Fractures of the adult femur excluding the femoral head and neck: a review and evaluation of current therapy.

A review and appraisal of current methods of treatment of fractures of the femur including operative and nonoperative methods as well as complications or limitations of various methods, reveals that a specific appliance or procedure is of value only when used with proper indication and proper technique. When internal fixation is performed, load-sharing between appliance and bone is mandatory, because of the large mechanical stresses involved. Intramedullary fixation permits load-sharing more often than extramedullary fixation and should be used on femoral fractures whenever possible. Conservative management with traction and braces can be valuable for young patients with fracture of the distal femur, but requires careful technique and follow-up to avoid excessive shortening or deformity. The proximal, middle and distal part of the femur should be evaluated separately as each area has specific anatomic limiations and biomechanical requirements.