Femoral Fractures: Difference between revisions

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== Definition/ Description<br>  ==
== Introduction ==
 
[[File:Femoral-shaft-fracture.jpeg|thumb|Femoral-shaft-fracture]]
add text here related to databases searched, keywords, and search timeline <br>
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]]
<br> A femoral fracture is a break in the femur, this is the thigh bone. The femur is the largest en strongest bone in our 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 wounds and jumps and falls from a height. A femoral fracture is a very serious injury and needs 3-6 months to heal.
 
Femur fractures can be classified in 3 types: Femoral head fracture, femoral shaft fracture and femoral condyles fracture.
 
== Clinically relevant anatomy  ==
 
Osteology:
 
Head, Greater and lesser trochantor, Shaft, Lateral and medial condyles with in between the patellar surface.
 
<br>
 
Musculature:
 
The femur is surrounded by different muscles: the quadriceps, the adductors, abductors and the hamstrings. 1. Quadriceps: M rectus femoris, M vastus lateralis, M vastus medialis, M vastus intermedius 2. Adductors: M adductor longus, M adductor brevis, M adductor longus, M pectineus, M gracilis 3. Abductors: M tensor fasciae latae 4. Hamstrings: M biceps femoris, M semimembranosus, M semitendinosus
 
After a femoral fracture, the most of this muscles are much weaker than before so a physiotherapy is very important.
 
{3} 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.
 
== Epidemiology/ Etiology  ==
 
A femoral fracture is related to different reasons: first of all, the age: older persons (over the 70) have a bigger chance to break the femur. Another reason is osteoporosis. Persons with osteoporosis has a also a higher chance to break their femur. {1}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.{3} 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.
 
== Characteristics/ clinical presentation<br> ==
 
A broken thigh bone is almost always very obvious. A few signs include a severe pain, you can’t move your leg, there’s a swelling, you can’t stand on the leg. There’s also an inability to bear weight and possibly a shortening of the affected leg is common when the fracture is displaced.
It also may result in a loss of blood in the femur and a haematoma can be present in the surrounding soft tissue
 
== Examination ==
 
Ante posterior and lateral x-rays (used to look for a break in the bone) views of the femur are obtained to confirm the fracture. It’s better to use the x-rays views also for the hip, the lower leg and the knee to detect any associated injuries, because a femur fracture is almost associated with other traumatic injuries. For that reason a general physical examination can be practice.
 
== Outcome Measures  ==
 
add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]])
 
== Examination  ==
 
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== Medical Management <br>  ==
 
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== Physical Therapy Management <br>  ==
A femur fracture is a very serious injury. Surgery is sometimes but not always needed. The surgeon will align the fractured parts of the bone. The long immobilization is followed by an extensive physical therapy. The physiotherapist has to begin with range of motion exercises for the hip, knee and ankle because the mobility is decreased after the immobilization. Mobilization is a very important treatment in the recover process.
The patient can also start with strengthening exercises. These are necessary because after the immobilization, there is a muscle atrophy in the surrounded muscles. 
 
 
Mobilization exercises :
Knee: flexion and extension, abduction and adduction
Hip: flexion and extension, abduction and adduction, rotation 
 
Quadriceps exercises need to start as soon as possible after the surgery because the quadriceps help for a good stability in the knee.
Flexion exercises also need to start as soon as possible, provided the means can be devised to support the fracture fully.
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.
 
== Key Research  ==
 
add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
 
== Resources <br>  ==
 
- Michael T. Greenberg, Greenberg’s text-atlas of emergency medicine, p 516-517
 
- Lorin A. Cartwright/ William A. Pitney, Fundamentals of athletic training, 2nd edition, p 130-132 - Brad Walker, Anatomy of sports injuries, p 174-176


- Ronald Mcrae/ Max esser, Practical fracture treatment, 5th edition, p 340-344
== Location ==
[[File:Distal-femoral-fracture.png|thumb|299x299px|Distal-femoral-fracture]]
There are different types of femoral fractures according where they occur, namely:


- Iwata K./ Masiba D., Surgical treatment of proximal femur fracture, sep 2010, 20(9) 1386-92
# 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 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 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.


&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (http://www.ncbi.nlm.nih.gov/pubmed/20808047) -  
== Types ==
 
There are 4 types of fracture:
- The orthopaedic clinic, Femur fracture
# [[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;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (http://www.ssoc.co.za/femur-fracture.html)
# 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>
== Clinical Bottom Line  ==
 
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
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== References  ==
== References  ==


- Michael T. Greenberg, Greenberg’s text-atlas of emergency medicine, p 516-517
<references />
 
- Lorin A. Cartwright/ William A. Pitney, Fundamentals of athletic training, 2nd edition, p 130-132
 
- Brad Walker, Anatomy of sports injuries, p 174-176
 
- Ronald Mcrae/ Max esser, Practical fracture treatment, 5th edition, p 340-344
 
- Iwata K./ Masiba D., Surgical treatment of proximal femur fracture, sep 2010, 20(9) 1386-92
 
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (http://www.ncbi.nlm.nih.gov/pubmed/20808047) (A2)
 
-The orthopaedic clinic, Femur fracture


&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (http://www.ssoc.co.za/femur-fracture.html) (D)<br>  
<br>  


- {1} James E Keany, MD, Fracture, Femur, 22 April 2009 (A1) (http://emedicine.medscape.com/article/824856-overview) - - {2} http://herkules.oulu.fi/isbn9514270959/html/c228.html (A1) - {3} Douglas F Aukerman, MD, Femur injuries and fractures, 30 October 2008 (http://emedicine.medscape.com/article/90779-overview) (A1)
[[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, Nupur Smit Shah, Vidya Acharya, Jentel Van De Gucht, Rachael Lowe, Alex Palmer, Daphne Jackson, Margaux Jacobs, Jason Coldwell, Aminat Abolade, 127.0.0.1, Evan Thomas, WikiSysop and Lauren Lopez

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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