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 login to view 5 more bullets 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 login to view 1 more bullet Medical prophylactic tetanus vaccination and antibiotics indication login to view 1 more bullet pain management indication login to view 1 more bullet modalities login to view 2 more bullets Operative orthopedic surgery indication login to view 1 more bullet modality login to view 1 more bullet 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