fractured_femur.pptx

8/15/2019 fractured_femur.pptx

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The Fractured Femur

Directed ReadingsIn the Classroom

January/ February 2013 issue of Radiologic Technology


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Instructions: This resentation ro!ides a frame"or# foreducators and students to use Directed Readingcontent ublished in Radiologic Technology $ This

information should be modi%ed to&1$ 'eet the educational le!el of the audience$

2$ (ighlight the oints in an instructor)s discussion orresentation$

The images are ro!ided to enhance the learninge* erience and should not be re roduced forother ur oses$


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Introduction The femur is the largest and strongest bonein the human body+ and great force isnecessary to fracture it$ Radiogra hy is thegold standard for diagnostic imaging offemurs+ but diagnosis can be com licated"ith nondis laced or occult fractures$,articularly in the emergency setting+modalities such as magnetic resonanceimaging or com uted tomogra hy may benecessary$ -.ecti!e treatment of femurfractures is needed to restore homeostaticfunction and re!ent com lications$


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SymptomsIn the case of high im act trauma+ it is oftenob!ious that the femur has been fractured$tress or insu ciency fractures that are not

ronounced may be a arent by ain in theu er leg or hi + and it may be e*tremelyainful or e!en im ossible for an indi!idualto lace any "eight on the a.ected leg$ Thefractured leg may be deformed or shorterthan the o osite leg+ and the femur maye!en ri through the s#in on the thigh incases of se!ere fracture$


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SymptomsFractures of the hi + including the femoralhead or femoral nec#+ are often e!idencedby ain in the hi + #nee+ or lo"er bac#$

ther common+ and some"hat mores eci%c+ sym toms include the inability tostand or "al# and the foot on the a.ectedside turning at an abnormal angle+ ma#ingthe leg loo# shorter than the leg on theuna.ected side of the body$


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Statistics and Riskss many as 240+000 hi 5oint fractures occurin the 6nited tates each year+ and thema5ority of hi fractures are the result of

falling$ 'ore than one third of mericansolder than 74 years of age fall each year+and 809 of all hi fractures occur inindi!iduals older than age 40$ ro*imately149 to 249 of elderly indi!iduals "ho su.era hi fracture die "ithin 1 year$


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Statistics and Risks6 to 809 of femoral shaft fractures inadolescents and the general o ulation arecaused by motor !ehicle accidents+ including

cars+ bicycles+ or being stuc# by a !ehicle asa edestrian$ Femur fractures also oftenresult from s orting accidents: illness ordisease that a.ects bone integrity+ such as!itamin D de%ciency+ systemic lu userythematosus+ or cancer: and certainmedications+ articularly long term use ofbis hos honates for osteo orosis andcancer related metastases$


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Statistics and RisksFemoral nec# stress fractures occur mostoften in highly acti!e indi!iduals+ such aselite distance runners+ military recruits+ and

dancers$ nother grou "ith adis ro ortionately high ris# of femoral nec#stress fractures includes ostmeno ausal"omen and indi!iduals "ith conditionsresulting in loss of bone mineral density+including osteo enia+ osteo orosis+ ,agetdisease+ and hy er arathyroidism$ tressfractures to the femoral nec# are uncommonin the general ublic and e*ceedingly rare in


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Statistics and Riskslthough most femur and hi 5oint fracturesin the general o ulation are the result of anaccident+ certain factors can increase the

ris# of these fractures in the elderlyo ulation+ including&

• ;o" bone mineral density$•


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Statistics and Risks'ore than 240 000 subca ital hi fracturesbelo" the femoral head are re ortedannually in the 6nited tates+ costing an

estimated ?14 billion er year$


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Anatomy - Skeletal The femur is the u er bone of the leg$ Its functionis to allo" for "al#ing by connecting the hi to the#nee$ The femoral head is a ball that %ts into thesoc#et 5oint of the hi at the acetabulum$ This balland soc#et system is held in lace by ligaments+ orligamentum teres femoris$ The femoral nec#connects to the shaft of the femur at an angle toallo" for ambulation$ The femur is almost

com letely cylindrical$ ;i#e other long bones+ thefemur consists of a body and 2 e*tremities =u erand lo"er>$ The u er = ro*imal> e*tremity is madeu of the femoral head+ nec#+ and greater and

lesser trochanters$ The lo"er =distal> e*tremity iscuboid and consists of 2 oblong ro5ections called


