Femoral Shaft Fractures

Question 1

What blood vessel supplies the femur?

Answer 1

Profunda femoris

NB: femur plays a large role in haematopoesis

Question 2

Where are Femoral shaft fractures most commonly seen?

Answer 2

• high energy trauma
• fragility fractures in elderly (low energy trauma)
• pathological fractures
• bisphosphonate related fractures

Question 3

What are the clinical features of femoral shaft fractures?

Answer 3

• pain in thigh/hip
• unable to weight bear
• may be obvious deformity

Asses skin which may be opened or threatened and preform full neurovascular examination of the lower limbs to check for nerve injury

Question 4

What position will the Proximal fragment of the femur be held in in a fracture?

Answer 4

Proximal fragment is pulled into flexion and external rotation by iliopsoas and and glut medius and minimus

Question 5

What investigations should be done for a femoral shaft fracture?

Answer 5

Routine urgent bloods, coagulation and group and save

Imaging - plain film radiograph
CT if polytrauma is suspected

Question 6

What is the conservative management for femoral shaft fractures?

Answer 6

AtoE assessment

Stabilise patient and fluid resuscitation
Adequate pain relief
Regional nerve blockade
Open fractures will need their own management

Immediately reduce and immobilise for appropriate haematoma formation

Traction splinting can be done but most fractures require surgery. Can do long leg casts if undisplaced and in patients with significant co morbidities.

Question 7

How are femoral shaft fractures surgically managed?

Answer 7

Surgically fixed within 24-48( hours although sooner if it’s an open fracture.

Can treat with an antegrade intramedullary nail if an isolated case.

External fixation may be used in unstable polytrauma or open fractures

Question 8

What are the common complications of a femoral shaft fracture?

Answer 8

• nerve injury or vascular injury
• mal union, delayed union or non union
• infection
• fat embolism