Fractures of the proximal one-third of the femoral shaft usually show abduction and flexion of the proximal fragment, due to the pull of the gluteal and iliopsoas muscles. In the middle one-third there is no constant deformity; however, overriding is usually present. In the distal one-third, or supracondylar type of fracture, the gastroenemius and soleus muscles cause posterior angulation of the distal fragment. In the emergency treatment of these fractures, as with all fractures, splints should be applied before moving the patient to prevent more soft-tissue damage, increased bleeding, and vascular and nerve injury. Emergency splinting cannot be overemphasized. A Thomas splint is the most satisfactory means of immobilization but is rarely available at the time of injury. A board from the groin to the toes or binding of the leg to the normal leg is an available and satisfactory method for emergency splinting. Most fractures of the femur can
SMITH JS. Injuries to the Thigh, Knee, and Leg. AMA Arch Surg. 1957;75(5):733–734. doi:10.1001/archsurg.1957.01280170043024
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