Femoral shaft fractures usually result from severe force and are clinically obvious. Treatment is with immediate splinting with traction followed by open reduction with internal fixation (ORIF).
(See also Overview of Fractures.)
The usual injury mechanism for femoral shaft fractures is severe direct force or an axial load to the flexed knee (typically in a motor vehicle crash or automobile-pedestrian collision). Thus, other serious injuries are often present.
Symptoms and Signs of Femoral Shaft Fractures
Fracture causes obvious swelling, deformity (often with shortening), and instability. Up to 1.5 L of blood for each fracture may be lost. Hemorrhagic shock is possible, particularly when the cause is blunt trauma and there are other injuries.
Diagnosis of Femoral Shaft Fractures
X-rays
Anteroposterior and lateral x-rays are diagnostic.
If the fracture resulted from great force, hip x-rays should always be done to look for an ipsilateral femoral neck fracture. The knee also needs to be carefully evaluated.
Image courtesy of Danielle Campagne, MD.
Treatment of Femoral Shaft Fractures
Immediate splinting with traction
Open reduction with internal fixation (ORIF)
Immediate treatment is splinting, usually with a commercially available femoral traction splint (such as a Hare traction or Sager traction splint), followed by ORIF. Because traction splints apply traction to the lower leg, they should not be used if patients also have a tibial fracture.
Key Points
Femoral shaft fractures usually result from severe forces and are not clinically subtle.
For each fracture, up to 1.5 L of blood may be lost.
X-ray the hip and evaluate the knee if the femoral shaft is fractured.
Splint femoral shaft fractures as soon as possible.
