- The document discusses a fracture of the shaft of the femur, including its causes, typical presentations, treatments, and complications. A fracture of the femur shaft is usually caused by direct or indirect severe force and commonly results in displacement of bone fragments. Treatment depends on age, with traction and hip spica casts used for children and intramedullary nailing or plating as operative options for adults. Potential complications include shock, fat embolism, infection, malunion, and knee stiffness.

1. Insha Aleena
Fracture: Shaft of Femur

2. • A fracture of the shaft of the femur is usually sustained by a severe violence
• Force:
A. Direct (twisting/ bendig)
B. Indirect (RTA)
• Upper 1/3rd shaft of femur most commonly fractured at birth
• Maximum shortening of lower limb is seen in fracture of shaft of femur and
posterior hip dislocation

3. Pathoanatomy
• The fracture may occur at any site
• Transverse, oblique, spiral or comminuted fracture.
• Displacements: Not much in children.
In adults (marked displacement)- The proximal fragment is flexed,
abducted and externally rotated due to pull by the muscles attached to
it. The distal fragment is adducted because of attachment of adductor
muscles. The unsupported fracture-end of the distal fragment sags
because of the gravity. There is proximal migration (overriding) of this
fragment because of the pull by the muscles going across the fracture.
Displacements in fracture of the shaft of the femur

4. Diagnosis
• Clinical Features:
1. H/o severe violence
2. Classic signs of fracture in the region of the thigh (pain, swelling, deformity,
abnormal mobility etc.)
•Radiology:
1. X-ray: whole femur
2. X-ray pelvis for associated injury

5. Treatment
Conservative methods
• Traction: with or without splint (Thomas
splint). Skin splint is enough for children.
Skeletal traction (through an upper-tibial
Steinmann-pin) for adults.
• Hip spica: plaster cast (part of trunk and
limb)— single or 1 1/2 spica.
Immobilising fractures in children and
young adults once it becomes sticky.
Hip Spica 1 1/2

6. • Closed interlocking
nailing: fracture is
reduced under x-ray
control, without opening
it. Two horizontal screws
are passed through two
holes at the end of the
nails.
Operative methods
Treatment of choice: intra-
medullary nailing
Open/closed reduction
Intra-medullary nailing

7. • Plating (fixing with a thick strip of
metal): for fractures where
medullary canal is too wide or
comminuted fractures
Minimum of 16 cortex hold (8
screws)
AO heavy duty plates, with or
without compression
Special condylar blade-plate for
fractures close to either ends
Plating

8. Treatment Plan
• Children:
Birth to 2y- Gallow’s traction
2y to 16y- essentially conservative
(different methods of traction and hip spica
after fracture becomes sticky). Sometimes
oldres children may need operative
treatment (TENS- Titanium Elastic Nail
System used)
• Adults and elderly: operative treatment if
available
Gallow’s Traction

9. Complications
Early
• Shock
• Fat embolism
• Injury to femoral artery
• Injury to sciatic nerve
• Infection

10. Late
• Delayed union: treated by bone grafting
• Non-union: internal fixation and bone grafting
• Malunion: treatment depends on degree of malunion
shortening- shoe raise
Younger patients- operative methods (osteotomy and then fixing the fracture
with internal fixation device)
Children- mild deformities are corrected by remodelling

11. • Knee stiffness;
1. Intra-articular adhesions: released by arthroscopic techniques (arthrolysis)
OR gentle manipulation by GA.
2. Quadriceps adhesions: release
3. Contracted quadriceps: lengthening (Quadricepsplasty)

12. Thank You