Foreign pathology fractured femur

2021-01-30 12:00 AM

The fracture position is in the 5cm region below the baby transfer tab. This is the fracture site with many complicated deviations due to the strong contraction of the muscle mass in different directions at the top of the femur.

Fracture of femur is limited from the lower margin of the posterior to the upper shore of 5cm outer bridge. The femur is a bone that has unique support against all injuries due to its anatomical structure. This is due to the 3 physiological curvature and the bearing area arrangement.

Because it is a large bone with many strong muscles attached, the femoral fracture is often caused by strong trauma, so it is easy to cause shock that requires emergency treatment as circulatory and immobilization.

Usually occurs at the working age of 12-15% and today many traffic accidents.

The femoral fracture is classified according to anatomy and fracture position: 1/4 upper, middle 2/4, lower 1/4. For a 1/4 fracture on close to the transfer jig, it is difficult to distinguish a transfer jig. Note a 1/4 fracture under the femur or joint convex fracture, treatment is quite complicated, complications of knee stiffness are easy to occur.

Fracture at the top of the femur

The fracture position is in the 5cm region below the baby transfer tab. This is the fracture site with many complicated deviations due to the strong contraction of the muscle mass in different directions at the top of the femur.

The gluteus muscles are very strong to cling to the large displacement region, when pulling, the head breaks on the form and rotates outwards.

Pelvic lumbar muscle clinging to the baby shifting tab, making the upper head fold forward.

This results in excessive bending and displacement.

The muscles closed and the inner straight muscles pull the lower inward and rotate outward.

2/4 fracture between femur body

There is less complicated displacement compared to the upper fracture, the canal is evenly narrow and cylindrical over a long segment, this property is more favourable for the application of the endostomyelation than other treatments.

Fracture at the lower end of femur

The fracture line is usually horizontal or diagonal downward and forward. The upper fracture is susceptible to strong stretching and jabbing into the thigh stretching muscle, while the lower segment is pulled back by the twin muscle mass, thus causing damage to the posterior nerve-bundle.

Reason

Usually due to a direct strong injury such as a traffic accident, or an indirect injury combined with folding and twisting. Common in adults and children from 3-5 years old.

Broken line

Including horizontal fracture, cross fracture, torsional fracture, double fracture or fracture.

Horizontal fracture line: Usually due to angled fracture, this fracture after good manipulation is usually stronger than other fractures.

 Diagonal fracture, twisting: Usually due to angle folding accompanied by twisting the body.

This fracture is not stable after manipulation.

Deviation

Depends on the fracture location and has different displacement patterns. Common deviations are angled, lateral deflection, overlap, and outer rotation of the far fracture.

Clinical examination

The patient may experience severe pain in the thigh area.

Completely disabled, the patient is unable to lift her legs.

There is a need to think about possible shock for prevention and treatment

On-site examination often clearly shows specific deformities:

Fold the angle, making the thigh shaped like a loop by opening the inside angle, especially when the upper thigh bone fracture.

Swollen thighs.

Chi is usually short compared to the healthy side.

Feet rotated outward; the outer edge of the foot lies close to the patient's lying flat. For low fracture, because the far fracture head is pulled back, it is easy to insert into the vascular bundle, nerve, and socket, so it is necessary to determine whether there is damage to blood vessels or nerves. Note the urgency to stretch the foot or the loss of sensation in the soles of the feet and a small area in front of the ankle in case of hip compression.

In addition, it is necessary to carefully examine the groin and pillow area to detect coordination injuries such as rupture of the mandrel, hip dislocation, posterior cross ligament rupture, patella fracture.

A careful examination of the foot is required to detect multiple injuries.

Note the skull, spine, ruptured organs in the peritoneum.

X-ray

Although radiological diagnosis is necessary, a careful clinical examination is required to avoid omitting lesions. Some cases miss the hip dislocation in femoral stem fracture because only limited fracture imaging. So to have a good X-ray film should pay attention:

Capture 2 joints of fractured head at least two straight and inclined planes.

A comparison scan of the healthy side bone if necessary.

Symptoms

Shock

Dizziness may be transient with pain relief because this good, temporary immobilization is often caused by pain.

Shock can be caused by blood loss of the fracture, the thigh should be measured to estimate, if the thigh is too tight compared to the healthy side, it can lose more than 500ml in a 50kg person.

Loss of vessels in the arches and ankles

Caused by the fracture of the femoral artery or compression of the furthest fracture is a fracture of the head below the femur, a fracture on the femoral convex. Or it could be that the blood from the fracture spills into the constriction artery. Symptoms may manifest with leg pain, numbness of the limbs, cold feet, and very stretched knuckles.

When a pinched or fractured angioma is diagnosed, surgery should be performed immediately for angioplasty or release of compression.

Fat embolism

Rarely, to pay attention when: Broken bones.

Soft tissue damaging a lot.

Threatened or dizzy.

Haemorrhage of the eye, skin conjunctiva.

Shortness of breath.

The PCO2 in the blood increases.

Faint scum in the urine.

Need for emergency care in time because the death rate is high.

First aid - first aid

Needs temporary immobilization and shock resistance. in adults up to 1 liter of blood can be lost through the fracture. Poor immobility will cause additional pain and can be potentially life threatening. Therefore, it is necessary to resist dizziness, need to transfuse 1-2 liters of fluid and blood transfusion if any, then check whether it is immobile well before transporting to the actual treatment place.

If the fracture has rubbing the skin or has a large wound, sterile compression bandages are required, a strong intravenous antibiotic and anti-tetanus medication should be used.