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Figure 1. Illustration of the anterior (A) and

posterior (B) femur.A


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Types of Fractures stress fracture is an o!eruse in5ury that results "henthe muscle becomes too fatigued to absorb shoc# andtransfers the o!erload of stress to the underlyingbone+ and may not be e!ident on initial radiogra hs$n radiogra hs+ it often a ears as a sclerotic bandacross the bone+ although a de%ned fracture line isin!isible$ In such cases+ radionuclide bone scanning isossibly the best imaging modality: stress fractures

a ear as areas of increased u ta#e before anychanges are !isible on radiogra hs$ imilarly+athologic fractures occur s ontaneously in abnormalbone+ articularly in the resence of bone tumors$ften+ a bone lesion is ob!ious: sometimes theborders of the lesion can be oorly de%ned+ and


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Fatigue fractures result from abnormal stress beinglaced on normal bone$ Com ression fractures occur"hen bone colla ses either because of e*cessi!eressure or illness$ These ty es of fractures occurmost commonly in the !ertebrae+ sacrum+ ubic rami+and femoral nec#$ alter (arris fractures are thosethat occur to the gro"th lates+ almost al"ays due toforce$ Gonaccidental fractures are lin#ed "ith abuse+

articularly in children but also in the elderly$Radiologic technologists+ and inter reting hysiciansshould be a"are of otential abuse+ "hich is oftenindicated by multi le fractures+ articularly fracturesthat a ear to ha!e ta#en lace at di.erent times$ther factors ointing to nonaccidental in5ury include

Types of Fractures


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Clinicians ha!e created se!eral systems to classifyfractures of the femur+ femoral head+ femoral nec#+and gro"th lates$ Fractures can be located on thero*imal+ middle+ or distal third of the femoral shaft+ and they can be characteri ed in se!eral "ays+according to&• The direction of the fracture line$•

The relationshi of the bone fragments in!ol!ed$• The number of fragments in!ol!ed$• ny e* osure to the outside air$

Classifying Fractures


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The direction of the fracture line often de ends on thety e of force causing the trauma$ Trans!erse fracturesare hori ontal brea#s across the femoral shaft and arecaused by a force e*erted er endicular to the shaft$Force a lied in the same direction as the long a*is ofthe bone roduces diagonal or obliEue fractures acrossthe shaft$ ;ongitudinal fractures also occur along thelong a*is of the bone$ Finally+ s iral fractures encircle

the femoral shaft and are roduced by a torEue in5ury$



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The fracture can dis lay 1 or a combination of the!ariations in osition&• Dis lacement H misalignment of the fragments:

re resents the distance the distal fracture fragmentis o.set from the ro*imal fracture fragment$• ngulation H the amount of de!iation from the

normal angle of the distal and ro*imal fragments$• hortening H the amount of o!erla in the ends of

the fracture fragments$• Rotation H the e*tent the fracture fragments i!ot or

turn from normal osition$



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alter (arris fractures in!ol!e the femoralgro"th lates+ either alone or combined "ithan ad5acent art of the femur$ This

classi%cation system includes 4 ty es and isarticularly im ortant because of its redicti!e!alue$ Ty e I and ty e II fractures areassociated "ith a good rognosis+ "hereas

ty e I and ty e can result in early fusion ofthe e i hysis and subseEuent shortening ofthe bone$



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Types of Fractures


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Femoral nec# fractures are categori ed according tothe arden Classi%cation+ "hich includes&• Ty e 1 H stable: in!ol!es a minor crac# in the

femoral nec#$• Ty e 2 H in!ol!es a com lete crac# in the femoral

nec# but no bone dis lacement$• Ty e 3 H a dis laced fracture "ith the fragments

remaining connected to one another: also mayin!ol!e rotation of the bone fragments+ angulation+or both$

• Ty e B H com letely dis laced "ith no connectionbet"een the fractured fragments: li#ely to disru t



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The ,i #in Classi%cation is the most "idely usedclassi%cation criteria for femoral head fractures =seeo! " >$ ccording to this system+ fractures arecategori ed into B ty es based on increasing se!erity$

