Femur Injuries and Fractures Workup

Updated: Oct 10, 2018
  • 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* [22, 23, 24, 25, 26, 27, 28]

  • Pathologic fracture laboratory studies

    • CBC

    • Chemistry panel

    • ESR/CRP

    • TSH, CEA, CA 19-9, CA 125 if concern of metastatic disease

    • Vitamin D levels* [22, 23, 24, 25, 26, 27, 28]

*Both patients with traumatic and pathologic stress fractures require thorough metabolic bone work-up including vitamin D and calcium levels. [22, 23, 24, 25, 26, 27, 28]

Next:

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 [29]

    • 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. [30]

      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. [31]

    • 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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