Femur Fracture
Basics
Description
Fractures classified according to: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
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
Geriatric Considerations
Atypical femur fractures have been associated with use of bisphosphonate medications
Pediatric Considerations
- 70% of femoral fractures in children <3 yr old are the result of nonaccidental trauma (NAT)
- Spiral fractures of the femur strongly suggest NAT
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Citation
Schaider, Jeffrey J., et al., editors. "Femur Fracture." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture.
Femur Fracture. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture. Accessed September 7, 2024.
Femur Fracture. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture
Femur Fracture [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2024 September 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture.
* Article titles in AMA citation format should be in sentence-case
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BT - 5-Minute Emergency Consult
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