Femoral Shaft Fractures Research Articles

Pediatric femoral shaft fracture requiring revision surgery for nonunion associated with vitamin D and K deficiencies: a case report

BackgroundNonunion of femoral shaft fractures in children is rare, and there is no clear treatment protocol. In this case report, a pediatric femoral shaft fracture that developed in nonunion due to vitamin deficiency after osteosynthesis, which was successfully treated with vitamin augmentation and replacement with a rigid antegrade intramedullary nail, is described.Case presentationThe patient is an 11-year-old Japanese girl. She injured her right femoral shaft fracture when she hit a wall after kickboarding down a hill and underwent osteosynthesis with a titanium elastic nail. Six months postoperatively, she developed nonunion, was found to be deficient in vitamins D and K, and was started on vitamin supplementation. She underwent replacement with a rigid antegrade intramedullary nail at 7 months postoperatively, and bone union was achieved 3 months after reoperation.ConclusionWhen delayed union of a fracture is observed postoperatively, even in children without underlying disease, the cause of the problem must be investigated and treated promptly.

Thigh compartment syndrome: Outcomes in an urban level 1 trauma center

IntroductionThigh compartment syndrome (TCS) is a rare surgical emergency associated with a high risk of morbidity with mortality rates as high as 47 %. There is sparse literature discussing the management as well as outcomes of these injuries. The purpose of this study is to review a consecutive series of patients presenting to a single urban Level 1 trauma center with TCS to identify injury characteristics, clinical presentation, and outcomes associated with this injury. MethodsA trauma database was queried for all patients with a diagnosis of TCS at a single level 1 urban trauma center between January 1, 2011 and December 31, 2021. Demographic and injury variables collected included age, sex, BMI, mechanism of injury, and creatine phosphokinase levels (CPK). Hospital quality measures including time from admission to surgery, length of both hospital and ICU stay, complications, and cost of care were collected. Descriptive statistics are reported as median [interquartile range] or N (percent). ResultsThere were 14 patients identified with a diagnosis of TCS. All were men with an average age 33.5 [23.5 - 38] years and an average BMI of 26 [22.9–28.1]. The most common cause of injury was blunt trauma (71.4 %), and the remaining 28.6 % were gunshot wound injuries. Within the cohort, 6 (42.9 %) patients sustained a femoral shaft fracture, and 4 (28.6 %) patients sustained a vascular injury. The median initial CPK of patients within this cohort was 3405 [1232–5339] and reached a peak of 5271 [3013–13,266]. The median time from admission to diagnosis was 6.8 [0–236.9] hours. The median time from admission to the operating room was 8.2 [0.6–236.9] hours, and the median number of operating room visits was 3 [2 - 6]. Five patients (35.7 %) wounds were closed with split thickness skin grafting. There were 12 (85.7 %) patients who required ICU care. The median ICU length of stay was 7.5 days [4–15]. The median hospital length of stay was 16.5 days [13.25–38.0]. The median total charges for a patient with thigh compartment syndrome was $129,159.00 [$24,768.00 - $587,152.00]. The median direct variable cost for these patients was $86,106.00 For comparison, the median direct variable cost for patients with femur fractures without TCS at this institution was $8,497.28 [$1,903.52–$21,893.13]. No patients required readmission within 60 days. There were no mortalities. ConclusionTCS is a rare and life-threatening injury associated with significant morbidity. Despite rapid diagnosis and fasciotomy, the majority of the patients have prolonged hospital courses, ICU lengths of stay, and significant costs of treatment. Providers can reference the outcomes reported in this study when caring for TCS patients.

The incidence, trends, and costs of treatment of femoral shaft fractures among Finnish children aged 2-12 years between 1998 and 2016.

