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| ==Overview==
| | #REDIRECT[[Femur fracture]] |
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| * <span style="line-height: 20px">Imaging</span>
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| ** Consider AP pelvis in addition to standard AP and lateral views to compare to contralateral side
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| ** Consider MRI if strong clinical suspicion but negative xray
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| * Most fractures, including all displaced fx, are treated with ORIF
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| ** Isolated trochanteric fx often does not require surgery�
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| * Skeletal traction is not beneficial�
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| * Type and cross/screen for pts at higher risk of hemorrhage
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| ** Age > 75 yrs
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| ** Initial hemoglobin < 12
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| ** Peritrochanteric fx�
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| * Adolescent + knee or hip pain = rule-out SCFE�
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| ==Intracapsular==
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| * ====Femoral Head====
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| ** Usually occurs along with dislocation
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| *** Posterior dislocation - Fracture of inf aspect of femoral head; concomitant sciatic nerve injury
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| *** Anterior dislocation - Fracture of anterior femoral head; concomitant vascular injury
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| * ====Femoral neck====
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| ** Typically minimal bruising (intracapsular)
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| ** If fractured and displaced:
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| *** Externally rotated and shortened
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| ** Garden Classification
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| *** Type 1: Impaction Fx
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| *** Type 2: Nondisplaced Fx�
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| *** Type 3: Displacement of the femoral head
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| *** Type 4: Complete loss of continuity between fragments<span style="line-height: 20px"><br /></span>
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| ==Extracapsular==
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| * ====Intertrochanteric====
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| ** Typically pain, swelling, ecchymosis
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| *** May lose 1-2L of blood
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| ** Unable to bear weight
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| ** Shortening and external rotation if fracture is significantly displaced�
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| ** Types
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| *** Stable - Lesser trochanter is not displaced, no comminution, medial cortices of prox and dist. fragments are aligned
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| *** Unstable - Displacement occurs, comminution is present, or multiple fracture lines exist
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| * ====<span style="line-height: 20px">Trochanteric</span>====
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| ** '''Lesser Trochanter'''
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| *** Pain in groin or�<span style="line-height: 20px">may present with knee or posterior thigh pain worse with hip flexion and rotation</span>
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| *** Most common in the young (due to forceful contraction of iliopsoas muscle)
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| **** If occurs in elderly pt with lack of trauma history consider lytic lesion�<span style="line-height: 20px">�</span><span style="line-height: 20px">�</span>
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| ** '''Greater Trochanter'''
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| *** Hip pain that increases with abduction and tenderness over the greater trochanter
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| ** Imaging
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| *** Lessor trochanter - �AP view with the leg in supported external rotation
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| *** Greater trochanter - Standard AP view
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| ** Treatment<span style="line-height: 20px">�</span>
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| *** NWB for 3-4 weeks for non-displaced fx
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| *** If displaced (> 1cm) refer to orthopedic surgeon for ORIF
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| * ====Subtrochanteric (including mid-shaft)====
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| ** Occur with severe trauma or in association with pathological bone
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| *** Blood loss can be substantial (average loss = 1L)
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| ** Clinical presentation is similar to intertrochanteric fracture
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| Source: UpToDate, Harwood-Nuss
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| [[Category:Ortho]] | |
