Fractures of the diaphysis of the femur

Fractures of the diaphysis of the femur occur as a result of indirect (skiing) or direct violence (run over by a car wheel, car accident). Fractures in the upper third of the femur (up to 3 cm below the lesser trochanter) are referred to as subtrochanteric and are classified as fractures of the proximal femur.

AO classification (32)

 * A – simple (1 – spiral, 2 – oblique, 3 – transverse)
 * B – wedge-shaped (1 – spiral wedge, 2 – bending wedge, 3 – broken wedge)
 * C – complex (1 – spiral, 2 – storied, 3 – coarsely fragmented)

Diagnostics



 * Clinical
 * thigh pain, disfigurement, pathological mobility, limited mobility, hematoma.


 * Imaging methods
 * X-ray in two projections (incl. hip and knee joint – storey fractures); typical is the shortening of fragment dislocations (pulling of the proximal fragment into abduction, the distal fragment medially and upwards).

Complications

 * 1) Complications of the injury:
 * 2) * injury to blood vessels and soft tissues (muscles) by sharp fragments - bleeding up to 2 liters ,
 * 3) * compartment syndrome.
 * 4) Treatment complications:
 * 5) * fat embolism, ARDS – during nail pre-drilling,
 * 6) * hip joint – incorrect insertion of the nail, axial deviation left,
 * 7) * limitation of knee movement – ​​insufficient rehabilitation.

First Aid

 * immobilization: vacuum splint, Cramer splints, binding of both DK, formerly Dietrichs splint;
 * anti-shock measures (infusions);
 * X-ray before removing the first fixation.

Surgical treatment

 * Osteosynthesis : must be stable to allow early mobilization (extension beyond the tuberositas tibiae is only a temporary preoperative measure),
 * intramedullary nail : anterograde and closed insertion after alignment of the axis and correct length; nails tend to be secured distally and proximally, preferably undrilled;
 * plate osteosynthesis: it is abandoned;
 * external fixation : open fractures (Tscherne II, III), comminuted fractures, polytraumas;
 * PFN (proximal femoral nail), gamma nail : in subtrochanteric fractures;
 * Prévot rods (TEN – titanium elastic nails): in children.

Conservative treatment

 * In children, it is possible to use a patch extension (suspension of DK vertically upwards) and after the formation of the muscle (in 4 weeks) immobilization with a plaster bandage follows.

Related articles

 * Fractures
 * Bone fractures