Management

Femoral Shaft Fracture - Emergency Management

Editors: Rachel Chin MD

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Background Information

Background

  • Fractures of the femoral shaft are most often the result of high-energy trauma

Anatomy

  • Bony anatomy
    • The femur is the largest, heaviest, and strongest bone in the human body and serves as one of the principle load-bearing bones in the lower extremity
    • The femur consists of 3 anatomical regions
      • Proximal (head, neck, intertrochanteric area)
      • Shaft (area between the lesser trochanter to the femoral condyles)
      • Distal (including supracondylar area)
  • Muscle anatomy
    • 3 muscle compartments
      • Anterior: sartorius, pectineus, quadriceps, iliopsoas
        • The quadriceps are responsible for knee extension
      • Medial: gracilis, adductor longus, adductor brevis, adductor magnus
      • Posterior ("hamstrings"): biceps femoris, semitendinosus, semimembranosus
        • Responsible for knee flexion
  • Neurovascular anatomy
    • Majority of blood supply is from the profunda femoris artery
    • Sciatic and femoral nerves are well-protected by the muscles surrounding the femur

Etiology

  • The mechanism of injury to the femoral shaft varies with age
    • Younger adults: high-energy trauma
      • Motor vehicle collisions, falls from heights of more than 3 meters, penetrating trauma (gunshot wounds)
    • Older adults: low-energy trauma
      • Slip and fall accidents, falls from less than 1 meter
    • Pathologic fractures are rare
      • Primary cancer (rare): osteogenic sarcoma
      • Metastatic from cancers typically of the breast, lung, and prostate
    • Insufficiency fractures: fractures caused by chronic, external physiologic stress upon weakened bone, such as in osteoporosis(
      1
      )
      • Rare and may not be associated with a traumatic event

Epidemiology

  • Annual incidence of femoral shaft fractures: 9.5-18.9 per 100,000 annually(
    2
    )
  • The age distribution for femoral shaft fractures is bimodal with the highest incidence occurring in people < 20 years old and > 75 years old(
    3
    ,
    4
    )
  • Young men have the highest incidence of femoral shaft fractures due to high-energy trauma
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1Level 1 (likely reliable) Evidence
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2Level 2 (mid-level) Evidence
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