and bruising in the thigh (uncommon).

Weakness and inability to bear weight on the

injured leg.

Paleness and deformity (less common).

ء

x-ray

well confirm the diagnosis and establish the

sites ,line ,extent and displacement

MANAGEMENT

SUPINE - BETTER FOR MULTIPLY INJURED

PATIENTS, TOUGH STARTING POINT

LATERAL - EASIER PIRIFORMIS FOSSA

STARTING POINT, DIFFICULT SET UP, ?

ROTATION

WITHOUT A FRACTURE TABLE, LENGTH,

DISTAL LOCK FIRST AND SLAP NAIL

Supine with bolster under torso

Manual traction and rotation

1-GENERAL

blood loss, shock ,imbolism, and acutrespiratory distress are common in hight-energy injuries

COMPLICATION

COMPLICATION

2-VASCULAR INJURY

3-THROMBOEMBOLISM

4-INFECTION

5-DELAY UNION AND NON-UNION

6-JOINT STIFFNESS