Presentation
Prodomal thigh or groin pain may occur before fracture In about 70% of patients, pain in the thigh or groin may be present for several weeks or months before the atypical femoral fracture occurs. 1 Patients receiving long-term antiresorptive treatment [cmaj.ca]
Femoral fractures typically present as a painfully swollen, tense thigh with restricted range of motion and signs of fracture (e.g., shortening). [amboss.com]
In addition, at least four of five major features must be present. None of the minor features are required, but have sometimes been associated with these fractures. [gmjournal.co.uk]
The data related to the mortality are presented in Table 1. [scielo.br]
Of the patients with Gamma nails, one presented with a 15° valgus angulation and one with a 10° varus alignment and excessive external rotation (fig 2). Shoe risers were used to treat the two patients presenting with a leg length difference of 1 cm. [bjsm.bmj.com]
Entire Body System
- Pain
At the time of consultation, the patient reported groin pain, significant pain following any activity, and painful locking and catching within the hip joint. [healio.com]
A common type of pain scale is a number chart ranging from 0 to 10. From 0 to 3 – No pain to moderate pain. Pain that is easy to manage and does not interfere with most daily activities. From 4 to 6 – Uncomfortable pain to distressing pain. [autoaccident.com]
Pain Management Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster. [bmc.org]
Prodomal thigh or groin pain may occur before fracture In about 70% of patients, pain in the thigh or groin may be present for several weeks or months before the atypical femoral fracture occurs. 1 Patients receiving long-term antiresorptive treatment [cmaj.ca]
- Falling
Some studies have included exercise and other non-pharmaceutical interventions [6] to reduce falls and fall related injuries. [journals.plos.org]
Falls in the elderly is a common cause of proximal hip fracture Causes In older individuals a fall is the most frequent cause for a proximal femur fracture (approximately of 90% of all hip fractures). [pathologies.lexmedicus.com.au]
Clinical Picture of Femoral Neck Fracture Older females present with a history of a fall, such as a fall in a bathroom and the sudden onset of pain and loss of function in the thigh region. [lecturio.com]
The damage patterns were similar to those observed during the failure during sideway fall experimental simulation. [arxiv.org]
You can reduce your risk of falling by: using walking aids, such as a walking stick assessing your home for hazards, such as loose carpeting, and making it safer doing exercises to improve your balance Find out more about preventing falls. [nhs.uk]
- Severe Pain
You feel immediate, severe pain. You’re unable to put weight on the injured leg. The injured leg appears to be shorter than the uninjured leg. The injured leg appears to be crooked. The femur is a very large, strong bone that is difficult to break. [healthline.com]
pain, which prevents movement of the leg. [4] Diagnosis [ edit ] Common locations of fracture of femur Physical exam [ edit ] Femoral shaft fractures occur during extensive trauma, and they can act as distracting injuries, whereby the observer accidentally [en.wikipedia.org]
Let your healthcare provider know right away if you see an increase in redness, swelling, or draining from your incision, a high fever, chills, or severe pain. Also, let him or her know about any loss of feeling in your leg. [hopkinsmedicine.org]
Some take even longer, especially if the fracture was open or broken into several pieces or if the patient uses tobacco products. Pain Management Pain after an injury or surgery is a natural part of the healing process. [orthoinfo.aaos.org]
- Surgical Procedure
Open reduction and internal fixation (ORIF) with pre-contoured distal femoral locking compression plate (DF-LCP) is one of the most acceptable surgical procedures these days. [nepjol.info]
This study case included 904 primary cementless surgical procedures in total hip arthroplasty, on 769 patients, between 2009 and 2015. On this group, there were 24 intraoperative proximal femoral fractures, about 2,65% of the cases. [blog.peekmed.com]
Details regarding the surgical procedures performed, including graft length and number of anchors used for allograft labral reconstruction, were also systematically recorded. [healio.com]
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the 20 most frequently performed inpatient surgical procedures ( 1 ). [aerzteblatt.de]
Regional anesthesia Neuraxial Benefits: Subarachnoid or epidural anesthesia provide dense anesthesia for these procedures with profound motor blockade that facilitates surgical manipulation. [clinicalpainadvisor.com]
- Weakness
Causes This injury is caused by trauma from: A motor vehicle accident Falls A blow Gunshot wounds Stress on a weakened bone Risk Factors Things that may raise the risk are: Having a health problem that may result in falls, such as weak muscles Playing [winchesterhospital.org]
These may be the result of bone weakness from osteoporosis or lytic lesions. The femur is the largest and strongest bone and has a good blood supply. [emedicine.medscape.com]
Hip fractures are also more common in women, who are more likely to get osteoporosis, a condition which makes bones weak and fragile. [nhs.uk]
Repetitive stress on a leg that has areas of weakness, such as is seen in metastatic disease, metabolic bone disease, or bony tumors, can create nondisplaced stress fractures. These might not be recognized on plain film x-ray. [autoaccident.com]
