Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Diaphyseal Femur Fractures Workup

  • Author: Bart Eastwood, DO; Chief Editor: William L Jaffe, MD  more...
 
Updated: Oct 05, 2015
 

Laboratory Studies

In cases of diaphyseal femur fracture, laboratory studies appropriate for a trauma patient may be indicated, depending on the situation.

The hemoglobin level and hematocrit (H/H) level should be monitored because of the relatively large amount of blood that can be lost into the compartments of the upper leg. However, the amount of blood lost with an isolated femur fracture should not cause clinically significant hypotension. If this occurs, bleeding from another site should be suspected.

Culture and sensitivity results may be obtained in cases of open fractures to determine the optimal antibiotic treatment after empiric therapy, though some believe that this is of little benefit because of gross contamination of the wound.

If a pathologic fracture is suspected, a more extensive workup is needed.

Next

Imaging Studies

In diaphyseal femur fracture, traction or splinting should be applied before radiography to prevent further soft-tissue damage.

Ensure that no radiopaque material obscures the femur; otherwise, pathologic findings or a nondisplaced neck fracture could easily be missed. Nondisplaced femoral shaft fractures can be easily missed on both plain films and computed tomography (CT) scans.[35]  The likelihood of nondisplaced neck fractures increases with femur fractures because some of the energy is dispersed from the fracture site.

Depending on the situation, an entire trauma series may be needed. The initial investigation of a femur fracture should involve an anteroposterior (AP) pelvic view, as well as AP and lateral views of the knee that show the entire femur. (See the images below.) Baseline chest images may also be needed to compare with later images to help in the diagnosis of a fat embolism. As always, poor-quality images are not acceptable.

Anteroposterior radiograph of a femur fracture in Anteroposterior radiograph of a femur fracture in a 45-year-old man.
Lateral radiograph of a femur shaft fracture in a Lateral radiograph of a femur shaft fracture in a 45-year-old man.

Classification

Femoral-shaft fractures can be classified by location, as follows: proximal third, middle third, distal third, and the junctions of the segments, among others. Geometry of the fracture, displacement, alignment, comminution, open versus closed status, and the amount of soft-tissue damage are also used.

No classification system is universally accepted. Two of the most commonly used classification systems are the Winquist-Hansen system and the  Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Association for the Study of Internal Fixation (ASIF) system. The Gustilo and Anderson classification of open fractures is also useful.

Winquist-Hansen classification

This system includes the following categories:

  • 0 - No comminution, simple transverse or oblique
  • I - Small butterfly fragment, minimal to no comminution
  • II - Butterfly fragment with at least 50% of the circumference of the cortices of the two major fragments intact
  • III - Butterfly fragment with 50-100% of the circumference of the two major fragments comminuted
  • IV - Segmental comminution, all cortical contact is lost

AO/ASIF classification

This system includes the following categories:

  • A - Simple
  • A1 - Simple spiral
  • A2 - Simple oblique
  • A3 - Simple transverse
  • B - Wedge
  • B1 - Spiral wedge
  • B2 - Bending wedge
  • B3 - Fragmented wedge
  • C - Complex
  • C1 - Complex spiral
  • C2 - Complex segmental
  • C3 - Complex irregular

AO classification

This system includes the following categories:

  • A1 simple fracture, spiral - (1) Subtrochanteric zone, (2) middle zone, (3) distal zone
  • A2 simple fracture, oblique (≥30°) - (1) Subtrochanteric zone, (2) middle zone, (3) distal zone
  • A3 simple fracture, transverse (<30°) - (1) Subtrochanteric zone, (2) middle zone, (3) distal zone
  • B1 wedge fracture, spiral wedge - (1) Subtrochanteric zone, (2) middle zone, (3) distal zone
  • B2 wedge fracture, bending wedge - (1) Subtrochanteric zone, (2) middle zone, (3) distal zone
  • B3 wedge fracture, fragmented wedge - (1) Subtrochanteric zone, (2) middle zone, (3) marked displacement
  • C1 complex fracture, spiral - (1) With 2 intermediate fragments, (2) with three intermediate fragments, (3) with more than 3 intermediate fragments
  • C2 complex fracture, segmental - (1) With one intermediate segmental fragment, (2) with one intermediate segmental and additional wedge fragment(s), (3) with two intermediate segmental fragments
  • C3 complex fracture, irregular - (1) With two or three intermediate fragments, (2) with limited shattering (<5 cm), (3) with extensive shattering (≥5 cm)

