femur

AO Classification

Types

1. Supracondylar

2. Unicondylar

3. Intracondylar

Xrays

Supracondylar / Extra-condylar

Issues

Femur

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

Acetabulum

Dysplasia often present

- not as severe as in DDH

LLD

Can be significant

Abductors

Have been short for long time

- difficult to restore length

Epidemiology

Usually young patients

- 15 - 40

15% compound

Aetiology

High velocity injury

- MBA

- MVA

- pedestrian v car

- fall from height

Emergency Managment

EMST principles

- need for transfusion not uncommon

Subcapital Femoral Neck Metastasis

Fractures

Principle

- do very poorly with fixation

- hemiarthroplasty or THR

- stem should be 2.5 cortical diameters beyond any area of weakness

- THR if acetabulum involved

Region specific approaches

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

Lower Limb

Thigh

Goal

Initial press fit

- implant geometry fits the cortical bone in the proximal femur

- good initial mechanical stability

Biological fixation for success

- good press fit

- minimal micromotion

- bony or fibrous tissue ingrowth or ongrowth

Goals in femoral cementing

Optimize cement-bone interface

Cement mantle free of defects

Minimum 2 mm thickness

Femoral component centred in cement mantle

Survival

Swedish Joint Registry

Reflection All Poly / Spectron 92% 10 year

Definition

Circulation of tissues within a closed osteofascial space are compromised by increased pressure within that space

Most common 

- anterior leg compartment

- flexor compartment forearm

- deep posterior leg compartment

Aetiology

Prerequisite is volume restricting envelope 

- fascia & skin

- POP

- dressings

1.  Increased contents

Bleeding / edema 

- fracture