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 orthopaedic, 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.
  

• 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.

ACL Injury

ACL injury or Anterior Cruciate Injury is a type of knee injury caused to the anterior cruciate ligament. The ACL runs transversely from the front portion of the knee beginning at the bottom of the femur(thigh bone) to the top of the tibia (bigger bone in the lower leg). Typical causes of ACL injury:

• Fall during any sporting activity such as football, soccer, basketball etc can result in the tear of ACL.
  
• Any damage to the side of the knee can result in a tear of the ACL.
  
• Suddenly halting after running continuously or after a jump.
  
• Any movement that causes great strain to the ACL can lead to the injury.
  
• Extending too much in the outward direction or in the inward direction can cause damage to the ligament.
  
• Any road accident where the knee suffers injury.
  

ACL injury leads to symptoms such as severe pain in the knee and unexpected shakiness of the knee. The knee gets inflamed and its movement gets restricted. RICE method is adapted. R- Rinse the affected area, I- Apply Ice packs to reduce inflammation of the area, C - Use a splint to compress the area, and E- Elevate the affected area above chest level. Physical therapy helps a lot. Anti-inflammatory drugs are prescribed. In rare cases, reconstruction of the ligament is suggested by the doctor. Ample rest is required till total recovery is confirmed.

Prevention of ACL injury is possible if:

• Proper care is taken while involving in a sport and if the right knee gear is used while playing.
  
• Reducing stress on the knee by undergoing the right training.
  
• Avoid running downhill at full speed.
  
• Limit the usage of high heeled shoes.
  

Patellofemoral stress syndrome

Patellofemoral stress syndrome also know as Runner's knee is one of most common sports injuries noticed among athletes. It is recurring pain that is shuttled between the patella and the femur. The occurrence of patellofemoral stress syndrome is dependent on the posture and the activity of the person. Activities such as running, walking, jumping and wrong method of lifting weights can induce the possibilities this syndrome.

The predominant symptoms associated with the patellofemoral syndrome include the pain caused around the knee cap also called the patella. The pain is circulatory in origin as it radiates around the knee cap disrupting the swift action of the socket movement. Other characteristics include sensitivity when touched at the knee and clicking noise with pain whenever the knee is bent. In most cases the injuries that lead to patellofemoral syndrome are reported with a tendon damage or a ligament tear.

Tests such as the patellar glide test and patellar slide test are performed along with radiological evidences to identify the underlying cause and intensity of the condition. Patients with patellofemoral syndrome are treated with NSAIDs to reduce the inflammation in the muscular region. In addition to this, patients are advised to maintain good posture.