Gustilo and Anderson classification of open fractures

This system includes the following categories:

  • Grade I - Clean skin opening, less than 1 cm, most often occurring from inside to out, with minimal soft-tissue damage (eg, chicken bite)
  • Grade II - Skin opening of more than 1 cm, extensive soft-tissue damage
  • Grade III - Massive soft-tissue damage more than 10 cm in length; may include skin, muscle, neurovascular structures; most often high-energy mechanism of injury; includes any open fracture that has not been treated within 8 hours
  • Grade IIIA - Massive soft-tissue damage, adequate bone coverage, minimal periosteal stripping, often occurs with gunshot injuries and often comminuted
  • Grade IIIB - Massive soft-tissue damage with exposed bone and periosteal stripping requiring soft tissue flap coverage, associated with heavy contamination (eg, barnyard injury)
  • Grade IIIC - Vascular injury requiring repair
Previous
 
 
Contributor Information and Disclosures
Author

Bart Eastwood, DO Orthopedic Surgeon, Southwest Virginia Orthopedics and Spine

Bart Eastwood, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Orthopedics, American Osteopathic Association, Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Knutson, DO Consulting Surgeon, Department of Orthopedic Surgery, Center for Orthopedic Excellence

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

B Sonny Bal, MD, JD, MBA Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

B Sonny Bal, MD, JD, MBA is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Received none from Bonesmart.org for online orthopaedic marketing and information portal; Received none from OrthoMind for social networking for orthopaedic surgeons; Received stock options and compensation from Amedica Corporation for manufacturer of orthopaedic implants; Received ownership interest from BalBrenner LLC for employment; Received none from ConforMIS for consulting; Received none from Microport for consulting.

Chief Editor

William L Jaffe, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases

William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American College of Surgeons, Eastern Orthopaedic Association, New York Academy of Medicine

Disclosure: Received consulting fee from Stryker Orthopaedics for speaking and teaching.

Additional Contributors

Steven I Rabin, MD Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Orthopedic Surgery, Podiatry, Rheumatology, Sports Medicine, and Pain Management, Dreyer Medical Clinic; Chairman, Department of Surgery, Provena Mercy Medical Center

Steven I Rabin, MD is a member of the following medical societies: AO Foundation, American Academy of Orthopaedic Surgeons, American Fracture Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author coauthor Dr H Kurtis Biggs to the development and writing of this article.

References
  1. Brinker MR, Miller MD. Femoral diaphyseal fractures. In: Review of Orthopaedics. WB Saunders Co. 2000:482-483.

  2. Starr, Bcucholz RW, Heckman JD. Fractures of the shaft of the femur. In: Rockwood and Green's Fractures in Adults. 5th ed. Lippincott Williams & Wilkins. 2001:1683-1730.

  3. Wolinsky P. Fractures of the femoral diaphysis, including the subtrochanteric region. In: Orthopaedic Knowledge Update: Trauma. Academy of Orthopaedic Surgeons. 2000:133-140.

  4. Peltier LF. Fractures: A History and Iconography of Their Treatment. Norman Publishing. 1990.

  5. Kanlic E, Cruz M. Current concepts in pediatric femur fracture treatment. Orthopedics. 2007 Dec. 30(12):1015-9. [Medline].

  6. Poolman RW, Kocher MS, Bhandari M. Pediatric femoral fractures: a systematic review of 2422 cases. J Orthop Trauma. 2006 Oct. 20(9):648-54. [Medline].

  7. Lee SH, Baek JR, Han SB, Park SW. Stress fractures of the femoral diaphysis in children: a report of 5 cases and review of literature. J Pediatr Orthop. 2005 Nov-Dec. 25(6):734-8. [Medline].

  8. Ramseier LE, Janicki JA, Weir S, Narayanan UG. Femoral fractures in adolescents: a comparison of four methods of fixation. J Bone Joint Surg Am. 2010 May. 92(5):1122-9. [Medline].

