Fractures of the femoral shaft are often the result of high energy trauma such as a motor vehicle crash, a fall from a height, or a gunshot wound. Most femoral shaft fractures require surgical treatment. Fractures in the diaphysis (i.e., the mid shaft) are typically treated with the insertion of a metal rod (also known as an intramedullary nail) into the canal of the femur. Fractures located closer to the hip or knee, whose angulation might disrupt joint mechanics and function, require more precise restoration of anatomical alignment that can be offered by an intramedullary nail. Such fractures are therefore usually treated with a surgical plate. The outcomes after femur fractures are usually good, but can be marred by blood loss, infection, delayed union, non-union, mal-union, or problems from associated injuries. Rarely but consequentially, fat from the medullary canal, exposed by the fracture, can travel through the vascular system to the lungs. This can produce a so-called fat embolism syndrome, a serious condition characterized by pulmonary dysfunction and mental status changes related to the resultant hypoxia.
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