How to treat a broken femur

Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.

Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction.

The femur, also known as the thigh bone, is one of the largest and strongest bones in the body extending from the hip joint all the way down to the knee joint. Because it is so strong, it requires a significant force to break it.

With that being said, certain medical conditions can weaken the bone and make it more vulnerable to fracture. These include osteoporosis, tumors, infection, and even certain bisphosphonate medications used to treat osteoporosis. Breaks of these sorts are referred to as pathologic femur fractures. Pathological fracture of the femur is a debilitating complication in patients with advanced stage of malignancy.  

Femur fractures are generally separated into three broad categories:

Proximal Femur Fractures

Proximal femur fractures, or hip fractures, involve the uppermost portion of the thigh bone just adjacent to the hip joint. These fractures are further subdivided into:  

• Femoral neck fractures are those that occur when the ball of the ball-and-socket joint is broken at the top of the femur.
• Intertrochanteric hip fractures occur just below the femoral neck and are more easily repaired than femoral neck fractures.

Femoral Shaft Fractures

A femoral shaft fracture is a severe injury that usually occurs as a result of a high-speed car collision or a fall from a great height.

The treatment almost always requires surgery. The most common procedure involves the insertion of a metal pole (known as an intramedullary rod) into the center of the thigh bone.   This helps reconnect the two ends which are then secured with screws above and below the fracture. The intramedullary rod almost always remains in the bone but can be removed if needed.

A less common technique involves the use of plates and screws to secure the fracture which is then held in place by an external fixator. The fixator, which is situated outside of the leg but penetrates the skin to stabilize the bone segments, ensures that the femur is fully immobilized and better able to heal. External fixation is usually a temporary treatment for patients who have multiple injuries and cannot have a longer surgery to fix the fracture.  

Supracondylar Femur Fractures

A supracondylar femur fracture, also called a distal femur, is a break in the bone that occurs just above the knee joint.   These fractures often involve the cartilage surface of the knee joint and are most commonly seen in people with severe osteoporosis or those who have previously undergone total knee replacement surgery.

A supracondylar femur fracture is a problematic condition as it can increase the risk of developing knee arthritis later in life.  

The treatment of a supracondylar femur fracture is highly variable and may involve a cast or brace, an external fixator, an intramedullary rod, or the use of plates and screws.

Treatment

A femur fracture is always considered a medical emergency requiring immediate evaluation and treatment in a hospital. The treatment is largely dependent on the location of the fracture and the pattern and extent of the break.

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• Call 911 if:
• 1. Reduce Swelling and Avoid Further Injury
• 2. Seek Medical Care Immediately
• 3. Follow Up

Call 911 if:

• You think a thighbone is broken. The thighbone (or femur) extends from the hip to the knee.
• A bone has punctured the skin.

For other breaks:

1. Reduce Swelling and Avoid Further Injury

• Keep the injured leg as still as possible. Do not let the person bear any weight on the leg.

• Apply ice.

• Keep the leg raised with pillows or cushions.

2. Seek Medical Care Immediately

• If you think a thighbone is broken or you are unable to move the person, call 911 and have the person taken to the hospital.

3. Follow Up

Treatment will depend on the nature of the injury.

• A health care provider will examine the person’s leg and likely do an X-ray.

• The bone may be realigned and a splint, cast, or brace put on.

• Surgery may be needed.

Sources

Dartmouth-Hitchcock Medical Center: “Broken Leg.”

KidsHealth: “Broken Bones” and “Broken Bone Instruction Sheet.”

American Association of Orthopaedic Surgeons: “Tibia (Shinbone) Fracture” and “Femur (Thighbone) Fracture.”

The femur — your thigh bone — is the largest and strongest bone in your body. When the femur breaks, it takes a long time to heal. Breaking your femur can make everyday tasks much more difficult because it’s one of the main bones used to walk.

• You feel immediate, severe pain.
• You’re unable to put weight on the injured leg.
• The injured leg appears to be shorter than the uninjured leg.
• The injured leg appears to be crooked.

The femur is a very large, strong bone that is difficult to break. A broken femur is usually caused by a severe accident; vehicle accidents are one of the primary causes.

