Reduction Techniques for Diaphyseal Femur Fractures

Philip R. Wolinsky, MD; Justin F. Lucas, MD


J Am Acad Orthop Surg. 2017;25(11):e251-e260. 

In This Article

Abstract and Introduction


Achieving and maintaining reduction in patients with a diaphyseal femur fracture may be difficult; therefore, thorough preoperative planning is required. To fully prepare for successful surgical management of diaphyseal femur fractures, surgeons must consider appropriate patient positioning and necessary tools, including surgical tables, traction devices, and instruments. Principles of acceptable reduction rely on the restoration of length, alignment, and rotation. Reduction of diaphyseal femur fractures should be attained in the least invasive manner, via percutaneous reduction techniques, if possible, to preserve fracture biology and promote successful fracture healing. Intraoperative assessment of reduction often requires imaging studies of the contralateral extremity as a reference. Intraoperative assessment for associated femoral neck fractures and postoperative clinical examination of the hip and knee are imperative to the successful management of diaphyseal femur fractures. Other reference modalities and clinical examinations are required in patients with bilateral diaphyseal femur fractures.


Diaphyseal femur fractures, which commonly result from a high-energy mechanism of injury, may be isolated or associated with multisystem trauma. Given that 1.1 to 2.9 million diaphyseal femur fractures occur each year, an emphasis has been placed on the efficient and effective management of diaphyseal femur fractures to maximize good patient outcomes.[1] The management of diaphyseal femur fractures begins with an assessment of a patient's overall clinical status, including resuscitation status; other associated solid organ, neurologic, or pulmonary injuries; and other orthopaedic injuries, including those that may be unrecognized at the time of initial presentation.[2,3] An incomplete patient workup before definitive management may result in complications, including acute respiratory distress syndrome; second-hit injuries; and the displacement of unrecognized fractures, including ipsilateral femoral neck fractures.[4–6] A series of decisions must be made before proceeding with definitive diaphyseal femur fracture fixation, including patient positioning, surgical approach, and implant type. Achieving and maintaining adequate fracture reduction is critical to prevent nonunion and malunion, which result in substantial disability-adjusted life-year burden.[1,7]