Femoral Fractures: Difference between revisions

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<div class="editorbox">'''Original Editors ''' - [[User:Vanderpooten Willem|Willem Vanderpooten]]  
<div class="editorbox"> '''Original Editors ''' - [[User:Vanderpooten Willem|Willem Vanderpooten]]  
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== &nbsp;<br>Definition/Description<br> ==
== Introduction ==
[[File:Femoral-shaft-fracture.jpeg|thumb|Femoral-shaft-fracture]]
The [[femur]] is the largest and strongest [[bone]] in the body. Due to its strength it requires a significant force to break it. However, certain medical conditions that weaken the bone make it more vulnerable to fracture, so called [[Insufficiency Fracture|pathological fractures]]. For example: [[osteoporosis]]; [[Oncology|malignancy]]; [[Infectious Disease|infection]].<ref>Very well health Femur Fracture Available;https://www.verywellhealth.com/femur-fracture-2549281 (accessed 10.12.2022)</ref>
[[File:Neck of femur fracture (garden IV).jpeg|thumb|Neck of femur fracture]]


A femoral fracture is a fracture of the thigh bone. The femur is the largest and strongest bone in the body, so it requires a large or high impact force to break this bone. Most femur fractures are the result of a high energy trauma, such as a motor accident, gunshot wound, or jump/fall from a height. A femoral fracture is a very serious injury and needs 3-6 months to heal. <br>Femur fractures can be classified in three types:<br>
== Location ==
[[File:Distal-femoral-fracture.png|thumb|299x299px|Distal-femoral-fracture]]
There are different types of femoral fractures according where they occur, namely:


*Femoral head fracture
# Femoral Head Fractures: often seen in the elderly osteoporotic population where the cortical bone is weak and so is the trabecular system. It occurs spontaneously or due to low-energy trauma. In the younger population, this fracture is rare and occurs due to high-energy trauma, usually associated with [[Hip Dislocation|hip dislocations]].<ref>Orthobullets Femoral Head Fractures Available:https://www.orthobullets.com/trauma/1036/femoral-head-fractures (accessed 10.12.2022)</ref>
*Femoral shaft fracture
#[[Femoral Neck Hip Fracture|Femoral Neck Fractures]]:  one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams.<ref>[[Femoral Neck Hip Fracture|Hip Fracture]]</ref>See link for more.
*Femoral condyle fracture <br>
# [[Femoral Shaft Fractures]]: more common in men after a high-energy impact or in elderly women after a low-energy fall. <ref>Mercer's Textbook of Orthopaedics and Trauma Tenth edition edited by Suresh  Sivananthan, Eugene Sherry, Patrick Warnke, Mark D Miller</ref>  They can be described as follows: Type I - Spiral or transverse (most common) Type II – Comminuted Type III - Open&nbsp;<ref>WebMD. Broken bone: types of fractures, symptoms and prevention. 2014. (Available at http://www.webmd.boots.com/a-to-z-guides/bone-fractures-types-symptoms-prevention, accessed on 21 december 2014)fckLR</ref>
# [[Distal femoral fracture]]: involve the femoral condyles and the metaphyseal region, often the resulting from high energy trauma eg motor vehicle accidents or a fall from a height. In the elderly, they may occur as an accident at home eg [[Falls in elderly|fall]].<ref>Radiopedia Distal femoral fracture. Available: https://radiopaedia.org/articles/distal-femoral-fracture (accessed 10.12.2022)</ref>See link for more.


[[Image:Types of fractures.jpg|500px]]
== Types ==
 
There are 4 types of fracture:
== Clinically relevant anatomy  ==
# [[Femoral Stress Fracture|Femoral stress fracture]]
 
