Tulang paha (femur) patah rehat dalam tulang atas kaki.

Kerana tulang paha adalah yang

paling lama, tulang kuat dalam tubuh, melainkan tulang berpenyakit, ia memerlukan daya yang
amat kuat untuk memecahkan. Patah tulang paha yang paling sering berlaku selepas satu
kemalangan kenderaan bermotor, perlanggaran yang bermain sukan, jatuh dari tempat yang
tinggi, atau akibat luka tembakan dan tumor ini (neoplasma). Walau bagaimanapun, individu tua
atau lain-lain yang telah lemah tulang akibat osteoporosis atau penyakit tulang yang lain
mungkin mengalami patah tulang paha daripada kejatuhan yang mudah di rumah. Patah tulang
paha yang berhampiran pinggul secara amnya digelar "keretakan pinggul," dengan istilah
"tulang paha patah" yang digunakan untuk keretakan yang berlaku dalam aci daripada tulang
paha atau berhampiran lutut.
Patah tulang paha dikelaskan mengikut asas garis patah, sama ada serpihan tulang pecah
melalui kulit, dan lokasi di mana rehat berlaku. Keretakan dikelaskan mengikut jenis, termasuk
mudah, comminuted, tertutup, terbuka, patologi, tekanan dan. Mudah patah terdiri daripada
berehat dalam hanya satu tempat di dalam tulang. Dalam keretakan comminuted, tulang pecah
di lebih daripada dua tempat. Dalam patah tertutup, kulit tidak dipecahkan oleh patah, manakala
dalam keretakan terbuka, kulit pecah dan serpihan tulang yang terdedah. Keretakan patologi
berlaku selepas tulang telah lemah oleh penyakit, dan patah tekanan terdiri daripada berehat
secara beransur-ansur berlaku yang begitu sedikit bahawa ia mungkin tidak muncul pada xray. Patah tulang paha lagi dikelaskan mengikut ijazah, bentuk, jenis dan kecederaan lembuttisu.
Risiko: Individu yang terlibat dalam aktiviti yang berisiko tinggi, seperti ski, mendaki batu
snowmobiling, dan menunggang kuda adalah yang paling mungkin mengalami patah tulang
paha. Individu yang mempunyai rendah diet miskin di kalsium dan vitamin D atau yang
mempunyai penyakit tulang osteoporosis atau satu lagi jenis penyakit yang melemahkan tulang
juga berisiko tinggi.
Patah tulang paha paling kerap berlaku pada individu yang lebih muda daripada 25 tahun atau
lebih tua daripada 65 tahun.
Insiden dan Kelaziman: patah tulang paha berlaku pada kadar 3 di 10,000 individu setahun
untuk individu yang lebih muda daripada 25 tahun dan berumur lebih dari 65 tahun, kadar untuk
individu di luar mereka adalah di antara umur adalah 1 dalam 10,000 individu setiap tahun
(Aukerman).

Femur Shaft Fractures (Broken Thighbone)

Types of Femoral Shaft Fractures
Cause
Symptoms
Doctor Examination
Treatment
Recovery
Complications

Your thighbone (femur) is the longest and strongest bone in your body. Because the femur is so strong, it usually
takes a lot of force to break it. Car crashes, for example, are the number one cause of femur fractures.
The long, straight part of the femur is called the femoral shaft. When there is a break anywhere along this length of
bone, it is called a femoral shaft fracture.

The femoral shaft runs from below the hip to where the bone begins to widen at the knee.

Types of Femoral Shaft Fractures

Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly
or be out of alignment (displaced), and the fracture may be closed (skin intact) or open (the bone has punctured the
skin).
Doctors describe fractures to each other using classification systems. Femur fractures are classified depending on:

The location of the fracture (the femoral shaft is divided into thirds: distal, middle, proximal)

The pattern of the fracture (for example, the bone can break in different directions, such as cross-wise,
length-wise, or in the middle)

Whether the skin and muscle above the bone is torn by the injury

The most common types of femoral shaft fractures include:

Transverse fracture. In this type of fracture, the break is a straight horizontal line going across the femoral shaft.
Oblique fracture. This type of fracture has an angled line across the shaft.
Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh
causes this type of fracture.
Comminuted fracture. In this type of fracture, the bone has broken into three or more pieces. In most cases, the
number of bone fragments corresponds with the amount of force required to break the bone.
Open fracture. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates
down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much
more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications
especially infections and take a longer time to heal.

