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Updated: Dec 27 2017

Femoral Shaft Fracture

  • 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
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