Femoral Fractures in Head-injured Adults

Abstract

The records of 65 head injured adults with 68 concomitant femoral fractures were reviewed. All patients were victims of high energy accidents. Forty-three fractures were treated by nonoperative methods. Treatment of 30 fractures with traction alone or with hip spica casts resulted in greater than 10 degrees of anterior angulation in 12 fractures (40%), greater than 5 degrees of valgus angulation in 13 fractures (43%), and shortening of greater than 2 cm in 13 fractures (43%). of eight fractures treated with a cast brace, two had shortening of 2.5 cm. Cast braces offered better fracture alignment, less shortening and more knee motion than traction and hip spica casts. The average time to union was four months. These fractures generally healed in the same fashion and at a similar rate as those of the general population. Ipsilateral hemiplegia prolonged union by one month but was not associated with excessive callus. Twenty-five fractures were treated by open reduction and internal fixation. Deep wound infection occurred in four femoral (16%) and osteomyelitis in two (8%). Reoperation was required in six femora (24%) as a consequence of the initial surgery. Excessive calculus was noted in 13 fractures (52%). Open reduction and internal fixation of femoral fractures in this population almost invariably required less nursing care, earlier mobilization, fewer angular deformities, less shortening and greater knee motion when compared to traction and hip spica casts.