Fractures of the Femur

Abstract

This paper will treat the subject of simple fractures of the shaft of the femur in a general manner, laying down the principles applicable to the management of fractures in the several regions of the bone, or divisions ordinarily designated in the study and treatment of fractures of the femur. Thirteen per cent of all fractures which come to our hospital as the result of industrial establishment, highroad, and railroad accidents, are fractures of the femur: 23 per cent is the ratio in military service. In the United States and Canada, about one-half of these fractures occur in the middle third of the bone, and about one-quarter each in the upper and lower thirds. By far the largest number of fractures occur in men in the age period 25–50 years, the active working period of a man's life. Over 80 per cent of fractures of the femur in civil life are produced by indirect violence; they are brought about by incoordinate leverage. When a break in the continuity of the largest and strongest bone in the human skeleton occurs, in a healthy person, the bone most essential in the proper support and the progression of a human being, great force must have been exerted. This great force will have caused not only the fracture of the bone itself and rupture of the periosteum, but in most instances will have produced marked injury, sometimes extremely serious injury, to the adjacent soft tissues. These fractures should be regarded, therefore, as serious and usually multiple or complicated injuries. It will be understood, as a matter of course, that the systemic effect of fractures of the femur will always be severe, sometimes most serious. Etiology This heading is introduced in order to emphasize the fact that certain conditions predispose to fractures of the femur, as to fractures of other bones. For the sake of classification, I will divide the causes of fracture into (A) Predisposing and (B) Determining. (A) Predisposing causes include (1) Senility and (2) Certain diseases, as follows: (a) Osteomalacia; (b) Osteomyelitis; (c) Tuberculosis of the bone; (d) Syphilitic infection of the bone; (e) The condition called “fragilitas osseum”; (f) Neoplasms. (B) Determining causes include violence (a) of a direct nature, and (b) of an indirect nature. The possibility of the existence of a predisposing cause must as a rule be considered in treating every case of fracture, because delayed union or non-union may result on account of the general systemic or local diseased condition, even when good reposition and retention of the fragments have been obtained. However, one need only mention the predisposing causes with this statement and pass on to (B) the Determining cause, namely, violence―of a direct or indirect nature. In civil life direct violence, that is to say, force applied directly to the bone in an overpowering degree, is comparatively rare.