The classi%cations in uence treatment decisions andredict outcomes$ For e*am le+ ty e I fracturesty ically ha!e better outcomes and often aremanaged "ithout surgery+ using hysical thera y and

limited "eight bearing$ The occurrence and se!erity ofcom lications increase from ty e I to ty e I $ alter(arris fractures in!ol!e the femoral gro"th lates+either alone or combined "ith an ad5acent art of thefemur$ This classi%cation system includes 4 ty es andis im ortant because of its redicti!e !alue$ Ty e I and



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Kith bone fracture+ radiogra hs remain the goldstandard for diagnostic imaging$ In the 6nited tates +nearly e!ery atient "ho resents to the emergencyde artment "ith a sus ected fracture undergoeslain %lm radiogra hy$ Got only can radiogra hs beused to !isuali e fracture or dislocation+ they also canhel determine "hether underlying bone is normal or"hether a fracture occurred because of an

abnormality =ie+ a athological fracture>$ Radiogra hycan be used to distinguish a fracture from otherconditions or diseases+ such as cancer and bonemetastases+ osteomyelitis+ ,aget disease+ ordislocation$ Radiogra hy also can sho" the osition ofthe bone ends before and after treatment of a

#iagnostic Imaging - Radiograp$y


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Kith bone fracture+ radiogra hs remain the goldstandard for diagnostic imaging$ In the 6nited tates +nearly e!ery atient "ho resents to the emergencyde artment "ith a sus ected fracture undergoeslain %lm radiogra hy$ Got only can radiogra hs beused to !isuali e fracture or dislocation+ they also canhel determine "hether underlying bone is normal or"hether a fracture occurred because of an

abnormality =ie+ a athological fracture>$ Radiogra hycan be used to distinguish a fracture from otherconditions or diseases+ such as cancer and bonemetastases+ osteomyelitis+ ,aget disease+ ordislocation$ Radiogra hy also can sho" the osition ofthe bone ends before and after treatment of a

#iagnostic Imaging

Radiography


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-!en "ith 2 ro5ections+ fractures may be in!isible onradiogra hs+ in "hich case additional ro5ectionsshould be erformed at the discretion of theradiologist as follo"s&• bliEue ro5ections$• tress images+ "hich are ta#en "ith a 5oint under

stress to sho" that it is unstable+ as in the case of

dislocation$• Fle*ion and e*tension ro5ections+ "hich should

only be ta#en "ith the indi!idual erforming themo!ement and not on an unconscious indi!idual$

• Radiogra hs of the nonfractured side for



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Intraca sular fractures =ie+ those abo!e thetrochanters> usually are a arent on radiogra hs:ho"e!er+ "hen a fracture is not e!ident and clinicalsus icion of a fracture is high+ magnetic resonance='R> imaging may be referred$



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ften+ acute in5uries to the gro"th lates are notclearly !isible because of the cartilaginous osseouscom osition and irregular contours of the hyses$ Thee i hyseal gro"th late a ears on radiogra hs as a"hite boundary+ ma#ing it easily confused "ith anim acted fracture in "hich trabeculae ha!e becomeenmeshed$


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Femoral nec# fractures often occur in elderlyindi!iduals because of falls$ In the elderly o ulationin articular+ it is im ortant to distinguish bet"eenfractures of the el!is and nondis laced+ im acted+ oroccult fractures of the femoral nec#$ Radiogra hicimaging of the femoral nec# should include , imagesand images of the lateral i silateral femur "ithinternal rotation$


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Radiogra hic imaging of the hi should include an ,and a lateral ro5ection$ The , image should beca tured "ith the atient su ine and the footinternally rotated 14 to secure the best !ie" of thefemoral nec#$ The central beam should be directedto"ard the femoral head$ The * ray tube should beositioned 100 cm from the focal lane of the imagerece tor to roduce an image at 209 magni%cation$

The cross table lateral ro5ection should be ta#en"hen an indi!idual is sus ected of ha!ing a hifracture or dislocation$ For the cross table lateralro5ection+ the atient should be su ine+ "ith theo osite hi e*ed and abducted$ The cassette shouldbe laced against the lateral side of the a.ected hi +



