|
|
| (19 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| ==Background==
| | #REDIRECT[[Femur fracture]] |
| * Imaging
| |
| ** Consider AP pelvis in addition to standard AP and lateral views to compare to contralateral side
| |
| **Consider MRI if strong clinical suspicion but negative x-ray
| |
| *Most fx, including all displaced fx, are treated with ORIF
| |
| **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
| |
| | |
| ==Intracapsular==
| |
| ===Femoral Head===
| |
| * Usually occurs along with dislocation
| |
| ** Posterior dislocation - Fracture of inf aspect of femoral head; concomitant sciatic nerve injury
| |
| ** Anterior dislocation - Fracture of anterior femoral head; concomitant vascular injury
| |
| ===Femoral neck===
| |
| * Typically minimal bruising (intracapsular)
| |
| * If fractured and displaced:
| |
| ** Externally rotated and shortened
| |
| * Garden Classification
| |
| ** Type 1: Impaction Fx
| |
| ** Type 2: Nondisplaced Fx
| |
| ** Type 3: Displacement of the femoral head
| |
| ** Type 4: Complete loss of continuity between fragments
| |
| | |
| ==Extracapsular==
| |
| ===Intertrochanteric===
| |
| * 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 - Lesser trochanter is not displaced, no comminution, medial cortices of prox and dist. fragments are aligned
| |
| ** Unstable - Displacement occurs, comminution is present, or multiple fracture lines exist
| |
| | |
| ===Trochanteric===
| |
| * '''Lesser Trochanter'''
| |
| ** Pain in groin or may present with knee or posterior thigh pain worse with hip flexion and rotation
| |
| ** Most common in the young (due to forceful contraction of iliopsoas muscle)
| |
| *** If occurs in elderly pt with lack of trauma history consider lytic lesion
| |
| * '''Greater Trochanter'''
| |
| ** Hip pain that increases with abduction and tenderness over the greater trochanter
| |
| * Imaging
| |
| ** Lessor trochanter - AP view with the leg in supported external rotation
| |
| ** Greater trochanter - Standard AP view
| |
| * Treatment
| |
| ** NWB for 3-4 weeks for non-displaced fx
| |
| ** If displaced (> 1cm) refer to orthopedic surgeon for ORIF
| |
| | |
| ===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
| |
| | |
| ==Source==
| |
| UpToDate, Harwood-Nuss
| |
| | |
| [[Category:Ortho]] | |