# Severe impaction fractures: the bone breaks into multiple fragments, which are driven into each other. It is a closed fracture that occurs when pressure is applied to both ends of the bone, causing it to split into two fragments that jam into each other. <ref>2.0 2.1 WebMD. Understanding Bone Fractures - the Basics. 2014. (Available at http://www.webmd.com/a-to-z-guides/understanding-fractures-basic-information, accessed 19 December 2014) fckLR</ref>&nbsp;
=== Osteology<br>  ===
# Partial fracture: incomplete break of a bone. This type of fracture refers to the way the bone breaks. In an incomplete fracture, the bone cracks but doesn’t break all the way through. In contrast, there is a complete fracture, where the bone snaps into two or more parts.<ref>Cleveland Clinic. Fractures. 2013. (Available at http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-fractures, assessed 21 December 2014)fckLR</ref><ref>WebMD. Broken bone: types of fractures, symptoms and prevention. 2014. (Available at http://www.webmd.boots.com/a-to-z-guides/bone-fractures-types-symptoms-prevention, accessed on 21 december 2014)fckLR</ref>
 
# Completed displaced fracture: breaks into two or more pieces and is no longer correctly aligned. Displacement of fractures is defined in terms of the abnormal position of the distal fracture fragment in relation to the proximal bone.&nbsp;<ref>2.0 2.1 WebMD. Understanding Bone Fractures - the Basics. 2014. (Available at http://www.webmd.com/a-to-z-guides/understanding-fractures-basic-information, accessed 19 December 2014) fckLR</ref>
The femur consists of a head, greater and lesser trochantor, shaft, and lateral and medial condyles with the patellar surface in between. <br>
 
=== Musculature<br>  ===
 
The femur is surrounded by different muscles: the quadriceps, the adductors, abductors and the hamstrings.
 
#Quadriceps: M rectus femoris, M vastus lateralis, M vastus medialis, M vastus intermedius
#Adductors: M adductor longus, M adductor brevis, M adductor longus, M pectineus, M gracilis
#Abductors: M tensor fasciae latae
#Hamstrings: M biceps femoris, M semimembranosus, M semitendinosus
 
Following a femoral fracture, most of these muscles are much weaker than before, so physiotherapy is very important for muscle strengthening.
 
Several large muscles attach to the femur. Proximally, the gluteus medius and minimus attach to the greater trochanter, resulting in abduction of the femur with fracture. The iliopsoas attaches to the lesser trochanter, resulting in internal rotation and external rotation with fractures. The linea aspera (rough line on the posterior shaft of the femur) reinforces the strength and is an attachment for the gluteus maximus, adductor magnus, adductor brevis, vastus lateralis, vastus medialis, vastus intermedius, and short head of the biceps. Distally, the large adductor muscle mass attaches medially, resulting in an apex lateral deformity with fractures. The medial and lateral heads of the gastrocnemius attach over the posterior femoral condyles, resulting in [[Flexion deformity]] in distal-third fractures<ref name="Aukerman">Aukerman DF. Femur injuries and fractures. http://emedicine.medscape.com/article/90779-overview (accessed 30 October 2008)</ref>.
 
== Epidemiology/Etiology  ==
 
The incidence of femoral fractures is reported as 1-1.33 fractures per 10,000 population per year in the USA. In individuals younger than 25 years and those older than 65 years, the rate of femoral fractures is 3 fractures per 10,000 population annually<ref name="Aukerman" />.
 
Several factors are related to increased risk of femoral fracture. Older persons (over 70) have a higher incidence of femoral fracture. Persons with [[Osteoporosis]] are also more likely to break their femur<ref name="Keany">Keany JE. Femur Fracture. http://emedicine.medscape.com/article/824856-overview (accessed 22 April 2009).</ref>.<br>
 
Morbidity and mortality rates have been reduced in femoral shaft fractures, mainly as the result of changes in methods of fracture immobilization. Current therapies allow for early mobilization, thus reducing the risk of complications associated with prolonged bed rest.
 
== Characteristics/Clinical presentation<br>  ==
 
A broken thigh bone is almost always very obvious. Signs of a fracture include severe pain, inability to move the leg or stand on it, and swelling. There individual may also be unable to bear weight, and apparent shortening of the affected leg may occur when the fracture is displaced. There may also be a resultant loss of blood in the femur, and a haematoma may be present in the surrounding soft tissue.  
 
