Femur fracture: Difference between revisions
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{{Adult top}} [[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> | *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}} | |||
==Clinical Features== | ==Clinical Features== | ||
*History of trauma | *History of trauma | ||
* | *Pain, point tenderness, deformity | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hip pain DDX}} | {{Hip pain DDX}} | ||
== | ==Evaluation== | ||
===Proximal=== | ===Proximal=== | ||
{{Proximal femur fracture diagnosis}} | {{Proximal femur fracture diagnosis}} | ||
| Line 19: | Line 20: | ||
==Management== | ==Management== | ||
*Pain control in ED with femoral nerve | {{General Fracture Management}} | ||
===Specific Management=== | |||
*Pain control in ED with [[femoral nerve block]] | |||
**[[Nerve Block: Fascia Iliaca Compartment]] | **[[Nerve Block: Fascia Iliaca Compartment]] | ||
**3 in 1 block (femoral, obturator, lateral cutaneous nerve of thigh) | **3 in 1 block (femoral, obturator, lateral cutaneous nerve of thigh) | ||
** No difference in 2 blocks listed above <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> | **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> | ||
*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 | *Most fractures, including all displaced, are treated with ORIF | ||
**Exception is isolated trochanteric fracture often does not require surgery | **Exception is isolated trochanteric fracture often does not require surgery | ||
**See individual pages for further discussion | **See individual pages for further discussion | ||
==See Also== | ==See Also== | ||
| Line 38: | Line 48: | ||
<references/> | <references/> | ||
[[Category: | [[Category:Orthopedics]] | ||
Revision as of 19:42, 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