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'R imaging lays an im ortant role in the diagnosis offemur fractures$ 'R can be used to assess soft tissuedamage resulting from femur fracture+ and is su eriorto CT in its ability to !isuali e soft tissue$ 'R imagingalso is used to assess tissue com osition and imagelesions in multi le lanes and to accurately delineategeogra hic relationshi s of the body)s internalstructures$ In the emergency setting+ 'R remains the

imaging modality of choice for occult hi and el!icfractures$ (i fractures often are missed onradiogra hy$ 'R imaging is indicated innonambulatory atients "ith negati!e radiogra hicimages+ and both insu ciency fractures and stressfractures a ear as characteristic bone marro" edema

#iagnostic Imaging - %agnetic

Resonance Imaging


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In a case re ort and literature re!ie" by Cheon et al+the utility of 'R imaging in diagnosing insu ciencyfractures of the femur not immediately e!ident onradiogra hy "as e!aluated$ Radiogra hic images "erecom ared "ith 'R images+ and the results indicatedthat B of the A indi!iduals studied had im endingfractures+ as indicated on 'R imaging =see Ta&le 1 >$

The resence of the femoral cortical ridge on

radiogra hy a eared as a com lete trans!ersefracture line on 'R imaging+ leading the authors toostulate that this %nding indicated the otential forfracture and ossible need for ro hylactic %*ation$'oreo!er+ the authors stated that although 'Rimaging is the most e.ecti!e modality for diagnosing


Resonance Imaging


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'R imaging is not as e.ecti!e as radiogra hy or CT insho"ing fracture lines because cortical bone does notroduce an 'R signal$ (o"e!er+ 'R imaging is use fulin sho"ing bony in5uries often not ob!ious on CTscans+ such as bone bruises that do not in!ol!ecortical bone disru tion but do result in hemorrhageand edema in the bone marro"$ This is because bonebruises+ for e*am le+ cause hemorrhage "ithin the

bone that re laces the marro" "ith fat+ therebyaltering the 'R signal$ n altered signal may be!isible in the resence of a hemorrhage+ and a bonebruise may be !isible e!en "ithout a discerniblefracture on a radiogra h$


Resonance Imaging


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'R imaging can de ict altered arrest lines andtrans hyseal bridging abnormalities before they aree!ident on radiogra hs$ In addition+ coronal 'Rimaging can be used to image a fracture to thefemoral nec# not !isible on radiogra hs of the hi $ Kith fractures of the gro"th late+ 'R imaging is themost accurate modality in sho"ing fracture anatomyin the acute hase of in5ury =ie+ the %rst 10 days

follo"ing in5ury>$ n T1 "eighted 'R imaging+fractures a ear as a trans!erse band of lo" intensity=bright signal> marro" re lacement$ n T2 "eightedimaging+ fractures a ear as high signal surroundingedema$


Resonance Imaging


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Com ared "ith radiogra hy+ CT has the distinctad!antage of more clearly sho"ing ob!ious fracturelines as "ell as cortical abnormalities associated "ithnondis laced fractures$ CT can sho" fracture lines ingreater detail+ as "ell as the osition and orientationof fracture fragments+ better than other imagingmodalities$ CT articularly is useful for imagingfractures in com le* s#eletal structures+ such as the

hi + face+ shoulder+ and foot$ CT can roduce sagittaland coronal reformations+ as "ell as 3 D models of thein5ured area+ that dis lay the osition and orientationof ma5or fracture fragments and allo" for !ie"ing ofthe bone as if the soft tissues "ere remo!ed$ lthoughCT has been sho"n to be less sensiti!e than 'R

#iagnostic Imaging - Computed

Tomograp$y


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Kith fractures around the hi + CT can sho" therelationshi of the fragments to the 5oint as "ell asany loose fragments in the 5oint$ CT also demonstratestissue damage and hematomas that can result fromfractures$ CT is often Euic#er and more comfortable+reEuiring less body mani ulation than radiogra hy+ma#ing it ad!antageous for seriously in5uredindi!iduals+ such as those in!ol!ed in a car accident$

