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This fracture is usually the result of a twisting fall when the foot is anchored. The force of the fall is transmitted to the femur. Other causes of a femoral shaft fracture include direct force (eg in a motor cycle accident). Note that if this fracture occurs in eg a motor cycle accident, then it is an indication of extreme violence. There are likely to be other injuries present. Femoral shaft fractures may also occur as pathological fractures (e.g. in Paget's disease).