The diaphysis is a smooth cylinder with differences in cortical thickness throughout its length, which may help assess intraoperative femoral rotation. It ends proximal to the condyles at a distance equal to the greatest width of the femoral condyles. According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification of fractures, the femoral shaft begins at the inferior border of the lesser trochanter. They will not be discussed in this article. These fractures are challenging to manage secondary to the muscular deforming forces. Classically the first 5 cm distal to the lesser trochanter is termed the subtrochanteric region and is considered a separate fracture pattern. The shaft, or diaphysis, is the segment inferior to the lesser and ending at the metaphyseal flair and condyles. Distally, the femur comprises the metaphyseal flare, which continues into the medial and lateral femoral condyles, separated by the intercondylar notch. Proximally, the femur is composed of a specialized metaphyseal region consisting of the head, neck, and greater and lesser trochanters. Treatment of modern-day femoral shaft fractures results in excellent outcomes. The goal of fixation is early healing and long-term functional recovery. Intramedullary nailing (IMN) is the most common treatment for physiologically stable patients. FSFs are also associated with other comorbidities necessitating a thorough advanced trauma life support (ATLS) assessment and interdisciplinary care. Femoral shaft fractures (FSF) typically occur in a bimodal distribution, high-energy trauma in the young population, and lower energy trauma in the elderly population. They commonly result from high-energy mechanisms such as motor vehicle collisions (MVC) with sequelae of limb shortening and deformities if not treated appropriately. These fractures are often associated with polytrauma and can be life-threatening. Fractures of the femoral shaft are one of the most common injuries treated by orthopedic surgeons.
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