'el!in et al conducted a study to assess the utility ofCT for detecting and managing femoral nec# fractures$Researchers found that the addition of CT+ as "ell asmodi%cation of the arden Classi%cation asnondis laced !s dis laced+ im ro!ed intraobser!erreliability in inter reting the %ndings in the 4 cases

#iagnostic Imaging - Computed

Tomograp$y


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Radionuclide bone scanning =also referred to as bonescintigra hy> "ith technetium 88m labeleddi hos honate tracer material lays a role indiagnosing fractures because of its high sensiti!ity

com ared "ith other imaging modalities$ Thedi hos honates accumulate ra idly in the bone+ andalmost 409 of the tracer is absorbed by the s#eletalsystem "ithin 2 to 7 hours after in5ection$ The rate of

u ta#e of the radiotracer de ends on blood o" andne" bone formation$ Thus+ radionuclide bone scanningcan be used to sho" signs of bone healing+ as "ell ascell turno!er and other hysiologic signs of fracture$

#iagnostic Imaging - 'uclear

%edicine


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Radionuclide bone scanning also is used to diagnosebone tumors or cancer+ rule out a bone infection ora!ascular necrosis+ and e!aluate metabolic disordersthat a.ect the bones =eg+ osteo orosis or ,aget

disease>+ thereby distinguishing such conditions froma fracture$ For e*am le+ on bone scans+ osteomyelitisalmost al"ays a ears as a combination of focalhy erfusion+ focal hy eremia+ and focally increased

bone u ta#e$


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#iagnostic Imaging

Nuclear Medicine


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,ositron emission tomogra hy using 1@Fuorodeo*yglucose =FD ,-T> scanning can be usedto e*amine an indi!idual for abnormal rocesses in thebone: its use in detecting femur fractures is limited$

FD ,-T measures metabolic acti!ity and molecularfunction !ia in5ected contrast material that is absorbedinto the body+ emitting radiation that is detected bythe ,-T scanner$


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#iagnostic Imaging - 'uclear

%edicineingle hoton emission com uted tomogra hy= ,-CT> is another ty e of nuclear medicinee*amination that uses radiotracer material togenerate gamma decay to obtain images$ ;i#e CT+ its

images can be formatted in multi le lanes$ Kithfemur fracture e*amination+ ,-CT may assist ine!aluating femoral nec# stress fractures in con5unction"ith lanar scintigra hy$ In a retros ecti!e study of 3@

indi!iduals in the military+ 33 had undergone lanarscintigra hy "ith ,-CT before 'R imaging of the hifor the e!aluation of femoral nec# fracture$ Khen,-CT "as added to lanar scintigra hy+ sensiti!ityrose from 409 to 82$39 = P L $03>+ and accuracy indetecting high grade fractures im ro!ed from 12$49


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Dual energy * ray absor tiometry =DM > may ha!e aotential role in detecting femur fractures+ although itmost commonly is used to detect changes in bonedensity$


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,-T scan cou led "ith CT =,-T CT> has sho"n romiseas a otential imaging modality for indi!iduals "ithosteo orosis and aty ical femoral shaft fracturesbecause of its usefulness in de%ning certain as ects of

athogenesis+ site s eci%city+ and otential rodromalabnormalities+ in addition to ro!iding insight aboutradio#inetic !ariables of s#eletal blood o" andmar#ers for bone formation$ (o"e!er+ more studies on

the clinical use of ,-T CT as a diagnostic imagingmodality for femur fracture are "arranted$

#iagnostic Imaging


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6ltrasonogra hy lays a limited role in boneassessment+ mostly in the imaging of 5oint e.usions+blood o"+ and the resence of foreign bodies "ithinthe soft tissues$ 6ltrasound guided femoral ner!e

bloc#s may be used in the emergency setting toachie!e adeEuate analgesia for se!ere femoralfractures$

Finally+ high resolution eri heral Euantitati!ecom uted tomogra hy =(R NCT> has sho"n romisein recent years because of its ability to image bonedensity and isotro ic !o*el si e+ "hich may ro!ehel ful in assessing osteo orosis and fracture ris# as

