Femoral Shaft Fracture

MANUAL MINORS

A femoral shaft fracture is a break in the middle portion or “body” of the femur, the longest and strongest bone in the human body. This type of fracture usually occurs due to high-energy trauma, such as car accidents or falls from significant heights.

In older individuals or those with bone conditions like osteoporosis, it can occur after low-energy trauma. These fractures are serious and require urgent management due to the risk of significant bleeding, hypovolemic shock, and associated injuries.

Diagnosis

Clinical diagnosis is made following major trauma, where the patient presents with severe pain, visible deformity (rotation, leg shortening), and an inability to move the limb. Physical examination reveals swelling, bruising, and sometimes abnormal movement at the fracture site.

Confirmation is achieved through anteroposterior and lateral X-rays of the limb, which show the type of fracture and displacement. Occasionally, a computed tomography (CT) scan may be needed to better evaluate complex fractures or associated injuries.

Differential Diagnosis

Condition	Key Differentiation
Intertrochanteric Fracture	Affects the area between the greater and lesser trochanter of the proximal femur.
Subtrochanteric Fracture	Occurs just below the lesser trochanter of the femur.
Supracondylar Fracture	Occurs in the distal part of the femur, near the knee.
Knee Ligament Injuries	Knee instability without femur fracture.
Hip Dislocation	Displacement of the femoral head out of the acetabulum, without fracture of the femoral shaft.

Emergency Management

Emergency management focuses on stabilising the patient and preventing complications. The steps include:

• Haemodynamic Stabilisation: Femoral fractures can cause significant bleeding. Intravenous fluids or blood transfusion may be necessary in severe cases.

  
  

• Temporary Immobilisation: Skin traction or splints are used to immobilise the limb and reduce pain and displacement of bone fragments.

  
  

• Analgesia: Strong pain relief, such as opioids, is administered to control pain.

  
  

• Evaluation of Associated Injuries: It is important to rule out vascular, neurological, or other injuries, particularly in cases of high-energy trauma.

  
  

Definitive Treatment

Definitive treatment is surgical in most cases, with the most common options including:

• Intramedullary Nailing: This is the treatment of choice for most femoral shaft fractures. It stabilises the fracture internally, promoting proper healing and allowing early mobilisation.

  
  

• Plates and Screws: In some cases, especially if the fracture is more complex or intramedullary nailing is not possible, plates and screws are used to fix the fracture.

  
  

• External Fixation: This is a temporary option in cases of severe trauma with soft tissue involvement, such as open fractures or polytrauma, until definitive surgery can be performed.

  
  

Rehabilitation begins as soon as possible with range-of-motion exercises and progressive strengthening. Depending on the type of fracture and the surgical treatment, weight-bearing on the affected limb may be restricted for several weeks or months. Regular follow-up with X-rays is necessary to ensure proper healing and to detect complications such as non-union or malunion.