Older adults can fracture their femur from a fall because their bones tend to be weaker. Depending on how close to the hip the break is, it may be called a hip fracture instead of a femur fracture.

In most cases, your doctor will start with an X-ray. If more information is needed, they might also order a CT (computed tomography) scan. Before recommending specific treatment, your doctor will determine what type of break you have. The most common types are:

• Transverse fracture. The break is a straight horizontal line.
• Oblique fracture. The break has an angled line.
• Spiral fracture. The break has a line that encircles the shaft like the stripes on a barber pole or candy cane.
• Comminuted fracture. The bone is broken into three or more pieces.
• Compound fracture. Bone fragments are sticking out through the skin.
• Open fracture. A wound penetrates down to the broken bone.

Because the femur is such a strong bone, a broken femur (excluding hip fractures) is rare. The healing process typically takes up to six months, going through four phases:

1. The body starts the healing process.
2. The body experiences inflammation.
3. The body regenerates with new bone growth.
4. The body remodels with mature bone being replaced by newly formed bone.

The majority of broken femurs require surgery and medication.

Surgery

There are different surgeries, either internal or external, to hold the bones in place while they heal. The most common surgery for a broken femur is called intramedullary nailing. This surgery inserts a rod into the length of the bone with screws above and below to hold it into place.

Medication

Before and after surgery, your doctor may help you manage your pain with over-the-counter and prescription medications, such as:

• acetaminophen
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• gabapentinoids
• muscle relaxants
• opioids
• topical pain medications

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The femur is the strongest and thickest bone in the body. It connects the hip joint and the knee joint. It takes an extremely strong force to break a femur. Sport injuries, car accidents and falls are the most likely causes of a broken femur. The following steps will help you during the recovery process.

Understand that a patient with a broken femur often suffers from severe pain and is unable to walk. You can observe significant swelling, bruising and deformity at the site of fracture. In some cases, you feel that the bone in your leg is moving. Based on these symptoms, your physician will order X-rays of your leg.

Know the different kinds of breaks. In a simple fracture, the femur is broken into two pieces. In a more complex case, the femur is broken into three or more pieces. Sometimes, the fracture is open and the bone is exposed. In a pathological femur fracture, the bone is weak and can easily break.

Keep in mind that the recommended treatment for a broken femur is surgery. Surgery for a broken femur may last three to four hours. In most cases, a metal rod, also known as the intramedullary rod, is inserted into the thigh bone. The intramedullary rod is held in place by screws. The rod can be taken out later if necessary. Casts are only used for broken femur in children but rarely used for healthy adults. The main complication of surgery for a broken femur is infection, which occurs in less than 1 percent of cases. Another complication is that your body might reject the rod.

Keep in mind that you will need to stay in the hospital for two to four days after the surgery. The length of the hospital stay depends on whether you can walk with crutches. A physical therapist will help you to learn how to use the crutches before going home.

Understand you will be on crutches for two to three months following the operation. Your doctor will schedule visits at two weeks, six weeks, 12 weeks, 24 weeks and one year. During each visit, X-rays of your fracture(s) will be taken. Based on the X-rays, the doctor will make decisions on how much weight you can put on the injured leg.

Know that in the first two to three weeks after the surgery, you will be in a lot of pain. Take pain medication regularly according to your doctor’s recommendations. You can also use ice to relieve pain and reduce swelling. Elevating your leg also helps to relieve the pain.

Remember that physical therapy is very important in helping you to regain strength and mobility of your leg. Schedule appointments with your physical therapist at least once every two weeks. Understand that your physical therapist is also going to give you some exercises to do at home. The types of exercises will depend on the stage of your recovery. At the beginning of the recovery, the exercises will focus on getting your range of motion back, since your knee is going to be very stiff. When your broken bone shows some signs of healing, the exercises will focus on getting your muscle strength back.

In addition to physical therapy, you can try to do other exercises such as biking on a stationary bike or swimming. Walking in water is also a good exercise to rebuild muscle strength.

