Fractures of Femur
Fractures of Femur
Fractures of Femur
(2) in pa'ents with metasta'c disease or Paget’s disease. 1) Dynamic Hip Screw (DHS) (135 degree), if troachntric + lesser trochantric fracture (unstable).).
3- Healing :
3) Fixation : 2) Reconstruction Nail, if associated wit
with subtroachntric, shaft & lower femur fracture .
- It's usually associated with non-union.
union.
- with cannulated screws :
3- Healing : - So, additionof of bone grafts may hasten union.
union
• 3 cannulated scews - one screw to support the inferior portion of the neck.
-two
two screw, centrally in level striking the ant. & post. cortices of - The addition of bone grafts may hasten union of the medial cortex.
4- Rehabilitation:
femoral neck. 4- Rehabilitation : patient is allowed partial weightbearing (with crutches)
• Dynamic compression screw ( DCS ) (95 degree) , which attaches to femoral shaft. - Exercises
xercises are started on the day after operation until union is secure.
4) Rehabilitation: - the patient allowed partial weightbearing using crutches.
- From the first day patients should sit up in bed or in a chair. - Breathing Exercise
- Encouraged
ncouraged to begin walking (with crutches or a walker) as soon as possible.
Supracondylar Fracture
ractures
Conservative Surgery
Indications : B-Surgery Operative treatment with internal fixation can enable accurate fracture
1- if the patient is young or (Elderly pa'ents tend not do as well with the 6 weeks of enforced reduction, especially of the joint surface, and early movement.
recumbency.) 1- Reduction : Open reduction
2- the facilities and skill to treat by internal fixation are absent.
2- Fixation: internal fixation :
1- Closed reduction (by traction):
a- If the fracture is only slightly displaced and extra-articular
extra articular or 1. For the type A &
If it reduces easily with the knee in flexion : - Locked intramedullary nails, which are introduced retrograde through the intercondylar notch
- It can be treated satisfactorily by skeletal traction through the proximal tibia; 2. For type B fractures (single condylar fracture):
The AO classification of supracondylar fractures
Type A : Extra-articular fractures have no articular splits and are truly - The limb is cradled on a Thomas’ splint with a knee flexion piece and movements - held with Kirschner wires preparatory to inserting Compression Screws (CS)
‘supracondylar’.
Type A1: Simple, two-part supracondylar fracture
are encouraged. 3. Simpler
impler type C fractures (T or Y shaped fracture ):
Type A2: Metaphyseal wedge - Locked intramedullary nails, which are introduced retrograde through the intercondylar notch
Type A3: Comminuted supracondylar fracture b- If the distal fragment is displaced
displa by gastrocnemius pull :
Type B : Uni-Condylar fractures are simply shear fractures of one of the
a second pin above the knee, and vertical traction, will correct this. - Or best fixed with a Dynamic (95 degree) condylar screw and plate.
condyles; and
Type B1: Lateral condyle, sagi6al 4. For severely comminuted type C fractures
Type B2: Medial condyle, sagi6al - Locked intramedullary nails, which are introduced retrograde through the intercondylar notch
Type B3: Coronal 2- Immobilization & rehabilitation :
Type C: Bi-Condylar fractures have supracondylar and intercondylar fissures . - At 4–6 6 weeks, when the fracture is beginning to unite, traction can be they provide adequate stability, even in the presence of osteoporotic bone,
Type C1: Noncomminuted supracondylar “T” or “Y” fracture
Type C2: Comminuted supracondylar fracture replaced by a cast-brace and N.B Reconstruction Nail, if associated with trochantric , subtroachntric & shaft fractures.
Type C3: Comminuted supracondylar and intercondylar fracture - the patient allowed up and partially weightbearing with crutches. Dynamic Compression Screw (DCS) , can also used (remember the indication of this screw )
rehabilitation :
- Unprotected
tected w
weight bearing is not permitted until thee fracture have
consolidated
lidated ( usually around 12 weeks).