Femur fracture

Background

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

Clinical Features

• History of trauma
• Pain, point tenderness, deformity
• Can occur with dislocation:
  • Posterior dislocation
    • Affected leg appears shortened, internally rotated, adducted
    • Fx of inf aspect of femoral head; concomitant sciatic nerve injury
  • Anterior dislocation
    • Affected leg appears shortened, externally rotated, abducted
    • Fx of anterior femoral head; concomitant vascular injury

Differential Diagnosis

Femur Fracture Types

Proximal

• Intracapsular
  • Femoral head fracture
  • Femoral neck fracture
• Extracapsular
  • Intertrochanteric femur fracture
  • Trochanteric femur fracture

Shaft

• Mid-shaft femur fracture (all subtrochanteric)

Hip pain

Acute Trauma

• Femur fracture
  • Proximal
    • Intracapsular
      • Femoral head fracture
      • Femoral neck fracture
    • Extracapsular
      • Intertrochanteric femur fracture
      • Trochanteric femur fracture
  • Shaft
    • Mid-shaft femur fracture (all subtrochanteric)
• Hip dislocation
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture

Chronic/Atraumatic

• Hip bursitis
• Psoas abscess
• Piriformis syndrome
• Meralgia paresthetica
• Septic arthritis
  • Septic arthritis of the hip (peds)
• Obturator nerve entrapment
• Avascular necrosis of hip

Diagnosis

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.
  • 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.
• 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 pts at higher risk of hemorrhage:
  • Age > 75 yrs
  • Initial Hb < 12
  • Peritrochanteric fracture

Disposition

• Generally requires admission for operative repair

See Also

• Fractures (Main)