Femur

Anatomy: The longest bone found in the body, the ‘thigh bone’ is the strongest and most voluminous bone in humans. Its upper portion forms part of the hip joint (acetabulum) and its lower portion forms the upper part of the knee joint.

Regions:


?Proximal Portion: head, neck, greater trochanter, lesser trochanter, intertrochanteric line, intertrochanteric crest


?Body: linea aspera. Gluteal tuberosity (third tubercle), pectineal line


?Distal Portion: adductor tubercle, medial/lateral epicondyles, medial/lateral condyles, patellar surface, intercondylar fossa

Articulation: proximally with acetabulum of pelvis forming the hip and distally with the tibia and patella forming the knee joint.

Muscle Origins: gastrocnemius, vastus lateralis/medialis/intermedius

Muscle Insertions: tensor fascia latae, gluteus medius/minimus/maximus, iliopsoas

Blood Supply: branches of the profunda femoris arising from the femoral artery.


?Head of Femur: medial/lateral epiphyseal artery


?Neck of Femur: superior/inferior metaphyseal artery

Fractures: can cause significant disability as muscles that originate/insert on the thigh can pull the bone fragments away from their original site causing improper alignment upon healing. To maintain proper alignment, femur fracture patients are put into traction to reduce the pulling of muscles on bony fragments. Surgery is an option with the insertion of rods and screws (anterograde/retrograde femoral rodding) and is quite successful at recovering full range of motion. Early weight-bearing after surgery may delay bone healing and a time-line to weight-bearing should be provided by your orthopaedic surgeon. Casts are not usually applied to the thigh as internal hardware (rods and screws) generally straightens the bone and holds the bones in place while healing. The hardware inserted usually does not need to be removed unless it is causing discomfort, which is seen more in patients with active lifestyles. Complications with the surgery can include: articular sepsis, arthritis, knee stiffness.

Garden Classification of Hip Fractures: determined by the appearance of the hip on anterior-posterior (AP) radiograph, which is then used to determine the appropriate treatment.


?stage I : incomplete fracture of the neck (abducted or impacted)


?stage II : complete neck fracture without displacement


?stage III: complete neck fracture with partial displacement (fragments are still connected by posterior retinacular attachment but there is malalignment of the femoral trabeculae)


?stage IV: this is a complete femoral neck fracture with full displacement (proximal fragment is free and lies correctly in the acetabulum making trabeculae appear normally aligned)

Pearls: Femoral neck fractures that are intracapsular may threaten any or all of the sources of blood to the femoral head as the artery supplying this area runs distal to proximal in regards to the femoral head.