Femoral and tibial fractures

Abstract Femoral shaft fractures have a bimodal distribution with high energy injuries in young patients and an increasing incidence of osteoporotic fractures in elderly patients. Adult diaphyseal fractures are invariably managed operatively and the procedure most commonly performed is stabilisation with antegrade reamed intramedullary nailing. Retrograde nailing is also used for specific indications. Plating is still used for more distal fractures. External fixation and non-operative treatment by traction are seldom used now due to high risk of complications. Tibial shaft fractures are the most common long bone fracture and the most common open long bone fracture (21%). Reamed intramedullary nailing is the most common treatment for unstable fractures. Low energy undisplaced fractures can be treated non-operatively in a cast or brace. Plating is not often used for diaphyseal injuries but is useful for metaphyseal fractures. External fixation is still commonly used for some severe open injuries or to correct deformity. Complications of femoral and tibial fractures include nonunion, malunion and infection in association with open fractures. Compartment syndrome complicates 2-10% of tibial fractures. For closed fractures the incidence of all of these complications should be less than 5%. Open fractures have a greater risk of complication which is generally proportional to the energy of the injury.