Femur Fracture

Description

• Location:
  • Proximal third (subtrochanteric region)
  • Middle third
  • Distal third (distal metaphyseal–diaphyseal junction)
• Geometry:
  • Spiral
  • Transverse
  • Oblique
  • Segmental
• Extent of soft tissue injury:
  • Open
  • Closed
• There are 2 commonly accepted classification systems of femoral fractures: The AO/OTA and the Winquist and Hansen
• Degree of comminution: Winquist and Hansen classification:
  • Grade I: Fracture with small fragment <25% width of femoral shaft; stable lengthwise and rotationally
  • Grade II: Fracture with 25–50% width of femoral shaft; stable lengthwise; may or may not have rotational stability
  • Grade III: Fracture with >50% width of femoral shaft; unstable lengthwise and rotationally
  • Grade IV: Circumferential loss of cortex; unstable lengthwise and rotationally

Etiology

• Usually requires major, high-energy trauma
• Patients are mostly young adults with high-energy injuries (motor vehicle accidents [MVAs], gunshot wounds [GSWs], falls):
  • Spiral fractures with falls from height
• Consider pathologic fracture if minor mechanism
• Can occasionally be due to stress fracture from repetitive activity
• Complications include compartment syndrome, fat embolism, adult respiratory distress syndrome (ARDS), hemorrhage

• 70% of femoral fractures in children <3 yr old are the result of nonaccidental trauma (NAT)
• Spiral fractures of the femur strongly suggest NAT