== Complications<ref name="OrthoInfo">OrthoInfo. Femur Shaft Fractures. http://orthoinfo.aaos.org/topic.cfm?topic=A00521 (accessed 24 Jan 2015).</ref><br> ==
 
<u>Complications from the fracture:</u><br>
 
*The sharp ends of the broken bone may lacerate blood vessels or nerves.<br>
*[[Compartment_Syndrome|Acute Compartment Syndrome]] may develop<br>
*Increased risk of infection with open fractures as they expose the bone to the outside environment.<br>
 
<u>Complications from surgery:</u><br>
 
*Infection<br>
*Blood Clots (Deep Vein Thrombosis or Pulmonary Embolism)<br>
*Damage to nerves or blood vessels<br>
*Fat Embolism (Bone marrow enters the blood stream and can travel to the lungs)<br>
*Malalignment of the bony fragments<br>
*Delayed union or non-union<br>
*Hardware Irritation (e.g. end of the nail or the screw can irritate the overlying muscles and tendons)
 
== Examination  ==
 
The [[Ottawa Knee Rules]] are a clinical tool that can be used to determine the need for radiography following knee injury based on the patient's presentation. Ante posterior and lateral x-rays (used to look for a break in the bone) views of the femur are typically obtained to confirm the fracture. X-ray views of the hip, the lower leg and the knee are also commonly reviewed to detect any associated injuries, because a femur fracture is almost associated with other traumatic injuries. For that reason a general physical examination should be included. Pain, swelling, deformity, abrasion, and protrusions should be noted.
 
== Outcome Measures  ==
 
[[Dynamic Gait Index]]<br> [[International Hip Outcome Tool (iHOT)]]<br> [[Lower Extremity Functional Scale (LEFS)]]<br> [[Timed Up and Go Test (TUG)]]<br>
 
== Medical Management <br>  ==
 
Surgical reduction and fixation is indicated for the following types of proximal femur fractures: <br>
 
*Intracapsular femoral neck fracture
*Dislocated femoral head
*Intertrochanteric fracture
*Subtrochanteric fracture<ref name="Kisner">Kisner C, Colby LA. Therapeutic exercises: foundations and techniques.  Philadelphia: F.A. Davis, 2012.</ref>
 
Alternatively, patients who are not medically stable or nonambulatory may be treated with traction.
 
Surgical reduction and fixation should be performed within 24-48 of the injury. <br>
 
{{#ev:youtube|-5hE0Ambr5A|300}} <br>Video Animation of Intramedullary Nail Fixation
 
== Physical Therapy Management <br>  ==
 
Surgical fixation and immobilization are followed by extensive physical therapy. After a femoral fracture, most of the muscles are much weaker than before so physiotherapy is very important. <br>
 
The physiotherapist will begin with range of motion exercises for the hip, knee and ankle because mobility is decreased following immobilization. Mobilization is a very important treatment in the recovery process. The patient can also begin strengthening exercises based on the surgeon's orders (typically six weeks post-op).
 
=== Mobility exercises  ===
 
Knee: flexion and extension, abduction and adduction<br> Hip: flexion and extension, abduction and adduction, rotation <br> Functional quadriceps exercises should be initiated as soon as possible after the surgery because the quadriceps help provide stability in the knee. Flexion exercises also need to start as soon as possible, provided the fracture is adequated supported (i.e. the selected fixation approach allows for weight bearing). Physiotherapy should be continued until an acceptable functional range has been achieved or until a static position has been reached. It is necessary to record the range of movements in the knee with accuracy; first this should be done at weekly and then at monthly intervals. <br>  
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox">
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1TEH1tG6NHxr9l1EWHjKGcVEwYMfFCvp13XhEx4mxZBo8N4kW5|charset=UTF-8|short|max=10</rss>
</div>  
== References  ==
== References  ==


<references /> <br><br>  
<references />  


[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] [[Category:Condition]] [[Category:Hip]] [[Category:Knee]]
<br>


<br>
[[Category:Injury]]
[[Category:Bones]]
[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]
[[Category:Conditions]]
[[Category:Hip]]
[[Category:Hip - Conditions]]
[[Category:Older People/Geriatrics]]
[[Category:Older People/Geriatrics - Conditions]]
[[Category:Knee]]
[[Category:Knee - Conditions]]
[[Category:Fractures]]

