This document summarizes fractures of the femur bone, including intertrochanteric and shaft fractures. Intertrochanteric fractures typically occur due to falls in elderly patients and result in the distal fragment riding up. They are usually comminuted and displaced. Shaft fractures result from high-energy trauma and can occur anywhere along the shaft. Treatment involves restoring alignment through conservative or operative methods like internal fixation. Complications include malunion, osteoarthritis, delayed healing, and infection.

1. INTER TROCHANTERIC
FRACTURES OF FEMUR

2. “Fractures in the inter trochanteric region of the proximal
femur, involving either the greater or the lesser trochanter or
both”
•In elderly the fracture is sustained by a sideway fall or a blow
over the greater trochanter.
•In young it occurs followed by violent trauma, as in RTA.

3. Pathoanatomy
• The distal fragment rides up
so that the femoral neck-shaft
angle is reduced (Coxa vera).
• The fracture is generally
comminuted and displaced.
• Rarely it can be undisplaced
fracture.

4. Diagnosis
Clinical features:-
• History of a fall or RTA.
• Pain in the region of the groin and inability to move the leg.
• Swelling in the region of the hip, and the leg will be short and externally
rotated.
• Tenderness over the greater trochanter.
• Physical findings are more marked.

5. Radiological features:-
• X-ray- presence of comminution
of the medial cortex of the neck
• avulsion of the lesser trochanter
• extension of the fracture to the
subtrochanteric region indicate
an unstable fracture.

6. Treatment
• These fractures unite readily.
• The main objective is to maintain the normal femoral neck shaft angle during the
process of union.
• This can be done by conservative method or by internal fixation.
Conservative method:-
• Used less often.
• Commonly used are Russell’s traction andThomas splint.

8. Operative method:-
• The fracture is reduced under x-ray control and fixed with internal fixation devices.
• Most commonly used are,
Dynamic hip screw (DHS).
Ender’s nails.
Nails such as gamma nail, Proximal Femoral Nail (PFN).

9. Complications
Malunion:-
• Failure in keeping the fragments aligned gives rise to coxa vara, shortening and leg in
external rotation.
• Corrected by inter trochanteric osteotomy.
Osteoarthritis:-
• Pain and stiffness in the hip after symptom free period following union of the fracture
confirmed by x-ray changes.
• Corrected by physiotherapy in early stages and in later stages trochanteric osteotomy
or total hip replacement may be required.

10. FRACTURE SHAFT OF
FEMUR

11. • Usually sustained by a severe violence as in RTA.
• Force causing the fracture may be direct (RTA) or indirect (twisting or bending)
Pathoanatomy:-
• The fracture may occur at any site and is almost equally comman in upper, middle and
lower third of the shaft.
• It may be transverse, oblique, spiral or comminuted depending upon nature of force.

13. Displacements:-
• The proximal fragment is
flexed, abducted and
externally rotated by the
pull of the muscles attached
to it.
• Distal fragment is adducted
because of attachment of
adducter muscles.
• Unsupported fracture ends
sags because of gravity.

14. Diagnosis
Clinical features:-
History of severe violence
followed by classical signs of
fracture in the region of thigh –
Pain, swelling, deformity,
abnormal mobility.
Radiological examination:-
• X-ray of the femoral shaft
including whole femur.
• In addition X-ray of the hip for
• any associated injury.

15. Treatment
Conservative methods:-
Traction- With or without splint.
UsuallyThomas splint is used.
Skin traction is sufficient in children,
Skeletal traction by stienmann pin in adults.
Hip Spica- Plaster cast involving part of trunk and the limb
It may be Single spica or one and a half.

16. Operative methods:-
• Intramedullary nailing is preferred method.
• Fracture may be reduced by open or closed methods.
• Commonly used methods are,
Closed interlock nailing.
Kuntscher’s clover intra-medullary nail (K-nail).
Plating (Fixing with a thick strip of metal).

17. Deciding treatment plan
The treatment plan depends upon
age of the patient,
location of the fracture,
type of the fracture,
presence of a wound.
• In children, treatment is mostly by non operative methods.
• From birth to 2 years fractures treated by Gallow’s traction.
• From 2 to 16 years conservative method as mentioned above.
• TENS (Titanium Elastic Nail System) can also be used.

18. Complications
Early Complications:-
Shock.
Fat embolism.
Injury to femoral artery.
Injury to sciatic nerve.
Infection.
Late Complications:-
Delayed union.
Non union.
Malunion.
Knee stiffness.

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