Pdf supracondylar fracture of the femur in children. This study aims to compare their mortality rates and assess whether surgical intervention improves either outcome or mortality following distal femoral fractures. A femoral fracture is a bone fracture that involves the femur. This condition is a break in the femur at the knee joint. Fracture shaft of femur a femoral shaft fracture is a fracture of the femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle 6. Complications and injuries associated with midshaft femur fractures in the adult can be lifethreatening and may include. The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture. Understanding characteristics of distal femoral fractures as well as the principles and challenges of management is important in optimizing outcomes. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee replacement surgery.
It includes the metaphyseal fractures supra condylar fractures and the fractures of the joint surface intraarticular fractures. There are different kinds of breaks, from simple to serious. Immobilisation in an aboveelbow backslab in 90 degrees elbow flexion with sling for 3 weeks. Typically, because of the strength of the bone, it takes either tremendous force or a defect of the bone to cause a femur fracture. The normal anatomic axis of the distal femur is 6 to 7 degrees of valgus in a male and 8 to 9 degrees in a female.
Spiral fractures that are related to low energy trauma situate in the middle third of. Patient ages ranged from 1month to 15 years, with a mean of 3. The third type is distal femoral fractures, also called supracondylar femur fracture, an injury to the thigh bone just above the knee joint. Surgical therapy is focused on immediate fracture stabilisation offering a durable and solid fixation. It is a fracture of femoral diaphysis occurring between 5cm distal to lesser trochanter and 5cm proximal to adductor tubercle. Management of fracture of distal end of femur by of. Fracture of shaft of femur 1 fracture of shaft of femur 2. Supracondylar sooprukondilar femoral fracture also called a distal distuhl fracture is when the thigh bone, or femur, is broken at the knee. Fractures of the femoral shaft often result from high energy forces such as motor vehicle collisions. Fifty consecutive patients were introduction abstract in this prospective study, 50 patients with distal femur fracture were treated using distal femur locking plate. Nerve injuries occur in about 40% of type iii gartlands classification supracondylar fractures earlier literature stated that radial nerve was the most commonly injured nerve in supracondylar fractures but recent studies indicate that the anterior interosseous branch of median nerve is mostly affected nerve involvement differ with the type of fracture anterior interosseous nerve is. Supracondylar femoral fractures occur commonly among two populations, young patients involved in highenergy accidents including motor vehicle and motorcycle accidents and sports trauma and older patients, often osteoporotic, sustaining low. Supracondylar fracture types, treatment, classification. Distal femur fractures and its treatment with distal femur.
Anteroposterior ap and lateral xrays of the distal humerus not elbow should be ordered if a supracondylar fracture of the humerus is suspected. Morbidity and mortality of bilateral femur fractures. The femur is the longest, strongest, and heaviest tubular bone in the human body and one of the principal load bearing bones in the lower extremity. Suffered since 3 hours before admitted to the hospital due to a traffic accident. Pdf diagnostic and management aspects of obstetric.
Proximal fracture of the femur is the main cause of morbidity, institutionalization and mortality in the elderly. Currently this cohort is not afforded the same resources as those with hip fractures. Under normal circumstances, our bones are continually breaking down and rebuilding themselves, allowing new bone to replace old, thereby constantly maintaining a. Supracondylar definition of supracondylar by the free. The role of fractureassociated soft tissue injury in the induction of systemic inflammation and remote organ dysfunction after bilateral femur fracture. They are typically sustained in highimpact trauma, such as car crashes, due to the large amount of force needed to break the bone. The thin soft tissue coverage on the anterior aspect of the distal end of the femur is a frequent.
Old and fresh cases and, simple or compound fractures were taken up. Treatment of supracondylarintracondylar fractures of the fe. Complications of supracondylar fractures of the elbow. Ease of insertion, the ability to obtain good fixation even in osteoporotic bone, and the capability of revising nonunions with a. Treatment of supraintercondylar aoota 33c and supracondylar aoota 33a femur fractures is generally challenging. Nail dynamization for delayed union and nonunion in femur. Unicondylar fractures of the distal femur are rare lesions, that often occur in combination with other posttraumatic injuries and may therefore fail to be recognised initially. The lower part of the knee joint is the shin bone, or tibia tihbeeuh. Management of fractures of distal femur journal of.
Type 1 this is a minimally or undisplaced fracture, which means there is a hairline fracture. C2 complete simple articular fracture with multifragmented metaphysis. Distal femoral fractures reportedly account for less than 1% of all fractures and comprise between 4%6% of all femoral fractures. Standard treatments include open reduction and internal fixation. The lateral cortex of the femur has a 10 degree slope, and the medial cortex slopes 25 degrees. B3 partial articular fracture, coronal hoffa fracture. The radial nerve lies posterolateral to the usual location of supracondylar fractures and, thus, is less commonly involved see fig. Midshaft femur fracture all subtrochanteric pediatric hip pain. Supracondylar femur fractures clinical presentation. The knees are the largest weight weightbearing joint in your body.
Supracondylar femoral fracture central coast orthopedic. In a recent study by louahem et al, 46 the most commonly injured nerve was the anterior interosseous branch of the median nerve. Whether they are transverse, oblique, or comminuted, supracondylar or intercondylar in a t, y or v fashion their management still evokes much controversy because of the consistently poor results obtained. These fractures usually occur in elderly patients with multiple comorbidities and osteoporotic bone.
Lowprofile, anatomically shaped plates designed for left or right femur. Treatment of supracondylarintracondylar fractures of the. The femur is composed of three separate regions figure 612 74. Schatzker j, horne g, waddell j 1974 the toronto experience with the supracondylar fracture of the femur 19661972. Operative treatment of acute distal femur fractures. The distal femur forms the top part of the knee joint. The most common fracture type of the femoral shaft is a noncomminuted simple ao type a, most of which, in traumatic fractures, are purely transverse and located in the middle third of the femur. Parallel increasing numbers of fatigue femur fractures are observed fol.