Listen closely and follow advice from your doctor and physical therapist. Be patient. You may damage your leg severely by doing too much too soon.

Keep in mind that in the worst case scenario, your broken bone might not heal. The probability of such event, also known as non-union, is 1 percent. Another surgery may be needed to take out the screws to accelerate bone growth.

Femur Break in a Nursing Home Resident

A femur break is a serious break at any age but it can be deadly to seniors that are 65 years and older. The femur is the longest bone in the body. Femur breaks/fractures are most likely at the hip but in some cases can be at the lower extremities.

These types of fractures are most prevalent in young men from high-energy injuries and elderly women in low-energy injuries. The largest difference between these two groups is the survival rate.

A retrospective study that reviewed a 105 femur fractures that occurred below the hip in 99 patients that were age 65 and older found that:

• Complication rate overall was 45%.
• Mortality rate was 10% within 2 months of the injury.
• Surgical success rates were increased by 39% in patients that were operated on within the first 48 hours.

According to another study that looked at 100 elderly patients that suffered a femur break over a 10-year period:

• The overall mortality rate with a follow up of 9.8 years was 38% without co-morbidity.
• Mortality rates at 30 days was 6%
• Mortality rates at 6 months was 18%
• Mortality rates at 1 year after surgery was 25%

Each study has found that quick action was one of the key factors in who survived the break and who did not. Speedy intervention can be a lifesaver. When these types of injuries happen in a nursing facility, staff members may be slow to report the injury for fear of reprisal from their employer.

Underreported

Many of these types of incidences are not reported in a timely manner by staff members at a nursing home because they occur out of neglect. The most common cause of a femur break in a nursing home is from a fall. Improper supervision while bathing, walking and even when being moved from the bed to a chair can easily cause a fall that results in a femur break.

Since speedy action and intervention is highly recommended by all medical professionals. When a staff member simply leaves their shift without reporting the incident, it can literally mean a death sentence for the resident.

In many cases, the staff member is afraid to report the injury because they do not want to suffer the consequences of potentially losing their job. It is not unusual for shift reports to be falsified.

It can be difficult to get to the “bottom” of the incident when the document trail is not consistent or reliable and the resident cannot tell you what happened because of preexisting conditions like dementia.

Other Factors

Femur breaks are more likely to occur in seniors that have other conditions like osteoporosis, poor nutrition and that take certain medications that contribute to bone thinning. Another risk factor for experiencing this type of break is institutional living. According to statistical data, a woman over the age of 65 that lives in a nursing home or assisted living facility has a 25% higher risk of suffering a femur break.

There is speculation that the risk factor is higher in nursing homes and other institutional living settings because of a “false” sense of security. Since these facilities are supposed to be a safe haven for the elderly that will help to protect them, relatives and friends do not feel the same compulsion to check the safety of the environment.

If you feel that a loved one is at risk because of neglect that caused a femur break you can take action:

• Go here and look up your state to find the number to call to report suspected abuse and/or neglect.
• Call local law enforcement.
• Hire an attorney.

Speak to an attorney that has experience in nursing home abuse/neglect cases and they can help you get the wheels in motion to report the incident to the proper authorities.

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• Who’s Most at Risk?
• Hip Fracture Symptoms
• Are Hip Fractures Dangerous?
• What’s the Treatment?
• How Can I Prevent a Hip Fracture?

A hip fracture is a break in the top quarter of the thighbone, which is also called the femur. It can happen for lots of reasons and in many ways. Falls — especially those to the side — are among the most common causes. Some hip fractures are more serious than others, but most are treated with surgery.

Who’s Most at Risk?

Each year about 300,000 Americans — most of them over age 65 – break a hip.

It happens to women more often than men. That’s because women fall more often and are more likely to have osteoporosis, a disease that makes bones weak.

Other things that increase your chances of a hip fracture include:

• Being underweight
• Not getting enough calcium or vitamin D
• Family history of osteoporosis
• Lack of exercise
• Drinking too much alcohol
• Smoking

Also, distance runners and ballet dancers sometimes develop thin cracks called stress fractures in their hips. They can grow bigger over time if they’re not treated.

