All

• Age: bimodal distribution, based on exposure to causative force

  • High-energy trauma associated: common in younger population (< 25 years)

  • Low-energy trauma associated: common in older population (> 65 years)

• Sex: ♂ > ♀

A fracture in the diaphysis (shaft) of the femur caused by:

• High-impact trauma: motor vehicle accidents, pedestrian-versus-vehicle accidents, falls, gunshot wounds

• Low-impact injuries associated with pathological fractures : fall from standing (height > 1 m)

• Stress fractures (rare): seen in long distance runners

Femoral shaft fractures are divided by the Winquist-Hansen classification, based on the degree of comminution. This includes the following categories:

• Type 0: no comminution, simple transverse or oblique

• Type I

  • Small butterfly fragment

  • Minimal to no comminution

• Type II: butterfly fragment with at least 50% of the circumference of the cortices of the two major fragments intact

• Type III: butterfly fragment with 50-100% of the circumference of the two major fragments comminuted

• Type IV

  • Segmental comminution

  • All cortical contact is lost

• Painfully swollen, tense thigh

• Restricted range of motion

• Signs of fracture (e.g., shortening, deformity)

• Crepitus and distal neurovascular deficits could be present.

Beware of symptoms associated with fat emboli: change in mental status, dyspnea, hypoxia, petechiae, or fever.

Open fractures are almost always associated with multiple injuries.

• Plain x-ray: See “X-ray signs of fracture.”

• CT and MRI if a tumor, infection, or other pathological process is suspected

• Arteriography if vascular injury is suspected

• Stabilization, analgesia, and open fracture management

• Splinting and traction

• Surgery (definitive treatment)

  • Intramedullary rod via an interlocking nail (antegrade nailing): treatment of choice

  • External fixation with conversion to intramedullary nail within 2–3 weeks

• Posttraumatic deformity

  • Rotational error

  • Osteoarthritis of the knee

• Myositis ossificans