Top of page

Cause
Femoral shaft fractures in young people are frequently due to some type of high-energy collision. The most common
cause of femoral shaft fracture is a motor vehicle or motorcycle crash. Being hit by a car as a pedestrian is another
common cause, as are falls from heights and gunshot wounds.
A lower-force incident, such as a fall from standing, may cause a femoral shaft fracture in an older person who has
weaker bones.
Top of page

Symptoms
A femoral shaft fracture usually causes immediate, severe pain. You will not be able to put weight on the injured leg,
and it may look deformed shorter than the other leg and no longer straight.
Top of page

Doctor Examination

Medical History and Physical Examination

It is important that your doctor know the specifics of how you hurt your leg. For example, if you were in a car accident,
it would help your doctor to know how fast you were going, whether you were the driver or a passenger, whether you
were wearing your seat belt, and if the airbags went off. This information will help your doctor determine how you
were hurt and whether you may be hurt somewhere else.
It is also important for your doctor to know whether you have other health conditions like high blood pressure,
diabetes, asthma, or allergies. Your doctor will also ask you about any medications you take.
After discussing your injury and medical history, your doctor will do a careful examination. He or she will assess your
overall condition, and then focus on your leg. Your doctor will look for:

An obvious deformity of the thigh/leg (an unusual angle, twisting, or shortening of the leg)

Breaks in the skin

Bruises

Bony pieces that may be pushing on the skin

After the visual inspection, your doctor will then feel along your thigh, leg, and foot looking for abnormalities and
checking the tightness of the skin and muscles around your thigh. He or she will also feel for pulses. If you are
awake, your doctor will test for sensation and movement in your leg and foot.

Imaging Tests
Other tests that will provide your doctor with more information about your injury include:

X-rays. The most common way to evaluate a fracture is with x-rays, which provide clear images of bone.
X-rays can show whether a bone is intact or broken. They can also show the type of fracture and where
it is located within the femur.

Computed tomography (CT) scan. If your doctor still needs more information after reviewing your xrays, he or she may order a CT scan. A CT scan shows a cross-sectional image of your limb. It can
provide your doctor with valuable information about the severity of the fracture. For example, sometimes
the fracture lines can be very thin and hard to see on an x-ray. A CT scan can help your doctor see the
lines more clearly.

Top of page

Treatment
Nonsurgical Treatment
Most femoral shaft fractures require surgery to heal. It is unusual for femoral shaft fractures to be treated without
surgery. Very young children are sometimes treated with a cast. For more information on that, see Pediatric
Thighbone (Femur) Fracture.

Surgical Treatment
Timing of surgery. If the skin around your fracture has not been broken, your doctor will wait until you are stable
before doing surgery. Open fractures, however, expose the fracture site to the environment. They urgently need to be
cleansed and require immediate surgery to prevent infection.
For the time between initial emergency care and your surgery, your doctor will place your leg either in a long-leg splint
or in skeletal traction. This is to keep your broken bones as aligned as possible and to maintain the length of your leg.
Skeletal traction is a pulley system of weights and counterweights that holds the broken pieces of bone together. It
keeps your leg straight and often helps to relieve pain.

External fixation. In this type of operation, metal pins or screws are placed into the bone above and below the
fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds
the bones in the proper position so they can heal.
External fixation is usually a temporary treatment for femur fractures. Because they are easily applied, external
fixators are often put on when a patient has multiple injuries and is not yet ready for a longer surgery to fix the
fracture. An external fixator provides good, temporary stability until the patient is healthy enough for the final surgery.
In some cases, an external fixator is left on until the femur is fully healed, but this is not common.

External fixation is often used to hold the bones together temporarily when the skin and muscles have been injured.

Intramedullary nailing. Currently, the method most surgeons use for treating femoral shaft fractures is
intramedullary nailing. During this procedure, a specially designed metal rod is inserted into the marrow canal of the
femur. The rod passes across the fracture to keep it in position.
An intramedullary nail can be inserted into the canal either at the hip or the knee through a small incision. It is
screwed to the bone at both ends. This keeps the nail and the bone in proper position during healing.
Intramedullary nails are usually made of titanium. They come in various lengths and diameters to fit most femur
bones.

Intramedullary nailing provides strong, stable, full-length fixation.

Plates and screws. During this operation, the bone fragments are first repositioned (reduced) into their normal
alignment. They are held together with special screws and metal plates attached to the outer surface of the bone.

Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend
into either the hip or knee joints.

(Left) This x-ray shows a healed femur fracture treated with intramedullary nailing. (Right) In this x-ray, the femur fracture
has been treated with plates and screws.
Top of page

Recovery
Most femoral shaft fractures take 4 to 6 months to completely heal. Some take even longer, especially if the fracture
was open or broken into several pieces.

Weightbearing
Many doctors encourage leg motion early in the recovery period. It is very important to follow your doctor's
instructions for putting weight on your injured leg to avoid problems.
In some cases, doctors will allow patients to put as much weight as possible on the leg right after surgery. However,
you may not be able to put full weight on your leg until the fracture has started to heal. It is very important to follow
your doctor's instructions carefully.
When you begin walking, you will most likely need to use crutches or a walker for support.

