2. Largest tubular bone in the body.
Surrounded by the largest mass of
muscle.
‘Antero-lateral’ bow – important
feature.
Isthmus – it is the region of femur
with smallest intra-medullary
diameter, it’s at the junction of
upper 1/3rd and lower 2/3rd .
3. ▪ rough crest of bone running down
middle third of posterior femur
▪ attachment site for various
muscles and fascia
▪ acts as a compressive strut to
accommodate anterior bow to
femur
4. ABDUCTORS :- They abducts hip joint and
are mainly gluteus medius and minimus.They
insert on greater trochenter , abduct proximal
femur following fracture.
ILIOPSOAS :- flex and external rotates the
proximal fragment by its attachment in lesser
trochenter.
ADDUCTOR :- Mainly Adductor longus,
Adductor magnus and Adductor brevis. Exerts
a strong axial and varus load to bone by
traction on distal part
FASCIA LATA :- acts as a tension band by
resisting the medial angulating forces of
abductor.It’s a continuation of Ilio-tibial tract
of thigh and is also known as DEEP FASCIA OF
Thigh.
5. Three compartments.
ANTERIORCOMPARTMENT - Quadriceps femoris,
iliopsoas, sartorius and pectineus. Femoral artery, vein,
nerve, lat femoral cutaneous nerve.
MEDIAL COMPARTMENT – gracilis, adductor longus,
brevis, magnus and obturator externus muscles.
Obturator artery,vein,nerve and profunda femoris
artery.
POSTERIORCOMPARTMENT –biceps femoris,
semitendinosus and semimembranosus, a portion of
the adductor magnus ( Hamstring muscles) branches
of profunda femoris artery, sciatic nerve, post femoral
cutaneous nerve.
6. Mainly from the profunda femoris,
branch of Femoral artery
One to two nutrient vessels usually
enter the bone proximally and
posteriorly along the linea aspera.
This artery then arborizes proximally
and distally to provide endosteal
circulation.
Periosteal vessels also entres along
the linea aspera.
7. Outer 1/3rd of cortex supply – periosteal vessels.
Inner 2/3rd of cortex supply – endosteal vessels.
After most of the femoral shaft fracture
- endosteal supply disrupted
- periosteal vessels proliferate to heal
- medullary vessels restored late in healing process.
8. TRAUMATIC
▪ high-energy
▪ most common in younger population
▪ often a result of high-speed motor vehicle accidents
▪ low-energy
▪ more common in elderly
▪ often a result of a fall from standing
9. Pathological fracture – elderly, inconsistent with
degree of trauma, at the weak metaphyseal-diaphyseal
junction.
10. Transverse
pure bending movement
Spiral
Rotational/twisting movement
Oblique
uneven bending movement
Segmental
More than 1 fracture line
Comminuted
Single fracture line with multiple fragments
11. Ipsilateral femoral neck fracture
▪ often basicervical, vertical, and nondisplaced
▪ missed 19-31% of time
Bilateral femur fractures
▪ significant risk of pulmonary complications
▪ increased rate of mortality as compared to unilateral fractures
Ipsilateral tibial shaft fractures
Ipsilateral acetabular fracture
12. Symptoms
▪ H/O trauma followed by inability to walk
Physical examination
Diagnostic features of fracture are
1.Bony crepitus
2.Abnormal mobility .
3. Loss of transmitted mobility
13. Type 0 • No comminution
Type I • Insignificant amount of comminution
Type II • More than 50% cortical contact
Type III • Less than 50% cortical contact
Type IV • Segmental fracture with no contact
between proximal and distal fragment
14.
15. Radiographs
AP and lateral views of femur with hip and knee
AP view of Pelvis
▪ important to rule-out coexisting femoral neck fracture
CT indications
may be considered in midshaft femur fractures to
rule-out associated femoral neck fracture
16.
17. Resuscitation of patient as per ATLS guidelines.
Airway
Breathing
Circulation
Disability
Normally 500ml -2000 ml blood loss occurs so patient
may present with shock.
Volume replenishment by IV fluids or blood
transfusion if required.
Catheterization to be done.
18. Application of below knee-skin traction with
Thomas splint should be done as early as
possible.
Stabilization should be done at the
emergency room.
19. Nonoperative
Long leg cast or hip spica cast in Paediatric age group upto 5 Years
Operative
Done after stabilization of patient usually after 5-7 days.
1. Adolescent age groups- Tension Elastic nail application,
done under IOTP without opening fracture site
2. After skeletal maturity -Antegrade intra-medullary
nail done under IOTP without opening the fracture site.