Hip

Femoral Shaft Fracture

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Femoral Shaft Fracture

  • Pathophysiology
  1. High energy injury (often in young adults)
    1. Motor Vehicle Accident
    2. Pedestrian accident
    3. Fall from height
  • Diagnosis
  1. See Hip Fracture
  2. Distal to first 5 cm of femoral shaft
    1. Below Subtrochanteric Fracture
  3. Descriptive Classification
    1. Proximal or distal location
    2. Transverse or oblique angle
    3. Comminuted (common)
  • Management
  1. See Femur Fracture (includes Hare Traction Splint)
  2. Immobilize hip and knee
  3. Evaluate for associated injuries (see pitfalls below)
  4. Closely manage fluid status
    1. Initial Resuscitation with isotonic crystalloid
    2. Average blood loss from Femur Fracture: 1.2 units
    3. Type and Cross for 2 Units pRBC
    4. Continually reassess hemodynamic status
  5. Open reduction and internal fixation
    1. Intramedullary rods
  • Complications
  1. Significant blood loss and hemodynamic instability
  2. Peroneal artery and peroneal nerve injury
    1. Associated with distal Femur Fracture
  • Pitfalls
  • Associated injuries (common)
  1. Hip Fracture including Femoral Neck Fracture
  2. Supracondylar Femur Fracture
  3. Patella Fracture
  4. Knee ligament injury
  • References
  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60
  2. Russell (2002) Orthop Clin North Am 33(1):127-42 [PubMed]