FEMUR FRACTURES. Common injuries. May be due to direct or indirect trauma. Signify significant trauma. Most common cause; M.V.A. Commonly closed fractures.

CLASSIFICATION. Many ways of classifying femur fractures. The easy way is to classify them ANATOMICALLY. This classification is relevant in terms of treatment : Proximal femur ; intracapsular ( neck #’s) , intertrochanteric and subtrochanteric. Femoral shaft fractures. Distal femoral fractures ( supracondylar and intra-articular).

PROXIMAL FEMUR FRACTURES. FEMORAL NECK FRACTURES. Intracapsular fractures. Caused by severe trauma especially in young patients. The most important complication is avascular necrosis. They are emergencies. They should always be managed or treated surgically.

CLASSIFICATION OF N.O.F. #’S. Classified according to Garden ; Garden 1 : incomplete fractures. Rx= fixation in situ. Garden 2 : complete but undisplaced fracture. Rx = internal fixation. Garden 3 : displaced fracture but there is still contact . Rx = reduction and fixation. Garden 4 : completely displaced fracture .Rx = depends on the age of pt., activity level and the general condition. Options ; reduction and internal fixation, hemi-arthroplasty or total arthroplasty.

INTERTROCHANTERIC #’S. May follow trivial trauma ; old patients. Strong abductors tend to cause significant displacement. The limb is shortened , abducted and externally rotated. If not fixed surgically , the limb will unite in this fashion. They are best treated by ORIF.

SUBTROCHANTERIC #’S. The fracture is within 5 cm of the lesser trochanter. The abductors and flexors of the hip tend to cause flexion , abduction and external rotation of the proximal fragment. Difficult to obtain and maintain reduction. These fractures are best treated by ORIF.

FEMORAL SHAFT #’S. The shaft lies between the subtrochanteric ( 5 cm below the lesser trochanter) and the supracondylar areas( 8 cm above the joint line). There are no predominantly strong muscle group. Femoral shaft fracture can be successfully managed conservatively ; closed reduction and skeletal traction ; Thomas’ splint.

DISTAL FEMORAL #’S. The gastrocnemius muscle is the deforming force ; the distal fragment is displaced posteriorly. The fracture tends to angulate posteriorly. It is difficult to manage conservatively. The majority are best treated by ORIF. Those fractures that extend intra-articularly , are managed according to the principles of Intra-articular fractures.