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Femur Fracture

Femur Fracture is a topic covered in the 5-Minute Emergency Consult.

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Fractures classified according to:
  • Location:
    • Proximal 3rd (subtrochanteric region)
    • Middle 3rd
    • Distal 3rd (distal metaphyseal–diaphyseal junction)
  • Geometry:
    • Spiral
    • Transverse
    • Oblique
    • Segmental
  • Extent of soft tissue injury:
    • Open
    • Closed
  • There are 2 commonly accepted classification systems of femoral fractures: The AO/OTA and the Winquist and Hansen.
  • Degree of comminution: Winquist and Hansen classification:
    • Grade I: Fracture with small fragment <25% width of femoral shaft; stable lengthwise and rotationally
    • Grade II: Fracture with 25–50% width of femoral shaft; stable lengthwise; may or may not have rotational stability
    • Grade III: Fracture with >50% width of femoral shaft; unstable lengthwise and rotationally
    • Grade IV: Circumferential loss of cortex; unstable lengthwise and rotationally


  • Usually requires major, high-energy trauma
  • Patients are mostly young adults with high-energy injuries (motor vehicle accidents [MVAs], gunshot wounds [GSWs], falls):
    • Spiral fractures with falls from height
  • Consider pathologic fracture if minor mechanism
  • Can occasionally be due to stress fracture from repetitive activity
  • Complications include compartment syndrome, fat embolism, adult respiratory distress syndrome (ARDS), hemorrhage.

Geriatric Considerations
  • Atypical femur fractures have been associated with use of bisphosphonate medications.

Pediatric Considerations
  • 70% of femoral fractures in children <3 yr old are the result of nonaccidental trauma (NAT).
  • Spiral fractures of the femur strongly suggest NAT.

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Rosen, Peter, et al., editors. "Femur Fracture." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture.
Femur Fracture. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture. Accessed April 22, 2019.
Femur Fracture. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture
Femur Fracture [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 22]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Femur Fracture ID - 307032 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307032/all/Femur_Fracture PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -