Femoral Shaft Fractures: NEET PG Essentials
1. Pathophysiology & Presentation
Femoral shaft fractures are high-energy injuries, often associated with significant blood loss (can sequester 1–1.5 liters in the thigh). They exhibit characteristic deformities due to muscle pull:
- Proximal segment: Flexed, abducted, and externally rotated (due to the iliopsoas and external rotators).
- Distal segment: Displaced posteriorly (gastrocnemius pull).
2. Classification (Winquist & Hansen)
Used to assess the degree of comminution:
| Grade | Definition |
|---|---|
| Type 0 | No comminution. |
| Type I | Small butterfly fragment (< 25% cortical width). |
| Type II | Butterfly fragment (25%–50% cortical width). |
| Type III | Butterfly fragment (> 50% cortical width). |
| Type IV | Segmental comminution. |
3. Examination & Management Pearls
- Gold Standard Treatment: Reamed Intramedullary (IM) Nailing. Provides stable fixation and allows early mobilization.
- Damage Control Orthopedics (DCO): In multiply-injured patients (polytrauma), temporary stabilization with an External Fixator is used to stabilize the patient physiologically before definitive nailing.
- Pediatric Management: Management depends on age; spica casting is common for younger children, while flexible titanium nails (TENS) are preferred for school-aged children.
- Associated Injury: Always rule out a concomitant ipsilateral femoral neck fracture.
- Fat Embolism Syndrome: A major systemic risk; monitor for petechiae, hypoxemia, and altered mental status.