The purpose of this study was to determine the incidence and trends of both hip spica casting and elastic stable intramedullary nailing in children aged 2-12 years who sustained femoral diaphyseal fracture between 1998 and 2016 in Finland. We also evaluated the actual hospital costs of both treatment methods as well as calculating the length of hospital stay. This study included all 2- to 12-year-old children with femoral diaphyseal fracture who were treated in Finland between 1998 and 2016. Data were collected from the National Hospital Discharge Register of Finland. Children were classified by age into five groups. The annual incidences per 100,000 persons were calculated using annual mid-year population census data obtained from Statistics Finland. Data on the annual actual daily hospital costs were collected from the Finnish Institute for Health and Welfare. In total, 1064 patients aged 2-12 years who had sustained femoral diaphyseal fracture were treated with elastic stable intramedullary nailing or hip spica casting between 1998 and 2016. In children aged 4-5 years, the incidence of elastic stable intramedullary nailing increased during the study period from 5.4 per 100,000 persons in 1998 to 8.1 per 100,000 persons in 2016. The length of hospitalization in patients treated with elastic stable intramedullary nailing was shorter and, therefore, the total costs of hospital treatment were lower than in those children treated with hip spica cast. level III.

Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review.

Prolonged bisphosphonate (BP) treatment for osteoporosis prevents hip and other fractures but causes atypical femoral fractures (AFF). To establish the relationship between patterns of BP use and the risk of AFF and hip fractures. Other potential risk factors for AFF were also examined. This population-based case-cohort study utilized data from the Danish National Healthcare system, including longitudinal records of medication use, healthcare utilization, and x-ray images. Among all 1.9 million Danish adults ≥50, those with subtrochanteric or femoral shaft fractures between 2010 and 2015 (n = 4973) were identified and compared to a random sample (n = 37 021). Bisphosphonate use was collected from 1995-2015. Fracture radiographs (n = 4769) were reviewed by blinded study radiologists to identify AFFs (n = 189) using established criteria. Traditional hip fractures in the random sample (n = 691) were identified by ICD-10. Compared to <1 year of BP use, 5 to 7 years of use was associated with a 7-fold increase in AFF (adjusted HR = 7.29 [CI: 3.07, 17.30]); the risk of AFF fell quickly after discontinuation. The 5-year number needed to harm for one AFF was 1424, while the 5-year number needed to treat to prevent one hip fracture was 56. Glucocorticoid and proton pump inhibitor use were independently associated with increased AFF risk. Thirty-one percent of those with AFF had no BP exposure. The risk of AFF increases with duration of BP use but the beneficial effects of BP therapy in adults ≥50 dramatically exceed this increased risk. Nearly one-third of those with AFF have no BP exposure.

Atypical femur fracture in a male without history of bisphosphonate use: a case report

BackgroundAtypical femur fractures are a rare occurrence, especially in bisphosphonate-naïve men, and merit reporting owing to their unusual presentation and clinical implications. This case report highlights a unique instance of atypical femur fractures in a 73-year-old male with no prior bisphosphonate exposure.Case presentationThe patient, a 73-year-old Indian male with no history of bisphosphonate use, presented with left thigh pain and swelling following a minor fall. Radiographic assessment unveiled a closed left mid diaphyseal femoral shaft fracture. Subsequent imaging revealed an impending fracture in the contralateral femur. A comprehensive diagnostic evaluation, encompassing radiographic analysis, laboratory tests, and clinical assessment confirmed the diagnosis. Surgical management via intramedullary nailing was pursued for both fractures. Notably, the patient’s medical history was characterized by radiographic manifestations, the infrequent occurrence of atypical femur fractures in men, and associated risk factors. Treatment encompassed anabolic bone therapy employing teriparatide, alongside discontinuation of antiresorptive agents.ConclusionsThis case underscores the significance of considering atypical femur fractures in older individuals with limited trauma history. It accentuates the role of anabolic agents in the therapeutic regimen and contributes to the evolving understanding of atypical femur fractures. The report underscores the need for vigilant monitoring and tailored management strategies in similar cases, thereby enhancing clinical practice and patient care.

Management of ipsilateral femoral neck and shaft fracture using reconstruction nail: A case report

Abstract Ipsilateral fractures of femoral shaft and neck of femur fracture are rare but challenging and typically caused by high energy trauma. Review of literature shows various options for implants and surgical techniques for the treatment of Ipsilateral femoral neck shaft fractures but still none of them can be considered as standard, or even preferable. This is a case of 25 year old male who had suffered injury to his left hip and left thigh following an RTA. Radiographs of pelvis and thigh showed fracture of neck of right femur [basicervial] with fracture of shaft of right femur [junction of proximal 2/3rd and distal 1/3rd]. He was managed using reconstruction nail for both fractures 3 days after injury. The patient has attained bony union of both fractures in 8 months and was able to carry out his all routine activities and has attained good functional range of motion at hip and knee joint. We concluded that reconstruction nail is an acceptable implant for the management of ipsilateral neck and shaft of femur fracture with good radiological and clinical outcomes.

