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A 26 year old man was admitted after a single vehicle road traffic accident. He was an unrestrained driver travelling at approximately 50 mph and was ejected from his vehicle. His initial hospital management followed standard Advanced Trauma and Life Support guidelines. He had no loss of consciousness and complained only of severe left thigh pain. On examination, there was gross angular deformity at the left mid-thigh level, consistent with a femoral shaft fracture. Left pedal pulses were palpable and there was no neurological deficit. When fully exposed, the patient was noted to have bruising on the posterior …