Winquist and Hansen developed a classification of femoral shaft fractures based on the extent of comminution. The classification is helpful in determining the best treatment for a specific injury and the risk for complications.
Fracture with Comminution
Grade
no comminution
0
very small fragment of bone broken off
I
fragment larger than in Grade I; >= 50% contact in abutting cortices; a nail has good purchase in both proximal and distal pieces
II
fragment larger than in Grade I; < 50% contact in abutting cortices, or poor purchase of the nail in either the proximal or the distal femur
III
multiple fragments with no circumferential buttress; no fixed contact between the proximal and distal fragments
IV
where:
• The presence of cracks in the bone may convert a stable fracture to an unstable one.
Grade
Significance
0
stable
I
stable and can be treated as if noncomminuted
II
contact sufficient to prevent shortening or translation; a closed intramedullary nail is usually sufficient therapy
III
rotation, translation and shortening may occur; casting, traction, wiring or other technique is required in addition to nailing to maintain length
IV
rotational control difficult, with no contacts to prevent shortening; usually requires additional stabilization in addition to nailing to maintain length
Additional types of fractures:
(1) segmental: fracture at 2 levels of the femoral shaft
(2) long oblique
(3) longitudinal
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