Factors Associated with Development of Thigh Compartment Syndrome Following Subtrochanteric and Diaphyseal Femoral Fractures.

Acute compartment syndrome of the thigh (CST) is an ongoing challenge for orthopaedic surgeons as the diagnosis is often difficult to establish. Currently, there is a shortage of studies investigating risk factors for the development of thigh compartment syndrome following subtrochanteric and diaphyseal femoral fractures. This study aimed to identify risk factors associated with the development of CST following femoral fractures. Retrospective review performed in a level one trauma center from January 2011 to December 2020 for all patients with non-pathological acute subtrochanteric or diaphyseal femoral fractures. Variables collected included demographics, injury severity score (ISS) scores, mechanism of injury, classification of femoral fracture, open versus closed injuries, development of compartment syndrome, time to compartment syndrome diagnosis, number of subsequent surgeries, and primary wound closure versus split-thickness skin graft. The statistical analysis of this study included descriptive analysis, simple logistic regression, paired T-test, and Wilcoxon Signed Rank. Thirty-one (7.7%) patients developed thigh compartment syndrome following 403 subtrochanteric or diaphyseal femoral fractures. The mean (SD) age for those who developed CST was 27.35 (8.42). For every unit increase in age, the probability of developing CST decreased. Furthermore, male gender had 18.52 times greater probability of developing CST (P <0.001). AO/OTA 32-C3 and subtrochanteric femoral fracture patterns demonstrated 15.42 (P = 0.011) and 3.15 (P <0.001) greater probability of developing CST, respectively. Patients who presented to the hospital following a motor vehicle accident (MVA) or gunshot wound (GSW) had 5.90 (P= 0.006) and 14.87 (P < 0.001) greater probability of developing CST, respectively. Patients who were male, younger in age, and had a 32-C3 and subtrochanteric femoral fractures were at increased probability of developing CST. High energy trauma also increased the risk of developing CST. A high index of suspicion should be expressed in patients with these risk factors.

Reliability of the 2018 Revised Version of AO/OTA Classification for Femoral Shaft Fractures.

The Arbeitsgemeinschaft für Osteosynthesefragen (AO) and the Orthopaedic Trauma Association (OTA) classification system for diaphyseal fracture has been recently revised to refine and enhance the accuracy of fracture categorization. This study aimed to investigate the interobserver reliability of the new AO/OTA classification and to compare it with the older version in femoral shaft fractures. We retrospectively analyzed 139 patients (mean age, 43.8 ± 19.5 years; 92 men and 47 women) with femoral shaft fractures who were treated from 2003 to 2017. Four well-trained observers independently classified each fracture following the previous and revised AO/OTA classification system. We calculated the Fleiss kappa for the interobserver reliability. The previous classification showed the kappa value of 0.580 (95% confidence interval [CI], 0.547-0.613), and the revised version showed 0.528 (95% CI, 0.504-0.552). Both the old and the revised versions showed moderate reliability. Our study highlights the moderate interobserver reliability of both the previous and new AO/OTA classification systems for diaphyseal femur fractures. These findings emphasize the importance of standardized systems in clinical decision-making and underscore the need for ongoing education and collaboration to enhance fracture classification.

Incidence and characteristics of ligamentous knee injuries accompanying a femur shaft fracture and their association with injury mechanism and fracture characteristics: A prospective-observational study in a low-middle-income country.

