Diaphyseal Femur Fractures

19/11/13
Diaphyseal Femur Fractures
Today
News
Reference
Education
Log In
Register

Author: Bart Eastwood, DO; Chief Editor: Carlos J Lavernia, MD, FAAOS more...
Updated: Oct 2, 2013
Background
Orthopedic surgeons often encounter diaphyseal femur fractures.[1, 2, 3] Because these fractures most often result
from high-energy trauma, one must have a high index of suspension for complications or other injuries. While the
mainstay of treatment has been reamed interlocking intramedullary nailing, a variety of treatment options exist for
solitary fractures or fractures with associated injury.
Anteroposterior radiograph of a femur fracture in a 45-year-old man.
Lateral radiograph of a femur shaft fracture in a 45-year-old man.
Adult nonsurgical treatment options include skin traction, skeletal traction, cast brace, and casting. Nonsurgical
options are used infrequently outside of the younger pediatric population. Children have the same options, as well
as spica casting for those patients weighing less than 80 lb.[4, 5, 6]
Surgical options in adults include the mainstays of intramedullary nailing, either antegrade or retrograde. Plate
fixation and external fixation are used less frequently, but these have a place in the decision-making process for
the ideal treatment in certain cases. Pediatric cases may also use flexible rods in addition to the adult options
mentioned. However, one must consider the patient's immature bones, open physes, parental care available, and
growth potential when forming a treatment plan in children.[4, 5, 6, 7]
emedicine.medscape.com/article/1246429-overview#showall
1/9
19/11/13
Anteroposterior radiograph of the hip and proximal femur after antegrade intramedullary (IM) nail placement.
Lateral radiograph of the distal femur after antegrade intramedullary (IM) nail placement.
History of the Procedure

Prior to the 1900s, diaphyseal femur fractures were treated with various types of splinting. However, with the
discovery of skeletal radiology near the end of the 19th century came an understanding of the forces acting on
fractured bones and a change in the treatment of such injuries. In 1907 and 1909, Steinmann and Kirschner
respectively developed the first traction treatment modalities with the use of pins or wires under tension.[8]
Early attempts at internal fixation of such fractures achieved little success until Kntscher developed and utilized
the intramedullary nail in 1937. After a short period of disagreement, the nailing method began to spread during
World War II in Europe and later in North America. Intramedullary nailing became prominent in the United States
in the 1970s. Since the intramedullary nailing technique was introduced in 1939, it has continued to evolve into the
antegrade reamed interlocking nails that are the standard today.
Ads not by this site
Problem
Femoral-shaft fractures are usually easy to treat compared with the high-energy injuries associated with the
fracture, in which complications tend to occur. Severetolife-threatening injuries often occur along with the
femoral-shaft fracture. Death, fat embolism,deep venous thrombosis (DVT),pulmonary embolism, pneumonia
development, multiorgan failure, long intensive care unit (ICU) stays, infection, hemorrhage, nerve palsies, rare
compartment syndrome, nonunion, delayed union, and malunion may also occur as complications of a diaphyseal
femur fracture.
Epidemiology
Frequency
Fractures of the femoral shaft are among the more common fractures that an orthopedist sees.[9] Injury is most
common among persons younger than 25 years and those older than 65 years. Analysis of a statewide discharge
database revealed an incidence of 1.33 fractures per 10,000 people. The number of shaft fractures in the elderly is
increasing secondary to the greater number of geriatric patients in the general population.
2/9
19/11/13
Etiology
Femoral-shaft fractures are usually the result of trauma.[10, 11] Motor vehicle accidents, pedestrian-versus-vehicle
accidents, falls, and gunshot wounds are among the most common causes. Pathologic fractures in adults are
most often the result of osteoporosis and metastatic disease. In children, it is also important to consider abuse
and underlying neuromuscular disorders and metabolic bone disease as causes of the fracture. Stress fractures
also may develop in the femur shaft, often associated with an increase in physical activity. Low-energy shaft
fractures have also been associated with the prolonged use of bisphosphonate drugs for treating osteoporosis.[12]
Pathophysiology
Fractures are most often due to a bending load applied to the femur with comminution occurring via higher
magnitude forces. Torsional loads, in contrast, form a spiral fracture pattern.
