DIAPHYSEAL FRACTURES SHAFT OF FEMUR . FOR UNDERGRADUATES

1. DIAPHYSEAL FEMUR
FRACTURES

2. ANATOMY
• LARGEST AND STRONGEST
BONE IN THE BODY
• ANTERIOR BOW
• ISTHMUS OF FEMUR – IS THE
REGION WITH SMALLEST
DIAMETER

3. ANATOMY

4. ANATOMY
• LINEA ASPERA -
• ROUGH CREST ON THE POSTERIOR ASPECT OF MIDDLE ONE
THIRD OF FEMUR
• SERVES AS ATTACHMENT FOR MUSCLES AND FASCIA’
• ACTS AS A COMPRESSIVE STRUT TO ACCOMMODATE THE
ANTERIOR BOW TO FEMUR

5. ANATOMY

6. ANATOMY-BLOOD
SUPPLY

7. ANATOMY –
OSSIFICATIO
N

8. EPIDEMIOLOGY
• 1 FEMUR FRACTURE FOR EVERY 10,000
• BIMODAL DISTRIBUTION –PEAKS AT 25 AND
65YRS
• SEEN IN MALES AGED 15 TO 24 YEARS
• SEEN IN ELDERLY FEMALES AGED 75 YEARS

9. MECHANISM OF INJURY
• IN YOUNG INDIVIDUALS DUE TO HIGH ENERYGY TRAUMA SUCH AS
MVA OR FALL FROM HEIGHT
• IN ELDERLY A SIMPLE FALL

10. ASSOCIATED FRACTURES
• OFTEN ASSOCIATED WITH IPSILATERAL FEMUR
NECK FRACTURE IN 2.6% INDIVIDUALS .
• MISSED 19-31% OF THE TIME

13. CLASSIFICATION
• WINQUIST AND HANSEN CLASSIFICATION
• TYPE 0 TO TYPE 4

14. TYPE 0
NO COMMINUTION

15. TYPE 1 –Insignificant comminution

16. TYPE 2
GREATER THAN 50% CORTICAL CONTACT

17. TYPE 3
LESS THAN 50% CORTICAL CONTACT

18. TYPE 4
SEGMENTAL FRACTURE WITH NO CONTACT BETWEEN PROXIMAL AND DISTAL FRAGMENTS

19. CLINICAL PRESENTATION
• SWELLING
• TENDERNESS
• ABNORMAL MOBILITY
• DEFORMITY

20. HAEMORRHAGE
• CLOSED – 1000 TO 1500 ML
• OPEN – DOUBLE !
• TIBIA – 500-1000ML IN A CLOSED FRACTURE

21. • NEUROVASCULAR STATUS IS TO BE
DOCUMENTED

22. RADIOLOGY
• AP AND LATERAL VIEW OF FEMUR
• AP VIEW OF IPSILATERAL HIP AND KNEE
• CT SCAN

23. TREATMENT
LONG LEG CAST – NON DISPLACED

24. TREATMENT
ANTEGRADE INTRAMEDULLARY
NAIL – GOLD STANDARD

25. TREATMENT
• ADVANTAGES –
• DECREASED PULMONARY COMPLICATIONS AND THROMBOEMBOLIC
EVENTS
• INCREASED RAHABILITATION

26. TREATMENT
• RETROGRADE NAILING – IPSILATERAL FEMORAL NECK
FRACTURE

27. TREATMENT
• EXTERNAL FIXATION AND CONVERSION TO NAIL WITHIN 3
WEEKS

28. TREATMENT
• ORIF WITH PLATE – WHEN FRACTURE AT METADPHYSEAL –
DIAPHYSEAL JUNCTION

29. COMPLICATIONS
• HETEROTOPIC OSSIFICATION
• INCIDENCE – 25 %
• PUDENDAL NERVE INJURY – DUE TO TRACTION
• FEMORAL ARTERY OR NERVE INJURY – RARE

30. COMPLICATIONS
MALUNION
DELAYED UNION
NON UNION –LESS THAN 10 %
INFECTION – LESS THAN 1%

31. CASE
• A 49-year-old man with a history of prostate cancer metastatic
to bone suffered a
pathological fracture to the left femur while hospitalized .
Eighteen hours after the
fracture, he developed hypoxemia and hypotension followed by
confusion and a
petechial rash in the left axilla. Chest X-ray obtained after
intubation demonstrated
new diffuse bilateral patchy infiltrates .

32. FAT EMBOLISM
• A SYNDROME CAUSED BY INFLAMMATORY RESPONSE TO EMBOLIZED
FAT GLOBULES
• CHARCATERIZED BY
• HYPOXIA
• DEPRESSION – CNS
• PULMONARY EDEMA
• PETECHIAL RASH

33. INCIDENCE
• 3-4% WITH ISOLATED BONE TRAUMA
• 10 -15% WITH ISOLATED POLYTRAUMA

34. PATHOPHYSIOLOGY
• MECHANICAL THEORY – EMBOLISM CAUSED BY BONE MARROW FAT
RELEASED INTO VENOUS SYSTEM
• METABOLIC THEORY – STRESS FROM TRAUMA CAUSES CHANGES IN
CHYLOMICRONS WHICH RESULT IN FORMATION OF FAT EMBOLI

37. TREATMENT
• NON OPERATIVE
• ICU MANAGEMENT

38. THANK YOU