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Fracture, Femur: Differential Diagnoses & Workup

Author: James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
Contributor Information and Disclosures

Updated: Apr 22, 2009

Differential Diagnoses

Fractures, Hip
Fractures, Knee
Fractures, Pelvic
Trauma, Peripheral Vascular Injuries

Workup

Laboratory Studies

  • No specific laboratory studies are indicated for femur fracture. In a patient with a large, expanding hematoma, measure serial hematocrits and obtain type and crossmatch in case a blood transfusion becomes necessary.
  • For patients who require open reduction and internal fixation (ORIF), obtain preoperative tests, including chest radiography and ECG.

Imaging Studies

  • Anteroposterior (AP) and lateral views of the femur normally are sufficient. As with all long-bone fractures, obtain images of the joint above and below fracture.
  • If a vascular injury is suspected, perform arteriography.
Anteroposterior radiograph of a femur fracture in...

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

Anteroposterior radiograph of a femur fracture in...

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


More on Fracture, Femur

Overview: Fracture, Femur
Differential Diagnoses & Workup: Fracture, Femur
Treatment & Medication: Fracture, Femur
Follow-up: Fracture, Femur
Multimedia: Fracture, Femur
References

References

  1. Alho A. Concurrent ipsilateral fractures of the hip and shaft of the femur. A systematic review of 722 cases. Ann Chir Gynaecol. 1997;86(4):326-36. [Medline].

  2. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. Nov 1996;7(6):612-8. [Medline].

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

  4. Braten M, Helland P, Myhre HO, Molster A, Terjesen T. 11 femoral fractures with vascular injury: good outcome with early vascular repair and internal fixation. Acta Orthop Scand. Apr 1996;67(2):161-4. [Medline].

  5. Clinkscales CM, Peterson HA. Isolated closed diaphyseal fractures of the femur in children: comparison of effectiveness and cost of several treatment methods. Orthopedics. Dec 1997;20(12):1131-6. [Medline].

  6. DiChristina DG, Riemer BL, Butterfield SL, Burke CJ 3rd, Herron MK, Phillips DJ. Femur fractures with femoral or popliteal artery injuries in blunt trauma. J Orthop Trauma. Dec 1994;8(6):494-503. [Medline].

  7. Harrington KD. Orthopaedic management of extremity and pelvic lesions. Clin Orthop. Mar 1995;(312):136-47. [Medline].

  8. Hogan TM. Hip and femur. In: Hart RG, Rittenberry TJ, Uehara DT, eds. Handbook of Orthopaedic Emergencies. Publishers: Lippincott Williams & Wilkins; 1999:307-8.

  9. Illgen R 2nd, Rodgers WB, Hresko MT, Waters PM, Zurakowski D, Kasser JR. Femur fractures in children: treatment with early sitting spica casting. J Pediatr Orthop. Jul-Aug 1998;18(4):481-7. [Medline].

  10. Kanel JS. Treatment of fractures of the femur in children and adolescents. West J Med. Dec 1995;163(6):570. [Medline].

  11. Macnicol MF. Fracture of the femur in children. J Bone Joint Surg Br. Nov 1997;79(6):891-2. [Medline].

  12. Mahaisavariya B, Laupattarakasem W. Late open nailing for neglected femoral shaft fractures. Injury. Oct 1995;26(8):527-9. [Medline].

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

  14. Robertson P, Karol LA, Rab GT. Open fractures of the tibia and femur in children. J Pediatr Orthop. Sep-Oct 1996;16(5):621-6. [Medline].

  15. Salminen S, Pihlajamaki H, Avikainen V, Kyro A, Bostman O. Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma. Jul 1997;43(1):117-22. [Medline].

  16. Sartoretti C, Sartoretti-Schefer S, Ruckert R, Buchmann P. Comorbid conditions in old patients with femur fractures. J Trauma. Oct 1997;43(4):570-7. [Medline].

  17. Starr AJ, Hunt JL, Reinert CM. Treatment of femur fracture with associated vascular injury. J Trauma. Jan 1996;40(1):17-21. [Medline].

Further Reading

Keywords

femur fracture, femoral diaphysis, fractures of the femoral diaphysis, femoral shaft fractures, spiral femur fractures, transverse femur fractures, comminuted femur fractures, open femur fractures, diaphyseal fractures, hip fractures, ligamentous knee injuries

Contributor Information and Disclosures

Author

James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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