Femur Fracture Follow-up

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

Further Inpatient Care

Adults with a femur fracture are best treated with immediate operative fixation, typically intramedullary nailing. [11, 12, 13]

Young children typically are treated with skeletal or skin traction for approximately 4 weeks, followed by a body spica cast. [14, 15, 16]

Depending on the stage of skeletal maturity, some adolescents may be treated with initial external fixation, intramedullary nailing, or compression screw plate fixation. [17, 18]

In the presence of contraindications to surgery, this repair may be delayed for days without significant complications if leg length is maintained with traction. [19]

Open fractures require immediate operative debridement followed by delayed intramedullary nailing. [20]

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Transfer

Transfer patients with femur fractures when the fracture is immobilized adequately. This is best accomplished with a traction device. As an alternative, use a pneumatic or posterior molded splint.

Reasons for transfer include the following: lack of appropriate orthopedic staff or operative facilities at the presenting center necessitates transfer; associated serious injuries, which are common, may require trauma center for ideal evaluation and management.

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Complications

Complications include the following:

  • Hemorrhagic shock
    • Closed fractures of the femur can result in significant blood loss (eg, 1 L) within the thigh. Open fractures have the potential for even greater blood loss.
    • Because of the high rate of associated injuries, actively seek out other sources of blood loss in patients with femur fractures and hypovolemic shock.
  • Neurovascular injury
    • Injuries to the neurovascular bundle are rare because of the large cushion of muscle protecting neurovascular structures.
    • Compartment syndrome of the thigh does not occur often, and peroneal nerve contusion is seen occasionally.
  • Infection: While open fractures are at high risk of soft-tissue and bony infection, postoperative infection is rare following repair of closed fractures.
  • Respiratory demise: Fat embolism and adult respiratory distress syndrome (ARDS) can occur. Femur fractures at a level one trauma center have been associated with double the risk of developing ARDS (odds ratio [OR], 2.129; 95% confidence interval [CI], 1.382-3.278) [21] compared with other patients admitted for musculoskeletal injury. The risk trends upward with delays in surgical repair greater than 24 hours.
  • More delayed complications include permanent stiffness of the hip or knee, shortening of the extremity, or malrotation, resulting in permanent deformity and decreased performance.
  • Complications directly related to repair include (in order of increasing frequency) breakage of fixator hardware, nonunion, malunion, or delayed union.
  • Finally, refracture has occurred at the initial injury site.
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Prognosis

Patients who survive the initial trauma associated with the injury typically heal well. Early mobilization following intramedullary nailing greatly reduces complications associated with prolonged immobilization.

Age affects the speed and quality of recovery. Fractures may be caused by underlying medical conditions such as osteoporosis or cancer metastasis; these conditions may complicate recovery further. [22]

Patients older than 60 years with closed fractures of femur have a mortality rate of 17% and a complication rate of 54%. [11]

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Patient Education

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education article, Broken Leg.

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