A fracture of the distal femur is a break or crack that occurs anywhere within the lower region of the femur near the knee fractures of the distal femur are usually caused by direct injuriestrauma to the leg, associated with falls. Femur fractures are typically described by location proximal, shaft, distal. Measure the proximal femur and make a reference resection mark and a rotation mark with either methylene blue or a cautery device figure 2. In many cases the experimental protocol provided a dominant influence on the range of experimental outcomes. It is a fracture of femoral diaphysis occurring between 5cm distal to lesser trochanter and 5cm proximal to adductor tubercle. Distal femur fracture ao type a and c1, open wound around the knee, bilateral femur fractures, ipsilateral segmental fracture and severe obesity.
Because the femur is so strong, it usually takes a lot of force to break it. The reduction of bmd related to age is the main factor which exposes elderly people to a greater risk of hip fracture figure figure2 2 810. The distal femur forms the top part of the knee joint. Complex proximal femoral fractures in the elderly managed. The thin soft tissue coverage on the anterior aspect of the distal end of the femur is a frequent problem. Femur injuries and fractures differential diagnoses. The association between bisphosphonates and femur fracture is discussed separately see risks of bisphosphonate therapy in patients with osteoporosis, section on atypical femur fractures and the use of bisphosphonates in postmenopausal women with osteoporosis, section on overview of approach. Proximal femoral fractures are a subset of fractures that occur in the hip region. Any pathological fracture except due to osteoporosis method of study every patient was evaluated after history, clinical examination and radiological investigation and fracture pattern was classified according to ao classification. This stir sequence image shows intense signal in the left femoral neck region, due to fracture much more extensive than that predicted by the radiograph.
Distal femur fracture, retrograde nail, union, complications, mortality. Medical complications and outcomes after hip fracture repair. Ppt fracture of shaft of femur powerpoint presentation. C2 complete simple articular fracture with multifragmented metaphysis.
Intramedullary nailing for femur fracture management. What the orthopedic surgeon wants to know1 each year, more than 250,000 hip fractures occur in the united states, resulting in considerable patient mortality and morbidity. Femur shaft fractures broken thighbone orthoinfo aaos. Fracture of the neck of femur was found in 152 41% patients. The anatomy of the region is important when considering fractures of the proximal femur. This shows a garden iii fracture of the proximal femur. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Supracondylar sooprukondilar femoral fracture also called a distal distuhl fracture is when the thigh bone, or femur, is broken at the knee. The long, straight part of the femur thighbone is called the femoral shaft. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee replacement surgery. Unstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases.
Proximal femur total femur orthopaedic salvage system. A second method of treatment for this combined injury is use of a cephalomedullary. May 08, 2020 lateral view of the femur in the same patient showing retrogradeinserted im nail in the femoral shaft fracture. Proximal hip fracture open reductioninternal fixation and. Fractures elsewhere in the femur or acetabulum, including femoral neck fractures, should be suspected and investigated. Your thigh bone femur is the longest and strongest bone in your body. Oct 10, 2018 the spectrum of femur fractures is wide and ranges from nondisplaced femoral stress fractures to fractures associated with severe comminution and significant softtissue injury. Occult hip fractures are often difficult to identify in busy trauma units. Content developed by victorian paediatric orthopaedic network. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. Proximal femoral fractures summary radiology reference.
Isolated femur fractures are relatively rare in healthy adults so that a femur fracture is a potential marker of high force injury. When a fracture of the femoral neck occurs, disruption to these blood vessels can occur result in devascularisation of the femoral head and resulting avascular necrosis. Randomised trial of the fascia iliaca block versus the 3in1 block for femoral neck fractures in the emergency department. Pain is the bodys instinctive response to a femur injury. The hip joint is a major weightbearing, ballandsocket joint comprised of the acetabulum and proximal femur. With the diagnosis completed, the next step is to fix the femur fracture. Lowlevel trauma, resulting in fracture of the femur or tibia must be treated with caution in case of metabolic bone disease or malignancy, as mentioned earlier. In this group of patients, fracture is usually the result of lowimpact trauma although, in younger patients they are usually victims of highimpact trauma, usually during a car accident. For more information, you can read a more indepth reference articles. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. Supracondylar femoral fractures hoffa fracture 33b3 coronal split posterior femoral condyle no dcs dynamic condylar screw no blade plate 7. They are typically sustained in highimpact trauma, such as car crashes, due to the large amount of force needed to break the bone. Diagnosis of a proximal femoral fracture is usually possible on a plain xray.
