Fractures of the femur and tibial shaft

Fractures of the femoral and tibial shaft are common injuries. They exhibit a bimodal age distribution and are frequently associated with other injuries. Their fracture patterns vary, and so are managed using a range of treatment options.The first priority is to check that there are no life-threatening injuries or acute complications associated with the injuries sustained. Once these are ruled out, the orthopaedic team can begin planning the treatment option best suited to the fracture and patient. For femoral fractures this usually involves intramedullary nailing, or plating, across the fracture site. Conservative and mono-lateral external fixation of the femur is now considered inadvisable because of the higher risk of complications and decreased rehabilitation potential. For tibial fractures the options are either conservative management, in a non-weight-bearing cast, or intramedullary nailing or plating. External fixation remains a useful modality in severe deformity or open fractures of the tibia. Complications commonly associated with both these fractures include venous thromboembolism, infection, compartment syndrome, fat embolism, vascular injury and mal- or non-union of bone.