Epidural analgesia is possible, but the lumbar level of block may produce motor weakness that interferes with ambulation and rehabilitation. It may be preferable in the elderly to avoid systemic medication if mental confusion is present. [clinicalpainadvisor.com]
Respiratoric
- Dyspnea
Beware of symptoms associated with fat emboli : change in mental status, dyspnea, hypoxia, petechiae, or fever ! Open fractures are almost always associated with multiple injuries! [amboss.com]
Gastrointestinal
- Nausea
Groans are meant to describe the gastrointestinal symptoms of nausea, vomiting, peptic ulcers and pancreatitis. However, Up to one third of patients may be asymptomatic [ 3, 4 ]. [archivesofmedicine.com]
These blocks can be performed in the emergency department after thorough initial neurologic assessment, and may allow greater patient comfort during subsequent evaluation as well as prevent the side effects associated with opioids (nausea, respiratory [clinicalpainadvisor.com]
- Vomiting
Groans are meant to describe the gastrointestinal symptoms of nausea, vomiting, peptic ulcers and pancreatitis. However, Up to one third of patients may be asymptomatic [ 3, 4 ]. [archivesofmedicine.com]
Musculoskeletal
- Fracture
FDA on Femur fracture CDC on Femur fracture Books Books on Femur fracture News Femur fracture in the news Be alerted to news on Femur fracture News trends on Femur fracture Commentary Blogs on Femur fracture Definitions Definitions of Femur fracture [wikidoc.org]
For fractures of the distal femur (supracondylar to condylar), see the article Fractures, Knee. [emedicine.medscape.com]
For fractures to the femoral head, neck and trochanteric region, see hip fracture. Femoral fracture X-ray image of a femoral shaft fracture Specialty Orthopedic A femoral fracture is a bone fracture that involves the femur. [en.wikipedia.org]
All fractures met the American Society for Bone and Mineral Research criteria for atypical femoral fractures 2. [jrheum.org]
See: - Distal Femoral Physeal Fractures - Hip Fractures in Children - IM Nailing of Pediatric Femoral Fractures - Discussion: - commonest site of fracture of the femoral shaft is in its middle third, where normal anterolateral bowing of the diaphysis [wheelessonline.com]
- Osteoporosis
Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis Int. 2014;25(10):2359-81. PMID: 25182228. PMCID: PMC4176573. https://doi.org/10.1007/s00198-014-2794-2. Black DM, Schwartz AV, Ensrud KE, et al. [asean-endocrinejournal.org]
[…] or osteopenia or glucocorticoid-induced osteoporosis. [eje.bioscientifica.com]
Cureus 11(7): e5113. doi:10.7759/cureus.5113 Abstract Bisphosphonates are the first line of treatment for osteoporosis. [cureus.com]
Osteoporosis is a common condition and is a cause of significant morbidity and mortality. There are approximately 536,000 fragility fractures in the UK each year and a proportion of these will be commenced on treatment for osteoporosis. [gmjournal.co.uk]
These include osteoporosis, tumors, infection, and even certain bisphosphonate medications used to treat osteoporosis. Breaks of these sorts are referred to as pathologic femur fractures. [verywellhealth.com]
- Knee Pain
If the femur is not set properly, there’s a chance the leg will become shorter than the other one and may cause hip or knee pain many years later. Poor alignment of the femur bone may also be painful. Peripheral damage. [healthline.com]
Occasionally, the ligaments around the knee can be injured during a femoral shaft fracture. If you have knee pain after surgery, tell your doctor. [bmc.org]
Presentation Pain is typically in the outer upper thigh or in the groin. Pain may radiate to the knee (isolated knee pain can occasionally be the only symptom). Inability to bear weight. [patient.info]
Psychiatrical
- Distractibility
key to minimizing the amount of shortening is to place lower extremity in relaxed position; - involves hip flexion, abduction, external rotation & knee flexion; - position & alignment of the frx frag are checked by periodic x-rays; - do not allow distraction [wheelessonline.com]
[…] are common. [3] The most common symptom is severe pain, which prevents movement of the leg. [4] Diagnosis [ edit ] Common locations of fracture of femur Physical exam [ edit ] Femoral shaft fractures occur during extensive trauma, and they can act as distracting [en.wikipedia.org]
Figure 24 Figure 25 Computer-generated image demonstrates the distracting forces applied to subtrochanteric fracture fragments at the key muscle insertions. [pubs.rsna.org]
Neurologic
- Seizure
Neurologic: Anti-seizure medication should be continued. A special issue beyond the scope of this short chapter is the issue of chronic opioid use. [clinicalpainadvisor.com]
Workup
Assessment Initial Investigations should include: General workup including FBC and cross match, renal function, glucose, ECG and, if indicated, CXR, intravenous access with intravenous infusion if indicated. [patient.info]
Elective: Scheduled procedures are reserved for revisions of previous reductions or “prophylactic” stabilization of a metastatic lesion in the femur after an appropriate cancer workup. 2. [clinicalpainadvisor.com]
■ Describe the appropriate imaging workup for different types of proximal femoral fractures. ■ List the potential complications and appropriate management strategies for these fractures. [pubs.rsna.org]
Treatment