  9. Laing P, Prembury, Kent. The Blood Supply of the Femoral Shaft. J Bone Joint Surg. 1953. 35B:462-466.

  10. Luedtke LM, Flynn JM, Ganley TJ, Hosalkar HS, Pill SG, Dormans JP. The orthopedists' perspective: bone tumors, scoliosis, and trauma. Radiol Clin North Am. 2001 Jul. 39(4):803-21. [Medline].

  11. Tscherne H, Regel G, Pape HC, et al. Internal fixation of multiple fractures in patients with polytrauma. Clin Orthop. 1998 Feb. (347):62-78. [Medline].

  12. Wood JN, Fakeye O, Mondestin V, Rubin DM, Localio R, Feudtner C. Prevalence of abuse among young children with femur fractures: a systematic review. BMC Pediatr. 2014 Jul 2. 14:169. [Medline].

  13. Lenart BA, Neviaser AS, Lyman S, Chang CC, Edobor-Osula F, Steele B. Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. 2009 Aug. 20(8):1353-62. [Medline].

  14. Fakhry SM, Rutledge R, Dahners LE, Kessler D. Incidence, management, and outcome of femoral shaft fracture: a statewide population-based analysis of 2805 adult patients in a rural state. J Trauma. 1994 Aug. 37(2):255-60; discussion 260-1. [Medline].

  15. Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma. 1999 Mar. 46(3):392-9. [Medline].

  16. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. JBJS, Vol. 66-A, April 1984. J Bone Joint Surg Am. 2001 Dec. 83-A(12):1912. [Medline].

  17. Herscovici D Jr, Whiteman KW. Retrograde nailing of the femur using an intercondylar approach. Clin Orthop Relat Res. 1996 Nov. 98-104. [Medline].

  18. Ricci WM, Bellabarba C, Evanoff B, et al. Retrograde versus antegrade nailing of femoral shaft fractures. J Orthop Trauma. 2001 Mar-Apr. 15(3):161-9. [Medline].

  19. Ostrum RF, Agarwal A, Lakatos R, Poka A. Prospective comparison of retrograde and antegrade femoral intramedullary nailing. J Orthop Trauma. 2000 Sep-Oct. 14(7):496-501. [Medline].

  20. Bostman O, Varjonen L, Vainionpaa S, et al. Incidence of local complications after intramedullary nailing and after plate fixation of femoral shaft fractures. J Trauma. 1989 May. 29(5):639-45. [Medline].

  21. Smrke D, Princic J. [Plate and screw osteosynthesis in femoral shaft fractures. Retrospective study of 500 femur shaft fractures]. Unfallchirurg. 2000 Feb. 103(2):110-4. [Medline].

  22. Seligson D, Mulier T, Keirsbilck S. Plating of femoral shaft fractures. A review of 15 cases. Acta Orthop Belg. 2001 Feb. 67(1):24-31. [Medline].

  23. Alonso J, Geissler W, Hughes JL. External fixation of femoral fractures. Indications and limitations. Clin Orthop. 1989 Apr. (241):83-8. [Medline].

  24. Dabezies EJ, D'Ambrosia R, Shoji H, Norris R, Murphy G. Fractures of the femoral shaft treated by external fixation with the Wagner device. J Bone Joint Surg Am. 1984 Mar. 66(3):360-4. [Medline].

  25. Cramer KE, Tornetta P 3rd, Spero CR, et al. Ender rod fixation of femoral shaft fractures in children. Clin Orthop. 2000 Jul. (376):119-23. [Medline].

  26. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg. 2004 Sep-Oct. 12(5):347-59. [Medline].

  27. Momberger N, Stevens P, Smith J, et al. Intramedullary nailing of femoral fractures in adolescents. J Pediatr Orthop. 2000 Jul-Aug. 20(4):482-4. [Medline].

  28. Macneil JA, Francis A, El-Hawary R. A systematic review of rigid, locked, intramedullary nail insertion sites and avascular necrosis of the femoral head in the skeletally immature. J Pediatr Orthop. 2011 Jun. 31(4):377-80. [Medline].

