Mid-shaft femur fracture: Difference between revisions

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==Background==
==Background==
[[File:Location of femur fracture.png|thumb|Location of femur fractures]]
[[File:Location of femur fracture.png|thumb|Location of femur fractures]]
*Occurs with severe trauma or in association with pathological bone
*[[File:Structure of a Long Bone.png|thumb|Long bone anatomy.]]
*Occurs with severe trauma or in association with pathologic bone
**Blood loss can be substantial (average loss = 1L)
**Blood loss can be substantial (average loss = 1L)


==Clinical Features==
==Clinical Features==
*Clinical presentation is similar to intertrochanteric fracture
*Clinical presentation is similar to intertrochanteric fracture
**Affected leg is shortened and externally rotated


==Differential Diagnosis==
==Differential Diagnosis==
{{Femur fracture types}}
{{Femur fracture types}}


==Diagnosis==
==Evaluation==
[[File:Medical X-Ray imaging IYN05 nevit.jpg|thumb|Spiral shaft fracture of femur.]]
===Workup===
*Radiography
**Obtain films of knee, femur, and hip for operative planning and to assess for other injury
*Pre-op labs
**CBC
**Chem 7
**PT/PTT
**Type & Screen
 
===Diagnosis===
*Typically via plain films


==Management==
==Management==
*Consider traction split though little evidence to support its use
*Resuscitation per [[Trauma (main)|ATLS]] guidelines
*ORIF
{{General Fracture Management}}
 
===Immobilization===
*Consider traction splint
**Little evidence to support its use<ref>Agrawal Y, Karwa J, Shah N, et al. Traction splint: to use or not to use. J Perioper Pract. 2009; 19(9):295-298.</ref>
**Theoretical benefit of traction splinting is reduction in bleeding and improved pain
**Sager and Hare splints are commonly used by EMS providers
**Buck's traction used by ortho


==Disposition==
==Disposition==
*Admit
*Admit
**Typically requires ORIF


==See Also==
==See Also==
*[[Femur fracture]]


==External Links==
==External Links==
*[http://www.wheelessonline.com/ortho/workup_for_femoral_shaft_frx Wheelers' Textbook - Femoral Shaft Fracture]


==References==
==References==
<references/>
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]

Revision as of 14:19, 11 January 2020

Includes all subtrochanteric femur fractures

Background

Location of femur fractures
  • Long bone anatomy.
  • Occurs with severe trauma or in association with pathologic bone
    • Blood loss can be substantial (average loss = 1L)

Clinical Features

  • Clinical presentation is similar to intertrochanteric fracture
    • Affected leg is shortened and externally rotated

Differential Diagnosis

Femur Fracture Types

Proximal

Shaft

Evaluation

Spiral shaft fracture of femur.

Workup

  • Radiography
    • Obtain films of knee, femur, and hip for operative planning and to assess for other injury
  • Pre-op labs
    • CBC
    • Chem 7
    • PT/PTT
    • Type & Screen

Diagnosis

  • Typically via plain films

Management

  • Resuscitation per ATLS guidelines

General Fracture Management

Immobilization

  • Consider traction splint
    • Little evidence to support its use[1]
    • Theoretical benefit of traction splinting is reduction in bleeding and improved pain
    • Sager and Hare splints are commonly used by EMS providers
    • Buck's traction used by ortho

Disposition

  • Admit
    • Typically requires ORIF

See Also

External Links

References

  1. Agrawal Y, Karwa J, Shah N, et al. Traction splint: to use or not to use. J Perioper Pract. 2009; 19(9):295-298.