Presentation
The usual history of diaphyseal femur fractures is that of trauma.[13] If the history does not consist of trauma, one
should suspect a pathologic bone condition. Clinically, the injury is most often apparent. Pain, swelling,
shortening, and deformity are usually present in the region.
Because of the high association of other injuries, the advanced trauma life support (ATLS) protocol should be
followed. As always, a neurovascular assessment should be completed, though this type of injury is rare with
femoral-shaft fractures. Examination of the pelvis and hip is of great importance to investigate possible fracture or
dislocation. A thorough examination of the knee also should be completed to detect any ligamentous or bony
injury.
Indications
Currently, surgery is indicated for most femur fractures because of the high rate of union, low rate of
complications, and the advantage of early fracture stabilization, which decreases the morbidity and mortality rates
in patients (especially polytrauma patients) with these fractures.
Definite indications include polytrauma patients, especially those with head and chest injuries, and those with
injuries to multiple limbs or those otherwise unable to care for themselves to maximize postoperative
independence. Most others are surgical candidates because of the lower incidence of complication and the higher
union rates with surgery. Those who should not be treated surgically include patients too unstable to tolerate the
procedure and children under 80 lb.
Relevant Anatomy
The femur is one of the largest and strongest bones in the human body. The femur can be divided into regions
consisting of the head, neck, intertrochanteric, subtrochanteric (extending 5 cm distal to the lesser trochanter),
shaft, supracondylar, and condylar regions.
The structures of the thigh also can be divided into compartments. Within the anterior compartment lies the
quadriceps femoris, sartorius, psoas, iliacus, pectineus, as well as the femoral artery, vein, and nerve, along with
the lateral femoral cutaneous nerve. The medial compartment holds the gracilis, adductor brevis and longus,
adductor magnus, obturator externus, profunda femoris artery and vein, and the obturator artery, vein, and nerve.
Finally, the posterior compartment holds the semitendinosus, the semimembranosus, the biceps femoris, portions
of the adductor magnus, perforating branches of the profunda femoris artery, the sciatic nerve, and posterior
femoral cutaneous nerve.
The metaphyseal area begins proximally with the subtrochanteric region and distally with the supracondylar region
with the diaphysis in between. Lying posterior on the femur is the linea aspera, which provides a major attachment
for fascia. The femur is not perfectly straight; it has a noted anterior bow. The degree of the bow varies from person
to person, but explains the need for curved nails in order to hold the reduction.
The femur has an abundant vascular supply, receiving the bulk of the blood from the profunda femoral artery.[14] A
nutrient artery usually enters along the linea aspera posteriorly and proximally on the femur and supplies the
3/9
19/11/13
endosteal circulation. The endosteal circulation supplies the inner two thirds to three fourths of the cortex, making
the normal blood flow centrifugal in direction. The periosteal circulation enters posteriorly for the most part along
the linea aspera.
The periosteal circulation is almost entirely directed in a circumferential direction, having little or no longitudinal
spread. Therefore, small wires may be placed around the femur without the danger of devascularizing an area, but
large bands should be avoided. Periosteal circulation has been estimated to serve only the outer one fourth of the
cortex. However, the periosteal circulation is critical to fracture healing in the diaphysis.
When a fracture is displaced, the medullary vessels are disrupted and the periosteal vessels predominate as the
vascular supply to the fracture site during early healing. In response to fracture, the periosteal vessels proliferate,
while the endosteal circulation is restored much later. Therefore, the use of slotted nails may allow for enhanced
return of endosteal neovascularization and a more normal blood flow pattern. The significance of periosteal blood
flow in healing also emphasizes the importance of avoiding periosteal stripping especially along the linea aspera.
Depending on the level of the fracture and the insertion and attachment of the different muscles of the thigh, varied
deformities result. The proximal segment of the femur is under a valgus force of abduction by the gluteus minimus,
medius, and maximus. The short external rotators also exert a force on the proximal segment of fractures. A
component of flexion and external rotation also exists due to the attachment of the iliopsoas on the less
trochanter.
The adductors span most of the medial femur and produce an axial and varus force on the femur. Some of these
medial forces are countered by the tension band effect of the fascia lata. The distal femur is under a flexing
influence by the gastrocnemius.
Contraindications
Surgery for diaphyseal femur fracture should be reserved for those able to tolerate the appropriate procedure for
their circumstance. Young children can often be treated successfully with noninvasive measures; thus, surgery
can be avoided.
