This ppt show the fracture of shaft and distal part ( condylar and supracondylar ) of femuarl bone which include anatomy , classification , clinical picture , diagnosis , treatment and complications . This PPT prepared by Ammar Alsabae , A medical student , faculity of medicine , Taiz university . Yemen .

1. Fracture of shaft and distal
part of femural bone
prepared by : Ammar Fuad Alsabae

2. Anatomy
Mechanism
Classification
Clinical picture
Diagnosis
Treatment
Complicatoin

3. Anatomy

4.  Femoral shaft is well
padded with muscle
 Advantage : protection
the bone .
 Disadvantage : in that
fracture are severly
displaced by muscle pull ,
macking difficulty in
reduction .

7. Special features of femoral shaft fracture :
 Essentially fracture of young
adult .
 Result from hiegh energy injury .
 If occur in eldery should be
considered pathological until
proved otherwise .
 In children under 4 years of age
the possibility of physical abuse
may be kept in mind .

8. Mechanism of Femoral shaft fracture :
This is usually a
fracture of young
adults and results
from a high energy
injury.

10. Classification (Winquist’s classification ) :
 Reflects the observation that the degree of soft tissue
damage .
 Fracture instability increase when increasing the grades
of comminution .

11. Type 1 Type 2 Type 3 Type 4
Type 1 there is only a tiny cortical
fragment.
Type 2 the ‘butterfly fragment is larger
but there is still at least 50 per cent
cortical contact between the main
fragments.
Type 3 the butterfly fragment involves
more than 50 per cent of the bone
width.
Type 4 is essentially a segmental
fracture .

12. Clinical picture :
 Pain
 Swelling
 Deformity
 Tenderness
 Loss of function

13. Diagnosis :
1- history and physical exam .
2- clinical picture .
3- X-Ray for femur but never
forget to x-ray the hip and knee .

14. CT scan :

15. Treatment :
Traction and bracing …conservative.
Open reduction and plating .
Intramedullary nailing .
External fixation .

16. Traction and bracing :
 Traction and bracing :
 Traction with a splint is first aid for a patient with a femoral
shaft fracture.
 Indication :
 1-fracture of children .
 2- contraindication to anesthesia .
 3- lack of suitable skills for internal fixation .
 Length of time spent in bed is about 10 – 14 weeks .
 Method : 1- thoma’s splint . 2- perkin’s traction .

18. Thoma’s splint
 This
method
rarely used
because it
lead to
knee
stiffness

21.  Skletal traction
without splints .
perkin’s traction

22. Open reduction and plating :
 Internal fixation with plate
and screws .
 Indications :
 1- combination of shaft and
femoral neck fracture .
 2- fracture associated with
vascular injury .

23. Intramedullary nailing :
 Is the method of choice and mostly used .
 Implantation of intramedullary nail and fixed by screws which inserted
transversely at proximal and distal ends .
 The implantation of intramedullary nail may be antegrade or retrograde .
 Antegrade nailing >> insertion of the nail through pyriform fossa and
transverse locking screws proximally and distally .
 Retrograde nailing >> insertion of the nail through intercondylar notch at
the knee .
 This operation control the rotatory movement and ensures stability .

26. Nail or… Plate

27. External fixation :
Main indication are :
1- treatment of severe open injuries .
2- patient with multiple injuries .
3- severe bone loss wich need to bone transport .
4- femoral fracture in adolescence .

30. Advantage & disadvantage of intramedullary
nailing and external fixation :
 Advantage :
 Not exposing the fracture site .
 Callus increase in the volume and quality .
 Promoting quicker consildation by increase stress transfre to the fracture
site .
 Disadvantage :
 Pins-site infection .
 Most femoral shaft fracture will unite in under 5 month but some take
longer if the fracture is badly comminuted or contact between fracture
end is poor .

31. Open fracture :
 In open fracture
should be carefully
assessed for :
 1- neurovascular
injury .
 2- muscle ischemia .
 3- skin loss .
 4- wound
contamination .

32. Warning sign in the fracture with vascular injury :
 Excessive bleeding or hematoma
formation .
 Parasthesia , pallor , pulselessness and
other 6P in the leg and foot .

33. Treatment of open fractures :
The immediate treatment is similar to that of closed
fractures; in addition:
1- the patient is started on intravenous line to prevent shock .
2- I.V antibiotics.
3- The wound will need cleaning .
4- contaminated areas and dead tissue must be excised and
the entire area should be washed thoroughly and the wound should
be left open .

34. Complications of femoral shaft fractures :
 Early :
 Fat embolism .
 Shock .
 Infection .
 Thromboembolism .
 :LATE
 Delayed union and non-union .
 Malunion .
 Joint stiffness .
 Refracture and implant failure .
 Shortening of limb .

35. Supracondylar and condylar fracture of femur :

36. Mechanism
Mechanism :
Direct violence is the usual cause.
 This fracture are seen in :
 1- young adult usually as a result of
high energy truma .
 2- in eldery due to osteoporosis .
 The fracture is line just above the
condyle .

37. AO group classification :
 Type A : fractures have no articular splits and are truly ‘supracondylar’; .
 Type B : fracture are simply shear fracture of one of the condyle .
 Type C : fracture have supracondylar and intracondylar fissure .
Type A Type B Type C

38. Clinical features :
 The knee is swollen and deformed because of a haemarthrosis .
 Movement is too painful .
 Important note : The tibial pulses should always be checked to ensure the
popliteal artery was not injured in the fracture.

39. Diagnosis :
 History and physical
exam .
 Clinical picture .
 By X-Ray .
 By CT scan .

40. Treatment :
 Non operative :
 Traction by
thoma’s splint :
skeletal traction
through the
proximal tibia .
 This method used
if the fracture only
slightly displaced
and extra-
articular .

41. Treatment :
 Operative treatment :
 1- locked intramedullary nail which are introduce retrograde through the
intercondylar notch >> suitable for the type A .
 2- Plates that are applied to the lateral surface of the femur >> suitable for
the type A and type C .
 3- Simple lag screws >> suitable for the type B .

43. Complications :
 Early :
 Arterial damage
 Infection
 Osteoarthritis
 Late :
 Joint stiffness
 Malunion
 Ununion

44. Prepared by : Ammar Fuad Alsabae .