Distal femur thighbone fractures of the knee orthoinfo aaos. The various types of adult proximal femoral fractures require different treatment strategies that depend on a variety of considerations. We conducted a sevenyear retrospective hospital medical record analysis. Fractures of the femur and tibial shaft sciencedirect. Fracture neck of femur is associated with high mortality in geriatric age group 2035% within the first year of injury. Two to six percent of femoral shaft fractures also have femoral neck fractures. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter see hip fractures. Femur fractures vary greatly, depending on the force that causes the break. Car crashes, for example, are the number one cause of femur fractures.
Retrograde nailing for distal femur fractures in the elderly. Risks of a fractured femur there are risks and complications with this procedure. Indications for retrograde im nailing for the treatment of distal femur fractures include 16,19,21,22. The femur is the longest and strongest bone in the body, and it takes a great deal of force to break it. Proximal femoral fractures include a broad group of common fractures of the femoral head and neck typically occurring in osteoporotic females. This is considered to be the terminal 1015 cm of the distal femur. Outcome of retrograde intramedullary nailing and locking.
Suffered since 3 hours before admitted to the hospital due to a traffic accident. Stabilization of distal femur fractures with intramedullary nails and locking plates eleven of 12 patients were exact matches based on open versus closed fracture. A femur fracture is typically sustained from highenergy impact such as motor vehicle collisions, falls from playground equipment, falls from furniture or resulting from a twisting mechanism. Your digital gateway to expertise, education, and innovation. A fracture that occurs at the distal end of the femur bone, which includes the femoral condyles and the metaphysis.
The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. The most recent axial knee impact tests melvin and stalnaker, 1975 and 1976. Fractures of the femoral shaft often result from high energy forces such as motor vehicle collisions. Management of fractures of distal femur journal of medical. Usually occur in young men after high energy trauma and elderly women even after a low energy fall. The best suitable fda approved implant for a particular fracture pattern of distal femur was used.
At latest followup, 9 month after the injury, uneventful healing of the femur fracture had occurred. In view of the comorbidities, it was a practice to manage these patients on traction and delaying surgery. Complications and injuries associated with midshaft femur fractures in the adult can be lifethreatening and may include. Distal femur thighbone fractures of the knee a fracture is a broken bone. Supracondylar femoral fracture central coast orthopedic. The most common cause of a fracture is direct trauma to the leg from an automobile accident or a fall. The xray also allows assessment of the type of fracture and the degree of displacement.
Mortality with these fractures can approach 20 % in the elderly. The lower part of the knee joint is the shin bone, or tibia tihbeeuh. They tend to occur in older patients, and in those who have osteoporosis. The spectrum of femur fractures is wide and ranges from nondisplaced femoral stress fractures to fractures associated with severe comminution and significant softtissue injury. Blood supply for the femoral head is derived from vessels within the hip capsule. In the femoral shaft, this refers to a fracture in any part of the bone from the lesser trochanter to the metaphyseal flare of the condylar region of the knee. Distal femur indicates the part of the thigh bone just above the knee. Up to 30% of femoral shaft fractures in children younger than 4 years is attributable to child abuse, and the most common cause of femur fractures in the nonambulatory infant is nonaccidental trauma. The initial evaluation of a trauma patient with a femur fracture should include radiographs of the chest, ap pelvis, hip, and knee.
