A 16-year-old male was in a motor vehicle collision while unrestrained and traveling at 75 mph. He sustained major vehicle damage and a prolonged extrication. At the scene, he complained of severe right thigh pain and inability to bear weight. Emergency medical services placed a traction splint on his right lower extremity. At the hospital, imaging revealed a transverse midshaft femoral fracture that was displaced with bone debris. He required intravenous fluids, possible blood transfusion, antibiotics, tetanus update, and emergent orthopedic consultation for admission and surgery.

2.  16 YOM s/p MVC. Pt was driving
75 MPH on the interstate,
unrestrained, no LOC, airbags
deployed, impacted from the
driver side of the vehicle, major
damages to the vehicle,
prolonged extrication, Pt
complains of severe pain to the
right thigh and inability to bear
weight. Traction splint placed on
the scene by EMS on the right
lower extremity.
 T 97.9 P 116 BP 95/55 RR 16 O2 95%





on 2L BNC
Gen: Uncomfortable and in distress
2/2 pain, GCS 15.
Pulm: BS equal and CTA bilaterally.
Trachea midline.
CV: S1S2 tachycardia, pulses weak
throughout.
Abd: soft, nondistended, 20 cm
RUQ contusion.
Ext’s: Right thigh circumferential
swelling and
ecchymosis, shortened
RLE, diminished dorsalis
pedis/posterior tibial pulse.
Decreased tactile sensation.
Preserved motor of ankle/toes.

4.  Transverse mid shaft
femoral fracture
 Displaced with
bayonet apposition
 Note the comminuted
bone debris at the
end of the fractured
surface of the
proximal femur.

5.  ABC’s of trauma resuscitation
 Type and Screen
 IV fluids/PRB’s transfused as needed.
 Antibiotics and copious irrigation if open fracture.
 Update Tetanus.
 Traction splint/Immobilization
 Emergent Orthopedic consult for admission,
surgery.

6.  Femoral Shaft Fractures can hemorrhage up to 1.5 L of
blood internally.
 Femoral Shaft Fractures are highly associated with
concomitant life threatening injuries 2/2 to the
high-energy mechanism of trauma.
 Investigate for intra-thoracic/abdominal/pelvic injury
in case of hemorrhagic shock.
 Traction splint contraindicated in the presence of an
open fracture with grossly contaminated exposed
bone or sciatic nerve injury.

7.  Oblique femoral shaft
fracture of an infant.
 Spiral Fracture
• Comminuted Fracture

8.  Robert R. Simon, Steven J. Koenigsknecht, "Chapter 14.
Thigh" (Chapter).
 http://www2.aaos.org/aaos/archives/acadnews/acad2
007/B8_2-16.asp
 http://www2.aofoundation.org
 Tintinalli's Emergency Medicine:
A Comprehensive Study Guide, 7e . Chapter 270:
Femoral Shaft Fractures.