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 login to view 1 more bullet Epidemiology Incidence login to view 1 more bullet Etiology Pathoanatomy login to view 7 more bullets High energy trauma to the femur Presentation Symptoms login to view 2 more bullets Physical exam login to view 2 more bullets Imaging Radiography login to view 4 more bullets Studies Labs login to view 3 more bullets Making the diagnosis login to view 1 more bullet Treatment Conservative login to view 3 more bullets Medical login to view 9 more bullets Operative login to view 5 more bullets Complications Infection Union problems login to view 3 more bullets 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