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Femoral injuries
Essentials
- 1
Early reduction of femoral fractures and immobilization in traction reduces mortality.
- 2
Haemorrhagic shock is a major complication; with a closed femoral fracture the average blood loss is 1200 mL.
- 3
Fractures of the femoral shaft are associated with other significant injuries including those to the pelvis, hip and/or knee as well as multitrauma.
Femoral shaft fracture
Mechanism
Considerable force is required to break the adult femur in the absence of osteoporosis or metastatic disease with a bony secondary. The majority of femoral shaft injuries occur in young adults following motor vehicle accidents, falls from a height or gunshot wounds.
Classification
No universally accepted classification system for femoral shaft fractures exists. A precise description of the fracture provides the orthopaedic specialist with an indication of the potential for blood loss and the urgency of definitive management.
Femoral fractures are either open or closed and may be transverse, oblique, spiral or segmental. They may occur within the proximal third, midshaft or distal third of the femur. The degree of fracture comminution, soft tissue involvement and neurovascular status should also be described.
The majority of fractures occur in young adults with healthy bones and are transverse. Greater mechanical force usually results in comminution ( Fig. 4.8.1 ). Minimal force with pathological bone tends to produce metaphyseal fractures with propagation into the shaft.
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