|
|
| (8 intermediate revisions by the same user not shown) |
| Line 1: |
Line 1: |
| ==Background==
| | #REDIRECT[[Femur fracture]] |
| * Imaging
| |
| **Consider AP pelvis in addition to AP/lateral views to compare contralateral side
| |
| **Consider MRI if strong clinical suspicion but negative x-ray
| |
| *Most fx, including all displaced fx, are treated with ORIF
| |
| **Exception is isolated trochanteric fx often does not require surgery
| |
| *Skeletal traction is not beneficial
| |
| *Type and cross/screen for pts at higher risk of hemorrhage:
| |
| **Age > 75 yrs
| |
| **Initial Hb < 12
| |
| **Peritrochanteric fx
| |
| *Despite good care, 30-day all cause mortality is 22% and grows to 36% at one year<ref>Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.</ref>
| |
| [[File:Location of femur fracture.png|thumb|Location of femur fractures]] | |
| | |
| ==Clinical Features==
| |
| | |
| ==Differential Diagnosis==
| |
| {{Hip pain DDX}}
| |
| | |
| ==Intracapsular==
| |
| ===Femoral Head===
| |
| *Results from high-energy trauma (e.g. dashboard to flexed knee)
| |
| *Usually occurs along with dislocation:
| |
| **Posterior dislocation
| |
| ***Fx of inf aspect of femoral head; concomitant sciatic nerve injury
| |
| **Anterior dislocation
| |
| ***Fx of anterior femoral head; concomitant vascular injury
| |
| *Management
| |
| **Immediate ortho consult; emergent closed reduction of dislocation
| |
| | |
| ===Femoral Neck===
| |
| *Common in older pts w/ osteoporosis; rarely seen in younger pts
| |
| *Typically minimal bruising (intracapsular)
| |
| *If fractured and displaced: externally rotated and shortened
| |
| *If non-displaced: pt may be ambulatory
| |
| *30% of pts w/ symptoms suggestive of fx but negative x-rays have fx on MRI
| |
| *Management
| |
| **Ortho consult; admit
| |
| **Skeletal traction is contraindicated (may compromise femoral head blood flow)
| |
| | |
| ==Extracapsular==
| |
| ===Intertrochanteric===
| |
| [[File:Garden's Classification.jpg|thumb|Garden's classification of intertrochanteric fractures]]
| |
| *Occur via fall in elderly or osteoporotic
| |
| *Typically pain, swelling, ecchymosis
| |
| **May lose 1-2L of blood
| |
| *Unable to bear weight
| |
| *Shortening and external rotation if fracture is significantly displaced
| |
| *Types:
| |
| **Stable (Garden's type I and II)
| |
| ***Lesser trochanter non-displaced, no comminution, medial cortices of prox/distal fragments aligned
| |
| **Unstable (Garden's type III and IV)
| |
| ***Displacement occurs, comminution is present, or multiple fracture lines exist
| |
| *Management
| |
| **Admit for eventual ORIF
| |
| | |
| ===Trochanteric===
| |
| *'''Greater Trochanter'''
| |
| **Via direct trauma (older pts) or avulsion injury (adolescents)
| |
| ** Hip pain that increases with abduction; tenderness over greater trochanter
| |
| *'''Lesser Trochanter'''
| |
| **Via avulsion due to forceful contraction of iliopsoas (adolescents) or pathologic bone
| |
| **Pts are usually ambulatory; c/o pain in groin worse w/ flexion
| |
| *Treatment for both types:
| |
| **NWB with ortho f/u in 1-2wk
| |
| | |
| ===Subtrochanteric (including Mid-Shaft)===
| |
| *Occurs with severe trauma or in association with pathological bone
| |
| **Blood loss can be substantial (average loss = 1L)
| |
| *Clinical presentation is similar to intertrochanteric fracture
| |
| *Management
| |
| **Consider traction split though little evidence to support its use
| |
| **Admit for ORIF
| |
| | |
| ==See Also==
| |
| *[[Fractures (Main)]]
| |
| | |
| ==Source==
| |
| <references/>
| |
| *UpToDate
| |
| *Harwood-Nuss
| |
| *Tintinalli
| |
| | |
| [[Category:Ortho]]
| |
