Femoral shaft fracture
Introduction
Introduction to femoral shaft fracture The femur is the longest tubular bone in the human body. The femoral shaft includes 2 to 5 cm under the trochanter to 2 to 5 cm above the femoral condyle. The femoral shaft is surrounded by three groups of muscles, of which the extensor muscle group is the largest and is innervated by the femoral nerve; the flexor muscle group is second, and is dominated by the sciatic nerve; the adductor muscle group is the smallest, dominated by the obturator nerve, due to the muscle development of the thigh, after the fracture There are many misplacements and overlaps. The abductor muscles around the femoral shaft are weaker than other muscle groups. The abductor muscles are located on the buttocks attached to the large trochanter. Due to the effect of the adductor muscle, the distal end of the fracture Often there is a tendency to shift inward, the contralateral fracture, often tend to bow outward, this displacement and angulation tendency, should be corrected and prevented in the treatment of fracture, the lower third of the femur fracture Because the blood vessel is located behind the fracture of the femur, and the distal end of the fracture is often angled backward, it is easy to stab the spurs and veins. basic knowledge The proportion of the disease: the proportion of the disease in a specific group is 0.001% - 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: femoral shaft fractures, hemorrhagic shock
Cause
Cause of femoral shaft fracture
(1) Causes of the disease
Mostly caused by strong direct violence, and also caused by indirect violence.
(two) pathogenesis
The femoral shaft is the thickest tubular bone in the whole body. It has the highest intensity. It is caused by high-intensity direct violence. It is common in crushing and horizontal fractures. Traffic accidents are the main cause of injury. Industrial and agricultural injuries, life trauma and sports injuries are second. Fall fractures are mostly caused by indirect violence. Skew fractures or spiral fractures are common. Children with or without fractures may have incomplete or incomplete fractures. Direct violent or firearm injuries may cause soft tissue damage around the fracture, more bleeding, and the amount of internal bleeding in closed fractures. Can reach 500 ~ 1000ml, can be combined with shock, such as head, chest, abdominal complex injury and / or multiple fractures are more prone to shock.
1. The upper 1/3 fracture of the femoral shaft fractures due to the iliopsoas, gluteus medius and external rotation muscles, flexion, abduction, external rotation, distal fractures due to adductor muscles, quadriceps The group and the posterior muscle group act to adduct and shift to the posterior superior.
2. The proximal fracture of the 1/3 fracture of the femoral shaft is affected by the partial adductor muscle group. There is no special displacement in the other direction except the flexion and external rotation. The distal fracture piece is pulled by the internal and external muscles. There are often more obvious overlapping shifts and easy outward angles.
3. The distal 1/3 fracture of the femoral shaft fractures are displaced obliquely by the gastrocnemius muscle, which can damage the blood vessels and nerves of the axillary fossa. It is difficult to reset and fix by non-surgical treatment. The above displacement is not fixed, and the fracture piece is not fixed. Due to various external forces, muscle contraction and limb weight and handling can affect the displacement of various directions, but its inherent displacement mechanism has reference value for both the method of reduction and continuous traction therapy.
Prevention
Femoral fracture prevention
The disease is mostly caused by traumatic factors, no special preventive measures, pay attention to production and life safety, avoiding trauma is the key. In terms of prevention, the focus of this disease is on patient care, including preoperative and postoperative care, care for patients. Pay attention to reasonable nutrition, early functional exercise, functional exercise is an important part of the treatment of fractures, so that the affected limbs can quickly return to normal function, functional exercise must be gradual and progressive according to certain methods, otherwise it will cause adverse consequences.
Complication
Complications of femoral shaft fracture Complications femoral shaft fracture hemorrhagic shock
Due to the strong violence caused by fractures, femoral shaft fractures are often accompanied by multiple injuries of the whole body, or injuries with vital organs. In the case of femoral shaft fractures, there are important neurovascular movements on the medial femoral shaft. Inappropriate handling at the time of injury or injury, sharp fractures pierce the blood vessels to form major bleeding, plus the bleeding of the fracture itself, the amount of internal bleeding in adults can reach 500-1500ml, severe hemorrhagic shock, lower third of the femur fracture The fracture segment is pulled backward by the gastrocnemius muscle. The distal fracture end can compress or stimulate the radial artery, the iliac vein and the sciatic nerve. The damage of the blood vessel may cause blood supply disorder at the distal end of the limb, and even limb necrosis and injury of the sciatic nerve. Typical symptoms and signs such as foot drop, toe flexion and weakness and foot sensory disturbance.
In addition to the above complications, the disease can also be complicated by complications such as infection and nonunion.
