Femoral shaft fracture

Case contributed by Samir Benoudina

Presentation

Accidental fall from a height. Deformity of the right thigh.

Patient Data

Age: 3 years
Gender: Male
x_ray

AP radiograph shows a displaced proximal third femoral shaft fracture.

Annotated image

Right proximal third femoral shaft fracture. With displacement:

  • Red arrow: Abduction
  • Blue arrow: External rotation
  • Yellow arrow: Adduction and shortening of the distal fragment.

Case Discussion

This case illustrates the main deformities seen in proximal third femoral shaft fractures, a result of the unbalanced muscle pulls. Understanding these deforming forces is important when planning the treatment:

On the proximal fragment:

  • Abduction: by the gluteus medius  and gluteus minimus
  • External rotation: by the action of the short external rotators
  • Flexion: by the iliopsoas (Not seen here – Can be seen on a lateral projection)

On the distal fragment:

  • Adduction and shortening: due to adductor muscles pull.

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