eMedicine Specialties > Sports Medicine > Lower Limb

Femur Injuries and Fractures: Differential Diagnoses & Workup

Author: Douglas F Aukerman, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Division of Sports Medicine, Penn State University
Coauthor(s): John R Deitch, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Team Physician, Penn State University; Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopaedic Surgery, Wishard hospital; William Ertl, MD, Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma
Contributor Information and Disclosures

Updated: Oct 30, 2008

Differential Diagnoses

Compartment Syndromes
Hip Dislocation
Hip Fracture

Other Problems to Be Considered

Associated extremity fractures
Disorders of bone metabolism
Ipsilateral femoral neck fracture
Ipsilateral knee ligament injury (up to 50%)
Ipsilateral meniscal injury (up to 30%)
Spine fractures
Stress fracture - Tumor (osteoid osteoma)
Tibia fracture (floating knee)
Trauma -Knee dislocation
Vascular injuries

Workup

Laboratory Studies

  • Laboratory workup in cases of traumatic femoral fractures
    • Complete blood cell (CBC) count
    • Chemistry panel
    • Prothrombin time (PT) / activated partial prothrombin time (aPTT)
    • Urinalysis (UA)
    • Type and screen or cross-match

Imaging Studies

  • Imaging studies in cases of traumatic femoral fractures
    • Radiograph of the chest
    • Spine radiograph series
    • Anteroposterior radiograph of the pelvis
    • Anteroposterior-lateral radiograph of the femur, hip, and knee
    • Computed tomography (CT) scan of the head, if indicated
  • Imaging studies in cases of femoral stress fractures
    • Anteroposterior-lateral radiographs of the femur: Findings are typically delayed for 2-6 weeks after the onset of symptoms; these films are useful for making a late confirmation of the diagnosis.
    • Radionucleotide scanning: This is the criterion standard for diagnosis; these studies are more sensitive than and may show abnormalities 3 weeks before plain radiographs.
    • Magnetic resonance imaging (MRI): MRIs reveal bone marrow signal earlier in the stress-reaction process than standard radiographs and radionuclear scanning.
    • Bone mineral density evaluation: Use this test to rule out osteoporosis or osteopenia.

More on Femur Injuries and Fractures

Overview: Femur Injuries and Fractures
Differential Diagnoses & Workup: Femur Injuries and Fractures
Treatment & Medication: Femur Injuries and Fractures
Follow-up: Femur Injuries and Fractures
Multimedia: Femur Injuries and Fractures
References
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References

  1. Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. 2nd ed. Philadelphia, Pa: WB Saunders; 1998.

  2. Delee JC Jr, Drez D, eds. Orthopaedic Sports Medicine: Principles and Practice. Philadelphia, Pa: WB Saunders; 1993.

  3. Lieurance R, Benjamin JB, Rappaport WD. Blood loss and transfusion in patients with isolated femur fractures. J Orthop Trauma. 1992;6(2):175-9. [Medline].

  4. Evans FG, Pedersen HE, Lissner HR. The role of tensile stress in the mechanism of femoral fractures. J Bone Joint Surg Am. 1951;333:485-501. [Medline]. [Full Text].

  5. Goodfellow J, O'Connor J. The mechanics of the knee and prosthesis design. J Bone Joint Surg Br. Aug 1978;60-B(3):358-69. [Medline]. [Full Text].

  6. DeFranco MJ, Recht M, Schils J, Parker RD. Stress fractures of the femur in athletes. Clin Sports Med. Jan 2006;25(1):89-103, ix. [Medline].

  7. Fitch KD. Stress fractures of the lower limbs in runners. Aust Fam Physician. Jul 1984;13(7):511-5. [Medline].

  8. Schmal H, Strohm PC, Mehlhorn AT, Hauschild O, Südkamp NP. [Management of ipsilateral femoral neck and shaft fractures] [German]. Unfallchirurg. Sep 6 2008;epub ahead of print. [Medline].

  9. Mutty CE, Jensen EJ, Manka MA Jr, Anders MJ, Bone LB. Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department. Surgical technique. J Bone Joint Surg Am. Oct 2008;90 suppl 2 pt 2:218-26. [Medline].

  10. Sanders DW, MacLeod M, Charyk-Stewart T, et al. Functional outcome and persistent disability after isolated fracture of the femur. Can J Surg. Oct 2008;51(5):366-70. [Medline]. [Full Text].

  11. Thomas HO. Diseases of the Hip, Knee, and Ankle Joints. Liverpool, England: T. Dobb & Co; 1875.

  12. Wolinsky P, Tejwani N, Richmond JH, et al. Controversies in intramedullary nailing of femoral shaft fractures. Instr Course Lect. 2002;51:291-303. [Medline].

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Further Reading

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Keywords

femur injuries and fracture, femoral shaft fracture, diaphyseal fracture of the femur, femoral stress fracture, femur fracture, femoral neck stress fracture, femur injury, femur stress fracture, femoral diaphyseal fracture, broken leg, leg fracture, fractured femur, femur trauma, leg trauma, fractured leg

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Contributor Information and Disclosures

Author

Douglas F Aukerman, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Division of Sports Medicine, Penn State University
Douglas F Aukerman, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

John R Deitch, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Team Physician, Penn State University
John R Deitch, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Pennsylvania Orthopaedic Society
Disclosure: Nothing to disclose.

Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopaedic Surgery, Wishard hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

William Ertl, MD, Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma
Disclosure: Nothing to disclose.

Medical Editor

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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