FRACTURE OF FEMUR

                                                                                     

 

Definition of femur:

When the fracture occurs in femur is called fracture femur.

 

 

 

Classification of femur:

 

 

1.    Proximal femur:

a) Head.

b) Intracapsular.

c) Extra capsular:

          i. Trochanteric.

          ii. Sub-trochanteric.

2.    Shaft.

3.    Distal femur:

i) Supracondylar.

ii) Intra-Articular.

 

 

Common site of facture of femur:

 

 

1.    Upper epiphyseal: separation in children.

2.    Trochanteric

3.    Neck of femur.

4.    Shaft of femur.

5.    Supracondylar.

6.    Condylar of femur.

7.    Intracondylar.

 

 

 

FRACTURE SHAFT OF FEMUR:

 

 

Definition of Fracture Shaft of Femur:

 

          When fracture occurs at any site of shaft of the femur is known as fracture femur.

Incidence: At any age.

 

 

Cause of Fracture Shaft of Femur:

 

 Due to-

1.    Direct / Indirect trauma.

2.    Road Traffic Accident.

3.    Fall from a height.

 

 

Radiological classification of fracture shaft femur:

 

 

1.    Transverse fracture.

2.    Oblique fracture.

3.    Spiral fracture.

4.    Comminuted fracture.

 

 

Clinical feature of fracture shaft femur:

 

 

A.   Symptoms:

 

          1. History of trauma.

          2. Pain and swelling around the affected part.

          3. Inability to move the affected lower limb.

          4. Abnormal shape of the affected thigh.

B.   Signs:

          1. Local rise of temperature.

          2. Swelling.

          3. Tenderness.

          4. Crepitation may be palpable.

          5. Deformity

          6. Shortening.

 

 

Complications of fracture shaft femur:

 

 

1.    Stiffness of the knee joint.

2.    Mal-union.

3.    Delayed-union.

4.    Non-union.

5.    Shortening.

6.    Osteomyelitis in case of open fracture.

7.     Re-fracture.

8.    Tetanus.

 

 

Treatment of fracture shaft femur:

 

 

A. Diagnosis and assessment:

1. Examine the patient thoroughly-check and record Temperature, Pulse, Respiration and blood pressure properly.

          2. History of trauma is to be taken.

          3. X-ray is done to confirm diagnosis.

 

 

B. Medication:

          1. Analgesic- To relieve pain like Inj-Diclofenac.

          2. Intra venous fluid is to be given.

          3. Blood transfusion is given if needed.

4. Antibiotic-To prevent infection. Like- Cloxacillin, Penicillin, Ceftraxon etc.

          5. Steroid is given if necessary. Like: Inj. Dexamethason.

          6. In case of external injury-

                    a) If the patient is not immobilized then-

i) Inj-TIG 250 i u 1ample i /m is to be given if not available then Inj-ATS1500 i u 1 ample i/m is given after skin test.

ii). Inj- TT1 ample i/m started and another one after one month.

b). If the patient is immunized then only Inj- T.T 1ample i / m given. (Buster dose).

                    c). Specific treatment-

1. Close reduction and internal fixation by continuous traction with stienmann’s pin or leukoplast.

2. In case of children below 2 years of age then Gallow’s traction is used.

3. If closed reduction is failed then open reduction and internal fixation is done under G /A with plate and screw.

 

 

Indication of open reduction:

1.    Mal union.

2.    Inter position of soft tissue.

 

 

FRACTURE NECK FEMUR:

 

 

Definition of Fracture of Neck Femur:

 

 

          When fracture occurs in the neck of the femur is known as fracture neck femur. Usually occurs in elderly as bones become weak by senite osteoporosis.

          Sex: Females are more sufferer

 

 

 

Causes of Fracture of Neck Femur:

 

 

1.    Fall on ground due to slip.

2.    Road Traffic Accident.

3.    Fall from height.

4.    During play.

 

 

 

Classification of fracture Neck femur:

 

 

A.   In relation with capsule:

 

1.    Intra-capsular-

                    i). Cervical.

                    ii). Basal.

2.    Extra-capsular-

i). Trochanteric.

ii). Basal cervical.

 

B.   Radiological:

Transvers fracture usually.

