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CPD article: Fractures of the femur

02 May 2021
39 mins read
Volume 26 · Issue 5
Figure 1. Two ventrodorsal views of the pelvis of a one-year-old Domestic Medium Haired Cat presenting with acute onset left hind limb lameness. Note that on the hip extended view on the left, the slipped capital femoral epiphysis is difficult to appreciate with very mild displacement and slight widening of the physis (green arrow), while on the frog-leg view on the right the displacement of the L-shaped physis is moderate and easily observed (yellow arrow).
Figure 1. Two ventrodorsal views of the pelvis of a one-year-old Domestic Medium Haired Cat presenting with acute onset left hind limb lameness. Note that on the hip extended view on the left, the slipped capital femoral epiphysis is difficult to appreciate with very mild displacement and slight widening of the physis (green arrow), while on the frog-leg view on the right the displacement of the L-shaped physis is moderate and easily observed (yellow arrow).

Abstract

Femoral fractures occur commonly in dogs and cats, accounting for 45% of all long bone fractures. Femoral fractures are classified based on anatomic locational and include fractures of the proximal epiphysis, proximal physeal fractures, subcapital fractures, fractures of the femoral neck, trochanteric fractures, subtrochanteric fractures, fractures of the femoral shaft, supracondylar fractures, distal physeal fractures, unicondylar fractures, bicondylar fractures and fractures affecting the femoral trochlea. In general, femoral fractures are not amenable to treatment with external coaptation, so surgical stabilisation or a salvage procedure is required. Selection of an implant system will depend on fracture configuration and location, and requires a thorough understanding of the forces to which the implant system will be subjected. Complications associated with stabilisation may include premature physeal closure, resorption of the femoral head or neck, malunion, non-union, altered coxofemoral development, implant failure, sciatic neurapraxia, quadriceps contracture, patellar luxation and infection. The complication rate can be substantially reduced by the use of meticulous surgical technique and appropriate implant selection with the prognosis for complete functional recovery remaining good to excellent, providing that an optimal healing environment is preserved.

Femoral fractures occur commonly in both cats and dogs accounting for 20–26% of all fractures and 45% of all long bone fractures (Whitehair and Vasseur, 1992). They appear to occur more commonly in younger animals, with one study reporting that 69% of femoral fractures occurred at or below 2 years of age. These fractures usually occur secondary to high impact injuries from vehicular trauma, falls or gunshot wounds (Whitehair and Vasseur, 1992). Fractures that result from minimal trauma warrant diagnostics to rule out an underlying pathological condition, most commonly neoplasia (Beale, 2004). Because of the extensive overlying musculature, which both protects the skin from the sharp bone fragments and acts as a shock absorber during trauma, the majority of femoral fractures remain closed (Braden et al, 1995; Beale, 2004). Only 8% of femoral fractures are reported to be open, which is substantially lower than corresponding percentages for the distal tibia where rates of up to 20% have been reported (Hayashi and Kapatkin, 2012).

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