Femur fracture

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For pediatric patient see Femur fracture (peds)

Background

  • Despite good care, proximal fracture 30-day all cause mortality is 22% and grows to 36% at one year[1]

Femur fractures

Proximal

Shaft

Clinical Features

  • History of trauma
  • Pain, point tenderness, deformity

Differential Diagnosis

Hip pain

Evaluation

Proximal

Location of femur fractures
  • Consider AP pelvis in addition to AP/lateral views to compare contralateral side
  • Consider MRI if strong clinical suspicion but negative x-ray

Mid-Shaft

  • Plain xrays of femur

Management

  • Pain control in ED with femoral nerve blocks.
  • Most fractures, including all displaced, are treated with ORIF
    • Exception is isolated trochanteric fracture often does not require surgery
    • See individual pages for further discussion
  • Type and cross/screen for patients at higher risk of hemorrhage:
    • Age > 75 yrs
    • Initial hemoglobin < 12
    • Peritrochanteric fracture

Disposition

  • Generally requires admission for operative repair

See Also

References

  1. Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.
  2. Reavley P, et al. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 2014 Nov 27.