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Forum Name: Bone trauma and fractures

Question: Femur Fracture non union


 Plutonium - Fri Dec 04, 2009 5:10 am

Broken Femur-mis aligned bone frag?
Hi
I broke my femur (comminuted rotated butterfly femur fracture-shaft) in a car accident on th 8th of Aug 2009. My Doc put in an IM titanium rod, with 3; 4.5mm dist screws, to stablise and align the fracture. My question is, in the xray, there is a piece of bone: which is not too big, but not small at all, rotated, and thats not aligned-so much so that there is a bump on my thigh. Is this normal? Its approx 35 degrees in angle against the femur. Its not callus beacuse its been there since day1. Also, when i bend my leg, i feel that frag moving, which is my biggest issue. I guess its always interfiering with my Quadriceps. Should the doc have reduced the fracture completely or is the piece thats not in alignment okay? Is the movement of the frag causing non-growth. also will it make it more sensitive when it does heal i.e, easy to refracture in the future? I came to kenya for vacation (was born n raised here) from the US for vacation, and this happend 2 days before i was supposed to leave. I am 19 yrs old male 6ft2 190lbs. don't smoke. Also, are the chances of non-union higher because of the piece? My ROM is excellent and muscle strength is not bad...I am currently on 50% WeightBearing. My xrays show no growth at the frag and slow growth at the very tiny pieces that are the only ones in contact!
Thank you so much for reading this...i really want to go out and play Basketball! Also is there any advice you can give me?
 Dr.M.Aroon kamath - Sun Dec 06, 2009 8:28 pm

User avatar Hi,
Femoral shaft fractures can be classified with the Winquist classification or the AO/OTA classification. The Winquist classification is based on the extent of comminution.

Type I represents a femoral shaft fracture with no comminution or a small butterfly fragment <25% of the bone.
Type II is a comminuted femoral shaft fracture with a butterfly fragment 50% or less of the width of the bone.
Type III is comminuted with a large butterfly fragment >50% of the width of bone.
Type IV is severe comminution of an entire segment of bone. Type V is a fracture with segmental bone loss.

Generally larger the butterfly fragment, more are the chances of non-union.

Isolated femoral shaft fractures treated with IM rods are expected to do well with nearly 90-100% union, <1% infection, and <10% incidence of malunion.

The fact that you are now 50% weight bearing indicates that the bone healing had been progressing well.It is probable that a small fragment of bone is still attached(pedicled) to the quadriceps or it could be an organised hematoma.

You must consult your ortho surgeon who will be able to assess and address your concerns.
Best wishes!

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