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

Fracture of the diaphysis of the femur in a child

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

Therapy

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).

Links

Related articles

• Fratures
• Fractured bones

Source

• PASTOR, Jan. Langenbeck's medical web page [online]. ©2006. [cit. 2022-16-12]. <http://langenbeck.webs.com/chirurgie.htm>.

Literature used

• KOUDELA, Karel, et al. Orthopedic traumatology. 1. edition. Karolinum, 2002. ISBN 80-246-0392-6.