Mid-shaft femur fracture

Includes all subtrochanteric femur fractures

Background

  • Long bone anatomy.
  • Occurs with severe trauma or in association with pathologic bone
    • Blood loss can be substantial (average loss = 1L)

Femur Fracture Types

Proximal

Shaft

Clinical Features

  • Clinical presentation is similar to intertrochanteric fracture
    • Affected leg is shortened and externally rotated

Differential Diagnosis

Hip pain

Acute Trauma

Chronic/Atraumatic

Evaluation

Location of femur fractures
Spiral shaft fracture of femur.

Workup

  • Radiography
    • Femur x-ray: PA and lateral
    • Consider films of knee and hip for operative planning and to assess for other injury
  • Pre-op labs
    • CBC
    • Chem 7
    • PT/PTT
    • Type & Screen

Diagnosis

  • Typically via plain films

Management

  • Resuscitation per ATLS guidelines

General Fracture Management

Immobilization

  • Consider traction splint
    • Little evidence to support its use[1]
    • Theoretical benefit of traction splinting is reduction in bleeding and improved pain
    • Sager and Hare splints are commonly used by EMS providers
    • Buck's traction used by ortho

Disposition

  • Admit
    • Typically requires ORIF

See Also

External Links

References

  1. Agrawal Y, Karwa J, Shah N, et al. Traction splint: to use or not to use. J Perioper Pract. 2009; 19(9):295-298.