"ell as treatment e cacy$

#iagnostic Imaging


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Treatment of femoral fractures ranges from immediatestabili ation of a atient to surgery$ In the emergencysetting+ the %rst ste is to stabili e the atient andaddress any uid or electrolyte abnormalities$ Keight

should not be laced on the a.ected leg or hi until a"or#u is conducted$


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In the adult o ulation+ fractures of the femoral shaftare most often treated surgically "ith intramedullarynails or late %*ation$ ther treatments includee*ternal %*ation+ although this rocedure is less

common and generally only a tem orary solution$lthough nonsurgical treatments for femur fracturee*ist+ including s#in traction+ s#eletal traction+ castbrace+ and casting+ these methods are rarely used

e*ce t for ediatric atients$ Intramedullary nail%*ation in!ol!es the insertion of a metal rod+ ty icallytitanium+ into the marro" canal of the femur$ The nailreattaches the fractured bone fragments to oneanother so that they can be realigned and heal$ Kiththis rocedure+ the nail is inserted either at the hi or

Treatment and %anagement


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'ore se!ere intra articular fractures =eg+ ty e III andty e I alter (arris> usually reEuire o en reductionand internal %*ation that a!oids crossing the hysis$mooth ins are im lanted arallel to the hysis in the

e i hysis or meta hysis$ bliEue insertion of insacross the hysis is considered only "hen satisfactoryinternal %*ation cannot be attained "ith trans!erse%*ation$ Ty e alter (arris fractures often are not

diagnosed in the acute hase: thus+ treatment isdelayed until a more ob!ious bony formation gro"sacross the hysis$



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Femoral nec# fractures are notoriously di cult totreat$ 'anagement can include nonsurgical methods"hen the fracture is nondis laced$ (o"e!er+ surgery+including internal %*ation+ is most often necessary to

a!oid com lications such as delayed union ornonunion+ refracture+ osteonecrosis+ and a!ascularnecrosis of the femoral head$ In some cases+arthro lasty and e!en total hi re lacement may be

necessary to ro erly treat a femoral fracture$ Internal%*ation is still arguably the most common treatmentfor femoral nec# fractures+ although its use is ta eringo.$ It in!ol!es inserting metal scre"s that attach toboth the femur and the femoral head to secure thefemoral nec#$ arious other techniEues "ere


Femoral Neck Fractures


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Femoral nec# fractures are notoriously di cult totreat$ 'anagement can include nonsurgical methods"hen the fracture is nondis laced$ (o"e!er+ surgery+including internal %*ation+ is most often necessary to

a!oid com lications such as delayed union ornonunion+ refracture+ osteonecrosis+ and a!ascularnecrosis of the femoral head$ In some cases+arthro lasty and e!en total hi re lacement may be

necessary to ro erly treat a femoral fracture =seeo! 3 >$



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Gor"ay has 1 of the highest incidences of hi fracture$Gor"egian researchers conducted a retros ecti!estudy of 33A atients to e*amine factors thatcontribute to unsuccessful internal %*ation of femoral

nec# fractures =see Ta&le " >$ The in!estigatorse*amined atient radiogra hs to determine ardenClassi%cation and the cause of the rocedure)s failure$Fi*ation failure+ nonunion+ and femoral head necrosis

"ere identi%ed as failure oints$ T"el!e atients "ithnondis laced fractures = arden Classi%cation I II>e* erienced failed internal %*ation !s 48 atients "ithdis laced fractures = arden Classi%cation III I >$



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Femoral Neck Fractures


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7 oint scale "as used to assess the Euality of thefracture reduction and lacement of hi ins+ "ith 7re resenting treatment success$ f the 11A atients"ith nondis laced femoral nec# fractures+ 1A "ere

assigned scores of less than 7 oints+ and internal%*ation failed in only 1 atient$ ,atients "ithnondis laced femoral nec# fractures and a lo"er%*ation score had no increased ris# of internal %*ation

failure$ The 220 atients "ith dis laced fractures hadan increased ris# of internal %*ation failure forfractures assigned a lo"er score$ The authorsconcluded that closed reduction and internal %*ationcarry a high ris# of treatment failure+ and oorreduction of fractures increases the ris# of failure



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rthro lasty is another common treatment for femoralnec# fractures+ es ecially those that are dis laced$

This rocedure can in!ol!e re lacing the head or nec#of the femur+ or both+ "ith a rosthesis