  29. Infante AF Jr, Albert MC, Jennings WB, Lehner JT. Immediate hip spica casting for femur fractures in pediatric patients. A review of 175 patients. Clin Orthop. 2000 Jul. (376):106-12. [Medline].

  30. Kregor PJ, Song KM, Routt ML Jr, Sangeorzan BJ, Liddell RM, Hansen ST Jr. Plate fixation of femoral shaft fractures in multiply injured children. J Bone Joint Surg Am. 1993 Dec. 75(12):1774-80. [Medline].

  31. Ward WT, Levy J, Kaye A. Compression plating for child and adolescent femur fractures. J Pediatr Orthop. 1992 Sep-Oct. 12(5):626-32. [Medline].

  32. Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop. 1997 May-Jun. 17(3):342-6. [Medline].

  33. Miner T, Carroll KL. Outcomes of external fixation of pediatric femoral shaft fractures. J Pediatr Orthop. 2000 May-Jun. 20(3):405-10. [Medline].

  34. Baumgaertner, M, Tornetta III, P. Orthopaedic Knowlodge Update, Trauma 3. Book. 2005. 93-106, 387-395.

  35. O'toole RV, Dancy L, Dietz AR, Pollak AN, Johnson AJ, Osgood G. Diagnosis of femoral neck fracture associated with femoral shaft fracture: blinded comparison of computed tomography and plain radiography. J Orthop Trauma. 2013 Jun. 27(6):325-30. [Medline].

  36. Berezka NI, Popov IF, Gnedushkin IuN, Vlasenko VG. [Treatment of diaphyseal femoral fractures in patients with associated and multiple traumas]. Ortop Travmatol Protez. 1991 Aug. 7-10. [Medline].

  37. Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989 Mar. 71(3):336-40. [Medline].

  38. Ricci WM, Gallagher B, Haidukewych GJ. Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg. 2009 May. 17(5):296-305. [Medline].

  39. Morshed S, Mikhail C, Miclau Iii T. Timing of Femoral Shaft Fracture Fixation Affects Length of Hospital Stay in Patients with Multiple Injuries. Open Orthop J. 2015. 9:324-31. [Medline].

  40. Carlson DW, Rodman GH Jr, Kaehr D, et al. Femur fractures in chest-injured patients: is reaming contraindicated?. J Orthop Trauma. 1998 Mar-Apr. 12(3):164-8. [Medline].

  41. Brundage SI, McGhan R, Jurkovich GJ, et al. Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries. J Trauma. 2002 Feb. 52(2):299-307. [Medline].

  42. Crist BD, Wolinsky PR. Reaming does not add significant time to intramedullary nailing of diaphyseal fractures of the tibia and femur. J Trauma. 2009 Oct. 67(4):727-34. [Medline].

  43. Winquist RA. Locked Femoral Nailing. J Am Acad Orthop Surg. 1993 Nov. 1(2):95-105. [Medline]. [Full Text].

  44. Williams MM, Askins V, Hinkes EW, Zych GA. Primary reamed intramedullary nailing of open femoral shaft fractures. Clin Orthop. 1995 Sep. (318):182-90. [Medline].

  45. Perez A, Mahar A, Negus C, Newton P, Impelluso T. A computational evaluation of the effect of intramedullary nail material properties on the stabilization of simulated femoral shaft fractures. Med Eng Phys. 2008 Jul. 30(6):755-60. [Medline].

  46. Ricci WM, Schwappach J, Tucker M, Coupe K, Brandt A, Sanders R, et al. Trochanteric versus piriformis entry portal for the treatment of femoral shaft fractures. J Orthop Trauma. 2006 Nov-Dec. 20(10):663-7. [Medline].

  47. James P. Stannard, MD. Choosing a Femoral Starting Point. St. Augusting, FL: AAOS/OTA Orthopaedic Trauma Update; 2008.

  48. Moed BR, Watson JT. Retrograde nailing of the femoral shaft. J Am Acad Orthop Surg. 1999 Jul-Aug. 7(4):209-16. [Medline].

  49. Goodwin R, Mahar AT, Oka R, Steinman S, Newton PO. Biomechanical evaluation of retrograde intramedullary stabilization for femoral fractures: the effect of fracture level. J Pediatr Orthop. 2007 Dec. 27(8):873-6. [Medline].

