Mid-shaft femur fracture

Includes all subtrochanteric femur fractures

Background

• 

  Long bone anatomy.
• Occurs with severe trauma or in association with pathologic bone
  • Blood loss can be substantial (average loss = 1L)

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)

Clinical Features

• Clinical presentation is similar to intertrochanteric fracture
  • Affected leg is shortened and externally rotated

Differential Diagnosis

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

Evaluation

Location of femur fractures

Spiral shaft fracture of femur.

Workup

• Radiography
  • Femur x-ray: PA and lateral
  • Consider films of knee and hip for operative planning and to assess for other injury
• Pre-op labs
  • CBC
  • Chem 7
  • PT/PTT
  • Type & Screen

Diagnosis

• Typically via plain films

Management

• Resuscitation per ATLS guidelines

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

Immobilization

• Consider traction splint
  • Little evidence to support its use
  • Theoretical benefit of traction splinting is reduction in bleeding and improved pain
  • Sager and Hare splints are commonly used by EMS providers
  • Buck's traction used by ortho

Disposition

• Admit
  • Typically requires ORIF

See Also

• Femur fracture

External Links

• Wheelers' Textbook - Femoral Shaft Fracture