SPECIFIC FEATURES ASSOCIATED WITH FEMORAL-SHAFT FRACTURES CAUSED BY LOW-ENERGY TRAUMA

Objective: To scrutinize the fracture patterns of femoral shaft fractu res caused by low-energy injury mechanism and to delineate the problem s associated with the treatment of these fractures. Materials and Meth ods: Of a total of 192 consecutive skeletally mature patients with 201 acute fresh femoral shaft fractures admitted during a 10-year period (1985-1994), 50 patients had a fracture caused by low-energy trauma. T he fractures were classified in terms of their configuration, site, de gree of comminution, and soft-tissue injury, The previous fractures, c hronic illnesses, and continuous medications of the patients as well a s the injury mechanisms and concomitant injuries were registered, All general and local complications and their consequences were recorded, Forty patients could be followed until the bony union of the fracture was achieved, the mean follow-up time being 14 months.Results: The inc idence of these injuries was 2.5 per 100,000 person-years, There were 32 women and 18 men, The mean age of the patients was 65 years (range, 17-92 years). Thirteen patients were younger than 60 years of age. Th irty-two (64%) had at least one local or general factor weakening the mechanical strength of the bone that predisposed them to a fracture. T hirty-two patients sustained a fracture of the left femur (p < 0.05), All fractures were closed, None of the patients had significant concom itant injuries, In 33 cases, the site of the fracture was in the middl e third of the femur, The fracture configuration was spiral in 29, tra nsverse in 10, oblique-transverse in 7, and oblique in 4 cases. Postop erative complications, including delayed union, nonunion, and malunion , occurred with 29 patients, Eighteen reoperations among 12 patients w ere performed because of these complications. Conclusions: Femoral sha ft fractures caused by low-energy violence occur mainly in patients su ffering from a chronic disease or a condition causing osteopenia of th e femur, The most common fracture pattern was a spiral one in the midd le third of the femoral shaft, Despite the low-energy violence, the tr eatment of these fractures is not devoid of complications, The treatme nt of these seemingly simple fractures requires careful planning and m eticulous operative technique.