Hip Fracture Symptoms

You’ll probably have a lot of pain in your hip or groin. You may be unable to walk. Your skin around the injury may also swell, get red or bruise. Some people with hip fractures can still walk. They might just complain of vague pain in their hips, butt, thighs, groin or back.

If your doctor thinks you’ve got a broken hip, he’ll ask questions about any recent injuries or falls. He’ll do a physical exam and take X-rays.

If the X-ray image is unclear, you may also need an MRI or bone scan. To do a bone scan, your doctor injects a very small amount of radioactive dye into a vein in your arm. The ink travels through your blood into your bones, where it can reveal fractures.

Are Hip Fractures Dangerous?

It depends. They can damage surrounding muscles, ligaments, tendons, blood vessels, and nerves. If they’re not treated right away, they could affect your ability to get around for long periods of time. When this happens, you run the risk of a number of complications, like:

• Blood clots in your legs or lungs
• Bedsores
• Urinary tract infection
• Pneumonia
• Loss of muscle mass. This puts you at risk for more falls and injuries.

Continued

What’s the Treatment?

Usually, you’ll need surgery. What type depends on the kind of fracture you have, your age, and your overall health. But first, your doctor will likely order a number of tests, like blood and urine, chest X-rays, and an electrocardiogram (EKG).

How Can I Prevent a Hip Fracture?

The best way is to make sure your bones stay strong and healthy. To that end, your doctor might recommend one or more of the following:

• Calcium supplements
• Vitamin Dsupplements
• Drugs called bisphosphonates – these prevent the loss of bone mass
• Calcitonin, a hormone that maintains calcium levels in your bones
• Regular physical activity
• Giving up tobacco and alcohol

Your doctor may also recommend you take drugs that increase the activity of the hormone estrogen and improve bone density. These are called selective estrogen receptor modulators.

Sources

American Academy of Orthopaedic Surgeons: “OrthoInfo: Hip Fractures.” “Hip Fracture Prevention.”

CDC: “Hip Fractures Among Older Adults.”

New York University Langone Medical Center: “Types of Hip & Pelvic Fractures.”

Houston Methodist Hospital: “Stress Fracture of the Hip.”

When four time Tour de France winner Chris Froome was relegated from pre-Tour form chasing to intensive care in the blink of an eye, cyclists the world over winced at the announcement of a broken femur.

The Team Ineos rider reportedly crashed into a wall at 54 kilometres per hour when a gust of wind grasped his front wheel and brought him to a dead stop.

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The 34-year-old’s injuries are said to involve fractured ribs and right elbow, pelvis, as well as the thigh bone.

Racing stat Bible, ProCyclingStats.com, has already confirmed that of the 19 riders in its database who fractured a femur after May 15, not one came back to race that season.

The femur is the longest and strongest bone in the human body. Breaking it often requires a fair amount of speed and force, and it’s usually an injury associated with motor vehicle collisions. But it’s not all bad news.

“If its just a clean break, and you’re relatively fit and healthy and have the right physiotherapy, your recovery can be quick,” explained former pro and osteopath to UCI WorldTour teams, Alice Monger-Godfrey.

“It will take at least six weeks, though there will be the odd person who gets back quicker. It doesn’t have to be the year out that people think. But you need to ensure it’s healed properly. You don’t want to rush back too soon, as pedalling puts a lot of force through the area.

“However, the length of recovery time depends on where you break the femur,” Monger-Godfrey explains.

“When the head of the femur is broken, it’s very different to a break half way down the femur. Recovery could be anything from 12 weeks to 12 months.”

Femur fracture types range from proximal femur fractures (or hip fractures) involving the hip joint, to f emoral shaft fractures, halfway down the bone, or supracondylar femur fractures where the bone is broken just above the knee.

The hip is rich in blood and nerve supply, but as Monger-Godfrey explains, “if blood supply has been affected it can cause complications and take a lot more time.”

Froome is at the top of his game (Photo by Anne-Christine POUJOULAT / AFP)

Of course, what’s most important is Froome’s overall health – but there’s a nation of cyclists eager to see him ride at the top level. After a successful operation, he’s already said to be looking at the rehab ahead – with surgeons quoting six months as a goal.

