Femur Fracture

Femur Fracture is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

Fractures classified according to:
  • 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

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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Basics

Description

Fractures classified according to:
  • 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

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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