What is the pathophysiology of a fractured femur?

Pathophysiology and Etiology Femoral-shaft fractures are usually the result of trauma. 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.

What is Peritrochanteric femur fracture?

Pertrochanteric femoral fractures are a subtype of trochanteric fractures involving the femur. They are one of the most common fractures in old patients. They can involve both the greater and lesser trochanter and are a type of extracapsular fracture.

Why do subtrochanteric fractures occur?

Subtrochanteric fractures in young patients are typically the result of high-energy trauma such as a motor vehicle collision or fall from height. This mechanism is often associated with other traumatic injuries and should be comprehensively evaluated by a trauma team through the Advanced Trauma Life Support system.

What causes shortening and external rotation of leg?

The affected leg is externally rotated and may be shortened. The extremity shortening occurs because the muscles acting on the hip joint depend on the continuity of the femur to act, and when this continuity is disrupted, the result is a shorter-appearing leg.

What is pathophysiology of a fracture?

Thus, the pathophysiology of fractures encompasses a multitude of factors that determine bone strength (bone mass, bone quality, age, skeletal geometry) and the frequency, nature, and effects of injuries (Figure 4.1).

What is the pathophysiology of an open fracture?

An open fracture, also called a compound fracture, is a fracture in which there is an open wound or break in the skin near the site of the broken bone. Most often, this wound is caused by a fragment of bone breaking through the skin at the moment of the injury.

What is Peritrochanteric?

The peritrochanteric space is the region of the hip between the greater trochanter, a bony prominence at the top of the thigh bone, and the illiotibial band, a thick band of tissue that runs over the greater trochanter and down the side of the thigh.

Where is a subtrochanteric femur fracture?

Subtrochanteric fractures are proximal femur fractures located within 5 cm of the lesser trochanter that may occur in low energy (elderly) or high energy (young patients) mechanisms.

Why is the leg externally rotated after hip fracture?

The degree of deformity seen is dependent on both the anatomical configuration of the fracture and the degree of displacement. The classically described presentation is a shortened and externally rotated limb due to the unopposed pull of the iliopsoas muscle that attaches to the lesser trochanter.

What is the pathophysiology of bone healing?

Primary bone healing is the reestablishment of the cortex without the formation of a callus. It occurs if a fracture is adequately “fixed” through reduction, immobilization, and rehabilitation. Secondary bone healing, as described above, occurs through the formation of a callus and subsequent remodeling.

What is the mechanism of injury of a fracture?

Fracture Patterns. The Mechanism of Injury is blunt trauma or indirect trauma (including overuse injury in throwers such as Little Leaguers shoulder. Often associated with trauma. Consider non-accidental trauma if less than three years of age and spiral fracture pattern.

What is a pathological fracture?

Listen to pronunciation. (PA-thuh-LAH-jik FRAK-sher) A broken bone caused by disease, often by the spread of cancer to the bone.

Is a fracture a pathology?

Understanding Pathologic Fractures. A fracture is a break in your bone. A break is called a pathologic fracture when force or impact didn’t cause the break to happen. Instead, an underlying disease leaves your bones weak and brittle.

What is Peritrochanteric edema?

Peritrochanteric pain syndrome includes a cluster of disorders that cause severe pain on the side of the hip and thigh region. They include: Snapping hip syndrome: slipping of the illiotibial band over the trochanter causing instability.

What is Peritrochanteric bursitis?

Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the part of the hip called the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.

What causes external rotation of leg?

Small muscles such as the piriformis, the gemellus and obturator groups, and the quadratus femoris originate in the hip bone and connect to the upper part of the femur, the large bone in your thigh. Together, they make the sideways motion required for hip external rotation possible.

What movements are contraindicated after a hip fracture?

For patients who underwent a prosthetic replacement have to avoid for approximately 12 weeks: Hip flexion greater than 70–90° External rotation of the leg. Adduction of the leg past midline.

How long does it take to recover from a broken femur?

The majority of people who suffer a femur fracture receive specialized treatment in a long-term nursing or rehabilitation facility. Full recovery from a femur fracture can take anywhere from 12 weeks to 12 months; however, most people begin walking with the help of a physical therapist in the first day or two after injury and/or surgery.

What are the symptoms of a femur fracture?

– Confusion or loss of consciousness for even a brief moment – Heavy or uncontrollable bleeding – Inability to move the leg – Low blood pressure ( hypotension) – Protruding fragments of bone through the skin – Severe pain

What causes pain after a broken femur?

– The cause is usually some type of high energy collisions such as a car or motorcycle accident. – A severe sports injury could also have the effect for athletes of young people. – Even a low force incident such as a fall can cause a broken femur in individuals with weak bones. – In the elderly, broken femur may be caused by a slip or fall.

What is the recovery time for a femur?

– Inflammation around the broken bone – Regeneration of new bone growth. – Remodelling of the mature bone or newly formed bone

Pathophysiology and Etiology

Femoral-shaft fractures are usually the result of trauma. 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.

Does hip fracture cause heart failure?

Heart failure was significantly associated with subsequent hip fracture in both men [unadjusted HR 1.87 (95% CI 1.2–2.93) and women (unadjusted HR 1.75 (95% CI 1.27–2.4)].

