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| ==Overview==
| | #REDIRECT[[Femur fracture]] |
| * Imaging
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| ** Consider AP pelvis in addition to standard AP and lateral views to compare to contralateral side
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| ** Consider MRI if strong clinical suspicion but negative xray
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| * Most fractures, including all displaced fx, are treated with ORIF
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| ** Isolated trochanteric fx often does not require surgery
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| * Skeletal traction is not beneficial
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| * Type and cross/screen for pts at higher risk of hemorrhage
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| ** Age > 75 yrs
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| ** Initial hemoglobin < 12
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| ** Peritrochanteric fx
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| * Adolescent + knee or hip pain = rule-out SCFE
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| ==Intracapsular==
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| ====Femoral Head====
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| * Usually occurs along with dislocation
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| ** Posterior dislocation - Fracture of inf aspect of femoral head; concomitant sciatic nerve injury
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| ** Anterior dislocation - Fracture of anterior femoral head; concomitant vascular injury
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| ====Femoral neck====
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| * Typically minimal bruising (intracapsular)
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| * If fractured and displaced:
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| ** Externally rotated and shortened
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| * Garden Classification
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| ** Type 1: Impaction Fx
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| ** Type 2: Nondisplaced Fx
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| ** Type 3: Displacement of the femoral head
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| ** Type 4: Complete loss of continuity between fragments
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| ==Extracapsular==
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| ====Intertrochanteric====
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| * Typically pain, swelling, ecchymosis
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| ** May lose 1-2L of blood
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| * Unable to bear weight
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| * Shortening and external rotation if fracture is significantly displaced
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| * Types
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| ** Stable - Lesser trochanter is not displaced, no comminution, medial cortices of prox and dist. fragments are aligned
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| ** Unstable - Displacement occurs, comminution is present, or multiple fracture lines exist
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| ====<span style="line-height: 20px">Trochanteric</span>====
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| * '''Lesser Trochanter'''
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| ** Pain in groin or may present with knee or posterior thigh pain worse with hip flexion and rotation
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| ** Most common in the young (due to forceful contraction of iliopsoas muscle)
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| *** If occurs in elderly pt with lack of trauma history consider lytic lesion
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| * '''Greater Trochanter'''
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| ** Hip pain that increases with abduction and tenderness over the greater trochanter
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| * Imaging
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| ** Lessor trochanter - AP view with the leg in supported external rotation
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| ** Greater trochanter - Standard AP view
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| * Treatment
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| ** NWB for 3-4 weeks for non-displaced fx
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| ** If displaced (> 1cm) refer to orthopedic surgeon for ORIF
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| ====Subtrochanteric (including mid-shaft)====
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| * Occur with severe trauma or in association with pathological bone
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| ** Blood loss can be substantial (average loss = 1L)
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| * Clinical presentation is similar to intertrochanteric fracture
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| ==Source==
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| UpToDate, Harwood-Nuss
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| [[Category:Ortho]] | |
