Abstract
BACKGROUND: Femoral shaft fractures (FSF's) represent common orthopaedic injuries, traditionally resulting from high-energy trauma in younger patients. Effective treatment is crucial for functional recovery, with significant social and economic implications. Despite extensive literature relating to FSF's, the quality of evidence and research trends remain unclear. METHODS: A bibliometric analysis was conducted using Web of Science (August 2024) to identify the top 50 most-cited publications related to FSF's. Publications were screened using specific inclusion and exclusion criteria, focusing on primary FSF-related research. Data including authorship, publishing institution, level of evidence (LOE), and study focus were analysed using VOSviewer software to explore bibliometric coupling, co-citation relationships and keyword co-occurrences. RESULTS: The 50 most-cited publications collectively received 9796 citations, with the highest cited paper accumulating 508 citations. Treatment outcomes (50 %) and epidemiology (32 %) were the predominant study focuses, while only 4 % addressed surgical techniques. Retrospective cohort and case-control studies constituted 84 % of the included papers, predominantly of level III evidence. The mean patient age was 37.96 years, with a majority being female (65.2 %). Hannover Medical School emerged as the most prolific institution, and the Journal of Bone and Joint Surgery published the highest number of articles. Co-occurrence analyses highlighted trends in osteoporosis and bisphosphonate-related FSFs. CONCLUSIONS: FSF literature has expanded, focusing primarily on treatment outcomes and epidemiological risk factors. However, a significant proportion of studies are of low evidence, with limited prospective research and an underrepresentation of topics such as FSF complications and paediatric fractures. Future studies should aim to maximise research quality and address emerging themes, including gender-specific analyses and the management of atypical fractures in elderly male populations.