[Selection of treatment in femoral shaft fractures]

It is not possible and seems not reasonable to treat all kinds of femoral shaft fractures in the same way. Any type of osteosynthesis has its own advantages and disadvantages. The decision towards an operative procedure and the application of a special method depends on the individual situation of the patient and on the familiarity and experience of the orthopedic surgeon with the different available procedures. Single fractures, shaft fractures in combination with jointnear lesions, fractures in polytraumatized patients require a differentiated approach. Doubtless, nowadays the trend to treat all femoral shaft fractures by i.m. nailing is obvious. But it seems that there still exist a lot of indications where the plate or an external fixation can be used with remarkable advantages.