Steady thigh immobility requires an over-hip brace, a handy brace is the Thomas - Lardennois brace, which is both motionless and lightly continuous and fast, especially in the case of a series of injuries.  In conditions in Vietnam can use bamboo brace, wood. The brace should be large (10cm) and thick (1cm). You can use 2 or 3 braces, usually use 2 braces: 1 placed outside from the armpit to beyond the ankle; 1 splint in groin to inner ankle.

Real treatment

Because the femur is large and strong, there are many strong muscles attached, so even if it is well formed, it cannot be fixed well in the dough, it is easy to have secondary displacement. Currently, orthopaedic treatments are mainly applied to children <15 years old, in addition, most of them require surgery.

Orthopaedic method

Powder bundle:

Only applicable to children, cases of fractures with less displacement, non-displacement fractures, interlocking fractures. In addition, in our country, where sterile, tools and economic conditions are not available, this is the only method.

Systemic pain relief is required if any, morphine (10mg / 50kg) is often used after contraindications are excluded. Also, can numb fracture with xylocaine (30-50ml) (1%).

After giving pain relief for about 10 minutes, it is necessary to conduct correction on the orthopaedic table. Slowly stretch for 10 minutes to correct short stack deflection (measure the absolute length of 2 limbs equal). Then correct the rotational deviation and make the two bones together and then correct the horizontal deviation. Maintain the manipulation position (thigh shape 300 compared to the body axis, pillow slightly folded 1700), then cast pelvic-back-legs; Powder is kept for 2-3 months depending on age as well as broken sugar. During the time of bundling for the patient to walk on crutches, not against sore legs. Do a weekly x-ray exam until the bones are solid.

After two months when the bones are healed, they can be given away on the dough for 1-2 months. After opening the powder, the patient will practice walking pain with crutches. Gradually, the quadriceps, hip joints and knees will recover from 6 months to a year.

Pulling continuously through the bone: usually applies to children (without surgery), the elderly, open fractures, fractures, pathological fractures, poor overall condition or pulling while waiting for surgery.

Pulling is done by mediating a tow hook with # 1/7 of body weight, pulling along the femur axis.

The nail can be pierced through the pre-tibial convex to pull in case of fracture of the lower 1/3, the inconvenience is ligament relaxation.

Or pull the bone through the femoral convex, allowing to pull directly on the femur, not afraid of stretching the knee ligaments, but inconvenience is hindering the bone combination later.

A big nail (Steimann 4mm) is required.

Should pull on the Braun truss, lightweight knee folded, feet 900. Thigh should be kept behind to avoid excessive stretch.

During the pull period should have daily clinical examination and weekly X-ray to adjust the weights, begin to gradually lose weight from week 8 and after 6 weeks can make pelvic-back-leg powder. While pulling weights, it is necessary to exercise quadriplegic muscle movements, joints to avoid complications after bone healing.

The nail can be pierced through the pre-tibial convex to pull in case of fracture of the lower 1/3, the inconvenience is ligament relaxation.

Or pull the bone through the femoral convex, allowing to pull directly on the femur, not afraid of stretching the knee ligaments, but inconvenience is hindering the bone combination later.

Surgical treatment

Is the most active and effective treatment today.

Inner marrow crucifixion:

Applies to femoral body fractures, preferably middle 2/4, applicable in all cases of transverse, cross, multi-piece, 2-drive fractures. Crucifixion is considered the best practice available today. Thanks to the light curtain, the nail was nailed without opening the fracture and the canal was drilled wide. To prevent rotation of the far fracture, the bolts are strengthened across the bone. In the case of a low fracture line in the middle and lower thirds, it is possible to perform the crucifixion with transverse pin upstream from the lower femoral tip.

For fractures that may not need the canal cavity, which only has a straight-axis bone arrangement, people pull continuously for 2-3 weeks until the can to prevent rotation.

In the absence of vehicles in Vietnam, the nail is often nailed upstream to open the fracture. After a week began to put his feet on the ground and practice walking with crutches in the broken schools.

Combining bones with a screw brace:

The advantage is complete manipulation of broken bones, early exercise.

Defect:

Slow down bone healing.

Limited muscle movements due to dissection during surgery.

Infection.

Combined bone brace is often used in the case of fractures near the ends of the bone.

External fixation:

Applied in cases of open fracture with soft and neural vascular damage.

Treatment of femur fracture in children

Due to the nature of the child's bones, the muscle contraction is weak, the bones are still developing and will correct themselves, so only limited surgery, but mainly orthopaedic treatment.

New-born: Due to the difficulty of giving birth, using a cardboard immobilizer for about 10 days is sufficient.

Children <2 years old: Frog cast for 3 weeks.

Children 2-6 years old:

Fracture less deviation: Pelvic foot powder 3 weeks.

If the fracture has a lot of deviation and is difficult to manipulate, it should be pulled continuously with tape to pull the leg straight up the sky, the buttocks on the side of the limb are a few centimetres away from the bed surface. Pull with 2-3 kg dumbbells for 3 weeks. Then should replace with pelvic-back-leg powder. Pulling on the tape can separate and straighten the fracture, but with a slight angle, the stacking will be slightly shortened and will correct itself a few years later.

The inconvenience is:

Lie for a long time in bed.

Limit movement of the pillow.

Can bad.

Children 6-14 years old:

If the fracture has less deviation, then stretch and cast the pelvis-back-leg cast for 6-8 weeks.

If the fracture is not stable much, it should be pulled continuously for 3-4 weeks with bone penetration, then reinforce castings.

Preventive

Propaganda and education in the community about traffic and labour laws.

It is necessary to educate the community on first aid and good fracture immobilization of fracture cases to limit complications in fracture and shock.

The grassroots health facilities need an early diagnosis, correct handling and early referral to specialized medical care to minimize complications caused by femoral stem fracture.

Educate patients on rehabilitation exercises after treatment.