32. Fracture of the femoral shaft

Essay 32- Fracture of the diaphysis of the femur

• What is the diaphysis of the femur?
• The diaphysis of the femoral bone is the region from the minor trochanter to the distal metaphysis of the femur
• This is the strongest cortical tubular bone
• Etiology (mechanisms)
• All mechanisms are possible
• Except the fragmentary mechanism
• Most commonly, high energy trauma results in fractures (vehicle accidents, other severe traumas)
• In fractures of the femoral diaphysis, all the main dislocations of the bone fragments take place at a right angle, along the width and on the periphery as well as longitudinally with shortening
• Bone tumours can also result in pathological fractures of the bone
• Indirect mechanisms- flexion, torsion, scissor like and compression
• Fracture lines
• In flexion mechanism- oblique fracture line with an additional third triangular fragment
• In torsion mechanism- screw-like
• In scissor like- transverse
• In compression mechanism- branching
• Symptoms
• Deformity in region
• Pathological mobility
• Bone crepitations
• Shortening of thigh
• Severe pain
• Edema
• Could be complicated with traumatic and hypovolemic shock
• Diagnosis
• X-ray:
• Reveals type of fracture, direction of fracture lines and positioning of bone fragments
• First aid
• The limb is pulled along its longitudinal axis and by means of additional methods, the extremity is straightened so that the toes point upwards
• Another person holds the limb whilst the doc places a padded plaster splint dorsally from the lower angle of the scapula to the toes
• When this is impossible, Cramer's splint is placed!
• If necessary, antishock resuscitation actions are undertaken

• Treatment
• Non-surgical
• Immobilization with ischiatic-leg plaster cast (only applied in early childhood)
• Proper fracture reduction- make sure the knee and hip joints are flexed to 90 degrees
• Traction method
• Surgical
• Direct skeletal extension with a Kirschner's needle passed through the tibial tuberosity
• Intramedullary osteosynthesis with a Kuncherʼs nail in transverse and slightly oblique fractures
• Can be performed in an open way or closed way
• In fractures of the proximal part of the femur, osteosynthesis is performed with a G-shaped plaque and screws!
• Also applied in fractures of the distal third
• Complications
• Early- vascular damage, neurological damage, compartment syndrome
• Late- infection, re-fracture, various deformities, pseudoarthroses, thromboembolic disease, knee joint contracture