Femoral shaft fractures occur in the diaphysis of the femur between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle. They are commonly caused by high-energy trauma in young adults and falls in the elderly. Clinical evaluation involves assessing neurovascular status, associated injuries, and deformity or shortening of the leg. X-rays are used to confirm the diagnosis and classify the fracture. Treatment options include traction, casting, intramedullary nailing, plate fixation, or external fixation depending on the patient's age and the fracture pattern. Complications can include blood loss, nerve injuries, infections, and non-union.
3. Compartments of thigh
Muscle of the thigh are arranged in three
Compartments
1-anterior compartment of thigh
Contains the sartorius and the four large
quadriceps
2-medial compartment of thigh
(gracilis ,pectineus, adductor longus, adductor
brevis, adductor magnus, and obturator
externus)
4. 3-posterior compartment of thigh
contain three large muscle termed the
‘”hamstring”
Femur is surrounded by massive musculature
,which provide the blood supply to femur
5.
6.
7. Fracture Shaft Of Femur
• A femoral shaft
fracture is a fracture
of the femoral
diaphysis occurring
between 5 cm distal
to the lesser
trochanter and 5 cm
proximal to the
adductor tubercle
8. Epidemiology
-Common injury due to major violent
trauma
-1 femur fracture/ 10,000 people
more common in people < 25 yr or >65 yr
-Motor vehicle, motorcycle, auto-
pedestrian, fall from height, and gunshot
wound
9. Mechanism Of Injury
• In Young Adults, almost always the result
of high-energy trauma,
– Motor vehicle accident
– Gunshot injury, or
– Fall from a height
• Pathologic fractures, especially in the
elderly, commonly occur following a trivial
fall
• Stress fractures occur mainly in military
recruits or runners
10. Symptoms
Diffuse pain or ache, and tenderness and
swelling in the thigh or groin.
Bleeding and bruising in the thigh
(uncommon).
Weakness and inability to bear weight on the
injured leg.
Paleness and deformity
11. Clinical Evaluation
• A full trauma survey is indicated (ABC)
• The patient is
–Non ambulatory with pain
–Variable gross deformity of thigh
–Swelling,
–Shortening of the affected extremity.
• A careful neurovascular examination is
essential
12. • A careful assessment of hemodynamic
stability is essential,
Average expected Blood loss of 750-1500ml
• Thorough examination of the ipsilateral hip
and knee should be performed
• Knee ligament injuries are common,
however, and need to be assessed after
fracture fixation
14. X-ray
Will confirm the diagnosis and establish the
sites ,line ,extent and displacement
• AP and Lateral views of
the femur, hip, and
knee
• AP view of the pelvis
should be obtained
• Look for evidence of an
associated femoral neck
or intertrochanteric
fracture, knee injuries
15.
16.
17.
18. Winquist and Hansen , 1984
* Type 0 - No commination
*Type 1 - Insignificant butterfly
fragment with transverse or short
oblique fracture,
*Type 2 - Large butterfly of less than
50% of the bony width, > 50% of
cortical contact
*Type 3 - Larger butterfly leaving less
than 50% of the cortex in contact
*Type 4 - Segmental commination
30. Indications for plating
• Patients wit extremely narrow medullary
canal
• Fractures around or adjacent previous
malunion
• Fractures extending proximally or distally into
the pertrochanteric or metaphyseal region
• Ipsilateral neck fractures
