Femoral shaft fractures occur in the diaphysis of the femur between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle. They are commonly caused by high-energy trauma in young adults and falls in the elderly. Clinical evaluation involves assessing neurovascular status, associated injuries, and deformity or shortening of the leg. X-rays are used to confirm the diagnosis and classify the fracture. Treatment options include traction, casting, intramedullary nailing, plate fixation, or external fixation depending on the patient's age and the fracture pattern. Complications can include blood loss, nerve injuries, infections, and non-union.

1. Femoral Shaft Fractures
Dr. Ajay Alex
CMC, Ludhiana

2. Anatomy
Long tubular
bone, anterior
bowed forward
and has oblique
course from the
neck to distal
end.

3. Compartments of thigh
Muscle of the thigh are arranged in three
Compartments
1-anterior compartment of thigh
Contains the sartorius and the four large
quadriceps
2-medial compartment of thigh
(gracilis ,pectineus, adductor longus, adductor
brevis, adductor magnus, and obturator
externus)

4. 3-posterior compartment of thigh
contain three large muscle termed the
‘”hamstring”
Femur is surrounded by massive musculature
,which provide the blood supply to femur

7. Fracture Shaft Of Femur
• A femoral shaft
fracture is a fracture
of the femoral
diaphysis occurring
between 5 cm distal
to the lesser
trochanter and 5 cm
proximal to the
adductor tubercle

8. Epidemiology
-Common injury due to major violent
trauma
-1 femur fracture/ 10,000 people
more common in people < 25 yr or >65 yr
-Motor vehicle, motorcycle, auto-
pedestrian, fall from height, and gunshot
wound

9. Mechanism Of Injury
• In Young Adults, almost always the result
of high-energy trauma,
– Motor vehicle accident
– Gunshot injury, or
– Fall from a height
• Pathologic fractures, especially in the
elderly, commonly occur following a trivial
fall
• Stress fractures occur mainly in military
recruits or runners

10. Symptoms
Diffuse pain or ache, and tenderness and
swelling in the thigh or groin.
Bleeding and bruising in the thigh
(uncommon).
Weakness and inability to bear weight on the
injured leg.
Paleness and deformity

11. Clinical Evaluation
• A full trauma survey is indicated (ABC)
• The patient is
–Non ambulatory with pain
–Variable gross deformity of thigh
–Swelling,
–Shortening of the affected extremity.
• A careful neurovascular examination is
essential

12. • A careful assessment of hemodynamic
stability is essential,
Average expected Blood loss of 750-1500ml
• Thorough examination of the ipsilateral hip
and knee should be performed
• Knee ligament injuries are common,
however, and need to be assessed after
fracture fixation

13. Associated Injuries
• Ipsilateral femur neck, intertroch, distal femur
#s
• Patella, tibia, acetabular, pelvic ring #s
• Soft tissue injuries of knee
• Thoracic & abdominal injuries(5-15%)

14. X-ray
Will confirm the diagnosis and establish the
sites ,line ,extent and displacement
• AP and Lateral views of
the femur, hip, and
knee
• AP view of the pelvis
should be obtained
• Look for evidence of an
associated femoral neck
or intertrochanteric
fracture, knee injuries

18. Winquist and Hansen , 1984
* Type 0 - No commination
*Type 1 - Insignificant butterfly
fragment with transverse or short
oblique fracture,
*Type 2 - Large butterfly of less than
50% of the bony width, > 50% of
cortical contact
*Type 3 - Larger butterfly leaving less
than 50% of the cortex in contact
*Type 4 - Segmental commination

20. AO classification

21. Management-paediatrics

22. Pavlik Harness for
Age<6months
Hip Spica Cast
for Age upto 5 years

23. Gallows
Traction
Paediatric
Thomas Splint

24. Flexible Intramedullary Nail Fixation

25. Adults-Non operative
• Traction- Skeletal, thomas splint
• Cast braces- uncommonly used

26. For patients in whom surgery needs to be
delayed, temporary stabilisation with
Skeletal traction is required

27. Operative Fixation Options
• Intramedullary Fixation
• Open Reduction and Plate Fixation
• External Fixation
(For Open/ Infected Fractures)

28. Intramedullary Fixation

29. Plate Fixation

30. Indications for plating
• Patients wit extremely narrow medullary
canal
• Fractures around or adjacent previous
malunion
• Fractures extending proximally or distally into
the pertrochanteric or metaphyseal region
• Ipsilateral neck fractures

31. External Fixation
• Severe soft tissue
injuries
• Contamination
• Associated vascular
injuries
• Polytrauma-temporary
method

32. COMPLICATION
1-GENERAL
Blood loss, shock ,fat embolism, and acut
respiratory distress are common in high-
energy injuries

33. COMPLICATION
2-Vascular injury
3-Nerve injury-iatrogenic(femoral, sciatic,
pudendal, peroneal)
4-Thromboembolism
5-Compartment syndrome(1-2%)
6-Infection
7-Delayed union and non-union
8-Joint stiffness, knee & hip pain
9-Heterotrophic ossification