Initial management of pelvic and femoral fractures in the multiply injured patient

Fractures of the shaft of the femur are the result of high-energy trauma such as motor vehicle collisions, pedestrian accidents, gunshot injuries, and falls from heights. High-energy injuries caused by direct force often are associated with other injuries and open wounds. These injuries, therefore, can be life threatening and result in long-term disability. Patients with femur fractures on average lose up to two or three units of blood as a result of the injury. Up to 50% of all patients require blood transfusion [1,2]. As with most traumatic orthopedic injuries, fractures of the femoral shaft occur in a bimodal distribution with regard to age. These injuries occur more frequently in patients younger than 25 years of age and older than 65 years of age [1]. Femur fractures occur at a rate of one fracture per 10,000 patients per year. There is an increasing incidence of these injuries in patients over the age of 65 as a result of population aging. Before routine surgical stabilization, femur fractures were associated with a high incidence of morbidity. Nonsurgical treatment options include skeletal traction followed by cast-brace application. Surgical treatments include external fixation, plate fixation, and intramedullary nail placement. Anterograde reamed intramedullary nail placement is the treatment of choice for most femoral shaft fractures. The goals of treatment are to stabilize the fracture to allow early patient mobilization, restore alignment to the extremity, and maintain normal hip and knee range of motion.