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FEMORAL
SHAFT FRACTURES
Evaluation
Make the diagnosis based on a history of major trauma and the
clinical findings of swelling, pain, angular or rotational
deformity or abnormal motion at the fracture site. Examine
the skin and soft tissue on all sides of the limb to check
for possible open fractures.
Evaluate the neurological and vascular status for injury
to the sciatic nerve and the femoral artery. Confirm
the diagnosis with X-rays of the entire femur,
including the femoral neck.
Treatment
| 1 |
Immediately
debride and lavage open fractures in the operating
room. Expose the bone ends and clean of all foreign
material. |
| 2 |
Apply
traction to control alignment, length and discomfort:
| • |
For
children below the age of six years, use Russell’s
skin traction (see page 17–5) |
| • |
Older
children and adults require skeletal traction
to accommodate the weight needed to control the
fracture position; balanced suspension and Perkin’s
traction (see page 17–5) work well |
| • |
In
fractures of the upper third of the femur, the
proximal fragment will be pulled into flexion
and abduction
– Adjust the traction to maintain alignment with the proximal fragment
– Use 90/90 traction in older children (see page 17–5) |
| • |
Use
portable X-rays for monitoring fracture position
and healing in traction; if not available, measure
the leg lengths and visually estimate angulation
and rotation as a guide to traction adjustment |
| • |
Perkin’s
traction allows the patient to flex his/her knees
and hips to 90 degrees. In this position, the
rotation of the limb through the fracture will
be maintained in an acceptable position. |
Fracture healing in adults takes about 10–12 weeks. By 6–8 weeks,
the fracture will show early signs of consolidation and it may be possible to
place the patient in a hip spica cast and begin non-weight bearing ambulation.
Treat fractures in the middle and distal third of the femur with a brace cast
and hinged knee instead of a spica.
External fixation is not sufficient to control the fracture position in large
muscular patients or in patients with unstable fracture patterns. It is a useful
method for temporary stabilization of femoral fractures in multiple trauma patients.
Place the frame on the lateral side of the thigh.
If the fracture position cannot be obtained or maintained, consider internal
fixation. |
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Femoral
shaft fractures result from high-energy trauma and
are often associated with other significant injuries
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Debride
and lavage open fractures under sterile conditions
as soon as possible
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Treat
in traction and monitor the fracture position with
or without X-rays
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Fracture
of the femoral neck is the most common associated skeletal
injury and is frequently overlooked.
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