Femoral Shaft Fractures Flashcards

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Questions and Answers

What are the most common mechanisms of femoral shaft fractures?

High energy mechanism

Low energy mechanism

Both A and B (correct)

None of the above

What other fractures are commonly associated with femoral shaft fractures?

Ipsilateral femoral neck fracture

What muscles are located in the anterior compartment of the thigh?

Sartorius and the quadriceps

What muscles are located in the posterior compartment of the thigh?

Biceps femoris, semitendinosus, semimembranosus Signup and view all the answers

What muscles are located in the medial compartment of the thigh?

Gracilis, adductor longus, adductor brevis, adductor magnus Signup and view all the answers

In which direction do the proximal and distal fragments of a fractured femur move due to their associated musculature attachments?

Proximal moves in abduction and flexion, distal moves in adduction and extension Signup and view all the answers

What is the Winquist and Hansen Classification used for?

Categorizing the degree of comminution in femoral shaft fractures Signup and view all the answers

What's Winquist and Hansen Classification Type 0?

No comminution Signup and view all the answers

What's Winquist and Hansen Classification Type 1?

Insignificant amount of comminution Signup and view all the answers

What's Winquist and Hansen Classification Type 2?

Comminuted with a butterfly fragment of 50% or less of the width of the bone Signup and view all the answers

What's Winquist and Hansen Classification Type 3?

Comminuted with a large butterfly fragment of greater than 50% of the width of bone Signup and view all the answers

What's Winquist and Hansen Classification Type 4?

Segmental comminution with no contact between proximal and distal fragment Signup and view all the answers

What is often found in the physical exam of a femoral fracture?

Tense, swollen thigh, affected leg often shortened, tenderness about thigh Signup and view all the answers

Difference in blood loss in closed femoral shaft and tibial shaft fractures?

Closed femoral shaft fracture: 1000-1500ml; Closed tibial shaft fracture: 500-1000ml Signup and view all the answers

What imaging studies are indicated for femoral shaft fractures?

AP and lateral view XR of entire femur and ipsilateral hip; CT for mid-shaft fractures Signup and view all the answers

What is the gold standard operative treatment for diaphyseal femoral shaft fractures?

Antegrade intramedullary nail with reamed technique Signup and view all the answers

Study Notes

Femoral Shaft Fractures Overview

High energy fractures are prevalent in younger populations, often resulting from high-speed motor vehicle accidents (MVAs).
Low energy fractures commonly occur in the elderly, typically after falls or from gunshot wounds (GSWs).

Associated Injuries

Ipsilateral femoral neck fractures are frequently associated with femoral shaft fractures.

Muscle Anatomy of the Thigh

The anterior thigh compartment includes the sartorius and quadriceps muscles.
The posterior thigh compartment contains the biceps femoris, semitendinosus, and semimembranosus.
The medial thigh compartment is comprised of the gracilis, adductor longus, adductor brevis, and adductor magnus.

Fracture Mechanics

In a femoral fracture, the proximal fragment moves in abduction and flexion due to the gluteus maximus and iliopsoas muscles.
The distal fragment experiences adduction and extension influenced by the adductor muscles and gastrocnemius attachment.

Winquist and Hansen Classification

This classification system categorizes femoral shaft fractures based on comminution levels.
Type 0: No comminution.
Type 1: Insignificant comminution present.
Type 2: Comminution with a butterfly fragment ≤50% of bone width.
Type 3: Comminution with a butterfly fragment >50% of bone width.
Type 4: Segmental comminution with no connection between proximal and distal fragments.

Physical Examination Findings

Physical examination may reveal a tense, swollen thigh.
The affected leg is often shorter than the uninjured leg.
Tenderness in the thigh region is commonly noted.

Blood Loss Comparison

Closed femoral shaft fractures can result in blood loss of 1000-1500 ml.
Closed tibial shaft fractures typically lead to blood loss of 500-1000 ml.

Imaging and Diagnosis

Anteroposterior (AP) and lateral X-rays of the entire femur are essential.
AP and lateral X-rays of the ipsilateral hip help rule out concurrent femoral neck fractures (common in 1-9% of cases).
CT scans are recommended for mid-shaft fractures to assess for associated femoral neck injuries.

Treatment Protocol

The gold standard for operative treatment of diaphyseal femoral shaft fractures is antegrade intramedullary nailing utilizing a reamed technique.

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Description

Test your knowledge on femoral shaft fractures with these flashcards. This quiz covers the mechanisms of injury, associated fractures, and muscle anatomy in the anterior thigh compartment. Perfect for medical students and professionals looking to reinforce their understanding.