Introduction distal femur fractures are relatively rare injuries accounting for approximately 1% of fractures in the elderly 1. Thus the presence of a fractured femur suggests a high energy injury and that the patient is at risk for multiple injuries such as internal bleeding, head injury or additional fractures. Both the fracture and injuries to the soft tissues near the fracture site can cause pain, bruising, swelling, and redness. This study aims to evaluate use of the russelltaylor reconstruction nail rtrn in this group with regard to mortality risk, complication rates and final outcome. Do you want to use the redesigned aosr like an app. Resection when the amount of proximal femoral bone loss is so severe that a minimum replacement of 10cm is indicated, the following steps are recommended for using the 7cm modular proximal femur and the diaphyseal segments figure 1. These injuries make up about 37 % of all femur fractures courtbrown and caesar 2006. Distal femur fractures can be closed meaning the skin is intact or can be open. Stability of this joint is achieved by the surrounding ligaments. A displaced femoral neck fracture may disrupt the blood supply to the femoral head resulting in avascular necrosis. Proximal femoral nail antirotation technique guide pfna short length 170 mm 240 mm indications pertrochanteric fractures 31a1 and 31a2 intertrochanteric fractures 31a3 high subtrochanteric fractures 32a1 contraindications low subtrochanteric fractures femoral shaft fractures. Hip and proximal femur fractures royal childrens hospital.
The femur, also known as the thigh bone, is the longest bone in the body. Two of 12 patient matches differed in the presence of diabetes. B3 partial articular fracture, coronal hoffa fracture. Hip fracture incidence was 17 times greater among 15%. The fracture mechanism depends on the segment of the femur involved but generally can. The knees are the largest weight weightbearing joint in your body.
There are three stages of pain from a broken femur. Distal femur fractures involve the distal one third of the femur, consisting of the region between the diaphysealmetaphyseal junction and the articular surface of the femoral condyles. The femur is the largest and strongest bone in the body, so it takes tremendous force to cause a fracture. Infection can occur, requiring antibiotics and further treatment. May 04, 2020 up to 30% of femoral shaft fractures in children younger than 4 years is attributable to child abuse, and the most common cause of femur fractures in the nonambulatory infant is nonaccidental trauma. Fracture of shaft of femur 1 fracture of shaft of femur 2. Proximal femoral fractures present unique challenges for anaesthetic departments, involving the perioperative care of large numbers of older patients with significant comorbidities. The distal femur is where the bone flares out like an upsidedown funnel.
Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. Aug 12, 2015 distal femur fractures involve the distal one third of the femur, consisting of the region between the diaphysealmetaphyseal junction and the articular surface of the femoral condyles. The rate of periprosthetic femoral fractures following total hip replacement has been growing steadily in the last 20 years and ranges from 0. Proximal femoral fractures radiology reference article. Unreamed antegrade unreamed nailing was performed with protection of the proximal fragment with cerclage wires. Proximal hip fracture open reductioninternal fixation and rehabilitation surgical indications and considerations anatomical considerations. Neurovascular injuries are mostly observed in the type 3 distal femur complex trauma. This procedure is the fixation of the thighbone femur using a nail, plate, rod and screws.
Hip fractures are strongly associated with bmd in the proximal femur, but there are also many clinical predictors of hip fracture risk that are independent of bone density figure figure3 3. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. Stay informed with the latest updates on coronavirus covid19. Whether they are transverse, oblique, or comminuted, supracondylar or intercondylar in a t, y or v fashion their management still evokes much controversy because of the consistently poor results obtained. The anatomy of the distal femur explains the three major types of fracture. Lateral view of the femur in the same patient showing retrogradeinserted im nail in the femoral shaft fracture. We believe that in elderly patients with covid19 who have proximal femoral fractures, surgery may contribute to the overall stability of the patient, seated mobilization, improvement in physiological ventilation, and general patient comfort in bed. Fractures in the shafts of both the femur and tibia are common injuries. Measure the proximal femur and make a reference resection. Complex proximal femoral fractures in the elderly managed by. Aug 06, 2017 supracondylar femoral fractures muller ao classification of fractures 3 femur 33 distal femur a1 a2 a3 b1 b2 b3 c1 c2 c3 c complete articular a extraarticular b partial articular 6. Despite guidance since the early 1990s concerning best practice management for these vulnerable patients, there remains considerable variation in models of perioperative care, rehabilitation and orthogeriatric.