Femur fracture: Difference between revisions
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{{Adult top}} [[femur fracture (peds)]] | {{Adult top}} [[femur fracture (peds)]] | ||
==Background== | ==Background== | ||
[[File:Fumur Posterior annoted.png|thumb|Posterior view]] | [[File:Fumur Anterior annoted.png|thumb|Anterior view.]] | ||
[[File:Fumur Posterior annoted.png|thumb|Posterior view.]] | |||
*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> | *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> | ||
Revision as of 19:21, 22 October 2020
This page is for adult patients. For pediatric patients, 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
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
Clinical Features
- History of trauma
- Pain, point tenderness, deformity
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
Proximal
- 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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Pain control in ED with femoral nerve block
- Nerve Block: Fascia Iliaca Compartment
- 3 in 1 block (femoral, obturator, lateral cutaneous nerve of thigh)
- No difference in 2 blocks listed above, which both reduced pain scores in the ED. [2]
- 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
Specialty Care
- 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