Femur Injuries and Fractures Workup

Updated: Oct 01, 2015
  • Author: Nicholas M Romeo, DO; Chief Editor: Sherwin SW Ho, MD  more...
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Workup

Laboratory Studies

See the list below:

  • Laboratory workup in cases of traumatic femur fractures
    • Complete blood cell (CBC) count
    • Chemistry panel
    • Prothrombin time (PT) / activated partial prothrombin time (aPTT)
    • Urinalysis (UA)
    • Type and screen or cross-match
    • Vitamin D* [21, 22, 23, 24, 25, 26, 27]
  • Pathologic fracture laboratory studies
    • CBC
    • Chemistry panel
    • ESR/CRP
    • TSH, CEA, CA 19-9, CA 125 if concern of metastatic disease
    • Vitamin D levels* [21, 22, 23, 24, 25, 26, 27]

*Both patients with traumatic and pathologic stress fractures require thorough metabolic bone work-up including vitamin D and calcium levels. [21, 22, 23, 24, 25, 26, 27]

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Imaging Studies

See the list below:

  • Imaging studies in cases of traumatic femur fractures
    • Radiograph of the chest
    • Spine radiograph series
    • Anteroposterior (AP) radiograph of the pelvis
    • AP and lateral radiograph of the entire femur, hip, and knee [28]
    • Computed tomography (CT) of the head, neck, abdomen and pelvis if indicated.
    • CT scan of the fracture for pre-operative surgical planning if indicated (e.g., comminuted intra-articular fracture)
    • CT of the pelvis is imperative in cases of high-energy femoral shaft fractures to rule out femoral neck fracture. [29]
      Full length AP radiograph of an intertrochanteric Full length AP radiograph of an intertrochanteric fracture.
  • Pathologic fracture imaging studies
    • AP and lateral radiographs of the full length femur
    • Radiographs of the contralateral femur if concern for metastatic disease
    • CT if concern for tumor
    • MRI if concern for tumor or infection
    • Chest radiograph for both suspected primary or metastatic femur tumor
    • CT chest to look for metastases from a primary bone tumor
    • CT chest, abdomen and pelvis if concern for metastatic bone tumor
    • Bone scan or positron emission tomography–computed tomography (PET-CT) to assess for other areas of involvement if concern for a tumor
  • Imaging studies in cases of femoral stress fractures. [30]
    • AP and lateral radiographs of the femur: Findings are typically delayed for 2-6 weeks after the onset of symptoms; these films are still useful for making a late confirmation of the diagnosis.
    • Radionucleotide scanning: This is the criterion standard for the diagnosis of stress fractures; 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 radionuclide scanning
    • Bone mineral density evaluation: Use this test to rule out osteoporosis or osteopenia.
      MRI of a patient with a stress fracture at the bas MRI of a patient with a stress fracture at the base of the femoral neck.
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