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DescriptionFractures classified according to:
- Proximal 3rd (subtrochanteric region)
- Middle 3rd
- Distal 3rd (distal metaphyseal–diaphyseal junction)
- Extent of soft tissue injury:
- 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
- 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.
- Atypical femur fractures have been associated with use of bisphosphonate medications.
- 70% of femoral fractures in children <3 yr old are the result of nonaccidental trauma (NAT).
- Spiral fractures of the femur strongly suggest NAT.