Latest revision as of 10:02, 10 May 2024

Original Editors - Willem Vanderpooten

Top Contributors - Margaux Jacobs, Kim Jackson, Vanderpooten Willem, Lucinda hampton, Admin, Vidya Acharya, Nupur Smit Shah, Jentel Van De Gucht, Rachael Lowe, Alex Palmer, Daphne Jackson, Margaux Jacobs, Aminat Abolade, Jason Coldwell, WikiSysop, Lauren Lopez, 127.0.0.1 and Evan Thomas

Introduction[edit | edit source]

Femoral-shaft-fracture

The femur is the largest and strongest bone in the body. Due to its strength it requires a significant force to break it. However, certain medical conditions that weaken the bone make it more vulnerable to fracture, so called pathological fractures. For example: osteoporosis; malignancy; infection.[1]

Neck of femur fracture

Location[edit | edit source]

Distal-femoral-fracture

There are different types of femoral fractures according where they occur, namely:

  1. Femoral Head Fractures: often seen in the elderly osteoporotic population where the cortical bone is weak and so is the trabecular system. It occurs spontaneously or due to low-energy trauma. In the younger population, this fracture is rare and occurs due to high-energy trauma, usually associated with hip dislocations.[2]
  2. Femoral Neck Fractures: one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams.[3]See link for more.
  3. Femoral Shaft Fractures: more common in men after a high-energy impact or in elderly women after a low-energy fall. [4] They can be described as follows: Type I - Spiral or transverse (most common) Type II – Comminuted Type III - Open [5]
  4. Distal femoral fracture: involve the femoral condyles and the metaphyseal region, often the resulting from high energy trauma eg motor vehicle accidents or a fall from a height. In the elderly, they may occur as an accident at home eg fall.[6]See link for more.

Types[edit | edit source]

There are 4 types of fracture:

  1. Femoral stress fracture
  2. Severe impaction fractures: the bone breaks into multiple fragments, which are driven into each other. It is a closed fracture that occurs when pressure is applied to both ends of the bone, causing it to split into two fragments that jam into each other. [7] 
  3. Partial fracture: incomplete break of a bone. This type of fracture refers to the way the bone breaks. In an incomplete fracture, the bone cracks but doesn’t break all the way through. In contrast, there is a complete fracture, where the bone snaps into two or more parts.[8][9]
  4. Completed displaced fracture: breaks into two or more pieces and is no longer correctly aligned. Displacement of fractures is defined in terms of the abnormal position of the distal fracture fragment in relation to the proximal bone. [10]

References[edit | edit source]

  1. ↑ Very well health Femur Fracture Available;https://www.verywellhealth.com/femur-fracture-2549281 (accessed 10.12.2022)
  2. ↑ Orthobullets Femoral Head Fractures Available:https://www.orthobullets.com/trauma/1036/femoral-head-fractures (accessed 10.12.2022)
  3. ↑ Hip Fracture
  4. ↑ Mercer's Textbook of Orthopaedics and Trauma Tenth edition edited by Suresh Sivananthan, Eugene Sherry, Patrick Warnke, Mark D Miller
  5. ↑ WebMD. Broken bone: types of fractures, symptoms and prevention. 2014. (Available at http://www.webmd.boots.com/a-to-z-guides/bone-fractures-types-symptoms-prevention, accessed on 21 december 2014)fckLR
  6. ↑ Radiopedia Distal femoral fracture. Available: https://radiopaedia.org/articles/distal-femoral-fracture (accessed 10.12.2022)
  7. ↑ 2.0 2.1 WebMD. Understanding Bone Fractures - the Basics. 2014. (Available at http://www.webmd.com/a-to-z-guides/understanding-fractures-basic-information, accessed 19 December 2014) fckLR
  8. ↑ Cleveland Clinic. Fractures. 2013. (Available at http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-fractures, assessed 21 December 2014)fckLR
  9. ↑ WebMD. Broken bone: types of fractures, symptoms and prevention. 2014. (Available at http://www.webmd.boots.com/a-to-z-guides/bone-fractures-types-symptoms-prevention, accessed on 21 december 2014)fckLR
  10. ↑ 2.0 2.1 WebMD. Understanding Bone Fractures - the Basics. 2014. (Available at http://www.webmd.com/a-to-z-guides/understanding-fractures-basic-information, accessed 19 December 2014) fckLR


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