Executive Editor: Chris Colton, Rick Buckley

Authors: Peter V Giannoudis, Hans Christoph Pape, Michael Sch├╝tz

Femur shaft

back to skeleton

Glossary

Simple, spiral, proximal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - Compression plating (DCS) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Compression plating (Locking plate) Failed indirect reduction, polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources

Simple, spiral, middle 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - Lag screw with protection plate Vascular injury or open fractures, polytrauma Highly experienced and skilled surgeon Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Simple, spiral, distal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - DCS and compression plating Polytrauma with chest injury, limited operative resources Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Simple, oblique, proximal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - Compression plating (DCS) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Compression plating (Locking plate) Failed indirect reduction, polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources

Simple, oblique, middle 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - Lag screw with protection plate Vascular injury or open fractures, polytrauma Highly experienced and skilled surgeon Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Simple, oblique, distal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - DCS and compression plating Polytrauma with chest injury, limited operative resources Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Simple, transverse, proximal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - Compression plating (DCS) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Compression plating (Locking plate) Failed indirect reduction, polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
ORIF - Bridge plating (blade plate) Non-union treatment Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources

Simple, transverse, middle 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - Compression plating Polytrauma patient with associated chest injury Highly experienced and skilled surgeon Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Simple, transverse, distal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - DCS and compression plating Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Wedge, intact, proximal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (Locking plate) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (Locking plate) Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources

Wedge, intact, middle 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
ORIF - Lag screw with protection plate Vascular injury or open fractures, polytrauma with chest injury Highly experienced and skilled surgeon Simple surgical and imaging resources
MIO - Bridge plating Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Wedge, Intact, distal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (LISS or LCP) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Wedge, fragmentary, proximal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (Locking plate) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (Locking plate) Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources

Wedge, fragmentary, middle 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Wedge, fragmentary, distal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (LISS or LCP) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Segmental, intact, proximal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (Locking plate) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (Locking plate) Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources

Segmental, Intact, middle 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Segmental, intact, distal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (LISS or LCP) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Segmental, fragmentary, proximal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (Locking plate) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (DSC) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (Locking plate) Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources

Segmental, fragmentary, middle 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating Polytrauma with chest injury Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Segmental, fragmentary, distal 1/3 fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment with limited resources Neither facilities, nor skills, for surgical treatment available Basic surgical experience, no specialized skills Basic equipment only
Temporary Thomas splint Damage control (medically unfit for surgery, usually temporary) Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
MIO - Bridge plating (LISS or LCP) Polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Bridge plating (DCS) Polytrauma with chest injury, limited operative resources Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing Closed isolated fractures, most open fractures, and stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing Middle or distal third fractures, "floating knee", obesity, polytrauma Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Infection
Compartment syndrome
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2018-07-05