What Is the Treatment for a Spiral Fracture of the Femur?

Violent blows, falls from heights, vehicle crashes, crushing, etc. can all cause femoral fractures. When a femoral fracture occurs, the lower limbs cannot move, the fractures are severely swollen and painful, and deformities such as distortion or angulation may occur, and sometimes the length of the lower limbs may shorten. If there is an open wound at the same time, the condition is more serious and often makes the patient suffer shock. The femur is the largest bone in the body. If it is not treated in time after a fracture, it can cause serious complications such as major bleeding and nerve damage. Therefore, it must be fastened and correctly fixed and then immediately sent to the hospital for treatment.

Basic Information

English name: femoral fracture
Visiting department: orthopedics

Common causes: Strong violence
Common symptoms: Pain, swelling, deformity

Causes of Femoral Fractures

Femoral shaft fractures are mostly caused by strong violence, and some fractures are caused by indirect violence. Mainly direct external forces, such as car collision, heavy object crushing, rolling or firearm injury. Injuries due to indirect external forces include falling from a high place, or a machine injury.

Clinical manifestations of femoral fractures

Trauma history

In general, there is a history of injuries. Most of the injured have a history of severe trauma. After the injury, the limbs have severe pain, movement disorders, local swelling and tenderness, abnormal activities, and shortened affected limbs. It is more common to have multiple injuries or visceral injuries and shock.

2. Pain, swelling, deformity

Fracture pain is more severe, tenderness, swelling, deformity and bone friction sounds and limb shortening dysfunction is very significant, and some areas may appear large hematomas, skin peeling and open injuries and bleeding. X-ray pictures can show the fracture site, type and displacement direction.

3. Other parts

It is particularly important to check for femoral tuberosity and knee signs to avoid omissions, as well as other injuries, such as hip dislocations, knee fractures, and vascular and nerve injuries. At the time of examination, close attention must be paid to the occurrence of combined injuries and shocks, and whether the injured limb has nerve and blood vessel damage.

Femoral fracture examination

X-ray examination.

Femoral fracture diagnosis

It is not difficult to draw a diagnosis based on clinical manifestations and related examinations.

Femoral Fracture Treatment

Non-surgical therapy

Femoral shaft fractures can not maintain the alignment of the fractures due to strong muscle pull around them, and external fixation with plaster or small splints after manual reduction. Therefore, no matter what type of complete femoral shaft fracture, it is an unstable fracture. It is necessary to use continuous traction to overcome muscle contraction and maintain it for a period of time before external fixation. Common traction methods are:

(1) Suspension traction method is used for children under 4 to 5 years old. Suspend both lower limbs with skin traction and weigh 1-2 kilograms. Keep your hips off the bed and use weight to fight traction. After the formation of epiphysis on the X-ray photographs at 3 to 4 weeks, the traction was removed, and the affected limb started to move on the bed. For children with femoral shaft fractures, good alignment is required, and alignment is required to reduce power, and anatomical reduction is not required. If the angle does not exceed 10 ° and the overlap does not exceed 2 cm, the function is generally not affected in the future. During traction, in addition to keeping the buttocks away from the bed surface, the blood circulation of the feet and the tightness of the bandage should be observed and adjusted in time to prevent ischemic necrosis of the toes.

(2) Skin traction method (Roseau traction method) is applicable to children from 5 to 12 years old. Put a soft pillow under the knees to flex the knees, pull up with a wide cloth band on the crotch, and perform skin traction on the calf, so that the combined force of the two directions is aligned with the longitudinal axis of the femoral shaft, and the traction force of the combined force is twice the traction gravity. Occasionally, the affected limb can be placed on the Thomas splint and Pearson's adapter for sliding traction. It can be reset manually before traction, or it can be reset by traction.

(3) Balanced traction is used for adolescent and adult femoral shaft fractures. A needle is inserted at the tibial tuberosity. If there is a wound, a needle (Kirschner's needle or Schiffer's needle) can be inserted at the femoral condyle. The affected limb is placed on the Tom's clamp for balanced traction, which has two functions of reduction and fixation.

2. Surgery method

(1) Surgical indications In recent years, surgical indications have been relaxed due to improved surgical techniques and improved medical devices. Specific surgical indications are: traction failure, embedded soft tissue, no contact at the fracture end, or inability to maintain alignment, no bone fricatives during examination; combined with major nerve and blood vessel injuries, who need surgical exploration, can be opened at the same time Reduction and internal fixation; fracture deformity healing or non-healing.

(2) Commonly used surgical methods Fractures in the upper 1/3 or middle 1/3 of the femur are mostly fixed with intramedullary needles. This method has the advantages of no external fixation and early getting out of bed after surgery. In the past, open-ended intramedullary needles have been used in the past ten years under the control of X-ray televisions (XTVs). Only small incisions have been made at the puncture points, and closed puncture methods that do not reveal fractured ends have been replaced. The closed method is smaller than the open injury, less bleeding, and does not damage the blood supply at the fracture end, which is conducive to fracture healing. The middle 1/3 or lower 1/3 of the femur is fractured. The traditional method is to use 6-8 holes bone plate screws and hip Herringbone plaster. At present, pressurized steel plate activities are mostly used. There are many types of pressurized steel plates. In the 1960s, the use of pressurized steel plates for fixing was used. Since then, self-pressurized steel plates have been used and fixed. Regarding the selection of femoral shaft fracture surgery and internal fixation materials, the indications must be seriously grasped and must not be abused. Strive for successful surgery to prevent infection and nonunion of fractures.

3. Treatment of old fracture deformity healing or non-healing

Open reduction, appropriate internal fixation, and bone grafting should be used to facilitate fracture healing.