Reading Femur X-rays
Length, rotation, and the second injury on the same bone.
Aug 31, 2026 · 3 refs
At a glance
Femur films must include the hip and the knee. A midshaft that looks isolated is how ipsilateral necks get missed. Rotation and length are the description that changes the nail plan.
Technique pointers
Series
- AP and lateral of the entire femur
- Dedicated hip (and AP pelvis) plus dedicated knee
- Look at the neck on every shaft film before you call it a simple shaft
Describe
- Location (subtroch / mid / distal)
- Winquist thinking for comminution
- Rotation relative to the proximal fragment
Decision-making
Polytrauma timing is a physiology decision; the film still has to show whether this is a neck-shaft combination. If the hip is not on the cassette, you are not done.
High-yield / exam
- Hip and knee on the series
- Search for an ipsilateral neck
- Rotation and shortening belong in the description
- Distal-third patterns need the knee articular surface
Questions
Ortho Skills (Real Life) and Boards items for this topic are coming.
Your pearl
One line you’d tell a junior at 2am.
References
- 01
Closed intramedullary nailing of femoral fractures
1984 · Journal of Bone and Joint Surgery (American) · review
Shaft care assumes you have seen the whole bone.
- 02
Femoral shaft fractures — associated injury and radiographic workup
2015 · Journal of the American Academy of Orthopaedic Surgeons · review
Ipsilateral neck is the miss that changes the construct.
- 03
OTA teaching on femoral shaft nailing and polytrauma timing
2020 · Orthopaedic Trauma Association · guideline
Films of hip-to-knee before the nail starts.
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