Physical Therapy
Because you will most likely lose muscle strength in the injured area, exercises during the healing process are
important. Physical therapy will help to restore normal muscle strength, joint motion, and flexibility.
A physical therapist will most likely begin teaching you specific exercises while you are still in the hospital. The
therapist will also help you learn how to use crutches or a walker.
Top of page

Complications
Complications from Femoral Shaft Fractures
Femoral shaft fractures can cause further injury and complications.

The ends of broken bones are often sharp and can cut or tear surrounding blood vessels or nerves.

Acute compartment syndrome may develop. This is a painful condition that occurs when pressure within
the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents
nourishment and oxygen from reaching nerve and muscle cells. Unless the pressure is relieved quickly,
permanent disability may result. This is a surgical emergency. During the procedure, your surgeon
makes incisions in your skin and the muscle coverings to relieve the pressure.

Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the
bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires
multiple surgeries and long-term antibiotics.

Complications from Surgery

In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of
surgery may include:

Infection

Injury to nerves and blood vessels

Blood clots

Fat embolism (bone marrow enters the blood stream and can travel to the lungs; this can also happen
from the fracture itself without surgery)

Malalignment or the inability to correctly position the broken bone fragments

Delayed union or nonunion (when the fracture heals slower than usual or not at all)

Hardware irritation (sometimes the end of the nail or the screw can irritate the overlying muscles and
tendons)

pengurusan
Rawatan bukan pembedahan

Jika pembedahan tidak dapat dijalankan, terdapat beberapa pilihan rawatan lain yang
boleh dilakukan. Salah satu daripadanya ialah dengan menggunakan Thomas Splint
dan bagi kanak-kanak Cast akan dipasang
Tulang yang paling kerap patah ialah shaft femoral dan memerlukan pembedahan untuk
penyembuhan

rawatan pembedahan
sekiranya berlaku patah di sekeliling kulit,kepatahan tidak akan rosak .Doktor akan
menunggu sehingga klien stabil sebelum
melakukan pembedahan. Patah terbuka,bagaimanapun, boleh terdedah kepada
persekitaran.dan perlu segera dibersihkan dan memerlukan pembedahan segera untuk
mengelak dari jangkitan.

Bagi masa antara rawatan kecemasan awal dan pembedahan anda, doktor anda
akanmeletakkan kaki anda sama ada dalam anduh panjang kaki atau daya
tarikan rangka. Iniadalah untuk menyimpan patah
tulang anda seperti yang sejajar mungkin dan untuk mengekalkan panjang kaki anda.

For the time between initial emergency care and your surgery, your doctor
will place your leg either in a long-leg splint or in skeletal traction. This is to
keep your broken bones as aligned as possible and to maintain the length
of your leg.
Daya tarikan rangka adalah sistem takal berat dan counterweights yang yang
memegang serpihan tulang bersama-sama. Ia memastikan kaki anda lurus

dan seringmembantu untuk melegakan kesakitan.

Skeletal traction is a pulley system of weights and counterweights that

holds the broken pieces of bone together. It keeps your leg straight and
often helps to relieve pain.

Penetapan luar. Dalam jenis

ini operasi, pin atau skru logam diletakkan ke dalam tulangatas dan di
bawah tapak patah. Jarum dan skru dilampirkan ke sebuah bar di luar kulit.Peranti ini
adalah rangka menstabilkan yang memegang tulang-tulang di dalam posisi yang betul supaya
mereka boleh sembuh.
Penetapan luar biasanya rawatan sementara untuk patah tulang paha. Kerana merekadengan
mudah boleh memohon, fixators luar sering diletakkan di atas apabila
pesakitmempunyai kecederaan yang pelbagai dan tidak lagi bersedia untuk pembedahan yang
lebih lama untuk
menetapkan patah. An penetap luaran menyediakan baik, kestabilansementara
sehingga pesakit cukup sihat untuk pembedahan akhir. Dalam sesetengah
kes, penetap luaran dibiarkan sehingga tulang paha sepenuhnya sembuh, tetapi
ini tidakberlaku.
Penetapan luar sering digunakan untuk memegang tulang bersamasama sementaraapabila kulit dan otot telah cedera.
Intramedullary pemakuan. Pada masa ini, kaedah yang paling pakar bedah gunakan
untuk merawat patah aci femoral intramedullary pemakuan. Semasa
prosedur ini, rodlogam yang direka khas dimasukkan ke dalam terusan sumsum tulang
paha itu. Rodmeninggal di seluruh patah untuk pastikan ia dalam kedudukan.
Satu paku intramedullary boleh dimasukkan ke dalam terusan
itu sama ada padapinggul atau lutut melalui insisi kecil. Ia diskrukan kepada tulang di keduadua hujungnya.Ini menyimpan kuku dan tulang dalam
kedudukan yang betul semasa penyembuhan.
Kuku intramedullary biasanya diperbuat daripada titanium. Mereka datang
dalampelbagai panjang dan diameter sesuai dengan kebanyakan tulang femur.
Intramedullary pemakuan menyediakan kukuh, stabil, penetapan penuh panjang.
Plat dan skru. Semasa operasi ini, serpihan
tulang 1 dipromosi (dikurangkan) ke dalamjajaran biasa. Mereka telah diadakan bersama-sama
dengan skru khas dan plat logamyang melekat pada permukaan luar tulang.
Plat dan skru sering digunakan apabila intramedullary pemakuan mungkin
tidak boleh,seperti untuk keretakan yang menjangkau ke sama ada pinggul atau sendi lutut.

