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| ==Background==
| | #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 x-ray
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| *Most fx, 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 Hb < 12
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| **Peritrochanteric fx
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| ==Intracapsular==
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| ===Femoral Head===
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| *Results from high-energy trauma (e.g. dashboard to flexed knee)
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| *Usually occurs along with dislocation:
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| **Posterior dislocation
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| ***Fx of inf aspect of femoral head; concomitant sciatic nerve injury
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| **Anterior dislocation
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| ***Fx of anterior femoral head; concomitant vascular injury
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| ===Femoral Neck===
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| *Common in older pts w/ osteoporosis; rarely seen in younger pts
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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
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| ***Lesser trochanter is not displaced, no comminution, medial cortices of prox and dist fragments are aligned
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| **Unstable
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| ***Displacement occurs, comminution is present, or multiple fracture lines exist
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| ===Trochanteric===
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| *'''Lesser Trochanter'''
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| **Via avulsion due to forceful contraction of iliopsoas (adolescents) or pathologic bone
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| **Pts are usually ambulatory; c/o pain in groin worse w/ flexion
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| *'''Greater Trochanter'''
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| **Via direct trauma (older pts) or avulsion injury (adolescents)
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| ** Hip pain that increases with abduction; tenderness over greater trochanter
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| *Treatment for both types:
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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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| * Occurs 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]] | |
