Femoral Shaft Fractures

Femoral shaft fractures are usually associated with young adults, but their presence in the elderly should arise suspicion of a ‘pathological’ fracture.

Mechanism of Injury

Considerable violence such as that experienced in road traffic accidents is needed for these fractures to occur. The type of fracture pattern present varies considerably depending on the cause. A spiral fracture is usually produced by a fall in which the foot has been anchored whilst a twisting force is transmitted to the femur. Transverse and oblique fractures occur from direct violence. In addition the fractures may be comminuted or segmental.

Classification

Fractures of the femoral shaft can be classified into three separate categories:

• Simple:
• Spiral
• Oblique
• Transverse
• Butterfly fragment:
• Single butterfly fragment
• Two fragments
• Three or more fragments
• Comminuted / segmental
• One segmental intermediate fragment
• One segmental fragment with short comminution
• Multiple fragments with large and significant length of comminution

Clinical Features

The patient complains of pain following an injury. The affected limb is shortened, externally rotated and may be deformed. The patient is unable to weight bear on the affected limb and unable to move either his hip or knee.

X-rays are needed to confirm the diagnosis. Pelvic x-rays also need to be taken.