Pemulihan

Paling patah aci femoral mengambil masa antara 4 hingga 6 bulan untuk sembuh. Ada yang
mengambil lebih lama, terutamanya jika patah adalah terbuka atau beberapa menjadi kepingan
yang telah patah.
Weightbearing
Ramai doktor menggalakkan awal gerakan kaki dalam tempoh pemulihan. Ia adalah sangat
penting untuk mengikuti arahan doktor anda untuk meletakkan berat badan pada kaki yang
tercedera anda untuk mengelakkan sebarang masalah.
Dalam beberapa kes, doktor akan membenarkan pesakit untuk meletakkan berat badan
sebanyak mungkin kaki kanan selepas pembedahan. Walau bagaimanapun, anda mungkin
tidak mampu untuk meletakkan berat badan penuh di kaki anda sehingga patah telah mula
sembuh. Ia adalah sangat penting untuk mengikuti arahan doktor anda dengan teliti.
Apabila anda mula berjalan, anda kemungkinan besar akan perlu menggunakan tongkat atau
pejalan kaki di atas sokongan.
Terapi fisik
Kerana anda kemungkinan besar akan kehilangan kekuatan otot di kawasan yang cedera,
latihan semasa proses penyembuhan adalah penting. Terapi fizikal akan membantu untuk
memulihkan kekuatan otot biasa, gerakan sendi, dan fleksibiliti.
Ahli terapi fizikal kemungkinan besar akan mula mengajar anda senaman yang tertentu semasa
anda masih di hospital. Terapi juga akan membantu anda belajar bagaimana untuk
menggunakan tongkat atau pejalan kaki.
Atas halaman

Komplikasi
Komplikasi dari Fraktur Aci femoral
Patah aci femoral boleh menyebabkan kecederaan dan komplikasi.
hujung patah tulang sering tajam dan boleh memotong atau lusuh sekitar saluran darah atau
saraf.
petak sindrom akut boleh membangunkan. Ini adalah suatu keadaan yang menyakitkan yang
berlaku apabila tekanan dalam otot membina kepada tahap berbahaya. Tekanan ini boleh
mengurangkan aliran darah, yang menghalang khasiat dan oksigen dari sampai ke saraf dan
sel otot. Melainkan jika tekanan lega dengan cepat, hilang upaya kekal boleh berlaku. Ini adalah
kecemasan pembedahan. Semasa prosedur, pakar bedah anda membuat pembelahan dalam
kulit anda dan penutup otot untuk melegakan tekanan.
patah Buka mendedahkan tulang kepada persekitaran luar. Walaupun dengan baik
pembersihan pembedahan tulang dan otot, tulang boleh menjadi dijangkiti. Jangkitan tulang
adalah sukar untuk dirawat dan sering memerlukan beberapa pembedahan dan antibiotik
jangka panjang.
Komplikasi pembedahan
Sebagai tambahan kepada risiko pembedahan secara umum, seperti kehilangan darah atau
masalah yang berkaitan dengan anestesia, komplikasi pembedahan mungkin termasuk:

 Jangkitan
Kecederaan pada saraf dan saluran darah
Darah beku
embolisme Lemak (sumsum tulang memasuki aliran darah dan boleh bergerak ke paru-paru;
ini juga boleh berlaku dari patah sendiri tanpa pembedahan)
Malalignment atau ketidakupayaan untuk meletakkan serpihan tulang yang patah betul
Kelewatan sekerja atau nonunion (apabila patah menyembuhkan lebih perlahan daripada
biasa atau tidak pada semua)
kerengsaan Perkakasan (kadang-kadang akhir paku atau skru boleh menyebabkan iritasi otot
dan tendon overlying)