General condition: Shock may be present either because of internal hemorrhage at the site of fracture or due to some other associated injury. Clinical evaluation of the patient is essential in all femoral fractures.
Local condition: There is apparent swelling of the thigh due to the collection of blood. About 1-2 pints of blood may be collected in the soft tissue. The affected limb may be shortened. Deformed and externally rotated. All the movements of the hip and knee are restricted.
X-ray diagnosis: X-ray findings confirm the nature of the fracture.
- Immediate measures: Immediate resuscitation is required when the patient is in a state of shock. Blood or plasma volume expander must be transfused in accordance with the requirement of the patient.
- Splintage: The limb is put on the Thomas splint. This prevents further soft tissue damage which is likely to develop by the irritation of bone fragments. The pain is relieved using analgesic drugs.
Specific treatment of fracture: The fracture can be treated either by conservative or by the operative procedure. Whichever technique is followed, the key to success depends upon the regular supervision of the case. This is followed until the patient attains the stage of normalcy. The result of the operation may be serious when performed without proper judgment and skill.
INDICATIONS OF CONSERVATIVE AND OPERATIVE PROCEDURES
Closed reduction: Conservative measures are ideal mostly in children and in fractures of compound, spiral and comminuted varieties.
Open reduction: This is done usually in young adults. Transverse and short oblique fractures are ideal for internal fixation. Many transverse fractures can be treated by closed reduction. Some surgeons prefer to reduce these varieties by closed technique and resort to surgery in cases of failure. The ortho implants are used in the surgeries, which are exported by the orthopedic implant exporters.
TECHNIQUE OF CLOSED REDUCTION
- Manipulation: This is done under general anaesthesia. Use of muscle relaxants is of great value.
- Preparation of skin: The skin of the limb is shaved and prepared for skin or skeletal traction.
- Traction: Either strapping is done for skin traction or the Steinmann’s pin is passed through the tibia at the level of tibial tubercle in cases of skeletal traction. Steinmann pin is an orthopedic implant.
- Traction and counter-traction: In cases of spiral and comminuted fractures, simple traction and counter-traction may achieve the result in putting the two fractured segments in an aligned position. Transverse fractures usually do suffer from displacement. The distal fragment is usually displaced posteriorly by the pull of the gastrocnemius muscle. It may be difficult to achieve successful reduction when there is superior displacement.