This study aims to elaborate the incidence, types, and characteristics of ligamentous knee injuries accompanying femoral-shaft fractures and their association with demographic data, fracture characteristics, and injury mechanism. This multi-center-prospective-observational study examined patients in the Shaheed Mohtarma Benazir Bhutto Institute of Trauma and Civil Hospital orthopedic wards. Using the consecutive sampling technique, 146 patients with femoral-shaft fractures were recruited, and scrutinized to determine the presence of ligamentous knee injury, through an evaluation form encompassing patients' demographic data, fracture characteristics, knee examinations, and confirmed through magnetic resonance imaging. Knee injuries were detected intra-operatively under regional/general anesthesia and post-operatively utilizing diagnostic maneuvers (varus/valgus stress, Lachman, anterior/posterior drawer, external rotation recurvatum, and McMurray tests) by 2-3 surgeons and confirmed through magnetic resonance imaging. Magnetic resonance imaging was exclusively employed in suspected false positive/negative cases, and when a titanium implant was utilized, that is, 131 cases (89.7%). Chi-square test was used to assess the relationship between incidence and type of ligamentous knee injury with demographic data, injury mechanism, and fracture characteristics. Among the 146 patients with femoral-shaft fractures, 78% and 22% were males and females, with 37% experiencing associated ligamentous knee injury. Medial collateral ligament and anterior cruciate ligament were the commonest types of ligamentous injuries accompanying femoral-shaft fractures, at 44% and 33%. The Chi-square revealed a statistically significant association between the incidence of ligamentous knee injury accompanying femoral-shaft fracture with demographic data, injury mechanism, and fracture characteristics (p-value < 0.05), and was noted to be higher among males (55.6%), participants aged 18-25 years (66.7%), involved in a road traffic accident (88.9%), resulting in a complex (77.8%) and close fracture (88.9%). A similar association was seen between medial collateral ligament and anterior cruciate ligament injuries with age, injury mechanism, and fracture characteristics (p-value < 0.05). Our study revealed the unaddressed fact that Pakistan has a significant incidence of ligamentous knee injuries accompanying femoral-shaft fractures. These insights can empower clinicians/surgeons to understand and manage this condition effectively.

Antegrade vs Retrograde Intra-Medullary Nailing in Femoral Shaft Fractures: A Systematic Review and Meta-Analysis.

Femoral shaft fractures are one of the most prevalent fractures found in clinical practice. Numerous operative and non-operative options are readily available for the treatment of such fractures with intra-medullary nailing being the gold standard. To date, no consensus has been reached favoring one approach over the other. Thus, this meta-analysis aims to compare the outcomes between an antegrade and retrograde intra-medullary nailing for the treatment of femoral shaft fractures. PubMed, Cochrane, Google Scholar (page 1-20), and Embase were searched till January 2024. The clinical outcomes evaluated were the incidence of adverse events, reoperations, hip and knee pain, and surgery-related parameters. Higher rates of hip pain, and heterotopic ossification (p=0.0003, and p=0.0002 respectively) was observed with antegrade nailing. However, a higher rate of knee pain (p=0.02) was appreciated in retrograde nailing. There was no statistically significant difference in the remaining analyzed outcomes such as operative time, reoperation rate or other complications. Despite a higher rate of heterotopic ossification using the antegrade nailing technique, both the antegrade and retrograde nailing techniques yield overall similar outcomes. Therefore, the decision to choose one or the other should be based on patient-related factors, and the surgeon's experience and preference.

Functional outcome of femur interlock nailing in shaft femur fractures in adults

Functional outcome of femur interlock nailing in shaft femur fractures in adults

Клинический случай оказания экстренной медицинской помощи пациенту с сочетанной травмой после дорожно-транспортного происшествия

Abstract. This research demonstrates a clinical observation of emergency medical care to a patient with associated trauma after a road traffic accident with the diagnosis: “Closed-skull brain injury. Brain concussion. Closed blunt chest trauma. Fracture of the IV–VII ribs on the right and left. Bruise of the right and left lungs. Closed comminuted fracture of the left femur in the middle third with displacement. Paresis of the left oculomotor nerve. Traumatic shock of the III degree”. The description of this case report allows to analyze the clinical and instrumental examination of the victim, tactics of intensive therapy and surgical treatment, clearly demonstrating that the primary task in the management of a victim with severe polytrauma after an accident is diagnosis, anti-shock therapy, pain relief, recovery of impaired vital functions of the body, stabilization of the patient’s condition and surgical treatment of damages and fractures. The research provides a demonstration of successful surgical treatment of a complex closed comminuted diaphyseal fracture of the left femur. A multidisciplinary approach to the treatment of a victim in a road traffic accident with combined trauma is an integrated approach that includes the coordinated action of specialists in various fields, aimed at maximizing the improvement of the victim’s condition. Correctly chosen tactics of diagnostic and treatment measures play a key role in ensuring a positive result and recovery of the victim. Thanks to the coordination of the actions of doctors of various specializations, the victim receives the necessary assistance at each stage of treatment, which contributes to rapid recovery and return to normal life.