What are the complications of femur fracture?

Complications and injuries associated with midshaft femur fractures in the adult can be life-threatening and may include hemorrhage, internal organ injury, wound infection, fat embolism, and adult respiratory distress syndrome [2,6].

What three deformities are commonly seen in a subtrochanteric fracture?

Subtrochanteric fractures often are associated with intertrochanteric fractures. The strong gluteal and thigh muscles create a classic deformity. The proximal fragment is held in abduction, flexion, and external rotation. The gluteus medius and minimus attach at the greater trochanter and provide an abduction force.

Fractures occur in patients with decreased bone strength and who experience an injury. Thus, the pathophysiology of fractures encompasses a multitude of factors that determine bone strength (bone mass, bone quality, age, skeletal geometry) and the frequency, nature, and effects of injuries (Figure 4.1).

Why is a femur fracture life threatening?

Caution: A fractured femur may be life-threatening.
Death can occur following a femur fracture due to complications such as blood clots, pneumonia, or infection. Symptoms of life-threatening injury include: Localized swelling in the legs or groin, with redness and tenderness to touch.

How does a fracture affect the cardiovascular system?

The resistance vessels of bone are regulated by local, neural, and humoral factors. Fractures of long bone provoke a decrease in blood flow followed by a large increase in blood flow driven by metabolic demand.

Can hip replacement cause heart problems?

Researchers found that one in 200 people who had a hip replacement had a heart attack within six weeks of surgery. The study also found that one in 500 people who had a knee replacement had a heart attack within six weeks of surgery.

What are potential complications of fractures?

Complications of Fractures

• Blood vessel damage. Many fractures cause noticeable bleeding around the injury.
• Pulmonary embolism. Pulmonary embolism is the most common severe complication of serious fractures of the hip or pelvis.
• Fat embolism.
• Compartment syndrome.
• Infections.
• Joint problems.
• Uneven limbs.
• Osteonecrosis.

What is the difference between intertrochanteric and subtrochanteric fractures?

Typically, isolated greater trochanteric fractures can be treated non-operatively. However fractures occurring between the greater and lesser trochanters, called Intertrochanteric Fractures do require surgery, as do fractures occurring below the trochanters known as Subtrochanteric Fractures.

What is subtrochanteric fracture of femur?

Subtrochanteric (ST) femur fractures are defined as fractures of the proximal femur that occur within 5 cm of the lesser trochanter. 1. Overall, the incidence of these fractures has been estimated to be approximately 15–20 per 100,000 individuals.

What is the most common pathological fracture?

The femoral neck and head are the most common locations for pathologic fracture because of the propensity for metastases to involve proximal bones and because of the stress of weight placed on this part of the femur.

How serious is a broken femur in an elderly person?

A femur break is a serious break at any age but it can be deadly to seniors that are 65 years and older. The femur is the longest bone in the body. Femur breaks/fractures are most likely at the hip but in some cases can be at the lower extremities.

Can a fracture affect the heart?

In conclusion, we found that prior fracture is associated with heart failure at least as strongly as heart failure is associated with subsequent fracture.

What body systems does a broken bone affect?

Fractures can break the skin (called open fractures) or not (called closed fractures). An injury that breaks a bone may also seriously damage other tissues, including the skin, nerves, blood vessels, muscles, and organs.

What causes your heart to stop during surgery?

Probable causes of cardiac arrest in patients undergoing noncardiac surgery include primary cardiac dysfunction (eg, myocardial infarction), pulmonary embolism, electrolyte abnormalities, hemorrhage, and the anesthetic used at the time of arrest.

Can you have surgery with CHF?

Smilowitz says, also need to be closely monitored during surgery and while they recover in hospital. Still, he says, some patients may need to delay their surgery until their heart failure is adequately treated, while others with more severe disease may choose to postpone their surgery indefinitely.

What is the pathophysiology of a fracture?

Can a bone fracture cause high blood pressure?

As sedentary lifestyle is a well-established risk factor for hypertension [11-14], history of fracture could be one of the causes for elevated blood pressure. In addition, human skeleton contains more than 90% of heavy metals from the environmental exposure which can be an endogenous source [15,16].

What part of the femur is the Subtrochanteric?

The subtrochanteric region of the femur, arbitrarily designated as the region between the lesser trochanter and a point 5 cm distal, consists primarily of cortical bone. The femoral head and neck are anteverted approximately 13º with respect to the plane of the femoral shaft.

Is a subtrochanteric femur fracture a hip fracture?

Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter. Subtrochanteric hip fracture is a break between the lesser trochanter and the area approximately 5 centimeters below the lesser trochanter.

Which disease process can lead to a pathologic fracture?

Only a small number of conditions are commonly responsible for pathological fractures, including osteoporosis, osteomalacia, Paget’s disease, Osteitis, osteogenesis imperfecta, benign bone tumours and cysts, secondary malignant bone tumours and primary malignant bone tumours.

What is the pathophysiology of fractures?

What are the 4 stages of fracture healing?

There are four stages in the repair of a broken bone: 1) the formation of hematoma at the break, 2) the formation of a fibrocartilaginous callus, 3) the formation of a bony callus, and 4) remodeling and addition of compact bone.