Timing of surgery. If the skin around your fracture has not been broken, your doctor will wait until you are stable before doing surgery.
Open fractures, however, expose the fracture site to the environment. They urgently need to be cleansed and require immediate surgery to prevent infection.
For the time between initial emergency care and your surgery, your doctor will place your leg either in a long-leg splint or in skeletal traction. This is to keep your broken bones as aligned as possible and to maintain the length of your leg.
Skeletal traction is a pulley system of weights and counterweights that holds the broken pieces of bone together. It keeps your leg straight and often helps to relieve pain.
External Fixation. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.
External fixation is usually a temporary treatment for femur fractures. Because they are easily applied, external fixators are often put on when a patient has multiple injuries and is not yet ready for a longer surgery to fix the fracture. An external fixator provides good, temporary stability until the patient is healthy enough for the final surgery. In some cases, an external fixator is left on until the femur is fully healed, but this is not common.
Intramedullary Nailing. Currently, the method most surgeons use for treating femoral shaft fractures is intramedullary nailing. During this procedure, a specially designed metal rod is inserted into the marrow canal of the femur. The rod passes across the fracture to keep it in position.
An intramedullary nail can be inserted into the canal either at the hip or the knee through a small incision. It is screwed to the bone at both ends. This keeps the nail and the bone in proper position during healing.
Intramedullary nails are usually made of titanium. They come in various lengths and diameters to fit most femur bones.
Plates and Screws. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone.
Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend into either the hip or knee joints.