 

 

Clinical features of fracture Neck femur:

 

 

1.    Pain and tenderness.

2.    Unable to walk.

3.    Movement restricted.

4.    Shortening.

5.    Pain on passive rotation of affected limb.

 

 

 

 

Treatment / Management of Fracture of Neck Femur:

 

 

 

A. Diagnosis and assessment:

 

1. Examine the patient thoroughly-Check and record pulse, temperature, Respiration and blood pressure properly.

     2. History of trauma is to be taken.

     3. X-ray is done to confirm diagnosis.

 

 

B. Medication:

 

     1. Analgesic-to relieve pain as like Inj - Diclofenac sodium.

     2. I/v fluid is to be given.

     3. Blood transfusion if necessary.

     4. Antibiotic-to prevent infection as like-Cloxacillin/Ampicillin /Ceftrxon etc.

     5. Steroid- if necessary.

     6. In case of external injury-

               a. If the patient is not immunized-

i. Inj-T,I,G 250 i.u 1 ample i/m is given if not available then Inj-A.T.S 1500 i.u i/m is given after skin test.

ii. Inj- T.T 1 ample i/m is given and another one after one month.

b. If the patient is immunized- Only Inj- T.T 1 ample   i/m given ( Buster dose).

 

 

C. Specific treatment:

 

1.    In case of extra-capsular fracture:

a)    Close reduction and internal fixation by continuous traction with leukoplast or pin and immobilized by Thomas splint.

b)    If closed reduction is failed then open reduction and internal fixation under G/A by pin and screw in case of elderly patient.

2.    In case of intra-capsular fracture:

Open reduction and internal fixation with nail plate and immobilize as early as possible.

 

 

 

Complications of Fracture of Neck Femur:

 

 

1.    Avascular necrosis of head of the femur.

2.    Non-union.

3.    Mal-union.

4.    Shortening.

5.    Osteoarthritis.

6.    Joint stiffness.

 

 

SUPRA CONDYLAR FRACTURE OF FEMUR:

 

 

 

Definition of Supra Condylar Fracture of Femur:

 

 

          When fracture occurs just above the condyle of femur is known as supra-condylar fracture of femur. It occurs at any age.

 

 

Causes of Supra Condylar Fracture of Femur:

 

 

 It occurs due to direct or indirect violence

 

a)    Direct cause: By direct hit.

 

b)    In direct cause:

             i) Road Traffic Accident.

             ii) Fall from a height.

             iii) During play etc.

 

 

 

Clinical features of Supra Condylar Fracture of Femur:

 

 

Symptoms:

i)                History of trauma.

ii)              Pain and swelling around the lower part of thigh.

iii)            Inability to move the lower limb.

iv)            Abnormal shape.

 

 

Signs:

i)                Rise of local temperature.

ii)              Swelling.

iii)            Tenderness at the lower end of the femur.

iv)            Deformity.

v)              Crepitation is palpable.

vi)            X-ray to confirm diagnosis.

vii)          Skin examination –skin injury-laceration.

 

 

 

Treatment of Supra Condylar Fracture of Femur:

 

 

A.   Diagnosis and assessment:

 

 

1.    Examine the patient thoroughly:Check and record temperature, pulse, respiration and blood pressure properly.

2.    History of trauma is to be taken.

3.    X-ray is done to confirm diagnosis.

 

 

B.   Medication:

 

1. Analgesic- to relieve pain as like Inj Diclofenac sodium.

          2. I/v fluid is to be given.

          3. Blood transfusion if necessary.

          4. Antibiotic-t prevent infection like cloxacillin, ampicillin, penicillin, ceftraxon etc.

          5. Steriod is to be given if necessary.

          6. In case of external injury:

 

a)    If the patient not immunized then.

i) Inj- T.I.G 250 i.u 1 ample i/m is to be given. If not available then Inj- A.T.S 1500 I.U 1 ample i/m is to be given.

ii). Inj-T.T1 ample i/m is to be given after skin test and another one after one month.

 

b)    If the patient is immunized then-

0nly inj –T.T 1 ample i/m is to be given after skin test. (Buster dose).

 

 

C.   Specific treatment:

 

1.    Close reduction and internal fixation by continuous traction by stienmann’s pin with knee 45* flexion.

2.    If close reduction is failed then open reduction and internal fixation by Rush nail or L. plate or plate and screw.

 

 

 

 

Complications of Supra Condylar Fracture of Femur:

 

 

1.    Stiffness of the knee joint.

2.    Mal-union.

3.    Osteoarthritis.

4.    Osteomyelitis.

5.    Vessel injury.

6.    Nerve injury.

7.    Tetanus.

8.    Compression of femoral artery.

9.    Complete injury of femoral artery.

10.In-complete injury of femoral artery.