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Femoral Shaft Fractures

By Danielle Campagne, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

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Femoral shaft fractures usually result from severe force and are clinically obvious. Treatment is with immediate splinting with traction followed by open reduction with internal fixation.

The usual injury mechanism for femoral shaft fractures is severe direct force or an axial load to the flexed knee (typically in a motor vehicle crash or automobile-pedestrian collision). Thus, other serious injuries are often present.

Symptoms and Signs

Fracture causes obvious swelling, deformity (often with shortening), and instability. Up to 1.5 L of blood for each fracture may be lost. Hemorrhagic shock is possible, particularly when the cause is blunt trauma and there are other injuries.


  • X-rays

Anteroposterior and lateral x-rays are diagnostic.

If the fracture resulted from great force, hip x-rays should always be done to look for an ipsilateral femoral neck fracture. The knee also needs to be carefully evaluated.


  • Immediate splinting with traction

  • Open reduction with internal fixation (ORIF)

Immediate treatment is splinting, usually with distraction force (such as with a Hare traction or Sager traction splint), followed by ORIF. Because traction splints apply traction to the lower leg, they should not be used if patients also have a tibial fracture.

Key Points

  • Femoral shaft fractures usually result from severe forces and are not clinically subtle.

  • For each fracture, up to 1.5 L of blood may be lost.

  • X-ray the hip and evaluate the knee if the femoral shaft is fractured.

  • Splint femoral shaft fractures as soon as possible.