Fractures of the femoral diaphysis

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

AO classification (32)

 * A – simple (1 - helical, 2 - oblique, 3 - transverse)
 * B - wedge-shaped (1 - spiral wedge, 2 - bending wedge, 3 - broken wedge)
 * C - complex (1 - helical, 2 - staggered, 3 - roughly splintered)

Diagnostics

 * Clinical: thigh pain, defiguration, pathological mobility, limited mobility, hematoma.
 * Imagining methods: X-ray in two projections (including hip and knee - echelon fractures); typical is shortening of dislocated fragments (thrust of proximal fragment into abduction, distal fragment medially and upwards).

Complications

 * 1) Complications of injury:
 * 2) * injury to blood vessels and soft tissues (muscles) by sharp fragments – bleeding up to 2 litres,
 * 3) * compartment syndrome.
 * 4) Complications of treatment:
 * 5) * fat embolism, ARDS – when pre-drilling nails,
 * 6) * pseudoarthrosis – malposition of the nail, left axial deviation,
 * 7) * restriction of knee movement - inadequate rehabilitation.

First aid

 * Immobilization: vacuum splint, Cramer's splint, tying both DK, formerly Dietrichs splint;
 * anti-shock (infusions);
 * X-ray before removal of the first fixation.

Surgical treatment

 * Osteosynthesis: must be stable to allow early mobilisation (extension beyond tuberositas tibiae is only a temporary preoperative measure),
 * intra-articular nailing: anterograde and closed insertion once the axis is aligned and the correct length is achieved; nails are secured distally and proximally, preferably undrilled;
 * splint osteosynthesis: not so much used nowadays;
 * external fixation: open fractures (Tscherne II, III), splinter fractures, polytrauma;
 * PFN (proximal femoral nail), gama nail: for subtrochanteric fractures;
 * Prévot's rods (TEN – titan elastic nails): in children.

Conservative treatment

 * In children, patch extension (hanging the DK vertically upwards) can be used, followed by immobilization with a plaster bandage after muscle formation (in 4 weeks).

Related articles

 * Fratures
 * Fractured bones