This document summarizes the treatment of femur shaft fractures. It describes the typical causes, presentation, and pathoanatomy of femur fractures. Conservative treatment options include traction with splints or casts. Operative options are closed intramedullary nailing or plating with screws. Treatment decisions depend on factors like age, location, and presence of wounds. Complications can include shock, fat embolism, nerve injuries, infection, malunion, and knee stiffness.

1. By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Femur shaft fracture

2. • Sustained by sever
violence
• Force may be direct
or indirect (Twisting
and bending force)

3. Pathoanatomy
• Common in the upper and middle-lower third
of shaft
• May be transvere, oblique, spiral or
comminuted
• Children no displacement
• Adult marked dispalcement
• Proximal fragment is flexed, abducted and ER
by the pull of muscles

4. • Distal fragment is adducted because of
adductor muscle
• Unsupported distal end of fracture sags
because of gravity
• There is proximal migration of this fragment

5. Diagnosis
• Clinical features
– History of fall or injury
– Pain, swelling, deformity and abnormal mobility
– Radiological features
– Pelvis is also included in x-ray

6. Treatment
• Conservative treatment
a) Traction
– With or without splint
– Usually thomas splint is used
– Skin traction in children
– Skeletal traction in adult by stienmann pin passed
through upped end of tibia

7. • Plaster cast
– May be single spica or one and a half spica
– It can be used in children
– It can be used in adult once fracture becomes
sticky

8. • Operative method
– Closed interlock nailing

9. • Platting
– Minimum 8 screw is desirable
– Special condylar blade plate may be used

10. Deciding the treatment plan
• It depends upon the age, location of fracture,
type of fracture and presence of wound. Open
fracture is treated conservatively and in bad
case an external fixator may be used

11. Deciding
treatment plan
Children
From birth to 2
years
Gallow’s traction
From 2 years to 16
years
Traction, once fracture becomes sticky gives spica
Internal fixation for more then 10 years of age
Adult
ORIF

12. Complications
1. Shock
– Average 1000-1500 ml of blood is lost
– Can result in hypovolaemic shock
– Immediate I.V. line
– A closed watch should be kept on pulse and blood
pressure post injury period

13. 2. Fat embolism
– Patient shows symptoms after 24-48 hours
– Frequent shifting without proper splintage should
be avoided

14. 3. Injury to femoral artery
– Sharp edge of bone may cause it
– Occurs at junction of middle and distal third of the
femoral shaft fracture
– Immediate repair required

15. 4. Injury to sciatic nerve
– Sharp edge of bone
– Injury may vary from neuropraxia to complete
severance of the nerve

16. 5. Infection
– Open fracture – wound contamination can lead to
osteomyelitis
– Risk is maximum in fracture with extensive wound
and those with gun shot wounds

17. 6. Delayed union
– If union is still insufficient to allow unprotected
weight bearing after 5 months, it is considered
delayed.
– Bone grafting surgery

18. 7. Non-union
– It occurs when the fracture surfaces become
rounded and sclerotic
– Can led to implant failure incase of operated cases
– Treatment is by internal fixation an bone grafting

19. 8. Malunion
– Deformity is lateral angulation and external
rotation
– Significant shortening due to overlap of the
fragments
– Corrective osteotomy and fracture is fixed with
internal fixation. Bone grafting is done additionally
– In children it is corrected by the process of
remodeling.

20. 9. Knee stiffness
– Intra articular and periarticular adhesions
– Quadriceps adhering to the fracture site
– An associated knee injury
– Quadricepsplasty

21. Thank you

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