Mid-shaft femur fracture: Difference between revisions
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''Includes all subtrochanteric femur fractures'' | ''Includes all subtrochanteric femur fractures'' | ||
==Background== | ==Background== | ||
[[File: | *[[File:Structure of a Long Bone.png|thumb|Long bone anatomy.]] | ||
*Occurs with severe trauma or in association with | *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) | ||
{{Femur fracture types}} | |||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Hip pain DDX}} | ||
==Evaluation== | ==Evaluation== | ||
[[File:Location of femur fracture.png|thumb|Location of femur fractures]] | |||
[[File:Medical X-Ray imaging IYN05 nevit.jpg|thumb|Spiral shaft fracture of femur.]] | |||
===Workup=== | |||
*Radiography | *Radiography | ||
** | **Femur x-ray: PA and lateral | ||
**Consider films of knee and hip for operative planning and to assess for other injury | |||
*Pre-op labs | *Pre-op labs | ||
**CBC | **CBC | ||
| Line 20: | Line 26: | ||
**PT/PTT | **PT/PTT | ||
**Type & Screen | **Type & Screen | ||
===Diagnosis=== | |||
*Typically via plain films | |||
==Management== | ==Management== | ||
*Resuscitation per [[Trauma (main)|ATLS]] guidelines | *Resuscitation per [[Trauma (main)|ATLS]] guidelines | ||
{{General Fracture Management}} | |||
===Immobilization=== | |||
*Consider traction splint | *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> | **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 | **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 | **Buck's traction used by ortho | ||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
**Typically requires ORIF | |||
==See Also== | ==See Also== | ||
[[Femur fracture]] | *[[Femur fracture]] | ||
==External Links== | ==External Links== | ||
[http://www.wheelessonline.com/ortho/workup_for_femoral_shaft_frx Wheelers' Textbook - Femoral Shaft Fracture] | *[http://www.wheelessonline.com/ortho/workup_for_femoral_shaft_frx Wheelers' Textbook - Femoral Shaft Fracture] | ||
==References== | ==References== | ||
Latest revision as of 19:45, 22 October 2020
Includes all subtrochanteric femur fractures
Background
- Occurs with severe trauma or in association with pathologic bone
- Blood loss can be substantial (average loss = 1L)
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
Clinical Features
- Clinical presentation is similar to intertrochanteric fracture
- Affected leg is shortened and externally rotated
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
Workup
- Radiography
- Femur x-ray: PA and lateral
- Consider films of knee 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
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
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
- ↑ Agrawal Y, Karwa J, Shah N, et al. Traction splint: to use or not to use. J Perioper Pract. 2009; 19(9):295-298.