Femur fracture
The word 'femur' is taken from Latin meaning 'thigh'. The femur is the thigh bone and it is the largest and strongest bone in the human body. The femur bone extends from the hip to the knee joint. A femur fracture can be life threatening. Since the inside of the thigh is a place of major blood vessels, broken femur means break in the artery. Femur fracture is also called femoral shaft fracture, femur injury, femur stress fracture, fractured femur, femur trauma and femoral diaphyseal fracture. Femur is a tremendously strong bone. It usually requires a great deal of force to break the femur bone. The most common causes for femur fractures include:
- Falls from a great height
- Blows that are strong in force
- Car accidents and Collisions
- Severe twists
- Bones weakened by osteoporosis, tumor or infection leading to a condition called pathologic femur fracture.
Proximal femur fracture: This involves fracture in the uppermost portion of the thighbone adjacent to the hip joint. are further sub divided into different types.
Femoral shaft fracture: The femoral shaft fracture is a severe injury that occurs during high-speed motor vehicle collisions and significant falls. Injuries caused by femoral shaft fractures are usually severe. Treatment of femoral shaft fracture is always with surgery. The common procedure is to insert a metal rod bone, called 'intramedullary rod' down the center of the thigh. The two ends of the bone are connected by the rod. This intramedullary rod usually remains in the bone for the life of the patient but can be removed if it causes pain and other problems.
Supracondylar femur fracture: In this kind of fracture, the injury occurs just above the knee joint. Cartilage surface of the knee joint is usually involved in this fracture. Patients who sustain supracondylar femur fracture are at high risk of developing knee arthritis later. Supracondylar femur fracture is common in patients with severe osteoporosis. Patients who have undergone total knee replacement surgery also run the risk of this fracture. Treatment for supracondylar femur fracture is highly variable. A cast or brace, external fixator, plate, screws or intramedullary rod are used for treatment.
Symptoms of femur fracture include swelling, bruising and severe pain. There may be numbness or paralysis in the leg below the femur fracture. Femur fractures are apparent and visible in many cases. Apart from clinical examination by the orthopaedician, for non-apparent fractures, a bone scan is required. Treatment for fractures of femur depends upon various factors such as the patient's age, type of fracture, location of the break, bone stability in the injured, mechanism of injury, direction of the blow, factors of twisting, existence of internal bleeding and extent of soft tissue damage. Some of the methods of treatment are:
- Reduction or re-alignment
- Immobilization whereby the movement is restricted
- Insertion of an intramedullary fixation
- A cast
- External fixation such as a frame on the outside of the leg anchored into the bone using pins.
Potential complications from fracture of femur
- Pain or arthritis
- Rotational deformity due to misalignment
- Infections in open fractures
- Uneven leg length
- Injury of blood vessels
- Nerve damage
- Compartment syndrome
- Amputation
- Failure to heal - 'non-union' is also a possibility
Intra articular sepsis, arthritis and knee stiffness are some of the permanent complications that can occur among persons who have undergone femur fracture and treatment. Sometimes femur fracture is bound to cause permanent disability in injured persons. This is due to the thigh muscle pull and incorrect reunion of fragments when they overlap. Femur fracture patients should be careful not to put weight on the leg as this can delay the healing process.
Basilar skull fracture
If there is a fracture or break in the cranial or skull bones, it is called a skull fracture. When the base of the skull is involved in a head injury, it is a basilar skull fracture or basal skull fracture. It is also known as depressed skull fracture and linear skull fracture. This linear fracture is rare and occurs in only 4% of patients with severe head injury. Falls, injuries caused by penetrating external objects like knives, hammers or axe or gunshot wounds may result in skull fractures. It can also occur when the skull hits a solid object with considerable force. Basilar skull fracture can be called a linear fracture at the base of the skull. Usually, dural tear is associated with this type of fracture. This fracture occurs at specific points on the skull base. While analyzing skull fractures, it is seen that 19-221% of all skull fractures happen to be basilar skull fractures.
