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.

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.

Patella Fracture

A break in the kneecap is known as a fracture of the patella. A fall from a height, a direct blow to the knee and indirect stress are some of the frequent causes of patella fractures. Severe pain, swelling, tenderness and difficulty in straightening the knee are some of the common symptoms associated with patella fracture. Fracture of the patella is also known as kneecap fracture, broken knee, knee fracture and broken patella.

Causes of a Patella Fracture

• Direct force on the patella can result in fracturing the patella.
  
• A fall from a height or a hit to the knee which is very common in contact sports.
  
• During an automobile accident, when a knee that is bent hits against the dashboard and can lead to a patella fracture.
  
• Indirect stress is one reason that can cause patella fracture.
  
• Twisting of the leg.
  
• Muscle contraction that is violent.
  
• Calcium deficiency due to poor nutrition.
  
• Persons who are obese are more prone to this kind of fracture if they suffer a fall.
  
• Joint diseases such as osteoporosis or bone diseases increase the risk of fracture of this kind.

Severe pain and swelling at the area of the fracture is noticed when a person fractures his patella. It will be difficult to move the leg either forward or backward or extend it. There may be swelling and tenderness around the kneecap along with catching or locking of the knee. If bone fragments split enough to bend or twist normal knee contours, deformity of the knee will be apparent. The patient may experience numbness and chill that extends beyond the site of the fracture, if the blood supply at the site gets affected. In a compound fracture or open fracture, the skin is broken by the bone in extreme cases. Immediate attention should be given to this open fracture to avoid infection. The fracture of the patella is classified into three different types.

• As a result of a direct blow an undisplaced fracture of the patella may occur
  
• A direct blow to the front of the knee or a fall can cause a stellate or comminuted fracture. Compromised anterior skin and subcutaneous tissue may be associated with this type of fracture which may be the result of a direct trauma.
  
• The third type is a transverse fracture where there is a gap between the fragments. There is possibility for this fracture when there is a forced, passive flexion of the knee joint is associated with a contraction of the knee joint extenders or the quadriceps muscles.
  

There should not be any delay in realigning the broken bones to reduce the shock. To determine if the patient has suffered a fracture the physician will request for x-rays and stress films after he examines the knee. To immobilize the fracture site, the physician may realign the broken bones and place the knee in a cast or splint only if the fragments of bones are lined up well. Surgery is the other option to remove broken pieces of the knee. A person who has suffered a patella fracture is more prone to knee problems in the future.