What are the management options for a left femoral (thigh bone) fracture?

From the Guidelines

Surgical fixation with intramedullary nailing is the preferred treatment for most displaced femoral fractures, offering stability while allowing early mobilization. Management of a left femoral fracture typically involves surgical intervention, though the specific approach depends on fracture location, pattern, and patient factors. For femoral shaft fractures, osteosynthesis by intramedullary nailing or plate osteosynthesis is the definitive reference treatment, as stated in the guidelines for the acute care of severe limb trauma patients 1.

Some key considerations in the management of femoral fractures include:

• Preoperative immobilization with traction or a splint for comfort and to prevent further soft tissue damage
• Pain management with multimodal analgesia, including acetaminophen, NSAIDs like ketorolac, and opioids such as morphine
• Thromboprophylaxis with enoxaparin or equivalent until fully mobile
• Postoperative early mobilization and physical therapy for optimal outcomes

It's also important to note that for femoral neck fractures in older adults, hip arthroplasty may be recommended, while in younger patients, internal fixation with cannulated screws is often attempted to preserve the native joint, as discussed in the aaos management of hip fractures in older adults evidence-based clinical practice guideline 1. However, the most recent and highest quality study, which is the 2021 guidelines for the acute care of severe limb trauma patients 1, prioritizes osteosynthesis by intramedullary nailing or plate osteosynthesis for femoral shaft fractures.

In terms of specific surgical techniques, the use of cemented femoral stem and unipolar femoral head may be beneficial, and tranexamic acid should be given to reduce blood loss and need for transfusion, as recommended in the 2022 aaos management of hip fractures in older adults evidence-based clinical practice guideline 1. However, the primary goal is to achieve stable fixation and allow early mobilization, which can be achieved through intramedullary nailing or plate osteosynthesis.

From the Research

Left Femoral Fracture Management Options

• The management of left femoral fractures can be complex and depends on various factors, including the patient's overall medical condition, co-morbidities, and the presence of additional injuries 2.
• Intramedullary fracture fixation is often the treatment of choice for femoral shaft fractures, with antegrade reamed femoral nailing via the piriformis entry point being a commonly used technique 3.
• However, the timing of fracture stabilization is crucial and should be determined by the patient's overall medical condition, with early definitive fixation often being implemented in the early total care concept for multiple injured patients 2.
• In cases where the patient has a high risk of pulmonary embolism, such as those with proximal femoral fractures, early anatomical reduction and surgical fixation is recommended to reduce the risk of complications 4, 5.
• The use of intramedullary nails, such as PFN, can be beneficial in treating intertrochanteric fractures with comminution and loss of lateral buttress, while sliding hip screws (DHS) are often used for stable intertrochanteric fractures 4.
• Plate osteosynthesis of the femur can be an option in selected patients, particularly those with complex fractures or those who are not suitable for intramedullary nailing 3.

Considerations for Left Femoral Fracture Management

• Fat embolism syndrome (FES) and thromboembolic events (TEV) should always be considered in patients with bilateral femoral shaft fractures, and the timing of definitive fixation should take into account the patient's risk of these complications 6.
• The incidence of pulmonary embolism (PE) in femur fracture patients is higher than commonly appreciated, with most cases occurring in the first 48 hours after injury 5.
• Careful preoperative planning is essential to choose the most adequate fixation device and to minimize the risk of complications, such as rotational malalignment and axis and length malalignement 2, 3.