Contributor Information and Disclosures

Author
Bart Eastwood, DO Orthopedic Surgeon, Regional Orthopedics, Spearfish, SD
Bart Eastwood, DO is a member of the following medical societies: American Academy of Orthopaedic
Surgeons, American Osteopathic Academy of Orthopedics, and American Osteopathic Association
Disclosure: Nothing to disclose.
Coauthor(s)
Thomas Knutson, DO Consulting Surgeon, Department of Orthopedic Surgery, Center for Orthopedic
Excellence
Specialty Editor Board
Steven I Rabin, MD Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation,
Loyola University, Chicago Stritch School of Medicine; Chairman, Department of Orthopedic Surgery and
Musculoskeletal Medicine, Dreyer Medical Clinic; Chairman, Department of Surgery, Provena Mercy Medical
Center
Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic
Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center
College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
4/9
19/11/13
B Sonny Bal, MD, JD, MBA Associate Professor, Department of Orthopedic Surgery, University of MissouriColumbia School of Medicine
B Sonny Bal, MD, JD, MBA is a member of the following medical societies: American Academy of Orthopaedic
Surgeons
Disclosure: Bonesmart.org None Online orthopaedic marketing and information portal; OrthoMind None Social
networking for orthopaedic surgeons; Amedica Corporation Stock options and compensation Manufacturer of
Orthopaedic Implants; BalBrenner LLC Ownership interest Consulting; Zimmer Royalty Consulting; Medtronic
None Consulting; ConforMIS Consulting
Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief
of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic
Surgeons
Chief Editor
Carlos J Lavernia, MD, FAAOS Adjunct Clinical Professor, Department of Orthopedic Surgery, University of
Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of
Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical
Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer
Additional Contributors
The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author
coauthor Dr H Kurtis Biggs to the development and writing of this article.
References
1. Brinker MR, Miller MD. Femoral diaphyseal fractures. In: Review of Orthopaedics. WB Saunders
Co;2000:482-483.
2. Starr, Bcucholz RW, Heckman JD. Fractures of the shaft of the femur. In: Rockwood and Green's
Fractures in Adults. 5th ed. Lippincott Williams & Wilkins;2001:1683-1730.
3. Wolinsky P. Fractures of the femoral diaphysis, including the subtrochanteric region. In: Orthopaedic
Knowledge Update: Trauma. Academy of Orthopaedic Surgeons;2000:133-140.
4. Kanlic E, Cruz M. Current concepts in pediatric femur fracture treatment. Orthopedics. Dec
2007;30(12):1015-9. [Medline].
5. [Best Evidence] Poolman RW, Kocher MS, Bhandari M. Pediatric femoral fractures: a systematic review
of 2422 cases. J Orthop Trauma. Oct 2006;20(9):648-54. [Medline].
6. Lee SH, Baek JR, Han SB, Park SW. Stress fractures of the femoral diaphysis in children: a report of 5
cases and review of literature. J Pediatr Orthop. Nov-Dec 2005;25(6):734-8. [Medline].
7. Ramseier LE, Janicki JA, Weir S, Narayanan UG. Femoral fractures in adolescents: a comparison of four
methods of fixation. J Bone Joint Surg Am. May 2010;92(5):1122-9. [Medline].
8. Peltier LF. Fractures: A History and Iconography of Their Treatment. Norman Publishing;1990.
9. Fakhry SM, Rutledge R, Dahners LE, Kessler D. Incidence, management, and outcome of femoral shaft
fracture: a statewide population-based analysis of 2805 adult patients in a rural state. J Trauma. Aug
1994;37(2):255-60; discussion 260-1. [Medline].
10. Luedtke LM, Flynn JM, Ganley TJ, Hosalkar HS, Pill SG, Dormans JP. The orthopedists' perspective:
bone tumors, scoliosis, and trauma. Radiol Clin North Am. Jul 2001;39(4):803-21. [Medline].
11. Tscherne H, Regel G, Pape HC, et al. Internal fixation of multiple fractures in patients with polytrauma.
Clin Orthop. Feb 1998;(347):62-78. [Medline].
12. Lenart BA, Neviaser AS, Lyman S, Chang CC, Edobor-Osula F, Steele B. Association of low-energy
5/9
19/11/13
femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. Aug
2009;20(8):1353-62. [Medline].
