Snapshot A 17-year-old boy presents to the emergency department after a motor vehicle accident. Emergency medical services arrived at the scene and the patient was in extreme pain. His lower extremity is deformed. An intravenous catheter is placed and he is administered analgesics and normal saline, and his lower extremity is immobilized. On physical exam in the emergency department, his left thigh is shortened with an opened wound. He is prophylactically given a tetanus vaccine and antibiotics. Radiography of the left leg demonstrates a femoral midshaft fracture. Orthopedic surgery is consulted and preparations are made to implant an antegrade reamed intramedullary nail. Introduction Clinical definition fracture of the femoral shaft Epidemiology Incidence more common in the young (< 20 years of age) and the elderly (> 75 years of age) Etiology Pathoanatomy the femur is the strongest, longest, and heaviest bone in the body composed of 3 regions proximal includes the femoral head, neck, and intertrochanteric area shaft distal includes the supracondylar region High energy trauma to the femur Presentation Symptoms pain patients typically report a history of trauma Physical exam leg deformity and swelling thigh shortening Imaging Radiography indication to assess for fracture views femur, hip, and knee Studies Labs complete blood count coagulation profile blood type and cross-match Making the diagnosis a clinical diagnosis supported by imaging Treatment Conservative stabilize and resuscitate the patient indication performed in patients who are bleeding from an open fracture or other wounds Medical prophylactic tetanus vaccination and antibiotics indication in patients with open fractures pain management indication an important component of the initial management of femoral fractures modalities medications femoral nerve block Operative orthopedic surgery indication definitive treatment for patients with femoral shaft fractures modality antegrade reamed intramedullary nail Complications Infection Union problems malunion delayed union ununion Hemorrhage Neurovascular injury Compartment syndrome Fat embolism Prognosis Low complication rates and the prognosis is usually favorable in patients with minimal or absent comorbidities and no other significant injuries