Trauma X-ray - Lower limb
Femoral shaft

Key points

  • Femoral fractures require high force trauma
  • Consider pathological fractures if there is a history of low force impact

Fractures of the femoral shaft usually result from high force impact such as in a road traffic crash. Injury often results in highly displaced fractures which are easily recognised both clinically and radiologically.

If there is a fracture of the femoral shaft without a history of high force trauma then the possibility of a pathological fracture should be considered.

Standard views

Anterior-Posterior (AP) and Lateral. Several images may be required to ensure at least 2 views covering the whole length of the femur.

Femoral shaft fracture

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Femoral shaft fracture

  • Spiral fracture with posterior angulation, lateral displacement and shortening
  • There is rotation of the distal femur so the knee faces laterally
  • X-rays of the proximal femur (not shown) did not reveal further injury
  • Injury occurred in a road traffic crash

Pathological femoral shaft fracture

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Pathological femoral shaft fracture

  • Transverse fracture with rotational displacement and shortening
  • Patient with known history of widespread bone metastases - note the abnormal bone texture
  • Injury occurred after a trivial fall