Femur fracture: Difference between revisions

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''For pediatric patient see [[Femur fracture (peds)]]''
==Background==
==Background==
*Despite good care, proximal fracture 30-day all cause mortality is 22% and grows to 36% at one year<ref>Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.</ref>
{{Femur fracture types}}
{{Femur fracture types}}


==Clinical Features==
==Clinical Features==
*History of trauma
*Pain, point tenderness, deformity


==Differential Diagnosis
==Differential Diagnosis==
{{Hip pain DDX}}
{{Hip pain DDX}}


==Diagnosis==
==Evaluation==
[[File:Location of femur fracture.png|thumb|Location of femur fractures]]
===Proximal===
* Imaging
{{Proximal femur fracture diagnosis}}
**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==
==Management==
*Most fx, including all displaced fx, are treated with ORIF
*Pain control in ED with femoral nerve blocks.
**Exception is isolated trochanteric fx often does not require surgery
**[[Nerve Block: Fascia Iliaca Compartment]]
*Skeletal traction is not beneficial
**3 in 1 block (femoral, obturator, lateral cutaneous nerve of thigh)
*Type and cross/screen for pts at higher risk of hemorrhage:
**No difference in 2 blocks listed above, which both reduced pain scores in the ED. <ref>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.</ref>
*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
**Age > 75 yrs
**Initial Hb < 12
**Initial hemoglobin < 12
**Peritrochanteric fx
**Peritrochanteric fracture
*Despite good care, 30-day all cause mortality is 22% and grows to 36% at one year<ref>Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.</ref>
 
==Disposition==
*Generally requires admission for operative repair


==See Also==
==See Also==
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<references/>
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]

Revision as of 04:14, 7 May 2017

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 Fracture Types

Proximal

Shaft

Clinical Features

  • History of trauma
  • Pain, point tenderness, deformity

Differential Diagnosis

Hip pain

Acute Trauma

Chronic/Atraumatic

Evaluation

Proximal

Hip fracture classification.
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.
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