Fractures Of The Femur Shaft Winquist & Hansen - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the Winquist and Hansen classification of the femur.

There are two classification systems that are currently used for fracture of the femur:
1-AO classification: AO classification is f academic interest, used in research and has minimal practical and clinical application. It may predict having another injury.
2-Winquist & Hansen classification: system based on the extent of comminution and the amount of cortical contact between the fractured fragments in the shaft of the femur. If you have a value in early weight bearing and in the use of interlocking screws.
•Type 0 : no comminution at the fracture site.
•Type I: small butterfly that covers less than 25% of the width of bone.
•Type II: larger butterfly that covers less than 50% of the width of the bone.
•Type III: large fragment more than 50% of the width of the bone. Small spike is the contact.
•Type VI: segmental comminution with no contact between the proximal and the distal fragments.
•Type I & II of midshaft fractures are stable in length (Axially stable) with good contact between proximal and distal fragments. Type III & IV are unstable in length and rotation.
This classification is for traumatic fractures, not for pathological or stress fractures. Axially stable fractures are more amenable to earlier weight bearing after IM rod. Antegrade reamed IM rodding (statically locked to control rotation) is the standard care for femur shaft fractures regardless of the type of fracture.
Technique: piriformis entry site is preferred. Insertion of the guide wire. Reaming. Rod & screw placement. The union rate is close to 98% with infrequent complications. early stabilization of femur shaft fractures within 24 hours decreases complications such as fat embolism, pulmonary complication and deep vein thrombosis (DVT). Balance the risk in fixation of the fractured femur in head injured patients. Consider external fixation first then convert it to IM rodding within 3 weeks. Reaming is not recommended in patients with bilateral chest trauma. Reaming and ARDS is a controversial subject. At least two interlocking screws should be used in all fractures, one proximal and one distal. Oblique orientation of the proximal screws is preferred instead of transverse orientation which could fail. For several and segmental comminution, multiple interlocking screws proximal and distal should be considered. IM nailing release IL-6 and IL-8.
Complications of IM rodding of the femur
•In supine position there is an increased incidence of internal rotational deformity.
•Pudendal nerve injury
•Heterotopic ossification is the most frequent complication but is not clinically significant.
•Varus malunion can occur in trochanteric start point.
Winquist & Hansen classification remains to be a good communication tool between health professionals. It is easy to remember and signify the severity of the injury, the higher the number the worse the injury, and it does not guide the clinician to the use of interlocking screws. The fracture classification may also change during surgery form a pre-existing undetected fracture or from an iatrogenic fracture.

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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step

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