DESFECHOS DO TRATAMENTO CIRÚRGICO DA FRATURA DIAFISÁRIA DO FÊMUR NA CRIANÇA POLITRAUMATIZADA

ABSTRACT Objective: This study aimed to evaluate the surgical treatment of diaphyseal femur fractures in polytraumatized children, considering consolidation rate, complications, and function as outcomes of interest. Methods: This is a quantitative, cross-sectional, and retrospective study of medical records of patients treated from 2012 to 2021. The 39 patients (41 femurs) were divided into four groups according to the method of osteosynthesis. We used the IBM SPSS Statistics software, version 20 (SPSS Inc, Chicago, IL), and performed Chi-square, Fisher, Kruskal-Wallis, and Shapiro-Wilk tests with a significance level of 5%. Results: We observed six complications among patients. Functional outcomes were satisfactory in 40 cases (97.6%) and unsatisfactory in one case (2.40%) according to the adopted criteria. We found one case (2.40%) of non-union and one case (2.40%) of malunion, whereas 39 cases (95.20%) achieved full consolidation. Conclusions: Flexible intramedullary nails and external fixators are the preferred options for patients aged 5 to 10 years. Intramedullary nails, plates, or external fixators are prioritized for patients over 11 years old. The type and pattern of fractures were considered relevant for treatment selection. Level of evidence III, Therapeutic study - Investigation of outcomes and treatment. Comparative retrospective study.

BAIXAS TAXAS DE INFECÇÃO E NÃO UNIÃO EM FRATURAS FEMORAIS EM POLITRAUMATIZADOS: UM ESTUDO RETROSPECTIVO

ABSTRACT Objective: Assess complications and risks in staged femoral shaft fracture treatment using external fixation and intramedullary nailing (DCO). Methods: Analysis involved 37 patients with 40 fractures, mostly male (87.5%), average age 32.9 years. Data included ASA score, AO/OTA and Gustilo classifications, Glasgow Coma Score, Injury Severity Score, times to external fixation and conversion, ICU duration, nail type, and reaming status. Complications tracked were mortality, deep infection, and non-union. Results: Predominant fracture type was AO/OTA A (45%), with 40% open (Gustilo A, 93.8%). Average ISS was 21; GCS was 12.7. Median ICU stay was 3 days; average time to conversion was 10.2 days. Retrograde nails were used in 50% of cases, with reaming in 67.5%. Complications included deep infections in 5% and non-union in 2.5%. Conclusion: DCO strategy resulted in low infection and non-union rates, associated with lower GCS and longer ICU stays. Level of Evidence III; Retrospective Cohort Study.

Nicotinamide mononucleotide enhances fracture healing by promoting skeletal stem cell proliferation.

The process of skeletal regeneration initiated by stem cells following injury, especially in fractures, is significantly impaired by aging and adverse factors. Nicotinamide mononucleotide (NMN), a critical endogenous precursor of nicotinamide adenine dinucleotide (NAD), has garnered extensive attention for its multifaceted regulatory functions in living organisms and its wide-ranging therapeutic potential. However, whether NMN contributes to trauma-induced skeletal regeneration remains unclear. Methods: The transverse femoral shaft fracture model was employed to evaluate the potential advantages of NMN administration for overall repair during the initial fracture stages in male mice through micro-CT analysis, histochemistry, and biomechanical testing. The pro-proliferative function of NMN on skeletal stem cells (SSCs) was investigated through flow cytometry, qRT-PCR, NAD content measurement, and cell proliferation assay. Results: In this study, we observed that the administration of NMN during the initial phase of fracture in mice led to a larger callus and corresponding improvement in micro-CT parameters. NMN enhances the cartilaginous component of the callus by elevating the NAD content, consequently accelerating subsequent endochondral ossification and the fracture healing process. Subsequent analyses elucidated that NMN was beneficial in promoting the expansion of diverse stem cells in vivo and in vitro potentially via modulation of the Notch signaling pathway. Moreover, the depletion of macrophages profoundly obstructs the proliferation of SSCs. Conclusion: Our discoveries provide a potential strategy for enhancing fracture healing through stimulation of callus SSC proliferation at an early stage, shedding light on the translational value of NMN as an enhancer for skeletal regeneration and highlighting the pivotal role of macrophage-stem cell interactions in governing the regenerative influence of NMN on stem cells.