13. Baumgaertner, M, Tornetta III, P. Orthopaedic Knowlodge Update, Trauma 3. Book . 2005;93-106, 387395.
14. Laing P, Prembury, Kent. The Blood Supply of the Femoral Shaft. J Bone Joint Surg. 1953;35B:462-466.
15. O'toole RV, Dancy L, Dietz AR, Pollak AN, Johnson AJ, Osgood G. Diagnosis of femoral neck fracture
associated with femoral shaft fracture: blinded comparison of computed tomography and plain
radiography. J Orthop Trauma. Jun 2013;27(6):325-30. [Medline].
16. Berezka NI, Popov IF, Gnedushkin IuN, Vlasenko VG. [Treatment of diaphyseal femoral fractures in
patients with associated and multiple traumas]. Ortop Travmatol Protez. Aug 1991;7-10. [Medline].
17. Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A
prospective randomized study. J Bone Joint Surg Am. Mar 1989;71(3):336-40. [Medline].
18. Ricci WM, Gallagher B, Haidukewych GJ. Intramedullary nailing of femoral shaft fractures: current
concepts. J Am Acad Orthop Surg. May 2009;17(5):296-305. [Medline].
19. Carlson DW, Rodman GH Jr, Kaehr D, et al. Femur fractures in chest-injured patients: is reaming
contraindicated?. J Orthop Trauma. Mar-Apr 1998;12(3):164-8. [Medline].
20. Brundage SI, McGhan R, Jurkovich GJ, et al. Timing of femur fracture fixation: effect on outcome in
patients with thoracic and head injuries. J Trauma. Feb 2002;52(2):299-307. [Medline].
21. Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J
Trauma. Mar 1999;46(3):392-9. [Medline].
22. Crist BD, Wolinsky PR. Reaming does not add significant time to intramedullary nailing of diaphyseal
fractures of the tibia and femur. J Trauma. Oct 2009;67(4):727-34. [Medline].
23. Winquist RA. Locked Femoral Nailing. J Am Acad Orthop Surg. Nov 1993;1(2):95-105. [Medline]. [Full
Text].
24. Williams MM, Askins V, Hinkes EW, Zych GA. Primary reamed intramedullary nailing of open femoral
shaft fractures. Clin Orthop. Sep 1995;(318):182-90. [Medline].
25. Perez A, Mahar A, Negus C, Newton P, Impelluso T. A computational evaluation of the effect of
intramedullary nail material properties on the stabilization of simulated femoral shaft fractures. Med Eng
Phys. Jul 2008;30(6):755-60. [Medline].
26. Ricci WM, Schwappach J, Tucker M, Coupe K, Brandt A, Sanders R, et al. Trochanteric versus piriformis
entry portal for the treatment of femoral shaft fractures. J Orthop Trauma. Nov-Dec 2006;20(10):663-7.
[Medline].
27. James P. Stannard, MD. Choosing a Femoral Starting Point [dissertation/master's thesis]. St. Augusting,
FL: AAOS/OTA Orthopaedic Trauma Update; 2008.
28. Moed BR, Watson JT. Retrograde nailing of the femoral shaft. J Am Acad Orthop Surg. Jul-Aug
1999;7(4):209-16. [Medline].
29. Goodwin R, Mahar AT, Oka R, Steinman S, Newton PO. Biomechanical evaluation of retrograde
intramedullary stabilization for femoral fractures: the effect of fracture level. J Pediatr Orthop. Dec
2007;27(8):873-6. [Medline].
30. Mohr VD, Eickhoff U, Haaker R, Klammer HL. External fixation of open femoral shaft fractures. J Trauma.
Apr 1995;38(4):648-52. [Medline].
31. Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary
nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. Jun
2000;82(6):781-8. [Medline].
32. Scalea TM, Boswell SA, Scott JD, et al. External fixation as a bridge to intramedullary nailing for patients
with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. Apr
2000;48(4):613-21; discussion 621-3. [Medline].
33. Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of locking compression plates for long bone nonunions
without removing existing intramedullary nail: review of literature and our experience. J Trauma. Aug
2008;65(2):482-6. [Medline].
6/9
19/11/13
34. Matsuo T, Sugita T, Shimose S, Kubo T, Sunagawa T, Yasunaga Y, et al. Rigid bridging of massive femur
defect using double vascularized fibula graft with hydroxyapatite. Arch Orthop Trauma Surg. Sep
2008;128(9):941-4. [Medline].
