(See also Overview of Fractures.)
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.
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.
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.