=hemiarthro lasty> or total hi re lacement$(emiarthro lasty can be uni olar+ meaning that thefemoral head is %*ed to the stem+ or bi olar+ meaningthat an additional olyethylene bearing is laced

bet"een the stem and the endo rosthetic head$ Thead!antages of hemiarthro lasty are that it eliminatesthe ris#s of nonunion and internal %*ation failure+thereby decreasing the ris# of re eated surgery$



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Femoral head fractures often are di cult both todiagnose and to treat$ Fractures classi%ed as ty e Iaccording to the ,i #in Classi%cation often aremanaged nonsurgically by limiting "eight bearing on

the a.ected side+ follo"ed by hysical thera y$,re!iously+ ty e II fractures also "ere treatednonsurgically: ho"e!er+ outcomes tended to beunfa!orable$ The treatment standard no" includes

surgical management+ although there remainsdiscussion regarding "hether free fragments shouldbe %*ated or e*cised$



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Ty e III femoral head fractures carry an increased ris#of a!ascular necrosis and reEuire immediate surgicalreduction of the femoral nec# fracture$ 'anagement ofthe femoral head fracture de ends on the resence of

ty e I or ty e II in!ol!ement$ e!ere ty e III femoralhead fractures may reEuire total hi re lacement$

Ty e I fractures in!ol!e e*tensi!e in5ury to theacetabulum+ "hich li#ely reEuires surgical reduction$

In this case+ the femoral head is treated at the sametime as the acetabulum reduction and the surgicaldirection "ill de end on ty e I or ty e II in!ol!ement$

The long term rognosis for ,i #in ty e I fractures isoor$ Reconstruction of the femoral head "ith anosteochondral allograft has been in!estigated as a



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,hysical thera y is almost al"ays initiated follo"ingtreatment of a femur fracture$ Its ur ose is to restorehi and #nee range of motion and strength$De ending on the fracture attern+ an indi!idual may

need gait training for crutch assisted+ touch do"n"eight bearing$ Kith sim le fracture atterns that arestable after surgery+ greater "eight bearing can beinitiated$ For femoral stress fractures+ use of crutches

can be discontinued once an indi!idual can "al#"ithout ain$ ;o" im act lo"er e*tremity aerobictraining =eg+ s"imming+ bi#ing+ or using an elli ticaltrainer> can be initiated "hile sym toms ermit$!erall+ the goal of ostsurgical hysical thera y is toachie!e range of motion and "eight bearing as soon

Reco)ery


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Fractures of the femur often are associated "ithfractures of the hi $ This is because the femoral nec#and head meet the acetabulum to form the ball andsoc#et 5oint of the hi + "hich allo"s for ambulation$

disru tion to this soc#et can lead to immobili ation+disability+ and increased morbidity and mortality$ * Inaddition+ the femoral area is highly !ascular+ and anin5ury to the femoral artery can lead to com licationsand e!en death if se!ere hemorrhaging occurs$

Conclusion


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Diagnosing femur and hi fractures relies on e.ecti!eradiologic imaging+ and radiogra hy remains the goldstandard for diagnostic imaging$ 'R imaging is oftenuseful for diagnosis+ articularly in the emergency

setting "hen fractures are subtle or occult$ CT may beuseful in sho"ing fracture lines in greater detail thanlain %lm radiogra hy+ and CT)s ability to create 3 Dmodels can be used to better !ie" the bones andbone fragments$ ther imaging modalities lay a rolein the diagnosis and management of femur fractures+but to a lesser degree than radiogra hy+ 'R+ and CT$Kith any imaging modality+ it is im ortant that theatient be stabili ed+ articularly in the emergencysetting+ and that the otentially fractured bones do

Conclusion


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#iscussion +uestionsDiscuss some of the health com licationsthat can result from fractured femurs$

Discuss the im ortance of classifying femurfractures in determining a ro riatetreatment$

Discuss the strengths and dra"bac#s of thedi.erent diagnostic imaging techniEuesdescribed in the a er$


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Additional Resources

isit """$asrt$org/students to %ndinformation and resources that "ill be

!aluable in your radiologic technologyeducation$

fractured_femur.pptx

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