Fracture Femur

8/17/2019 Fracture Femur

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Presented by:

Erin Triana

Ronald Tejoprayitno

Fracture Femur


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Anatomy


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Anatomy

The Head (caput femoris)

The head which is globular and forms rathermore than a hemisphere, is directed upward,medialward, and a little forward, the greater

part of its conveity being above and infront! "ts surface is smooth, coated withcartilage in the fresh state, ecept over anovoid depression, the fovea capitis

femoris, which is situated a little below andbehind the center of the head, and givesattachment to the ligamentum teres!


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AnatomyThe Neck (collum femoris).

The nec# is a $attened pyramidal process of bone,connecting the head with the body, and forming withthe latter a wide angle opening medialward! The angleis widest in infancy, and becomes lessened duringgrowth, so that at puberty it forms a gentle curve from

the ais of the body of the bone! "n the adult, the nec#forms an angle of about %&'( with the body, but thisvaries in inverse proportion to the development of thepelvis and the stature! "n addition to projectingupward and medialward from the body of the femur,the nec# also projects somewhat forward) the amount

of this forward projection is etremely variable, but onan average is from %&( to %*(!


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Anatomy

The Trochanters

The trochanters are prominentprocesses which a+ord leverage tothe muscles that rotate the thigh onits ais! They are two in number, thegreater and the lesser!

Picture right femur anterior surface


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Anatomy The Greater Trochanter -trochanter major; great trochanter . is a

large, irregular, /uadrilateral eminence, situated at the junctionof the nec# with the upper part of the body

The lateral surface, /uadrilateral in form, is broad, rough, conve,

and mar#ed by a diagonal impression, which etends from thepostero0superior to the antero0inferior angle, and serves for theinsertion of the tendon of the 1lut2us medius! 3elow and behindthe diagonal impression is a smooth, triangular surface, overwhich the tendon of the 1lut2us maimus plays, a bursa beinginterposed!

The medial surface, of much less etent than the lateral, presentsat its base a deep depression, the trochanteric fossa -digitalfossa., for the insertion of the tendon of the 4bturator eternus,

and above and in front of this an impression for the insertion ofthe 4bsturator internus and 1emelli!

The superior border is free) it is thic# and irregular, and mar#ednear the center by an impression for the insertion of thePiriformis!

The inferior border corresponds to the line of junction of the baseof the trochanter with the lateral surface of the body) it is mar#edby a rough, prominent, slightly curved ridge, which gives origin to

the upper part of the 5astus lateralis! The anterior border is prominent and somewhat irregular) it

a+ords insertion at its lateral part to the 1lut2us minimus! Theposterior border is very prominent and appears as a free,rounded edge, which bounds the bac# part of the trochantericfossa!

Picture of right femur posterior surface


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Anatomy

The Lesser Trochanter -trochanter minor;small trochanter . is a conical eminence, whichvaries in si6e in di+erent subjects) it projectsfrom the lower and bac# part of the base of

the nec#! From its ape three well0mar#edborders etend) two of these are above7amedial continuous with the lower border ofthe nec#, a lateral with the intertrochanteric

crest) the inferior border is continuous withthe middle division of the linea aspera! Thesummit of the trochanter is rough, and givesinsertion to the tendon of the Psoas major!


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Anatomy

The Body or haft (corpus femoris)

The body, almost cylindrical in form, is a littlebroader above than in the center, broadest andsomewhat $attened from before bac#ward

below! "t is slightly arched, so as to be convein front, and concave behind, where it isstrengthened by a prominent longitudinalridge, the linea aspera. "t presents for

eamination three borders, separating threesurfaces! 4f the borders, one, the linea aspera,is posterior, one is medial, and the other,lateral!


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Anatomy The anterior surface includes that portion of the shaft

which is situated between the lateral and medialborders! "t is smooth, conve, broader above and belowthan in the center! From the upper three0fourths of thissurface the 5astus intermedius arises) the lower fourthis separated from the muscle by the intervention of the

synovial membrane of the #nee0joint and a bursa) fromthe upper part of it the Articularis genu ta#es origin! The lateral surface includes the portion between the

lateral border and the linea aspera) it is continuousabove with the corresponding surface of the greatertrochanter, below with that of the lateral condyle: from

its upper three0fourths the 5astus intermedius ta#esorigin! The medial surface includes the portion between the

medial border and the linea aspera) it is continuousabove with the lower border of the nec#, below with themedial side of the medial condyle: it is covered by the5astus medialis!


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Anatomy The medial epicondyle is a large conve eminence to which

the tibial collateral ligament of the #nee0joint is attached!At its upper part is the adductor tubercle, already referredto, and behind it is a rough impression which gives origin tothe medial head of the 1astrocnemius!