This is likely due to its anatomic arrangement of the exclusively motor posterior fascicles which are exposed to the zone of injury, and its tight tethering to. Pediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 57 years of age, usually from a fall on an outstretched hand. Locked plating lp of distal femoral fractures has become very popular. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter see hip fractures. The femur is the largest and strongest bone in the body. The clavicle fracture was the most common obstetric bone lesion in our series with a percentage of 77% followed by fracture of the femur and humerus with 12% and 11% respectively. Distal femur lecture orthopaedic trauma association ota. The incidence of pediatric femur fractures is 19 in.
Neurovascular injuries are mostly observed in the type 3 distal femur complex trauma. Usually occur in young men after high energy trauma and elderly women even after a low energy fall. Nonphyseal supracondylar fractures of the femur are considered to be uncommon in children and have received little attention in the literature. Management of fractures of distal femur journal of medical. Supracondylar soopruhkondehlahr femoral fracture also called distal distuhl femur fracture is when the thigh bone breaks at the knee.
Therefore, the purpose of this study was to analyze the complications and clinical outcomes of locked plating for supracondylar femur fractures utilizing cains 9, kristensens 11, and. Supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. The anatomy of the distal femur explains the three major types of fracture. May 04, 2016 the b3 type fracture popularly known as hoffas fracture has immense clinical signifcance in the outcome following treatment and has been further subdivided into three types 3,8,10. These fractures were surgically treated by ao principles and fixation, and the surgery performed mainly by the two authors. Gartlands classification of supracondylar fracture of humerus. The thin soft tissue coverage on the anterior aspect of the distal end of the femur is a frequent problem.
Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion nu, and revision is limited. This injury can involve the cartilage on the base of the femur in the knee joint, and may increase the risk of developing knee arthritis later in life. Using mullers fracture classification, the less comminuted fractures were found to have better results than those with more comminution. The incidence of supracondylar fracture after total knee arthroplasty is approximately 1%. The purpose of this study was to analyze the complications and clinical outcomes of lp treatment for distal femoral fractures. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. This type of cornoal fractures of he distal femur are further classified into. Comparison of supraintercondylar and supracondylar femur. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. Osteolytic or osteoblastic metastasis can lead to pain and immobilisation due to a pathologic femur fracture. Unicondylar fractures of the distal femur sciencedirect. Most nerve injuries are associated with type iii displaced supracondylar fractures.
Anteroposterior radiograph of the proximal femur a and lateral b and anteroposterior c radiographs of the distal femur showing femur fracture without evidence of healing in a 30yearold man. Epidemiology common injury due to major violent trauma 1 femur fracture 10,000 people more common in people 65 yr motor vehicle. Nerve injury in supracondylar fracture of humerus pg blazer. The most common cause of a fracture is direct trauma to the leg from an automobile accident or a fall. Fracture of distal of femur, neer scale, asif introduction the fractures of distal femur are defined as those fractures involving the last 15 cm of the femur measured from the knee joint line. Open fracture occurs in 5% to 10% of supracondylar fractures. The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. As the most commonly fractured long bone, it is not surprising that the femur was the first bone in which internal fixation was attempted. The fracture can range from a small crack to a full break that allows part of the bone to separate. Analysis of femoral fracture post motor vehicle accidents finnegan 1978. They are caused by a direct impact on the flexed knee during weight bearing. The overall results were seen to be excellent to good in 71%, and excellent to good to fair in 83% of the cases. A comparison of mortality following distal femoral. Pdf current concepts in fractures of the distal femur.
Supracondylar femur fractures orthopaedicsone articles. The femur is the largest and strongest bone in the body, so it takes tremendous force to cause a fracture. Jul 10, 2015 the role of fractureassociated soft tissue injury in the induction of systemic inflammation and remote organ dysfunction after bilateral femur fracture. Rightleft % 5149 compound fracture % 17 multiple fractures % 44 knee osteoarthritis % 5 type of trauma % from standing height 42 fall from. Supracondylar fractures of the femur 33a, b, and c. This study focus on the comparison between clinical and functional outcomes of fractures treated with condylar buttress plates cbps. Jun 08, 2018 distal femur supracondylar fracture everything you need to know dr. Predicting survival after treatment for fracture of the. A supracondylar fracture has three classifications, determined by the degree of separation of the fracture fragments. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture.
Oct, 2017 supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. Apr 20, 2016 fracture shaft of femur a femoral shaft fracture is a fracture of the femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle 6. It take a great deal of force to break the thigh bone. Clinical outcomes of locked plating of distal femoral. A thorough neurovascular examination of the affected extremity before and after reduction is essential. Nov 27, 20 locked plating lp of distal femoral fractures has become very popular.
Femur fractures the femur, or thigh bone, is one of the largest and strongest bones in the body. The fracture line starts in the lateral or medial intercondylartrochlear groove. Patients suffering a distal femoral fracture are at a high risk of morbidity and mortality. Mortality is estimated at 24% up to 12 months after the hip. Another genesis of femur fractures is carcinogenic. The backslab and sling should be worn under clothing e. However, optimal implants are now being welldefined. Supracondylar fracture pediatric pediatrics orthobullets. The association between bisphosphonates and femur fracture is discussed separately see risks of bisphosphonate therapy in patients with osteoporosis, section on atypical femur fractures and the use of bisphosphonates in postmenopausal women with osteoporosis, section on overview of approach. Ap and lateral radiographs of the thigh showing displaced oblique femoral mid shaft fracture.
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