Mid-shaft femur fracture

Includes all subtrochanteric femur fractures

Background

Location of femur fractures

• Occurs with severe trauma or in association with pathological bone
  • Blood loss can be substantial (average loss = 1L)

Clinical Features

• Clinical presentation is similar to intertrochanteric fracture
  • Affected leg is shortened and externally rotated

Differential Diagnosis

Femur Fracture Types

Proximal

• Intracapsular
  • Femoral head fracture
  • Femoral neck fracture
• Extracapsular
  • Intertrochanteric femur fracture
  • Trochanteric femur fracture

Shaft

• Mid-shaft femur fracture (all subtrochanteric)

Diagnosis

• Radiography
  • Obtain AP films of knee, femur, hip on bilateral legs

Management

• Consider traction splint
  • Little evidence to support its use
  • Theoretical benefit of traction splinting is reduction in bleeding and improved pain
  • Sagar and Hare splints are commonly used by EMS providers
• ORIF

Disposition

• Admit