  50. Mohr VD, Eickhoff U, Haaker R, Klammer HL. External fixation of open femoral shaft fractures. J Trauma. 1995 Apr. 38(4):648-52. [Medline].

  51. Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000 Jun. 82(6):781-8. [Medline].

  52. Scalea TM, Boswell SA, Scott JD, et al. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000 Apr. 48(4):613-21; discussion 621-3. [Medline].

  53. Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma. 2008 Aug. 65(2):482-6. [Medline].

  54. Matsuo T, Sugita T, Shimose S, Kubo T, Sunagawa T, Yasunaga Y, et al. Rigid bridging of massive femur defect using double vascularized fibula graft with hydroxyapatite. Arch Orthop Trauma Surg. 2008 Sep. 128(9):941-4. [Medline].

  55. Wolinsky PR, Johnson KD. Ipsilateral femoral neck and shaft fractures. Clin Orthop. 1995 Sep. (318):81-90. [Medline].

  56. Zettas JP, Zettas P. Ipsilateral fractures of the femoral neck and shaft. Clin Orthop. 1981 Oct. (160):63-73. [Medline].

  57. Bartlett CS. Clinical update: gunshot wound ballistics. Clin Orthop. 2003 Mar. 408:28-57. [Medline].

  58. Brien WW, Kuschner SH, Brien EW, Wiss DA. The management of gunshot wounds to the femur. Orthop Clin North Am. 1995 Jan. 26(1):133-8. [Medline].

  59. Ordog GJ, Wasserberger J, Balasubramaniam S. Shotgun wound ballistics. J Trauma. 1988 May. 28(5):624-31. [Medline].

  60. Cannada LK, Jones TR, Guerrero-Bejarano M, Viehe T, Levy M, Farrell ED, et al. Retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots. Orthopedics. 2009 Mar. 32(3):162. [Medline].

  61. Smith HW, Wheatley KK Jr. Biomechanics of femur fractures secondary to gunshot wounds. J Trauma. 1984 Nov. 24(11):970-7. [Medline].

  62. Wiss DA, Brien WW, Becker V Jr. Interlocking nailing for the treatment of femoral fractures due to gunshot wounds. J Bone Joint Surg Am. 1991 Apr. 73(4):598-606. [Medline].

  63. Koval K, Zuckerman J. Femoral shaft, pediatric femoral shaft. In: Hand Book of Fractures. 2002:212-7, 364-7.

  64. Madhuri V, Dutt V, Gahukamble AD, Tharyan P. Interventions for treating femoral shaft fractures in children and adolescents. Cochrane Database Syst Rev. 2014 Jul 29. 7:CD009076. [Medline].

  65. Greene WB. Displaced fractures of the femoral shaft in children. Unique features and therapeutic options. Clin Orthop. 1998 Aug. (353):86-96. [Medline].

  66. Mostafa MM, Hassan MG, Gaballa MA. Treatment of femoral shaft fractures in children and adolescents. J Trauma. 2001 Dec. 51(6):1182-8. [Medline].

  67. Parsch KD. Modern trends in internal fixation of femoral shaft fractures in children. A critical review. J Pediatr Orthop B. 1997 Apr. 6(2):117-25. [Medline].

  68. Stilli S, Magnani M, Lampasi M, Antonioli D, Bettuzzi C, Donzelli O. Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children. Chir Organi Mov. 2008 Jan. 91(1):13-9. [Medline].

  69. De Palma L, Schiavone Panni A. [Growth disorders of the legs in the outcome of diaphysial fractures of the tibia in children]. Arch Putti Chir Organi Mov. 1984. 34:315-9. [Medline].

  70. Anastasopoulos J, Petratos D, Konstantoulakis C, Plakogiannis C, Matsinos G. Flexible intramedullary nailing in paediatric femoral shaft fractures. Injury. 2010 Jun. 41(6):578-82. [Medline].

  71. Kong H, Sabharwal S. External fixation for closed pediatric femoral shaft fractures: where are we now?. Clin Orthop Relat Res. 2014 Dec. 472 (12):3814-22. [Medline].

