Title: Operative Difficulties in the Management of a 4-Month Neglected Femoral Shaft Fracture Treated by Double Plating: A Case Report
Authors: Authors: ZAJLI Driss¹
ABAYDI Anass¹
SAHBANI Khalil¹
LAHLOU Hamza¹
RADI Jihad¹
LAHRACH Kamal¹
BOUTAYEB Fawzi¹.
Volume: 10
Issue: 8
Pages: 83-87
Publication Date: 2026/08/28
Abstract:
Neglected femoral shaft fractures, frequently encountered in settings where recourse to traditional treatment remains common, expose patients to specific operative difficulties that distinguish them from recent fractures. We report the case of a 70-year-old patient presenting with a closed fracture at the junction of the middle and lower thirds of the left femoral shaft, in three fragments, neglected for 4 months after initial traditional treatment. Surgical management, performed through a lateral approach with double-plate osteosynthesis combined with cerclage wiring, revealed several major difficulties: significant intraoperative bleeding, difficult release of fragments trapped within dense fibrosis, a reduction rendered complex by limb shortening requiring lengthening of the fascia lata, and a narrow, curved medullary canal that made intramedullary nailing difficult to perform. Intraoperative knee mobilization under general anesthesia allowed flexion to improve from 20° to 80°. The postoperative course at 2 months was uneventful, with rehabilitation ongoing. Through this case, we discuss the technical particularities of these neglected fractures and highlight the value of rigorous preoperative preparation - anticipating blood loss, ensuring availability of suitable implants, and allowing for a prolonged operative time - when facing this type of injury.