Presentation
Femoral fractures typically present as a painfully swollen, tense thigh with restricted range of motion and signs of fracture (e.g., shortening). [amboss.com]
Prodomal thigh or groin pain may occur before fracture In about 70% of patients, pain in the thigh or groin may be present for several weeks or months before the atypical femoral fracture occurs. 1 Patients receiving long-term antiresorptive treatment [cmaj.ca]
In addition, at least four of five major features must be present. None of the minor features are required, but have sometimes been associated with these fractures. [gmjournal.co.uk]
The data related to the mortality are presented in Table 1. [scielo.br]
We present a 35 year-old East Indian woman who presented with a pathological, atraumatic right femoral diaphyseal fracture. [archivesofmedicine.com]
Neurologic
-
Cognitive Impairment
Total hip replacements for patients with a displaced intracapsular fracture who: Are able to walk independently out of doors with no more than the use of a stick; and Are not cognitively impaired; and Are medically fit for anaesthesia and the operation [patient.info]
Risk Factors of Femoral Neck Fracture Elderly populations have an increased risk of a fractured neck of the femur due to osteoporosis and high risk of falls due to neurovascular lesions, medications, dehydration, and cognitive impairment. [lecturio.com]
Consent and mental capacity Approximately 25% of patients with hip fracture have moderate or severe cognitive impairment, and a further 15–25% have mild cognitive impairment. [onlinelibrary.wiley.com]
Partial hip replacement may be recommended for adults who have other health conditions or cognitive impairment or who no longer live independently. [mayoclinic.org]
Four factors were identified in these patients closely related with a larger number of deaths: advanced age, polymorbidity, male gender and the presence of cognitive impairment. [scielo.br]
-
Personality Change
If a person changed the subpopulation within the observation period person-years at risk started again at the date of the assignment to the new subpopulation. [academic.oup.com]
Workup
Assessment Initial Investigations should include: General workup including FBC and cross match, renal function, glucose, ECG and, if indicated, CXR, intravenous access with intravenous infusion if indicated. [patient.info]
Elective: Scheduled procedures are reserved for revisions of previous reductions or “prophylactic” stabilization of a metastatic lesion in the femur after an appropriate cancer workup. 2. [clinicalpainadvisor.com]
Describe the appropriate imaging workup for different types of proximal femoral fractures. List the potential complications and appropriate management strategies for these fractures. [pubs.rsna.org]
Treatment
Nonoperative treatment The advantages of nonoperative treatment are: noninvasiveness and negligible infection rate. [intechopen.com]
Treatment A femur fracture is always considered a medical emergency requiring immediate evaluation and treatment in a hospital. The treatment is largely dependent on the location of the fracture and the pattern and extent of the break. [verywellhealth.com]
Treatment of Vancouver type B1 and C fractures For these PPFF types, angle-stable plate osteosynthesis is the only suitable treatment option. [aerzteblatt.de]
[…] piriformis entry rigid nailing are not treatment options. [emedicine.medscape.com]
Treatment Conservative treatment involves a prolonged immobilisation Nonoperative treatment A non-displaced, intracapsular proximal femur fracture is normally treated conservatively but requires a longer hospitalisation period. [pathologies.lexmedicus.com.au]
Prognosis
Fractures have the following pattern 6 : T1 : low signal fracture line; diffuse low marrow signal T2 and STIR : low signal fracture line; diffuse high marrow signal Treatment and prognosis After a diagnosis of an atypical fracture is confirmed (complete [radiopaedia.org]
However, the type of fixation remains debatable Prognosis The prognosis of patients with diaphyseal femur fracture varies on age, comorbidity, presence of osteoporosis and type of treatment. [ncbi.nlm.nih.gov]
The presence of these other injuries substantially complicates management and portends a considerably worse prognosis. [pubs.rsna.org]
Introduction The introduction of bisphosphonates into osteoporosis therapy was a great breakthrough, leading to a remarkable reduction of fracture incidence and improvement of prognosis. 1 Since the effect is caused by a reduction of bone turnover, long-term [online.boneandjoint.org.uk]
Secondary prevention of falls and osteoporosis should be actively considered in the early postoperative period, as subsequent fragility fracture or periprosthetic fracture is associated with a particularly poor prognosis. [onlinelibrary.wiley.com]
Etiology
Etiology A fracture in the diaphysis (shaft) of the femur caused by: References: [1] [2] Clinical features Painfully swollen, tense thigh Restricted range of motion Signs of fracture (e.g., shortening, deformity) Crepitus and distal neurovascular deficits [amboss.com]
“Pathological” fracture at the site of a cancer metastasis is another etiology, but is less common. [clinicalpainadvisor.com]
In this review article, we will discuss the etiology, pathogenesis, and clinical studies, as well as case studies and their management per the latest clinical guidelines. [cureus.com]
Investigations should also look for the etiology of the fall including fall management and future prevention. Thromboembolic prophylaxis should be considered due to proven efficacy in decreasing the mortality in patients with femoral neck fractures. [lecturio.com]
Etiology The femur is one of the strongest and largest bones in the body; it is divided into the following regions: head, neck, intertrochanteric, subtrochanteric, shaft, supracondylar and condylar areas. [ncbi.nlm.nih.gov]
Epidemiology
Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
From the case rID: 48181 ) OTA Classification System OTA Classification of Femur Fractures (www2.aofoundation.org) References Arneson TJ et al Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. [coreem.net]
Cameron, 1 Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany 2 Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany Search for other works by this author on: Jochen Klenk, 2 Institute of Epidemiology [academic.oup.com]
Aetiology Varies per age group Trauma 60% Non Accidental Injury 15 - 30% - suspect if non walker / 1 year - walking status single best indicator of risk OI / Pathological 10 % Epidemiology Bimodal distribution - peaks at 2 and 12 years Management AAOS [52.62.202.235]
Epidemiology There are an estimated 9 to 22 femur fractures per 1000 people worldwide that present every year. These injuries present in a bimodal distribution. [ncbi.nlm.nih.gov]
Pathophysiology
Orthop Rev. 2014, 6:4-6. 10.4081/or.2014.5067 Compston J: Pathophysiology of atypical femoral fractures and osteonecrosis of the jaw. [cureus.com]
The first task force report in 2010 ( 5 ) provided a definition, speculations on the pathophysiology, and early suggestions for management. [eje.bioscientifica.com]
Pathophysiology The femur is the largest bone in the human body. [ncbi.nlm.nih.gov]
These injuries must be differentiated from insufficiency fractures, which, though similar in appearance and presentation, result from entirely different pathophysiology and occur in a different population. [1] The femur is the largest and strongest bone [physio-pedia.com]
Prevention
In conclusion, the Bavarian fracture prevention study demonstrates positive results of a multifactorial program for fracture prevention. [journals.plos.org]
This can be prevented using specific bed characteristics, massage and frequent reposition of the patient. [pathologies.lexmedicus.com.au]
Plain radiographs showing complete AFF left femur and incomplete AFF contralateral femur Prevention of AFFs Since such a high proportion of AFFs are linked with bisphosphonate use this is the area of greatest importance in the prevention of AFFs. [gmjournal.co.uk]
Prevention Most fractures are due to accidents. Always wear a seatbelt. Healthy bones and muscles may also prevent injury. This may be done through diet and exercise. [winchesterhospital.org]
It could be a promising approach to extend the nurses' tasks by fall prevention activities. [academic.oup.com]