Treatment of femoral fractures

Femoral shaft fractures usually occur following high-impact trauma. Therefore, patients may suffer additional life-threatening injuries, which require adequate diagnostic work up and appropriate therapy. In addition to polytrauma injuries, diagnostic attention must be directed to detect vascular and nerval lesions. Often primary stabilization is performed using an external fixator as part of the concept of damage control surgery. For definitive stabilization, ante- or retrograde intramedullary nailing is predominately used and less frequently conventional or angular stable plate osteosynthesis or combination of these stabilization techniques. The concept of i.m. nailing preserves the soft tissue envelope by utilizing insertion points distant to the fracture site. Regularly, closed techniques can be employed for fracture reduction. Femur shaft fractures may be accompanied by ipsilateral fractures of the femur, and by injuries of the knee joint and lower leg. Although compartment syndrome is a rare complication of femoral shaft fractures, soft tissue condition require careful clinical evaluation prior to and after fracture stabilization.