Comparison of Results between Minimally Invasive Plate Fixation and Antegrade Intramedullary Nailing of Recon-Type in Low-Energy Injury Distal Femoral Shaft Fractures

Comparison of Results between Minimally Invasive Plate Fixation and Antegrade Intramedullary Nailing of Recon-Type in Low-Energy Injury Distal Femoral Shaft Fractures

A prospective observational study examining the radiological and functional results of locking compression plate treatment for femur diaphyseal fractures in children

A prospective observational study examining the radiological and functional results of locking compression plate treatment for femur diaphyseal fractures in children

Mean independent walking time for children with Femoral Shaft fractures using Titanium Elastic Nailing VS Hip Spica Cast treatment

Objective: To investigate the mean amount of time it took children with Hip spica casts versus titanium elastic nailing for the treatment of femoral shaft fractures to walk independently. Design: Retrospective cohort study. Place and Duration of Study: From 1st September 2021 to 31st September 2022 at Department of Orthopedic Surgery, Benazir Bhutto Hospital, Rawalpindi. Methodology: A study on 60 pediatric patients suffering from femoral shaft fractures of both genders aged four till eight years of age using convenient sampling. Results: The patients' average age was 5.58 ±1.24 years. There were 39 (65.0%) male and 21 (35.0%) female patients in the study group with a male to female ratio of 1.9:1. Compared to hip spica casts, children treated with titanium elastic nails had a considerably shorter mean time to walk independently (5.60±1.28 weeks vs. 8.93±1.98 weeks; p-Value = 0.001). Numerous patient subgroups based on age, gender, and weight showed similar statistically significant variations among the cohorts. Conclusion: In terms of considerably reducing the mean time to walk freely, this study found that titanium elastic nailing is preferable to the traditional method of hip spice cast. Future orthopaedic practice should prioritise the titanium elastic nails to be used in the fractures of this kind because to their minimally invasive nature, improved patient hygiene, and aesthetic appearance. Keywords: Shaft of femur, Fracture, Elastic Nailing, Hip Spica Cast, Walking time. How to Cite This: Shahid R, Haider M, Talib A, Butt NS, Mirza AN, Fazal F. Mean independent walking time for Children with Femoral Shaft fractures using Titanium Elastic Nailing VS Hip Spica Cast Treatment. Isra Med J. 2023; 15(2): 47-50. DOI: https://doi.org/10.55282/imj.oa1382

Percutaneous TENS in Pediatric diaphyseal femoral fractures- Respects biology and ends happily

Femoral shaft fractures are amongst the most common major pediatric injuries treated by orthopaedic surgeons. They represent 1-2% of all fractures in the paediatric population. Paediatric males are affected more commonly than females. [1] There are various methods available for operative stabilization of paediatric femoral shaft fractures, which include external fixation, compression plating and rigid and flexible intramedullary nailing. [2] There is no uniform consensus on the treatment modality for femoral shaft fracture in school-aged children between 6 years to16 years. Titanium elastic nailing system (TENS) is a recent and widely used technique which allows stable reduction, maintenance of reduction and early mobilization. [3] American Academy of Orthopaedic Surgeons (AAOS) recommends with strong evidence based support in favour of the use of flexible intramedullary nailing for treating children age five to eleven years diagnosed with diaphyseal femur fractures. [4, 5] This device exploits a child’s denser bone, rapid healing and ability to remodel during period of bone growth. Here, we establish this axiom by a detailed case presentation, who was successfully treated with flexible intramedullary nailing for diaphyseal fracture of the femur.

A Major Orthopaedic Surgery in a Hundred-year-old Patient During Pandemic of COVID 19: A Case Report

It has been undoubtedly assumed that COVID-19 imposes an immense economical and psychological trauma to all common people. It is also true that COVID-19 had been appeared like a “world war” for health care workers all over the world. However, either conservative or operative treatment were offered for all trauma patients even during that period. We report a 100 years old female patient with femoral shaft fracture who was treated with intramedullary interlocking nail with full precautions to prevent virus transmission during lock down period. The post and perioperative complications were uneventful, and she was walking comfortably after surgery. Keywords: COVID 19; Femoral fracture; Lock down; Pandemic