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Femoral Shaft Fracture

See Also
1. Hip Fracture
Pathophysiology
1. High energy injury (often in young adults)
  1. Motor vehicle accident
  2. Pedestrian accident
  3. Fall from height
Diagnosis
1. See Hip Fracture
2. Distal to first 5 cm of femoral shaft
  1. Below Subtrochanteric Fracture
3. Descriptive Classification
  1. Proximal or distal location
  2. Transverse or oblique angle
  3. Comminuted (common)
Management
1. Immobilize hip and knee
2. Evaluate for associated injuries (see pitfalls below)
3. Closely manage fluid status
  1. Initial Resuscitation with isotonic crystalloid
  2. Type and Cross for 2 Units pRBC
  3. Continually reassess hemodynamic status
4. Open reduction and internal fixation
  1. Intramedullary rods
Complications
1. Significant blood loss and hemodynamic instability
Pitfalls
1. Associated injuries are common
  1. Hip Fracture including Femoral Neck Fracture
  2. Supracondylar femur Fracture
  3. Patella Fracture
  4. Knee ligament injury
References
1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60
2. Russell (2002) Orthop Clin North Am 33(1):127

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.