eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Femur

Author: James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
Contributor Information and Disclosures

Updated: Apr 22, 2009

Introduction

Background

This article discusses fractures of the femoral diaphysis. For proximal femur fractures (subtrochanteric to femoral head), see the article Fractures, Hip. For fractures of the distal femur (supracondylar to condylar), see the article Fractures, Knee.

The femur is the largest and strongest bone and has a good blood supply. Because of this and its protective surrounding muscle, the shaft requires a large amount of force to fracture. Once a fracture does occur, this same protective musculature usually is the cause of displacement, which commonly occurs with femoral shaft fractures.

As with many orthopedic injuries, neurovascular complications and pain management are the most significant issues in patients who come to the ED. The rich blood supply, when disrupted, can result in significant bleeding. Open fractures have added potential for infection.

The 3 types of femoral shaft fractures are as follows:

  • Type I - Spiral or transverse (most common)
  • Type II - Comminuted
  • Type III - Open

Associated injuries are common.

Anteroposterior radiograph of a femoral-shaft fra...

Anteroposterior radiograph of a femoral-shaft fracture in a 19-year-old man.

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Anteroposterior radiograph of a femoral-shaft fra...

Anteroposterior radiograph of a femoral-shaft fracture in a 19-year-old man.


Pathophysiology

Diaphyseal fractures result from significant force transmitted from a direct blow or from indirect force transmitted at the knee.

Pathologic fractures may occur with relatively little force. These may be the result of bone weakness from osteoporosis or lytic lesions.

Mortality/Morbidity

Morbidity and mortality rates have been reduced in femoral shaft fractures, mainly as the result of changes in methods of fracture immobilization. Current therapies allow for early mobilization, thus reducing the risk of complications associated with prolonged bed rest.

Clinical

History

History usually is obvious in cases of femoral diaphyseal fractures. Typically, patients describe a significant force applied to the extremity. Significant pain and deformity are reported as well.

Physical

  • Conduct a thorough examination to rule out associated injury. Hip fractures and ligamentous knee injuries commonly are observed in association.
  • At the site of fracture, tenderness on examination and visible deformity typically are noted.
  • The extremity may appear shortened, and crepitus may be noted with movement.
  • The thigh is often swollen secondary to hematoma formation.
  • Perform a thorough vascular examination on the extremity. Signs of vascular compromise should prompt arteriography and a vascular surgery consult. Physical signs of arterial injury include the following:
    • Expanding hematoma
    • Absent or diminished pulses
    • Progressive neurologic deficits in a closed fracture
  • Because of extensive blood supply to the musculature surrounding the femur, diaphyseal fractures may be associated with significant blood loss (ie, 1 L or more) and resulting tachycardia and hypotension.
  • Test distal neurologic function, though examination is frequently unreliable because of the amount of pain associated with these fractures. Nerve injury is rare because of protective surrounding musculature.

Causes

More on Fracture, Femur

Overview: Fracture, Femur
Differential Diagnoses & Workup: Fracture, Femur
Treatment & Medication: Fracture, Femur
Follow-up: Fracture, Femur
Multimedia: Fracture, Femur
References
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References

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  2. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. Nov 1996;7(6):612-8. [Medline].

  3. Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop. May-Jun 1997;17(3):342-6. [Medline].

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  8. Hogan TM. Hip and femur. In: Hart RG, Rittenberry TJ, Uehara DT, eds. Handbook of Orthopaedic Emergencies. Publishers: Lippincott Williams & Wilkins; 1999:307-8.

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  14. Robertson P, Karol LA, Rab GT. Open fractures of the tibia and femur in children. J Pediatr Orthop. Sep-Oct 1996;16(5):621-6. [Medline].

  15. Salminen S, Pihlajamaki H, Avikainen V, Kyro A, Bostman O. Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma. Jul 1997;43(1):117-22. [Medline].

  16. Sartoretti C, Sartoretti-Schefer S, Ruckert R, Buchmann P. Comorbid conditions in old patients with femur fractures. J Trauma. Oct 1997;43(4):570-7. [Medline].

  17. Starr AJ, Hunt JL, Reinert CM. Treatment of femur fracture with associated vascular injury. J Trauma. Jan 1996;40(1):17-21. [Medline].

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Further Reading

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Keywords

femur fracture, femoral diaphysis, fractures of the femoral diaphysis, femoral shaft fractures, spiral femur fractures, transverse femur fractures, comminuted femur fractures, open femur fractures, diaphyseal fractures, hip fractures, ligamentous knee injuries

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Contributor Information and Disclosures

Author

James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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