The lateral epicondyle, smaller and less prominent than

the medial, gives attachment to the 8bular collateralligament of the #nee0joint! 9irectly below it is a smalldepression from which a smooth well0mar#ed groovecurves obli/uely upward and bac#ward to the posterioretremity of the condyle! This groove is separated from thearticular surface of the condyle by a prominent lip acrosswhich a second, shallower groove runs vertically downward

from the depression! "n the fresh state these grooves arecovered with cartilage! Above and behind the lateralepicondyle is an area for the origin of the lateral head ofthe 1astrocnemius, above and to the medial side of whichthe Plantaris arises!


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5ascularisation of Femur

The Femoral artery is one of the major arteries in the human body thatetends from the iliac artery near the abdomen, down to the legs! The

primary function of this artery is to supply blood to the lower portion of thebody! This artery is anatomically sub0divided into a super8cial artery, adeep artery and a common artery! Each of these sub0arteries suppliesblood to di+erent parts of the body! The largest branch of the Femoralartery is the profunda femoris, which supplies blood to the buttoc#s andthigh area! The femoral vein runs along this artery to bring the

deoygenated blood from these areas bac# to the heart!


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5ascularisation of Femur The deep femoral artery is a branch of the common femoral

artery of the human body! The common femoral artery isone of the largest arteries in the human body, with multiplebranches!

The deep femoral artery is a major blood vessel supplying theleg! The deep femoral artery supplies the thigh with blood!As an artery, it carries oygenated -oygen0rich. blood tothe muscles of the thigh and upper leg in general) a vein will

remove deoygenated -oygen0depleted. blood from thethigh!

The deep femoral artery branches o+ from the commonfemoral artery at a point #nown as the femoral triangle!After leaving the femoral triangle, the deep femoral arterydevelops further branches to supply blood to the bac# of thethigh!

Two such branches are the medial and lateral circum$efemoral arteries! 3oth of these branches, as well as thedeep femoral artery itself, are important suppliers of bloodto the entire thigh and underlying bones!

The medial circum$e is also particularly important as itsupplies the femur with blood!


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Fracture9e8nition

A structural bra#e in continuity


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lassi8cation of femoralfractureProimal femoral FractureFemoral ;ec# Fracture

Femoral "ntertrochanteric Fracture

Femoral


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Femoral


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linical =anifestation>istory ? Physical EaminationematomaPain@Tenderness9eformity


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or#up3lood test : cross match for transfusion,

serial 3

B0ray : AP ? lateral, including hip ? #nee

T0


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Treatment of fracture femurEmergency treatment:

Fluid Resuscitation @ 3lood TransfusionCCC

Reduction using Traction ?


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9e8nitive Treatment;on operative -Traction.hildrenontraindicated for anesthesiaac# of facility for 4R"F

*R:0 Recognition0 Reduction0 Retention0 Rehabilitation

9isadvantage: Re/uire longer time in bed -%0%*wee#s.

Advantage : there are no operative ris#


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4perative"ntramedullary naillingPlate ?


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omplicationEarlyemorrhagicFat Embolismompartment


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3one Fracture >ealing


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"llustration ase

"dentity;ame: Garoh

Age : *H years old

Address: 3ula# abe

Patient comes to the emergency installation withmain complain bro#en of her leg from & wee#s ago!3efore that, patient feel intermittent pain in her legwithin ' months ago! There was absent of trauma

before! Patient feel loosening weight about % #gwithin & months! =enstrual period cycle patientstopped H years ago! Patient had child with legdeformity and her father had that leg appearance!


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"llustration ase

Physical eamination The primary survey during physical

eamination was clear airway, spontaneous

breathing, vital signs was within normal

limits, with 1< %' -E*=I5'., and onsecondary survey there was found

deformity of both leg, and right arm -seelocal status.! 4ther physical eaminations

were within normal limits ecept bloodpressure %'@J mm>g


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"llustration ase

aboratory 8ndingsLaboratory !indin"s Normal

>emoglobin %,' %&0%I

>emato#rit K& KI0*'

eu#osit '& *%0%J

Trombosit &'%! %*0**

Eritrosit K,'L *0'

=5 HJ H0%

=> &J &I0K*=> KK K%0KI


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"llustration aseaboratory 8ndings

Laboratory !indin"s NormalE9 IL M%'

=asaperdarahan

* %0I

APTT KK,* K%0*L

PT %,% J,J0%,I


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"llustration aseRight leg

eft leg


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"llustration ase


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"llustration ase

The diagnosis for this patient was fracture-R. shaft femur!

Patient was treated with #etorolac and pro4R"F

Fracture Femur

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