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Femur Fractures

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Management of Musculoskeletal Injuries in the Trauma Patient

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Abstract

Femoral shaft fractures are typically markers of significant trauma, and appropriate management of these injuries is a crucial component of the overall management of polytraumatized patients. Motor vehicle collision is the most common cause of femoral shaft fractures, followed by auto versus pedestrian accidents, falls from height, and gunshot wounds. Associated injuries to the brain, chest, and abdomen must be considered. Additional bony injuries, particularly to the ipsilateral femoral neck, must be sought and managed. Immediate definitive treatment is an option in a patient with an isolated femur fracture or in a polytrauma patient that has been sufficiently resuscitated. Where available, reamed, locked, intramedullary nailing represents the standard of care for femoral diaphyseal fractures. Outcomes following treatment of femoral diaphyseal fractures with intramedullary nailing are excellent, and the complications are minimal. Patients whose resuscitation fails to correct critical parameters such as metabolic acidosis, hypothermia, and coagulopathy are not safe candidates for intramedullary definitive stabilization of the femur and should be considered candidates for damage control measures. Open femur fractures require appropriate debridement of devitalized tissue and bone and usually remain amenable to definitive management with an intramedullary device. Thigh compartment syndrome, though not common, may occur after femoral shaft fracture or treatment and requires expeditious fasciotomy to prevent permanent muscle damage. Overall, a systemic approach to the patient with femoral shaft fracture will permit safe treatment with good functional outcome.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA

    David C. Teague MD, BS

  2. Department of Orthopaedic Surgery, University of Colorado, 12631 E 17th Avenue, B202 Aurora, New Orleans, CO, 80045, USA

    Melissa A. Gorman MD

Authors
  1. David C. Teague MD, BS
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  2. Melissa A. Gorman MD
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Correspondence to Melissa A. Gorman MD .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Swedish Medical Center, Englewood, Colorado, USA

    Wade R. Smith

  2. Department of Orthopedics, Denver Health Medical Center, Denver, Colorado, USA

    Philip F. Stahel

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Teague, D.C., Gorman, M.A. (2014). Femur Fractures. In: Smith, W., Stahel, P. (eds) Management of Musculoskeletal Injuries in the Trauma Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8551-3_6

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  • DOI: https://doi.org/10.1007/978-1-4614-8551-3_6

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8550-6

  • Online ISBN: 978-1-4614-8551-3

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