Shaft of Femur Fractures — Reamed Nailing

Femoral shaft fractures are major injuries involving the diaphysis of the femur between the lesser trochanter and the supracondylar region. These fractures usually occur following high-energy trauma such as road traffic accidents, falls from height, or severe sports injuries. Because the femur is the strongest bone in the body, a large force is usually required to produce a shaft fracture in healthy adults.

Femoral shaft fractures are associated with significant blood loss, soft tissue injury, and systemic complications. Each femoral shaft fracture may result in approximately 1–1.5 liters of blood loss into the thigh, which can contribute to hypovolemic shock. Therefore, these injuries must be managed promptly as part of trauma resuscitation protocols.

The current gold standard treatment for most femoral shaft fractures in adults is intramedullary interlocking nailing. Reamed intramedullary nailing provides strong mechanical fixation, allows early mobilization, and has high union rates.

The femoral shaft is a cylindrical structure composed primarily of dense cortical bone. The femur is designed to withstand substantial compressive and bending forces during activities such as walking and running.

• Length approximately 45 cm in adults
• Strong cortical bone structure
• Large medullary canal
• Surrounded by powerful thigh muscles

Several muscle groups influence fracture displacement:

• Quadriceps cause anterior displacement of distal fragment
• Hamstrings cause shortening
• Adductor muscles cause medial displacement
• Iliopsoas flexes the proximal fragment

These muscular forces often produce significant shortening and angulation of fracture fragments.

• Accounts for approximately 3–5% of all fractures
• Common in young males due to high-energy trauma
• Increasing incidence in elderly due to osteoporosis

• Road traffic accidents
• Motorcycle accidents
• Fall from height
• Direct blow to thigh
• Pathological fractures due to tumors

Femoral shaft fractures are commonly classified using the AO/OTA classification system.

• Severe thigh pain
• Deformity of thigh
• Shortened limb
• Inability to bear weight
• Swelling and bruising

Due to the high-energy nature of injury, patients may have associated injuries such as head trauma, pelvic fractures, or chest injuries.

• Follow Advanced Trauma Life Support (ATLS) protocol
• Control hemorrhage
• Immobilize fracture
• Provide analgesia
• Assess neurovascular status

Temporary stabilization using traction splints may reduce pain and blood loss during initial management.

Reamed intramedullary nailing is the gold standard treatment for most adult femoral shaft fractures. Reaming enlarges the medullary canal, allowing insertion of a larger and stronger nail.

• Provides strong mechanical stability
• Allows early mobilization
• High union rates
• Restores alignment

1. Patient positioned supine on fracture table
2. Closed reduction of fracture
3. Entry point at piriformis fossa or greater trochanter
4. Guidewire insertion
5. Sequential reaming of medullary canal
6. Insertion of intramedullary nail
7. Proximal and distal locking screws

• Better mechanical stability
• Higher union rates
• Allows early weight bearing
• Minimal soft tissue disruption

• Fat embolism syndrome
• Infection
• Nonunion
• Malalignment
• Hardware failure

• Gold standard treatment is reamed intramedullary nailing
• Each fracture may cause up to 1.5 liters of blood loss
• AO classification type 32
• Early fixation reduces complications