Symptom
Femoral shaft fracture symptoms Common symptoms Thigh local swelling deformation Blood pressure lower limb shortening Elderly hip pain Facial shock Hip dislocation Butterfly fracture Comminuted fracture
Femoral shaft fractures are mostly caused by strong violence, so attention should be paid to the general condition and the damage of adjacent parts.
1. Systemic manifestations: femoral shaft fractures are mostly caused by severe trauma, the amount of bleeding can reach 1000 ~ 1500ml, if the system is open or comminuted fracture, the amount of bleeding may be greater, patients may be accompanied by blood pressure, pale and other bleeding The performance of shock; if combined with the damage of other organs, shock performance may be.
More obvious, therefore, for such cases, blood pressure should be measured first and closely observed, and attention to peripheral blood circulation.
2. Local manifestations: may have common symptoms of general fractures, including pain, local swelling, angular deformity, abnormal activity, limited limb function and longitudinal slap pain or bone squeak, in addition, should be based on the external part of the limb The initial situation of the deformity, especially the distal extremity of the lower extremity, should not be confused with the performance of hip injury such as intertrochanteric fracture. Sometimes there may be two kinds of injuries, such as nerve and vascular injury. The dorsal artery of the foot may be pulsating or pulsating slightly, and the injured limb may have abnormal circulation, and may have a shallow paresthesia or a distally-dominated muscle muscle abnormality.
3. Classification: The classification method developed by the Swiss Internal Fixation Society (AO/ASIF) is more practical. The femoral shaft fractures can be divided into three categories: A, B, and C. The types are divided into three subtypes: 1, 2, and 3, A. The type is simple fracture, A1 is spiral, A2 is >30° oblique, A3 is <30° horizontal, B is wedge or butterfly fracture, B1 is wedge or spiral wedge fracture, B2 is curved wedge, B3 is smash Wedge fracture, type C is a complex fracture, C1 is a spiral comminuted fracture, C2 is a multi-stage comminution type, and C3 is an irregular severely comminuted fracture.
Examine
Femoral shaft fracture examination
The auxiliary examination method for this disease is mainly X-ray examination:
In severe cases, fractures can be detected early in the X-ray examination, and in mild fractures, or special types of fractures, such as stress fractures, X-ray examination can have the following performance.
There was no abnormality in the early X-ray. After 2 to 4 weeks, the periosteal reaction and/or epiphyseal formation were observed. It was parallel or mound-like. The proliferative periosteum and/or the epiphysis and the cortical bone showed parallel low-density gaps. In the medial plane of the proliferative periosteum and/or epiphysis, a transversely dense band and/or a transverse serrated fracture line can be seen. Over time, the proliferative periosteum completely evolves into a callus, the density gradually increases, and the inter-cortical low-density gap Disappeared, the upper and lower ends are displaced from the cortical bone, and the density is equivalent to the cortical bone at the time of complete repair, and the X-ray is characterized by localized cortical thickening.
If the disease is complicated by acute fractures, the proliferative periosteum and/or osteophytes may be fractured at the proximal edge of the fracture. Combined with medical history, symptoms, etc. may be associated with old fractures.
Diagnosis
Diagnosis and diagnosis of femoral shaft fracture
diagnosis
History of trauma, local swelling and deformation of the thighs are severe, the lower limbs are shortened, there are obvious abnormal activities and bone rubs when moving, blood pressure, pulse and breathing should be routinely measured to determine whether there is shock or other systemic complications and major organ injuries. At the same time, carefully check the color, temperature and flexion of the toes to determine whether there are major blood vessels and/or nerve damage. A few patients may have femoral neck fractures or hip dislocations. Do not miss the physical examination. Lateral radiographs can identify the location, type and displacement of the fracture as a basis for treatment.
Differential diagnosis
The femoral shaft fracture needs to be differentiated from the soft tissue injury around the femur. The upper femoral fracture should be differentiated from the intertrochanteric fracture.
1. Muscle soft tissue injury around the femoral shaft: mainly manifested as muscle traction injury, sprain, laceration, etc., local muscle swelling and tenderness, positive resistance test, limited lower limb activity, no longitudinal axis sputum pain, no bone Abnormal activity of rubbing or thighs.
2, femoral intertrochanteric fracture: this type of fracture is found in the femur size between the rotor, easy to identify.
In femoral shaft fractures, fatigue femoral shaft fractures are easily misdiagnosed. In the analysis of the causes of misdiagnosis, one is that such fractures are rare, followed by the occurrence of fatigue femoral shaft fractures, which happens to be the site of osteosarcoma. X-ray performance has the same point, so it is easy to cause misdiagnosis, and clinical attention should also be paid when it is diagnosed.