35. Wolinsky PR, Johnson KD. Ipsilateral femoral neck and shaft fractures. Clin Orthop. Sep 1995;(318):8190. [Medline].
36. Zettas JP, Zettas P. Ipsilateral fractures of the femoral neck and shaft. Clin Orthop. Oct 1981;(160):63-73.
[Medline].
37. Bartlett CS. Clinical update: gunshot wound ballistics. Clin Orthop. Mar 2003;408:28-57. [Medline].
38. Brien WW, Kuschner SH, Brien EW, Wiss DA. The management of gunshot wounds to the femur. Orthop
Clin North Am. Jan 1995;26(1):133-8. [Medline].
39. Ordog GJ, Wasserberger J, Balasubramaniam S. Shotgun wound ballistics. J Trauma. May
1988;28(5):624-31. [Medline].
40. Cannada LK, Jones TR, Guerrero-Bejarano M, Viehe T, Levy M, Farrell ED, et al. Retrograde
intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots. Orthopedics. Mar
2009;32(3):162. [Medline].
41. Smith HW, Wheatley KK Jr. Biomechanics of femur fractures secondary to gunshot wounds. J Trauma.
Nov 1984;24(11):970-7. [Medline].
42. Wiss DA, Brien WW, Becker V Jr. Interlocking nailing for the treatment of femoral fractures due to
gunshot wounds. J Bone Joint Surg Am. Apr 1991;73(4):598-606. [Medline].
43. Koval K, Zuckerman J. Femoral shaft, pediatric femoral shaft. In: Hand Book of Fractures. 2002:212-7,
364-7.
44. Greene WB. Displaced fractures of the femoral shaft in children. Unique features and therapeutic options.
Clin Orthop. Aug 1998;(353):86-96. [Medline].
45. Mostafa MM, Hassan MG, Gaballa MA. Treatment of femoral shaft fractures in children and adolescents.
J Trauma. Dec 2001;51(6):1182-8. [Medline].
46. Parsch KD. Modern trends in internal fixation of femoral shaft fractures in children. A critical review. J
Pediatr Orthop B. Apr 1997;6(2):117-25. [Medline].
47. Stilli S, Magnani M, Lampasi M, Antonioli D, Bettuzzi C, Donzelli O. Remodelling and overgrowth after
conservative treatment for femoral and tibial shaft fractures in children. Chir Organi Mov. Jan
2008;91(1):13-9. [Medline].
48. De Palma L, Schiavone Panni A. [Growth disorders of the legs in the outcome of diaphysial fractures of
the tibia in children]. Arch Putti Chir Organi Mov. 1984;34:315-9. [Medline].
49. Anastasopoulos J, Petratos D, Konstantoulakis C, Plakogiannis C, Matsinos G. Flexible intramedullary
nailing in paediatric femoral shaft fractures. Injury. Jun 2010;41(6):578-82. [Medline].
50. Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop. MayJun 1997;17(3):342-6. [Medline].
51. Nork SE, Hoffinger SA. Skeletal traction versus external fixation for pediatric femoral shaft fractures: a
comparison of hospital costs and charges. J Orthop Trauma. Nov-Dec 1998;12(8):563-8. [Medline].
52. Ramseier LE, Bhaskar AR, Cole WG, Howard AW. Treatment of open femur fractures in children:
comparison between external fixator and intramedullary nailing. J Pediatr Orthop. Oct-Nov 2007;27(7):74850. [Medline].
53. Mortier D, De Ridder K. Flexible intramedullary nailing in the treatment of diaphyseal fractures of the
femur in preschool children. Acta Orthop Belg. Apr 2008;74(2):190-4. [Medline].
54. Aktekin CN, Oztrk AM, Altay M, Toprak A, Ozkurt B, Tabak AY. [Flexible intramedullary nailing of
children]. Ulus Travma Acil Cerrahi Derg. Apr 2007;13(2):115-21. [Medline].
55. Robinson CM, Ludlam CA, Ray DC, et al. The coagulative and cardiorespiratory responses to reamed
intramedullary nailing of isolated fractures. J Bone Joint Surg Br. Sep 2001;83(7):963-73. [Medline].
56. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of
five hundred and twenty cases. JBJS, Vol. 66-A, April 1984. J Bone Joint Surg Am. Dec 2001;83A(12):1912. [Medline].
7/9
19/11/13
57. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing
of femoral shaft fractures. J Orthop Trauma. Jul 2002;16(6):394-402. [Medline].
58. Kusz D, Dudko S, Wojciechowski P, Guzik H. Selected problems in the bone union of complicated
diaphyseal fractures treated with interlocking nail. Ortop Traumatol Rehabil. Aug 31 2006;8(4):449-54.
[Medline].
59. Schwartz JT Jr, Brumback RJ, Lakatos R, et al. Acute compartment syndrome of the thigh. A spectrum
of injury. J Bone Joint Surg Am. Mar 1989;71(3):392-400. [Medline].
60. Herscovici D Jr, Whiteman KW. Retrograde nailing of the femur using an intercondylar approach. Clin
Orthop Relat Res. Nov 1996;98-104. [Medline].
61. Ricci WM, Bellabarba C, Evanoff B, et al. Retrograde versus antegrade nailing of femoral shaft fractures. J
Orthop Trauma. Mar-Apr 2001;15(3):161-9. [Medline].
62. Ostrum RF, Agarwal A, Lakatos R, Poka A. Prospective comparison of retrograde and antegrade femoral
intramedullary nailing. J Orthop Trauma. Sep-Oct 2000;14(7):496-501. [Medline].
63. Bostman O, Varjonen L, Vainionpaa S, et al. Incidence of local complications after intramedullary nailing
and after plate fixation of femoral shaft fractures. J Trauma. May 1989;29(5):639-45. [Medline].
64. Smrke D, Princic J. [Plate and screw osteosynthesis in femoral shaft fractures. Retrospective study of
500 femur shaft fractures]. Unfallchirurg. Feb 2000;103(2):110-4. [Medline].
65. Seligson D, Mulier T, Keirsbilck S. Plating of femoral shaft fractures. A review of 15 cases. Acta Orthop
Belg. Feb 2001;67(1):24-31. [Medline].
66. Alonso J, Geissler W, Hughes JL. External fixation of femoral fractures. Indications and limitations. Clin
Orthop. Apr 1989;(241):83-8. [Medline].
67. Dabezies EJ, D'Ambrosia R, Shoji H, Norris R, Murphy G. Fractures of the femoral shaft treated by
external fixation with the Wagner device. J Bone Joint Surg Am. Mar 1984;66(3):360-4. [Medline].
68. Cramer KE, Tornetta P 3rd, Spero CR, et al. Ender rod fixation of femoral shaft fractures in children. Clin
Orthop. Jul 2000;(376):119-23. [Medline].
69. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg. SepOct 2004;12(5):347-59. [Medline].
70. Momberger N, Stevens P, Smith J, et al. Intramedullary nailing of femoral fractures in adolescents. J
Pediatr Orthop. Jul-Aug 2000;20(4):482-4. [Medline].
71. Macneil JA, Francis A, El-Hawary R. A systematic review of rigid, locked, intramedullary nail insertion
sites and avascular necrosis of the femoral head in the skeletally immature. J Pediatr Orthop. Jun
2011;31(4):377-80. [Medline].
72. Infante AF Jr, Albert MC, Jennings WB, Lehner JT. Immediate hip spica casting for femur fractures in
pediatric patients. A review of 175 patients. Clin Orthop. Jul 2000;(376):106-12. [Medline].
73. Kregor PJ, Song KM, Routt ML Jr, Sangeorzan BJ, Liddell RM, Hansen ST Jr. Plate fixation of femoral
shaft fractures in multiply injured children. J Bone Joint Surg Am. Dec 1993;75(12):1774-80. [Medline].
74. Ward WT, Levy J, Kaye A. Compression plating for child and adolescent femur fractures. J Pediatr
Orthop. Sep-Oct 1992;12(5):626-32. [Medline].
75. Miner T, Carroll KL. Outcomes of external fixation of pediatric femoral shaft fractures. J Pediatr Orthop.
May-Jun 2000;20(3):405-10. [Medline].
Medscape Reference 2011 WebMD, LLC
8/9
19/11/13
9/9

Diaphyseal Femur Fractures

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Diaphyseal Femur Fractures

Transféré par

Droits d'auteur :

Formats disponibles

19/11/13