If the patient is treated at the site of the accident then shock should be treated and the fracture splinted before the patient is moved. A Thomas' splint is ideal for transport of the patient: this device involves threading the leg through the ring of the splint and pulling it straight; traction is then maintained by tying the shod foot to the cross-piece; the splint and the limb are firmly bandaged together.
A closed fracture is treated by closed reduction and closed nailing e.g. by inserting an intramedullary nail from the proximal end of the bone, under x-ray control, without exposing the fracture.
In many centres open fractures of the femoral shaft are also treated by intramedullary nailing.
Exercises are begun after the operation. The patient may be allowed to walk with the aid of crutches, allowing limited weight-bearing, within a week or two of the operation. The patient can only resume full weight-bearing when the fracture is seen to have united on x-ray.
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