Synopsis
Treat femoral-shaft fracture as a major-trauma and haemorrhage problem, protect skin and neurovascular function, identify ipsilateral neck and knee injury, and choose temporary stabilisation or definitive fixation according to physiology.
- Treat a femoral-shaft fracture as a potential major haemorrhage: assess physiology and search chest, abdomen, pelvis and other limbs rather than attributing all shock to one thigh.
- Expose the whole limb for wounds and degloving and document femoral, popliteal, dorsalis pedis and posterior tibial pulses plus peroneal and tibial nerve function.
- Give early analgesia, gently restore gross length and alignment and splint; a traction splint can reduce pain and bleeding in an isolated shaft injury but is unsuitable with some pelvic, hip, knee or lower-leg injuries.
Key red flags
Hypotension, tachycardia, increasing thigh size, falling haemoglobin or a transient response to blood indicates significant ongoing haemorrhage until chest, abdomen, pelvis and limbs are controlled.
Investigation priorities
Define shaft morphology and include hip and knee injury.
Management branches
A femoral-shaft fracture is suspected with pain, deformity or abnormal physiology.
- Run ABCDE, control bleeding, activate major-haemorrhage support when indicated and examine for pelvic, abdominal, chest and contralateral injury.
- Document open wounds, degloving, compartments, named distal nerve function and pulses before manipulation.
Fixation and haemostasis are stable enough for rehabilitation.
Key medicines
Tranexamic acid for major traumatic bleedingGive 1 g intravenously over 10 minutes followed by 1 g infused over 8 hours, starting as soon as possible and within 3 hours of injury when significant bleeding is present or suspected.