Orris

Shaft of femur fracture

Reading File
Finding Sources
Finding Sources
Searching PubMed

femoral shaft fracture

Searching the Web

AAOS femoral shaft fractures treatment intramedullary nailing guideline

Searching Images

femoral shaft fracture AP lateral radiograph intramedullary nail

Postoperative AP radiograph of the right femur demonstrating dual-site orthopedic internal fixation. The image shows a mid-shaft femoral fracture stabilized with a long retrograde intramedullary nail. The nail is secured proximally with two interlocking transverse screws and distally with a single large interlocking screw. Centrally, a transverse fracture line remains visible with a slight radiolucent gap and minimal callus formation, suggesting early postoperative status or delayed union. Simultaneously, a femoral neck fracture is managed with three parallel cannulated cancellous screws inserted from the lateral femoral cortex into the femoral head. This combination of hardware addresses concomitant shaft and neck fractures, often referred to as a 'floating hip' or 'ipsilateral neck-shaft' injury pattern. Key educational elements include the identification of retrograde nailing technique, multiple screw fixation for neck stabilization, and the assessment of postoperative fracture alignment and hardware positioning.

Postoperative AP radiograph of the right femur demonstrating dual-site orthopedic internal fixation. The image shows a mid-shaft femoral fracture stabilized with a long retrograde intramedullary nail. The nail is secured proximally with two interlocking transverse screws and distally with a single large interlocking screw. Centrally, a transverse fracture line remains visible with a slight radiolucent gap and minimal callus formation, suggesting early postoperative status or delayed union. Simultaneously, a femoral neck fracture is managed with three parallel cannulated cancellous screws inserted from the lateral femoral cortex into the femoral head. This combination of hardware addresses concomitant shaft and neck fractures, often referred to as a 'floating hip' or 'ipsilateral neck-shaft' injury pattern. Key educational elements include the identification of retrograde nailing technique, multiple screw fixation for neck stabilization, and the assessment of postoperative fracture alignment and hardware positioning.

This composite of clinical radiographs displays the orthopedic management of a concomitant ipsilateral proximal and mid-shaft femoral fracture. Panel A provides preoperative views, including an anteroposterior (AP) pelvis and lateral femur radiograph, revealing a displaced transverse fracture of the right femoral mid-shaft and a concomitant intertrochanteric fracture. Panel B shows the 20-week postoperative follow-up, demonstrating surgical stabilization via internal fixation. The hardware consists of a single reconstruction intramedullary nail spanning the length of the femur. Two proximal cephalomedullary screws secure the intertrochanteric fracture, while distal interlocking screws provide rotational stability. The postoperative images in AP and lateral projections show evidence of advanced fracture union, cortical bridging, and restoration of anatomical alignment. This case illustrates the 'single implant' technique for managing complex, multi-level femoral fractures in orthopedic traumatology.

This composite of clinical radiographs displays the orthopedic management of a concomitant ipsilateral proximal and mid-shaft femoral fracture. Panel A provides preoperative views, including an anteroposterior (AP) pelvis and lateral femur radiograph, revealing a displaced transverse fracture of the right femoral mid-shaft and a concomitant intertrochanteric fracture. Panel B shows the 20-week postoperative follow-up, demonstrating surgical stabilization via internal fixation. The hardware consists of a single reconstruction intramedullary nail spanning the length of the femur. Two proximal cephalomedullary screws secure the intertrochanteric fracture, while distal interlocking screws provide rotational stability. The postoperative images in AP and lateral projections show evidence of advanced fracture union, cortical bridging, and restoration of anatomical alignment. This case illustrates the 'single implant' technique for managing complex, multi-level femoral fractures in orthopedic traumatology.

Reading File
Finding Sources
Finding Sources

Shaft of femur fracture

A shaft of femur fracture is a break through the diaphysis of the femur, usually between about 5 cm below the lesser trochanter and 5 cm above the adductor tubercle.
Femoral shaft fracture treated with intramedullary nail

Causes

  • Young adults: high-energy trauma, especially road-traffic collision, fall from height, or crush injury.
  • Older adults: low-energy trauma may suggest osteoporosis, metastatic disease, or another pathological lesion.
  • Children: consider non-accidental injury when the mechanism and injury are inconsistent.

Types

Describe by:
  • Level: proximal, middle, or distal third
  • Pattern: transverse, oblique, spiral, wedge, segmental, or comminuted
  • Skin status: closed or open
  • Displacement: shortening, angulation, rotation, translation

Clinical features

  • Severe pain and inability to bear weight
  • Swollen, tender, deformed thigh with shortening and external rotation
  • Crepitus or abnormal mobility, but do not repeatedly test for these
  • Check distal pulses, capillary refill, motor and sensory function
  • A substantial volume of blood can be lost into the thigh, so monitor for hemorrhagic shock
Associated injuries are common, including ipsilateral femoral neck, hip, knee, patella, and knee-ligament injuries. Plain AP and lateral radiographs of the entire femur, including hip and knee, are usually required. Rosen's Emergency Medicine, p. 698.

Emergency management

  1. ATLS approach: airway, breathing, circulation, disability, exposure.
  2. Control external bleeding and give analgesia.
  3. Establish IV access, assess for shock, send blood for grouping/cross-match.
  4. Immobilize the limb with a traction splint if appropriate. Avoid traction splinting with suspected pelvic fracture, ipsilateral tibial/ankle injury, or major knee injury.
  5. Give IV antibiotics and tetanus prophylaxis promptly for open fractures.
  6. Reassess neurovascular status before and after splintage.
  7. Urgent orthopaedic referral and admission.

Definitive treatment

Adults
  • Locked intramedullary nailing is the usual definitive treatment for most femoral shaft fractures.
  • External fixation may be used temporarily in unstable polytrauma patients, severe open injury, or extensive soft-tissue damage.
  • Plate fixation is reserved for selected fractures, including situations where nailing is unsuitable.
Children Management depends mainly on age, weight, fracture pattern, and associated injuries:
  • Infants/young children: Pavlik harness or hip spica casting.
  • School-age children: flexible intramedullary nails may be used.
  • Older adolescents nearing skeletal maturity: rigid locked intramedullary nailing is often used. The AAOS pediatric guideline outlines age-based options.

Complications

Early
  • Hemorrhagic shock
  • Open-fracture infection
  • Fat embolism syndrome
  • Deep venous thrombosis and pulmonary embolism
  • Neurovascular injury, though uncommon in closed shaft fractures
  • Associated occult femoral neck or knee injury
Late
  • Delayed union or nonunion
  • Malunion with shortening, angulation, or rotational deformity
  • Infection after fixation
  • Implant failure
  • Knee stiffness and chronic pain
Most appropriately treated fractures unite well. A recent systematic review also highlights that associated knee injuries may be missed, supporting careful knee assessment after the acute pain and swelling permit it (2026 review).
This is a shared conversation. Sign in to Orris to start your own chat.