Fractures of Femoral Shaft - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University
devaki
devaki21 December 2012

Fractures of Femoral Shaft - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University

PDF (370 KB)
54 pages
4Number of download
1000+Number of visits
Description
Fractures of Femoral Shaft, Pediatric Femur Fractures, Osteonecrosis, Disruption of Blood Supply, Physeal Injury, Distal Femoral Physes, Trochanteric Apophysis, Fracture Subtrochanteric are some points from this lecture....
20 points
Download points needed to download
this document
Download the document
Preview3 pages / 54

This is only a preview

3 shown on 54 pages

Download the document

This is only a preview

3 shown on 54 pages

Download the document

This is only a preview

3 shown on 54 pages

Download the document

This is only a preview

3 shown on 54 pages

Download the document
Fractures of the femoral shaft in the pediatric patient

Fractures of the Femoral Shaft in the Pediatric Patient

Docsity.com

Pediatric Femur Fractures

• 1.6 % all children's Fx’s • 28/100,000 child years (Holland) • 3:1 Male / Female ratio • Children >3 y.o.- highest incidence • Seasonal- highest summer

Docsity.com

Treatment Goals - Restore

• Length • Alignment • Rotation

Docsity.com

Treatment Goals - Avoid

• Osteonecrosis - disruption of blood supply to femoral head

• Physeal injury- preserve future growth potential (proximal and distal femoral physes, trochanteric apophysis)

Docsity.com

Anatomy and Growth

• Proximal femoral physis- 30% of longitudinal growth

• Distal femoral physis- 70% of longitudinal growth

• Trochanteric apophysis- most of trochanteric growth appositional after age 8 years

Docsity.com

Anatomy- Blood Supply Proximal Femoral Epiphysis

• Predominantly ascending cervical branch (B) of medial circumflex femoral artery

• Physis (D) - a barrier to intraosseous blood supply from femoral neck

Chung S. JBJS 58A, 1976

Docsity.com

Pediatric Femur Fractures-Mechanism of Injury

• Rule out NAT in children <1year old • Falls- young children/toddlers • Struck by car- juvenile • Recreational sports/activities- adolescent • Motor vehicle crashes- all age groups

Docsity.com

Mechanism of Injury

• Low Energy • High Energy *predicts

behavior/treatment of the fracture (Blount-1973, Pollack-1994)

Docsity.com

Pediatric Femur Fractures- Associated Injuries

• Struck by car- triad of femur fracture, torso injuries, head injury

• Potential damage to physes of femur and proximal tibia

• Head Injury – spasticity can make traction and cast treatment difficult

• Abdominal injury – spica cast can constrict abdomen and limit ability to examine

Docsity.com

Physical Exam

• Complete exam: head, chest, abdomen, and other skeletal segments

• Document distal neurologic and vascular function

• Palpate all bones • First Aid principles - Splint or traction,

especially prior to transfer to another institution

Docsity.com

Radiographic Evaluation

• AP Pelvis • AP/Lat femur • Visualize hip & knee joints

Docsity.com

Classification

• Open or closed • Location of fracture- subtrochanteric,

diaphyseal (proximal, mid, distal third), supracondylar

• Fracture pattern- transverse, spiral, oblique, comminuted, greenstick

• Amount of shortening • Angular deformity

Docsity.com

7 Principles Dameron & Thompson JBJS 1959

• 1. Simplest treatment best • 2. Initial treatment permanent when possible • 3. Perfect anatomic reduction not essential

for perfect function • 4. More potential growth= more remodeling

capability

Docsity.com

Dameron & Thompson JBJS 1959

• 5. Restoration of alignment more important than fragment position

• 6. Overtreatment usually worse than undertreatment

• 7. Immobilize/splint injured limb before definitive treatment

Docsity.com

Decision Making

• Age • Mechanism of injury • Fracture pattern & location • Associated Injuries • Surgeon preference

Docsity.com

Traction Techniques

• Skin or skeletal • Avoid physes if place skeletal traction pins • Place pin perpendicular to shaft to avoid

varus/valgus angulation • Longitudinal in line traction for comfort prior

to definitive treatment • Split Russells traction (90-90) if awaiting early

healing prior to casting

Docsity.com

Immediate or Early Spica Cast- Ideal Patient

• Less than 5 years old • Less than 100 lbs • Initial shortening not excessive • Isolated injury

• Note -Spica casts used for decades and can

work for almost any pediatric femur fracture

Docsity.com

Spica Cast Technique

• Appropriate padding • Cast liners may decrease skin problems • Traction to get 0-15 mm shortening • Mold laterally to prevent varus • Can wedge for unacceptable angulation at

1-2 week checkups (>10-20° varus/valgus, >15-30° procurvatum/recurvatum – age dependent)

Docsity.com

Immediate Spica Cast

• Fiberglass lighter, easier to x-ray through • Often strong enough to obviate need for

connecting bar • See Kasser AAOS Instructional Course Lectures

Volume XLI, 1992

Docsity.com

Immediate Spica Cast

• X-ray weekly for 3 weeks • Time in spica = age in years + 3 weeks up to

maximum 8 weeks • Wedge cast for malalignment • Rotational alignment important at initial cast

application

Docsity.com

AAOS Managing Orthopaedic Malpractice Risk 2000

• Closed treatment of children’s femur fractures resulted in the most frequent and expensive complications, including foot drop, skin loss, compartment syndrome, and malrotation / shortening.

Docsity.com

Surgical Options

• Plate & screw fixation • External fixation • Flexible nailing • Rigid nailing

Docsity.com

ORIF with Plates/Screws

• Advantages – rigid, technique familiar to most surgeons, allows early motion, favorable results reported in children with associated head injuries

• Disadvantages- large scar, possible refracture after plate removed, higher infection rate in some earlier series

Docsity.com

External Fixation

• Advantages – can be applied rapidly, allows soft tissue injury management , early mobilization, avoid cast

• Disadvantages- pin site sepsis, pin site scarring, refracture, malunion

Docsity.com

External Fixator Tips

• Appropriate size half pin diameter • Proper pin placement relative to fracture for

biomechanical rigidity • Do not remove ex fix until see bridging

cortices (3 or 4 of 4)

Docsity.com

comments (0)

no comments were posted

be the one to write the first!

This is only a preview

3 shown on 54 pages

Download the document