Fractures of the femoral shaft

Fractures of the femoral shaft are associated with high-energy, multisystem trauma. Management must be methodical, initially excluding life-threatening injuries. Patients surviving for the first 24 hours after major injury as a result of effective resuscitation remain at risk of progressive organ failure and death from a local and general inflammatory response. The involvement of senior clinicians is vital to ensure there is not a delayed decline in condition after initial injury.Femoral fractures are usually managed surgically, though traction should be considered in certain circumstances. Ninety-five percent of post-traumatic diaphyseal femoral fractures heal with antegrade femoral nailing. Minimal-invasive devices stabilize these fractures without extensive dissection of soft tissue. Flexible intramedullary rods may be used in children to achieve fracture stability, but immature bones, open physes, parental care available, and growth potential must be considered when forming the management plan.Early complications include haemorrhage, fat embolism, pneumonia, multiorgan failure, neurovascular injury and compartment syndrome. Later complications include infection, non-union, delayed union, metalwork failure and heterotopic ossification.The goal of the physiotherapy programme should be weightbearing to tolerance provided surgical stability allows. The fracture should progress to union by four months.