FEMUR BONE FRACTURE

Introduction
• The structure of the head and neck of femur is
developed for the transmission of body weight
efficiently, with minimum bone mass, by
appropriate distribution of the bony trabeculae in
the neck. The tension trabeculae and compression
trabeculae along with the strong calcar femorale
on the medial cortex of the neck of the femur form
an efficient system to withstand load bearing and
torsion under normal stresses of locomotion and
weight bearing.
 Blood Supply
Crock described the arteries of the proximal end
of the femur in three groups
(a) an extra-capsular arterial ring located at the
base of the femoral neck;
(b) ascending cervical branches of the
extracapsular arterial ring on the surface of the
femoral neck (known as retinacular arteries)
(c) the arteries of the ligamentum teres
 Ligaments
• Iliofemoral
• Ischipfemoral
• Pubofemoral
 Muscles
• Quadriceps
• Hamstring
• Iliopsoas
• TFL
• It Band
• Abductors
 Patho Anatomy
• Most fracture are displaced with
distal fragment – externally rotated, adducted,
and proximally migrated.
These displacement are less marked than in
intertrochanteric fracture because the capsule of
hip joint is attached to distal fragment and
prevent extreme rotation and displacement of
distal fragment.
 Patho Anatomy
• Displacement of the lower bone fragment
caused by the pull of the powerful muscles.
• In particular the outward rotation of the leg so
that the foot characteristically points laterally.
(GM) gluteus maximus; (PI) piriformis; (OI)
obturator internus; (GE) gemelli; (QF)
quadratus femoris; (RF) rectus femoris; (AM)
adductor muscles; (HS) hamstring muscles
 Femoral shaft fracture
• Definition - Femoral shaft fracture is defined as a
fracture of the diaphysis occurring between 5 cm distal
to the lesser trochanter and 5 cm proximal to the
adductor tubercle
• High energy injuries frequently associated with life-
threatening conditions
• The femoral shaft is circumferentially padded with large
muscles. Advantage: improved healing potential due to
good vascular tissue coverage. disadvantage: difficult
reduction due to possible displacement due to muscle
pull.
 Mechanism of injury
• Traumatic
– high-energy
• most common in younger population
• often a result of high-speed motor vehicle accidents
– low-energy
• more common in elderly
• often a result of a fall from standing
• Gunshot

spiral fracture is usually caused by a fall in which the foot is anchored while a
twisting force is transmitted to the femur.
Transverse /oblique : angulation or direct violence.
comminuted/ segmental: very high energy trauma
 Clinical features
• Pain
• Tenderness
• Physical exam
– inspection
• tense, swollen thigh
– blood loss in closed femoral shaft fractures is 1000-
1500ml (features of shock may be present)
» for closed tibial shaft fractures, 500-1000ml
– blood loss in open fractures may be double that of closed
fractures
• tenderness present over thigh
• Distal neurovascular status may be compromised
 Radiological imaging
• Recommended views
• AP and lateral views of entire femur
• AP and lateral views of ipsilateral hip
• AP and lateral views of ipsilateral knee
 Management
• Once the diagnosis of #shaft of femur is
established
following steps should be taken in the ER before
starting the definitive treatment
1. Resuscitation/management as per the ATLS
protocol
2. Immobilization(using splints)
3. Elevation
 Treatment
• Non conservative management
 Traction – thomas splint and hip spica
 Operative treatment
• IMIL – INTRAMEDULLARY INTERLOCKING
• ORIF WITH PLATE
 EARLY COMPLICATIONS
• SHOCK(1000-1500ml in closed # double in open)
• Fat embolism: symptoms occur with in 24-48 hrs
proper splinting required to prevent this from
occurring.
• Injury to femoral artery: most commonly in
fractures at the junction of middle and distal
third of femoral shaft
• Injury to sciatic nerve.
• Infection
 LATE COMPLICATIONS
• Delayed union(union still insufficient to allow
unprotected weight bearing after 5 months, bone
grafting)
• Non union(internal fixation and bone grafting)
• Malunion( lateral angulation and external rotation,
shoe raise, internal fixation ,bone grafting)
• Knee stiffness(intraarticular periarticular adhesions,
quadriceps adhering to fracture site , undetected
knee injury, physiotherapy ,athrolysis
quadricepsplasty)
THANK YOU