Transcript FEMUR FRACTURES.

FEMUR FRACTURES.
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Common injuries.
May be due to direct or indirect trauma.
Signify significant trauma.
Most common cause; M.V.A.
Commonly closed fractures.
CLASSIFICATION.
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Many ways of classifying femur fractures.
The easy way is to classify them
ANATOMICALLY. This classification is relevant in
terms of treatment :
1. Proximal femur ; intracapsular ( neck #’s) ,
intertrochanteric and subtrochanteric.
2. Femoral shaft fractures.
3. Distal femoral fractures ( supracondylar and
intra-articular).
PROXIMAL FEMUR FRACTURES.
• FEMORAL NECK FRACTURES.
 Intracapsular fractures.
 Caused by severe trauma especially in young
patients.
 The most important complication is avascular
necrosis.
 They are emergencies.
 They should always be managed or treated
surgically.
CLASSIFICATION OF N.O.F. #’S.
Classified according to Garden ;
Garden 1 : incomplete fractures. Rx= fixation in situ.
Garden 2 : complete but undisplaced fracture. Rx =
internal fixation.
Garden 3 : displaced fracture but there is still
contact . Rx = reduction and fixation.
Garden 4 : completely displaced fracture .Rx =
depends on the age of pt., activity level and the
general condition. Options ; reduction and internal
fixation, hemi-arthroplasty or total arthroplasty.
INTERTROCHANTERIC #’S.
 May
follow trivial trauma ; old patients.
 Strong abductors tend to cause significant
displacement.
 The limb is shortened , abducted and
externally rotated.
 If not fixed surgically , the limb will unite
in this fashion.
 They are best treated by ORIF.
SUBTROCHANTERIC #’S.
The fracture is within 5 cm of the lesser
trochanter.
The abductors and flexors of the hip tend to
cause flexion , abduction and external rotation
of the proximal fragment.
Difficult to obtain and maintain reduction.
These fractures are best treated by ORIF.
FEMORAL SHAFT #’S.
The shaft lies between the subtrochanteric
( 5 cm below the lesser trochanter) and
the supracondylar areas( 8 cm above the
joint line).
There are no predominantly strong muscle
group.
Femoral shaft fracture can be successfully
managed conservatively ; closed reduction
and skeletal traction ; Thomas’ splint.
DISTAL FEMORAL #’S.
♠ The gastrocnemius muscle is the deforming force
; the distal fragment is displaced posteriorly.
♠ The fracture tends to angulate posteriorly.
♠ It is difficult to manage conservatively.
♠ The majority are best treated by ORIF.
♠ Those fractures that extend intra-articularly , are
managed according to the principles of Intraarticular fractures.