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]

Femoral fractures typically present as a painfully swollen, tense thigh with restricted range of motion and signs of fracture (e.g., shortening). [amboss.com]

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]

Of the patients with Gamma nails, one presented with a 15° valgus angulation and one with a 10° varus alignment and excessive external rotation (fig 2). Shoe risers were used to treat the two patients presenting with a leg length difference of 1 cm. [bjsm.bmj.com]

• Fever

  Beware of symptoms associated with fat emboli : change in mental status, dyspnea, hypoxia, petechiae, or fever ! Open fractures are almost always associated with multiple injuries! [amboss.com]

  […] breath or chest pain when you breathe Frequent urination or burning when you urinate Redness or increasing pain around your incision Drainage from your incision Swelling in one of your legs (it will be red and warmer than the other leg) Pain in your calf Fever [mountsinai.org]

  Let your healthcare provider know right away if you see an increase in redness, swelling, or draining from your incision, a high fever, chills, or severe pain. Also, let him or her know about any loss of feeling in your leg. [hopkinsmedicine.org]

• Sepsis

  […] violent trauma, there are many adverse outcomes, including fat embolism, acute respiratory distress syndrome (ARDS), multisystem organ failure, and shock associated with severe blood loss. [4] Open fractures can result in infection, osteomyelitis, and sepsis [en.wikipedia.org]

  Factors that may lead to new or fast AF include hypokalaemia and hypomagnesaemia, hypovolaemia, sepsis, pain and hypoxaemia. [onlinelibrary.wiley.com]

• Thrombosis

  Complications Complications that may occur following a proximal femur fracture include: Local infection - requiring antibiotic treatment as a prevention measure Deep vein thrombosis (DVT) and pulmonary embolism – thrombosis mostly occurs in the deep veins [pathologies.lexmedicus.com.au]

  Patients are susceptible to deep vein thrombosis and fat emboli due to surgery and prolonged recumbency. [lecturio.com]

  Deep vein thrombosis and pulmonary emboli No patient suffered from this complication in this series. 8– 11 Postoperative mortality and morbidity Except for the aforementioned patients with degenerative hip joint disease after malaligned fractures (n = [bjsm.bmj.com]

  Deep vein thrombosis and pulmonary embolus. Pressure ulcers. [patient.info]

  The older types of treatments included risk factors such as pulmonary thrombosis, deep vein thrombosis, or joint stiffness. The leg has a great blood supply. Bleeding can happen because of a fracture that can lead to a significant blood supply. [autoaccident.com]

• Hypotension

  Routine fluid treatment Protocol guided fluid treatment used in the clinical routine Other Names: Buffered Glucose 25 mg/ml 1ml/kg/h Ringer´s Acetate 2 ml/kg/h Voluven at the attending anaesthetist's discretion Phenylephrine 50 μg for correction of hypotension [clinicaltrials.gov]

  Peripheral blocks are not associated with the risk of hypotension induced with neuraxial anesthesia. [clinicalpainadvisor.com]

  Lower doses of intrathecal bupivacaine (< 10 mg) appear to reduce associated hypotension [ 32, 33 ]. [onlinelibrary.wiley.com]

  Different stages of bone loss in osteoporosis Risk factors Leading risk factors for a proximal femur fracture include: Elderly age Female gender: women lose bone density after menopause Osteoporosis Chronic medical conditions (hyper-/hypotension, stroke [pathologies.lexmedicus.com.au]

  A significant amount of blood loss can occur with a femur fracture, which can lead to hypotension. If the wound is open, cultures should be obtained. [ncbi.nlm.nih.gov]

• Amenorrhea

  A history of amenorrhea and eating disorders also predisposes to the fracture. The pain is insidious with a stressed fracture and is associated with exercise and weight bearing, but relieved by rest. [lecturio.com]

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]

We could not compare the outcome and the cost of treatment among the different treatment methods because of the small number of forms of treatment other than skin traction. [afrjpaedsurg.org]

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]

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]

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]

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 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]

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]

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]

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]

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]

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]

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]

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]

Preventing hip fractures It may be possible to prevent further hip fractures by taking steps to prevent falls and by treating osteoporosis. [nhs.uk]