Femur

1. Femoral Shaft Fracture

• Cause: High-energy trauma (e.g., fall, car accident)

• Presentation: Shortened, swollen, painful thigh

• Treatment (age-based):

  • <6 months: Pavlik harness or spica cast

  • 6 months–5 years: Spica cast

  • >5 years or displaced/unstable: CONSULT ORTHO: Traction or surgical fixation (e.g., flexible nails, plate, or external fixator). An image of a flexi nail is seen to the right.

2. Proximal Femur Fracture (Hip Fractures)

• Definition: Involves the proximal femur and can involve the hip joint (such as the the femoral head, femoral neck and the upper femur growth plate)

• Special Considerations: This involves high-energy trauma and there is a risk of avascular necrosis (especially femoral neck fractures) given the vasculature around the region. These patients can have associated injuries. Assess for:

  • Associated Conditions:

    • head or facial trauma

    • splenic lacerations

    • retroperitoneal hemorrhage

    • perineal injury

    • pelvic ring or acetabular fractures

    • hip dislocation

    • femur fractures

• Treatment: CONSULT ORTHO- Requires surgical fixation

3. Distal Femur Fracture

• Definition: Fracture of the diaphysis of the femur bone

• Special Considerations: Can involve the growth plate and can lead to growth arrest

• Treatment:

  • CONSULT ORTHO

  • Closed reduction and percutaneous fixation followed by casting: Done in the majority of cases, limit attempts at reduction since excessive manipulation increases risk of complications, should still be secured intraoperatively

  • ORIF if the fracture is a Salter-Harris III and IV or an irreducible SHI and SHII fracture