Femur

Femur fracture

Look for externally rotated and shortened leg.

Femoral neck fractures can be classified into two major types – intertrochanteric/pertrochanteric basal extracapsular fractures, and subcapital basicervical fractures, which occur within the joint capsule.

Malunion may occur in any of the types.

Infection following surgical treatment can occur with any type of fracture.

Nonunion can occur with displaced subcapital fractures of the neck due to the orientation of the fracture line. The bone is often osteoporotic and obtaining good purchase of the internal fixation metal device used to treat the fracture can sometimes be difficult. This can lead to the metal cutting out of the soft bone or displacement of the fracture. It is for this reason of likely nonunion that the treatment of elderly people with a displaced subcapital fracture is often better with a prosthetic replacement than an internal fixation (C is correct).

Mx

• Femoral neck fractures are at high risk of avascular necrosis (tenuous blood supply) and are best treated with femoral head replacement.
• Intertrochanteric fractures are treated with open reduction and pinning.
• Femoral shaft fractures are treated with intramedullary rod fxation. Be aware of a high risk for fat emboli.

Tibia

Rupture of the Achilles tendon

risk factors:

• age
• overuse (exercise, tennis, basketball)
• quinolone use

S/S

sudden "popoing" and limping