View source for Fractures of the diaphysis of the femur

[[Fracture|Fractures]] of the diaphysis [[Femur|of the femur]] occur as a result of indirect (skiing) or direct violence (run over by a car wheel, car accident). Fractures in the upper third of the femur (up to 3 cm below the lesser trochanter) are referred to as subtrochanteric and are classified as fractures of the proximal femur.

== AO classification (32) ==

* A – simple (1 – spiral, 2 – oblique, 3 – transverse)
* B – wedge-shaped (1 – spiral wedge, 2 – bending wedge, 3 – broken wedge)
* C – complex (1 – spiral, 2 – storied, 3 – coarsely fragmented)

== Diagnostics ==
[[File:604CBC90-6350-40DA-B2FA-740ED9F02C4E.jpg|alt=Fracture of the diaphysis of the femur in a child|thumb|Fracture of the diaphysis of the femur in a child]]

; Clinical
: thigh pain, disfigurement, pathological mobility, limited mobility, hematoma.
; Imaging methods
: [[X-rays|X-ray]] in two projections (incl. hip and knee joint – storey fractures); typical is the shortening of fragment dislocations (pulling of the proximal fragment into abduction, the distal fragment medially and upwards).

== Complications ==

# Complications of the injury:
#* injury to blood vessels and soft tissues (muscles) by sharp fragments - bleeding up to 2 liters ,
#* [[Kompartment syndrom|compartment syndrome]] .
# Treatment complications:
#* fat embolism, [[ARDS]] – during nail pre-drilling,
#* [[Pakloub|hip joint]] – incorrect insertion of the nail, axial deviation left,
#* limitation of knee movement – insufficient rehabilitation.

== Therapy ==

=== First Aid ===

* immobilization: vacuum splint, Cramer splints, binding of both DK, formerly Dietrichs splint;
* anti-shock measures (infusions);
* [[RTG|X-ray]] before removing the first fixation.

=== Surgical treatment ===

* [[Osteosyntéza|Osteosynthesis]] : must be stable to allow early mobilization (extension beyond the tuberositas tibiae is only a temporary preoperative measure),
** intramedullary nail : anterograde and closed insertion after alignment of the axis and correct length; nails tend to be secured distally and proximally, preferably undrilled;
** plate osteosynthesis: it is abandoned;
** external fixation : open fractures (Tscherne II, III), comminuted fractures, polytraumas;
** PFN (proximal femoral nail), gamma nail : in subtrochanteric fractures;
** Prévot rods (TEN – titanium elastic nails): in children.

=== Conservative treatment ===

* In children, it is possible to use a patch extension (suspension of DK vertically upwards) and after the formation of the muscle (in 4 weeks) immobilization with a plaster bandage follows.

== Links ==

=== Related articles ===

* [[Zlomeniny|Fractures]]
* Bone fractures

=== Source ===

* {{Cite|type = web| surname1 = Pastor| name1 = Jan| source_name = Langenbeck's medical web page
|year = 2006
|cited = 2011-02-02
|url = http://langenbeck.webs.com/chirurgie.htm}}

=== References ===

* {{Cite
| type = book
| surname1 = Koudela
| name1 = Karel
| others = yes
| title = Ortopedická traumatologie
| edition = 1
| publisher = Karolinum
| year = 2002
| isbn = 80-246-0392-6
}}
[[Category:Surgery]][[Category:Traumatology]]
 [[Category:Orthopedics]]