Femur Fracture Clinical Presentation

Updated: Sep 28, 2015
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

History

History usually is obvious in cases of femoral diaphyseal fractures. Typically, patients describe a significant force applied to the extremity. Significant pain and deformity are reported as well.

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Physical

Conduct a thorough examination to rule out associated injury. Hip fractures and ligamentous knee injuries commonly are observed in association. [5]

At the site of fracture, tenderness on examination and visible deformity typically are noted.

The extremity may appear shortened, and crepitus may be noted with movement.

The thigh is often swollen secondary to hematoma formation.

Perform a thorough vascular examination on the extremity. Signs of vascular compromise should prompt arteriography and a vascular surgery consult. Physical signs of arterial injury include the following: expanding hematoma, absent or diminished pulses, progressive neurologic deficits in a closed fracture.

Because of extensive blood supply to the musculature surrounding the femur, diaphyseal fractures may be associated with significant blood loss (ie, 1 L or more) and resulting tachycardia and hypotension.

Test distal neurologic function, though examination is frequently unreliable because of the amount of pain associated with these fractures. Nerve injury is rare because of protective surrounding musculature.

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Causes

Causes include the following:

A number of studies have shown an association between atypical femoral shaft fractures and the extended use of bisphosphonates for osteoporosis. [6, 7, 8]  According to the American Society for Bone and Mineral Research, long-term use may be associated with a risk of approximately 100 per 100,000 person-years. [9]

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