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Complex Femoral Fractures

The femur is one of the largest and strongest bones in the body. The femur is the thigh bone which extends from the hip joint down to the knee joint. Because the femur is such a strong bone, it can take tremendous force to cause a fracture of the femur.

Femoral stress fracture

A femur stress fracture is the result of cyclic overloading of the bone or a dramatic increase in the muscular forces across their insertion, causing microfracture. These repetitive stresses overcome the ability of the bone to heal the microtrauma. The area most susceptible to stress fracture is the medial junction of the proximal and middle third of the femur, which occurs as a result of the compression forces on the medial femur.
Stress fractures can also occur on the lateral aspect of the femoral neck in areas of distraction and are less likely to heal non-operatively than compression-side stress fractures. Stress fractures occur most often in repetitive overload sports such as in runners and in baseball and basketball players.

What causes femur fractures?

As stated previously, the femur is a tremendously strong bone - in order for a femur fracture to occur, either a large force must be applied or something is wrong with the bone. In patients with normal bone strength, the most common causes of femur fractures include:

  • Car accidents
  • Falls from a height
  • Patients may also have bone that is weakened by osteoporosis, tumor, or infection. These conditions can lead to a so-called pathologic femur fracture.

Symptoms of a Femoral fracture

Symptoms of a femur fracture may include:

  • Thigh pain (unilateral) and swelling
  • Hip pain (unilateral) and swelling
  • Knee pain (unilateral) and swelling
  • Leg swelling (unilateral)
  • Leg tenderness:
    1. Bone tenderness in the thigh
    2. Hip tenderness
    3. Thigh tenderness
  • Bruising of the thigh
  • Thigh deformity
  • Leg shortening
  • Inability to move the leg
  • Inability to stand

Femur Fracture Treatment

Femur fractures are generally divided into three broad categories and their treatment also varies accordingly:

1.Proximal Femur Fractures: Proximal femur fractures, or hip femur fractures, involve the upper-most portion of the thigh bone, just adjacent to the hip joint. These fractures are further subdivided into different types of hip fractures.

  • Femoral Neck Fractures: A fracture of the femoral neck occurs when the ball of the ball-and-socket hip joint is fractured off the femur. Treatment of a femoral neck fracture depends on the age of the patient and the amount of displacement of the fracture.
  • Intertrochanteric Femur Fractures: An intertrochanteric hip fracture occurs just below the neck of the femur. These fractures are amenable to repair more often than femoral neck fractures. The usual surgical treatment involves placement of a plate and screws to stabilize the fractures. Treatment of a hip fracture almost always requires surgery. In some cases, such as some stress fractures of the hip, or in patients who have severe medical problems that prevent surgical treatment, non-operative treatment may be recommended. However, most all hip fractures are treated with surgery. The type of surgery that is preferred depends on the type of fracture.

2.Femoral Shaft Fractures: A femoral shaft fracture is a severe injury that generally occurs in high-speed motor vehicle collisions and significant falls. These injuries are often one of several major injuries experienced by a patient.
The treatment of a femoral shaft facture is almost always with surgery. The most common procedure is to insert a metal rod down the center of the thigh bone called an intramedullary rod. This procedure reconnects the two ends of the bone, and the rod is secured in place with screws both above and below the fracture. The intramedullary rod generally remains in the bone for the life of the patient, but can be removed if it causes pain or other problems.
Other less commonly used treatments for femur fracture include a plate and screws or an external fixator. These treatment options may have to be used if an intramedullary rod cannot be used for some reason. In certain patients, depending on the fracture type and associated injuries, an intramedullary rod may not be an option; in these cases one of the other treatments (plate and screws, external fixator, etc.) will be selected.

3.Supracondylar Femur Fractures: A supracondylar femur fracture is an unusual injury to the femur just above the knee joint. These fractures often involve the cartilage surface of the knee joint, and must be treated with this cartilage injury in mind. Patients who sustain a supracondylar femur fracture are often at high risk of developing knee arthritis later in life.
Supracondylar femur fractures are more common in patients with severe osteoporosis and in patients who have previously undergone total knee replacement surgery. In these groups of patients the bone just above the knee joint may be weaker than in normal patients, and therefore more prone to fracture. The treatment of a supracondylar femur fracture is highly variable, and may utilize a cast or brace, external fixator, plate, screws, or an intramedullary rod. There are many variations to these fractures that affect the best choice for fixation of the fracture. Recovery includes ambulation, occupational therapy etc.

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