We could not compare the outcome and the cost of treatment among the different treatment methods because of the small number of forms of treatment other than skin traction. [afrjpaedsurg.org]
Nonoperative treatment The advantages of nonoperative treatment are: noninvasiveness and negligible infection rate. [intechopen.com]
Treatment A femur fracture is always considered a medical emergency requiring immediate evaluation and treatment in a hospital. The treatment is largely dependent on the location of the fracture and the pattern and extent of the break. [verywellhealth.com]
Treatment of Vancouver type B1 and C fractures For these PPFF types, angle-stable plate osteosynthesis is the only suitable treatment option. [aerzteblatt.de]
[…] piriformis entry rigid nailing are not treatment options. [emedicine.medscape.com]
Prognosis
However, the type of fixation remains debatable Prognosis The prognosis of patients with diaphyseal femur fracture varies on age, comorbidity, presence of osteoporosis and type of treatment. [ncbi.nlm.nih.gov]
Fractures have the following pattern 6 : T1 : low signal fracture line; diffuse low marrow signal T2 and STIR : low signal fracture line; diffuse high marrow signal Treatment and prognosis After a diagnosis of an atypical fracture is confirmed (complete [radiopaedia.org]
The presence of these other injuries substantially complicates management and portends a considerably worse prognosis. [pubs.rsna.org]
Introduction The introduction of bisphosphonates into osteoporosis therapy was a great breakthrough, leading to a remarkable reduction of fracture incidence and improvement of prognosis. 1 Since the effect is caused by a reduction of bone turnover, long-term [online.boneandjoint.org.uk]
Secondary prevention of falls and osteoporosis should be actively considered in the early postoperative period, as subsequent fragility fracture or periprosthetic fracture is associated with a particularly poor prognosis. [onlinelibrary.wiley.com]
Etiology
Etiology A fracture in the diaphysis (shaft) of the femur caused by: References: [1] [2] Clinical features Painfully swollen, tense thigh Restricted range of motion Signs of fracture (e.g., shortening, deformity) Crepitus and distal neurovascular deficits [amboss.com]
“Pathological” fracture at the site of a cancer metastasis is another etiology, but is less common. [clinicalpainadvisor.com]
Etiology The femur is one of the strongest and largest bones in the body; it is divided into the following regions: head, neck, intertrochanteric, subtrochanteric, shaft, supracondylar and condylar areas. [ncbi.nlm.nih.gov]
In this review article, we will discuss the etiology, pathogenesis, and clinical studies, as well as case studies and their management per the latest clinical guidelines. [cureus.com]
Investigations should also look for the etiology of the fall including fall management and future prevention. Thromboembolic prophylaxis should be considered due to proven efficacy in decreasing the mortality in patients with femoral neck fractures. [lecturio.com]
Epidemiology
Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
From the case rID: 48181 ) OTA Classification System OTA Classification of Femur Fractures (www2.aofoundation.org) References Arneson TJ et al Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. [coreem.net]
Epidemiology There are an estimated 9 to 22 femur fractures per 1000 people worldwide that present every year. These injuries present in a bimodal distribution. [ncbi.nlm.nih.gov]
Cameron, 1 Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany 2 Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany Search for other works by this author on: Jochen Klenk, 2 Institute of Epidemiology [academic.oup.com]
Aetiology Varies per age group Trauma 60% Non Accidental Injury 15 - 30% - suspect if non walker / < 1 year - walking status single best indicator of risk OI / Pathological 10 % Epidemiology Bimodal distribution - peaks at 2 and 12 years Management AAOS [52.62.202.235]
Pathophysiology
Orthop Rev. 2014, 6:4-6. 10.4081/or.2014.5067 Compston J: Pathophysiology of atypical femoral fractures and osteonecrosis of the jaw. [cureus.com]
The first task force report in 2010 ( 5 ) provided a definition, speculations on the pathophysiology, and early suggestions for management. [eje.bioscientifica.com]
Pathophysiology The femur is the largest bone in the human body. [ncbi.nlm.nih.gov]
These injuries must be differentiated from insufficiency fractures, which, though similar in appearance and presentation, result from entirely different pathophysiology and occur in a different population. [1] The femur is the largest and strongest bone [physio-pedia.com]
Prevention
In conclusion, the Bavarian fracture prevention study demonstrates positive results of a multifactorial program for fracture prevention. [journals.plos.org]
This can be prevented using specific bed characteristics, massage and frequent reposition of the patient. [pathologies.lexmedicus.com.au]
Plain radiographs showing complete AFF left femur and incomplete AFF contralateral femur Prevention of AFFs Since such a high proportion of AFFs are linked with bisphosphonate use this is the area of greatest importance in the prevention of AFFs. [gmjournal.co.uk]
Prevention Most fractures are due to accidents. Always wear a seatbelt. Healthy bones and muscles may also prevent injury. This may be done through diet and exercise. [winchesterhospital.org]
Preventing hip fractures It may be possible to prevent further hip fractures by taking steps to prevent falls and by treating osteoporosis. [nhs.uk]