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 .
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 .
5.
6.
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.
9.
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 .
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 .
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 .
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 .
28.
29.
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 .
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 .