  72. Nork SE, Hoffinger SA. Skeletal traction versus external fixation for pediatric femoral shaft fractures: a comparison of hospital costs and charges. J Orthop Trauma. 1998 Nov-Dec. 12(8):563-8. [Medline].

  73. Ramseier LE, Bhaskar AR, Cole WG, Howard AW. Treatment of open femur fractures in children: comparison between external fixator and intramedullary nailing. J Pediatr Orthop. 2007 Oct-Nov. 27(7):748-50. [Medline].

  74. Mortier D, De Ridder K. Flexible intramedullary nailing in the treatment of diaphyseal fractures of the femur in preschool children. Acta Orthop Belg. 2008 Apr. 74(2):190-4. [Medline].

  75. Bhuyan BK, Mohan Singh S. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 5-16 years - A short term study. J Clin Orthop Trauma. 2014 Dec. 5 (4):203-10. [Medline].

  76. Aktekin CN, Oztürk AM, Altay M, Toprak A, Ozkurt B, Tabak AY. [Flexible intramedullary nailing of children]. Ulus Travma Acil Cerrahi Derg. 2007 Apr. 13(2):115-21. [Medline].

  77. Robinson CM, Ludlam CA, Ray DC, et al. The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures. J Bone Joint Surg Br. 2001 Sep. 83(7):963-73. [Medline].

  78. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma. 2002 Jul. 16(6):394-402. [Medline].

  79. Kusz D, Dudko S, Wojciechowski P, Guzik H. Selected problems in the bone union of complicated diaphyseal fractures treated with interlocking nail. Ortop Traumatol Rehabil. 2006 Aug 31. 8(4):449-54. [Medline].

  80. Schwartz JT Jr, Brumback RJ, Lakatos R, et al. Acute compartment syndrome of the thigh. A spectrum of injury. J Bone Joint Surg Am. 1989 Mar. 71(3):392-400. [Medline].

 
Previous
Next
 
Anteroposterior radiograph of a femur fracture in a 45-year-old man.
Lateral radiograph of a femur shaft fracture in a 45-year-old man.
Anteroposterior radiograph of the hip in a 45-year-old man. Distal portion shows the femur fracture.
Anteroposterior radiograph of the hip and proximal femur after antegrade intramedullary (IM) nail placement.
Cross-table radiograph of the hip and proximal femur after antegrade intramedullary (IM) nail placement.
Lateral radiograph of the distal femur after antegrade intramedullary (IM) nail placement.
Anteroposterior radiograph of the distal femur after antegrade intramedullary (IM) nail placement.
Anteroposterior radiograph of a femoral-shaft fracture in a 19-year-old man.
Anteroposterior radiograph of the hip and femur in a 19-year-old man shows a fracture of the femoral shaft.
Lateral radiograph shows flexible nailing in a 19-year-old man.
Anteroposterior radiograph shows flexible nailing in a 19-year-old man.
Anteroposterior and lateral radiographs show flexible nailing in a 19-year-old man.
Example of retrograde nail on distal anteroposterior and lateral radiographs.
Example of retrograde nail on proximal anteroposterior and lateral radiographs.
Patient positioned on a fracture table.
Incision for rod and proximal screw removal.
Example of secondary fracture healing evident on radiography.
Example of an open segmental femur fracture in a 16-year-old, multitrauma patient who sustained this and pelvic, pilon, and Lisfranc injuries on the ipsilateral extremity. Also sustained major chest and head injuries.
As the above patient was extremely unstable, emergent external fixation of the open femur fracture was completed
After delayed antegrade nailing and repeat incision and drainage, note antibiotic beads placed in wound, removed at last incision and drainage.
Table. Spica Casting Results
Group Average Shortening Before Casting, cm Average Shortening After Casting, cm Average Time of Casting Needed, wk Average AP Varus/Valgus Before Average AP Varus/Valgus After
1 (10-49 lb) 1.7 0.7 6 10.4/8.6 7.6/4.3
2 (50-80 lb) 1.5 1 7.1 9.4/5.4 5.6/2.6
3 (81-100 lb) 2.1 0.9 8 12/14 6.8/2.6
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.