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[Conditions](https://durgical.com/en/conditions/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/)

# Femoral shaft fracture

A femoral shaft fracture is a break in the long middle part of the thigh bone, usually from high-energy trauma such as a traffic crash.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Femur](https://durgical.com/en/anatomy/femur/)
- [Femoral artery](https://durgical.com/en/anatomy/femoral-artery/)
- [Deep femoral artery](https://durgical.com/en/anatomy/deep-femoral-artery/)
- [Sciatic nerve](https://durgical.com/en/anatomy/sciatic-nerve/)
- [Vastus intermedius](https://durgical.com/en/anatomy/vastus-intermedius-muscle/)
- [Vastus lateralis](https://durgical.com/en/anatomy/vastus-lateralis-muscle/)
- [Adductor magnus](https://durgical.com/en/anatomy/adductor-magnus/)

## Why it happens

- [Fat, air and amniotic fluid embolism](https://durgical.com/en/general-pathology/fat-air-and-amniotic-fluid-embolism/)
- [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/)

## What it is

A fracture of the diaphysis of the femur, between the region below the lesser trochanter and the area just above the condyles, usually caused by high-energy trauma.

## Who gets it

Mostly young adults after traffic collisions (including motorcycle crashes, very common in Colombia), falls from height or gunshot wounds; in older people a low-energy fall on weak bone can be enough.

## Causes

- High-energy trauma: traffic collisions, motorcycle crashes, falls from height
- Gunshot wounds
- Low-energy falls in osteoporotic bone
- Pathological fracture through a tumour or metastasis
- Atypical femoral fracture after long-term antiresorptive therapy

## Risk factors

- Motorcycle use and road traffic exposure
- Osteoporosis
- Bone metastases
- Long-term bisphosphonate therapy (atypical fractures)
- Non-accidental injury in young children

## Pathophysiology

The femoral shaft is the strongest bone in the body, so breaking it takes a lot of force and associated injuries are common. The thigh can hide a large amount of blood, enough to cause shock. Marrow fat released into the circulation can lodge in the lungs, brain and skin (fat embolism).

## Classification

- By location: proximal, middle or distal third
- By pattern: transverse, oblique, spiral, comminuted or segmental
- Winquist-Hansen grading of comminution
- Open or closed (Gustilo-Anderson for open fractures)

## Symptoms and signs

- Severe thigh pain after trauma
- Swelling and deformity of the thigh
- Shortening and rotation of the limb
- Inability to stand or move the leg

## Red flags

- Signs of hypovolaemic shock (tachycardia, hypotension, pallor)
- Confusion, breathlessness and petechiae 1 to 3 days after injury (fat embolism syndrome)
- Weak or absent distal pulses
- Tense, painful compartments of the thigh or leg
- Bilateral femoral fractures, a marker of very high energy

## Diagnosis

**Clinical**
Trauma assessment by the ATLS approach first, then examination of the limb, distal pulses and nerves (sciatic, tibial and fibular), and the [skin](https://durgical.com/en/anatomy/skin/) for open wounds.

**Tests**
Blood count, cross-match and lactate in trauma; arterial blood gas if fat embolism is suspected.

**Imaging**
Radiographs of the entire [femur](https://durgical.com/en/anatomy/femur/) plus the hip and knee; CT of the femoral neck to exclude an associated fracture; angiography or CT angiography if a vascular injury is suspected.

## Differential diagnosis

- Femoral neck or intertrochanteric fracture
- Distal femur (supracondylar) fracture
- Hip dislocation
- Pathological fracture
- Thigh muscle injury or haematoma

## Goal of treatment

Resuscitate the patient, stabilise the fracture early to reduce blood loss and pulmonary complications, restore length, alignment and rotation, and get the patient moving.

## Treatment

**Acute**
Primary survey and resuscitation with fluids and blood products; analgesia, including a [femoral nerve](https://durgical.com/en/anatomy/femoral-nerve/) or fascia iliaca block.

**Acute**
Temporary traction splint or skeletal traction to reduce pain and bleeding until surgery.

**Surgical**
Intramedullary nailing within the first day or so in stable patients; the standard treatment in adults.

**Surgical**
External fixation as damage control in unstable polytrauma, converted to a nail later.

**Medical**
Antibiotics and debridement for open fractures; thromboprophylaxis with anticoagulants.

**Conservative**
Spica cast or flexible nails in young children, depending on age and weight.

**Rehabilitation**
Early weight-bearing as tolerated and physiotherapy for knee and hip motion.

## Complications

- Haemorrhagic shock
- Fat embolism syndrome
- Deep vein thrombosis and pulmonary embolism
- Associated femoral neck fracture missed at first
- Compartment syndrome
- Infection, delayed union, nonunion or malunion (rotation or length)
- Knee stiffness

## Prognosis

With intramedullary nailing most fractures unite, and most patients regain walking. Outcomes depend on associated injuries, open wounds and age.

## Prevention

- Road safety measures: helmets, speed limits and seat belts
- Osteoporosis treatment and fall prevention in older adults

## Test yourself

Think of the answer, then tap the question to see it.

## What is the standard treatment for a femoral shaft fracture in an adult?

Early intramedullary nailing, once the patient is stable.

## Which complication causes confusion, hypoxaemia and petechiae 1 to 3 days after a femoral shaft fracture?

Fat embolism syndrome, from marrow fat entering the circulation.

## Why can a closed femoral shaft fracture cause shock?

The thigh can hold a large volume of blood, enough to cause hypovolaemic shock.

## Which associated fracture must be excluded in every femoral shaft fracture?

An ipsilateral femoral neck fracture, which is easy to miss.

## What does early fracture stabilisation reduce in femoral shaft fractures?

Pulmonary complications such as fat embolism and ARDS, plus pain, bleeding and immobility.

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## Related conditions

- [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/)
- [Acute compartment syndrome](https://durgical.com/en/conditions/acute-compartment-syndrome/)
- [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/)
- [Hip dislocation](https://durgical.com/en/conditions/hip-dislocation/)
- [Femoral Neck Fracture](https://durgical.com/en/conditions/femoral-neck-fracture/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Femoral Shaft Fractures](https://www.ncbi.nlm.nih.gov/books/NBK556057/) (StatPearls (NCBI Bookshelf), 2023).

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Source: https://durgical.com/en/conditions/femoral-shaft-fracture/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/femoral-shaft-fracture/