Thoracic and lumbar fractures associated with femoral shaft fractures in the multiple trauma patient. Occult presentations and implications for femoral fracture stabilization.

Two-hundred-and-one patients with femoral shaft fractures were identified in a 5 year period at three institutions. Seven patients (3.5%) were found to have associated thoracic or lumbar fractures of various types. All resulted from high-velocity trauma. Four (57%) of these patients had thoracic or lumbar fractures that were undiagnosed on admission and before femoral fracture stabilization. A neurologic deficit persisted in four patients, and the possible contribution of femoral intramedullary rodding with positioning and traction must be considered. A high index of suspicion for thoracic and lumbar fractures is required when evaluating the high velocity trauma patient with a femoral shaft fracture. Presence of the thoracic or lumbar fracture may require initial spine stabilization or alter the method of femoral fracture treatment.