Fractures of the femur

♥ fr. Neck femur

♥ fr. Shaft femur
♥ fr. Distal femur :
- supracondylar fr.
- intercondylar fr.
Fracture neck femur

♥ Common in old age due to

osteoporosis.
- intra-capsular [ trans-cervical ]

- extra-capsular [ trochanteric ]

♥ Intra-capsular fr. :
Usually do not heal
spontaneously due to :
- interruption of its bl. supply
- difficult immobilization
- dilution of the fr. hematoma
by synovial fluid.
Blood supply of the femoral head
Classification
Garden’s classification :
1- incomplete fr.
2- complete un-displaced
3- partial displacement
4- complete displacement.

Site of fr. :
♥ subcapital
♥ mid-cervical
♥ basal
Clinical picture :
- pain, tenderness……
- external rotation of
the affected limb.

♥ Shenton’s line [ in x-ray ] :

smooth curve joining inf.
border of the sup. pubic
ramus and inf. border of the
neck.
 Complications :
- AVN
- Non-union
Treatment : [ surgical ]

♥ Recent fr. :
- un-displaced : cannulated screws
- displaced : closed reduction + I.F.
[ cannulated screws or DHS ]

♥ Old, neglected fr. :

- young adult :
subtrochanteric osteotomy + I.F.
- old age :
hip replacement [ hemiarthroplasty].
Austin Moore, or Thompson prosthesis.
Extra-capsular fr. [ trochanteric fr.]

♥ Cancellous bone, usually good healing

♥ Clinical picture:
- pain,…
- marked external
rotation of the
affected limb.
Treatment :
♥ Dynamic Hip Screw [ D.H.S.].
Subtrochanteric fr.
Area 3 inches below
lesser trochanter.

♥ Treatment :
- I.M. interlocking nail
- Gamma nail
- D.C.S.
Fr. middle 2/3 of the shaft :
♥ TYPES:
- simple
- compound

Fr. Line may be :

- transverse
- oblique
- comminuted
Treatment
♥ 1st. aid : skin traction on Thomas
splint.
♥ Treatment :
- simple fr. :
· children up to 12 years :
skin traction on Thomas
splint
· adults : int. fix. :
- I.M. interlocking nail
- compound fr. : external fixator till
soft tissue healing, then I.F.
Interlocking i.m. Nail
External fixation of compound fractures
 Supracondylar fr. femur:
♥ distal fragment flexed by
gastrocnemius, may press
popliteal artery.
♥ Treatment :
- retrograde interlocking I.M. nail.
- condylar buttress plate
- Dynamic Condylar Screw [D.C.S.].
Intercondylar T or Y-shaped fr.

♥ Intra-articular fr.
♥ Treatment :
- restore smooth articular
surface, then I.F. by the
same implants as S.C.Fr.
Complications of fr. femur :
♥ General complications :
- shock
- fat embolism
- prolonged bed recumbency :
( if not treated surgically)

Bed sores
EARLY LATE
♥ local complications :
- AVN of femoral head [ in fr. neck ]
- Vascular injury [ popliteal a.]
- Infection [ in compound fr. ]
- Mal-union
- Delayed union
- Joint stiffness [ hip, and knee ]
Fracture patella :
♥ Direct or indirect trauma.
♥ Clinical picture:
- pain, swelling…..
- gap is felt in the fr. site.
- usually , inability to fully
extend the knee.
Treatment :
♥ fr. proximal, or distal pole:
excision of the fragment
[ partial patellectomy]
♥ transverse fr. :
suture by stainless-steel wire
[ tension band]

♥ comminuted fr. :
excision of the patella
[ total patellectomy].
 Fractures of the leg
Fr. Tibial plateau
Intra-articular fr.
♥ Treatment : O.R.I.F.
meticulous technique
is required to restore
the smooth articular
surface.
 Fr. both bones of the leg:
♥ Tibia is subcutaneous bone, very liable to trauma .
♥ Treatment:
- simple fr.:
- transverse , stable fr. :
closed reduction + plaster fixation.
- oblique, or comminuted fr.:
I.F. [interlocking I.M.N.,or
plate & screws].
- compound fr.: external fixator.
♥ Complications:
Delayed union in fr. L 1/3, poor blood
supply.
Simple fr. tibia :
Treatment : I.M. interlocking nail
Compound fracture

Treatment : ext. fixator

Isolated fr. Tibia
♥ Naturally splinted by fibula,
minimal displacement,
usually conservative ttt. by
plaster cast.
Isolated fr. Fibula
♥ risk of lat. popliteal N. injury
in upper 1/3 drop foot.
♥ no need for casting, non
weight – bearing bone .
 Fractures around the ankle
Pott’s fracture
ADD ABD
♥ Types :
- Adduction fr.
- Abduction fr.
- External rotation fr.
- Vertical compression fr.
[ Pilon fr.]
♥ fr. line caused by ligamentous
pull : transverse

♥ fr. line caused by bony

compression : oblique

♥ Degrees : each type may be:

uni- malleolar,
bi- malleolar, or
tri- malleolar.
 :Treatment
♥ uni-malleolar fr. : try
conservative ttt. by
closed reduction and
plaster fixation,
- If failed : O.R.I.F.
♥ bi-malleolar, and tri-
malleolar fr. :
usually unstable : O.R.I.F.
 Fracture metatarsals
♥ Usually stable, with minimal displacement.
♥ Treatment : B.K.P.
♥ March fr. : stress fr. of the 2nd and 3rd
metatarsals after un-accustomed exercise.
- x- ray reveals callus after 2-3 weeks.
♥ John’s fr. : base 5th. metatarsal.
Plaster casts for ankle and foot injuries
 Fractures of the Pelvis
♥ Usually crush injury, with
risk of int. hemorrhage
and damage to urethra &
urinary bladder.
Types :
♥ fr. of individual bones:
- iliac bones
- acetabulum
- sacrum
- coccyx
♥ fr. of the pelvic ring :

- incomplete : little or
no displacement
- complete : double
dislocations, or fr.
dislocations.
Treatment:
♥ General condition, shock.
♥ Treatment of visceral injuries
♥ Stable fr. : bed rest + analgesics
♥ Displaced, unstable fr.: O.R.I.F., or external
fixator.
Internal Fixation of fr. pelvis