There may be a traumatic brain injury when the skull is fractured. The area of the brain injured and the severity of injury is diagnosed by examining the fracture. If bacteria enter inside the skull through this fracture of the skull, it will lead to infection. Sudden blow to the back of the head can also result in a basilar skull fracture.
After a head injury, if there is a leak of a clear fluid from the nose or ears, it indicates that the clear fluid is cerebrospinal fluid (CSF) that surrounds the brain. CSF drains out through the ears or nose, when the skull is fractured and the Meninges or the covering of the brain is torn. The typical nasal drainage due to allergies, cold or crying is different from this drainage of CSF. It is also an indication of a fracture of the frontal bone or the base of the skull i.e. sphenoid or temporal bone or of the ethmoid bones (bones that support the nose and sinuses).
If bleeding from the ears or nose is not due to a cut or a direct blow, it may be an indication of a fracture of the base of the skull. Determine the cause of the bleeding by washing the blood thoroughly and see if the bleeding is from a cut or not. Ascertain the source of bleeding from the ear. It is an indication of a skull fracture if a nose bleed does not stop with home treatment. If bruising or dislocation develops within 24 hours after a head injury, it also indicates a basilar skull fracture. Often bleeding within the skull may occur with a basilar skull fracture. This condition may lead to infection.
- Battle's sign-bruising behind one ear.
- Raccoon eyes-bruising around both eyes.
- Abnormalities pertaining to vision.
- Weakness of facial muscles.
- Problems in hearing.
- Difficulties in smelling.
- Nasal drip due to leaking of cerebral spinal fluid.
Diagnosis is made with laboratory check of the clear dripping fluid for the presence of CSF. A CT scan of the head with the focus on bones can reveal the extent of damage to the bones. CSF otorrhea and bruising over the mastoids commonly known as 'battle sign' is an indication of a fracture of the petrous temporal bone. Rhinorrhea and bruising around the eyes (raccoon eyes) are noticed with anterior cranial fossa fractures. Depending on an associated intracranial pathologic condition, the Glasgow Coma Score and loss of consciousness may differ from patient to patient. Temporary deafness is a possibility but it resolves in about three weeks.
Hemotympanum and mucosal edema in the middle ear fossa cause this temporary hearing loss. Basilar skull fractures sometimes leads to meningitis in some patients. If the bones around the foramen magnum are broken, there is a risk of damage to the blood vessels and nerves exiting the hole.
Torus fracture
Torus fracture also known as buckle fracture is a very common injury suffered by children. The Latin word 'Tori' which means swelling or protuberance explains the origin for the word torus. Known as an incomplete fracture as one side of the bone buckles upon itself without hurting the other side, children are prone to this type of fracture. The bone in the fractured area only bends and does not break.
Considered to be the most common fracture site in young children, this forearm fracture is a common occurrence next to the hand fracture. Both the radius and ulna are involved when the distal third of the forearm is injured. Generally the fractures involving the forearm can be classified under simple torus fracture or greenstick fracture. These incomplete fractures reveal cortical breaking on one side with or without a bulging or buckling of the cortex. Between the two incomplete fractures, torus or buckling fracture is more common. Children sustain this injury more, because their bones are weak due to immature mineralization. The buckling reaction is caused when there is axial stress on the bone.
With adequate rest torus fractures normally heal, but there may be soreness and discomfort in the area of fracture. There may not be any deformity in the case of torus fracture, since the cortex and periosteum are intact on one side of the bone. The orthopedic should carefully examine the x ray to ascertain that the side where there is tension is intact. There is the possibility of a greenstick fracture at the point, if the fracture is not on the compression side. In that case, the fracture may tend to deform in the cast. Casting for a short duration of about three weeks is done to heal torus fracture. Though it is similar to greenstick fracture, healing time is quicker in the case of torus fracture.
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