Mid-shaft femur fracture

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Includes all subtrochanteric femur fractures

Background

Location of femur fractures
  • Occurs with severe trauma or in association with pathologic bone
    • Blood loss can be substantial (average loss = 1L)

Clinical Features

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

Differential Diagnosis

Femur fractures

Proximal

Shaft

Evaluation

  • Radiography
    • Obtain films of knee, femur, and hip for operative planning and to assess for other injury
  • Pre-op labs
    • CBC
    • Chem 7
    • PT/PTT
    • Type & Screen

Management

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

Disposition

  • Admit

See Also

Femur fracture

External Links

Wheelers' Textbook - Femoral Shaft Fracture

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.