“Froome is fit and healthy, at the top of his game, which will speed up recovery. But unless he’s completely super-human, that will likely be the end of the season for him. There will be a lot of recovery – a severe amount of pain – and you don’t know the extent of swelling, scar tissue, any nerve damage,” she explains.

Collarbone breaks are the most common fracture in cycling, with neck and vertebrae cracks not unusual either. Breaking a femur takes quite a bit of work.

“It is definitely a rare injury – the glutes and surrounding muscle mass mean it’s quite a protected joint, and breaking a femur is more often a result of trauma. There’s also an element of weight and bone density. If you have low bone density, if you fall, you are more likely to break a bone.”

Rare doesn’t mean it’s not something that affects amateurs. First category rider for TAAP Cervelo, Ryan Visser, broke his greater trochanter – at the top of the femur – in 2017. He was back racing on the road and track in eight weeks.

A post shared by TAAP Cervelo Cycling Team (@taap_racing) on May 28, 2019 at 2:34am PDT

“I was doing some descending practice in Mallorca – trying to push myself and try a few new things,” Visser explains.

“It was a tight hairpin, I just leaned a bit too much and hit some sand. I dropped heavily on to my hip. I got back on my bike, but starting the next ascent, I realised I couldn’t put any force through the pedal.”

“There’s two types of greater trochanter break. You can break the head off, which is basically game over because it’s really hard to pin it. Or you can fracture it, which is what I did.

“I was told its six to 10 weeks until you heal. I had six weeks on crutches, and then I could sit on the Wattbike, gently pedalling. I was racing eight weeks after the accident.

“I’ve crashed before – you usually break a shoulder or a collarbone. You always feel like those are minor and you can bounce back. As soon as I broke my leg, I realised I won’t bounce back every time. I’ve realised I am vulnerable, and that can cause you to lose your edge.

“Another area I was told about afterwards was bone density. I crashed at slow speed but still broke a bone. Since then I’ve tried to do more jogging, more weights, to try and make my bones stronger.

“I still struggle with walking up the stairs. I push off with my right foot, and the left hip follows – I’m not pushing with my left foot. This is two years after. It’s just not quite the same – though I don’t notice it on the bike, our team raced the Cicle Classic this year and I’m getting better results than ever on the track.”

Visser is keen to highlight that a strong support structure got him back on the bike quickly, with a limited break in the season – and of course, that’s something Froome has in abundance.

“Froome will have the best team around him. If its diagnosed quickly and treated correctly, he will be back on track as quickly as possible. I can’t imagine his prognosis will be the same as someone not in the same athletic form,” Monger-Godfrey confirms.

You had a fracture (break) in the femur in your leg. It is also called the thigh bone. You may have needed surgery to repair the bone. You may have had surgery called an open reduction internal fixation. In this surgery, your surgeon will make a cut to the skin to align your broken bone.

Your surgeon will then use special metal devices to hold your bones in place while they heal. These devices are called internal fixators. The complete name of this surgery is open reduction and internal fixation (ORIF).

In the most common surgery to repair a femur fracture, the surgeon inserts a rod or large nail into the center of the bone. This rod helps support the bone until it heals. The surgeon may also put a plate next to your bone that is attached by screws. Sometimes, fixation devices are attached to a frame outside your leg.

What to Expect at Home

Recovery most often takes 4 to 6 months. The length of your recovery will depend on how severe your fracture is, whether you have skin wounds, and how severe they are. Recovery also depends on whether your nerves and blood vessels were injured, and what treatment you had.

Most of the time, the rods and plates used to help the bone heal will not need to be removed in a later surgery.

Wound Care

You may be able to start showering again about 5 to 7 days after your surgery. Ask your health care provider when you can start.

Take special care when showering. Follow your provider’s instructions closely.

• If you are wearing a leg brace or immobilizer, cover it with plastic to keep it dry while you shower.
• If you are not wearing a leg brace or immobilizer, carefully wash your incision with soap and water when your provider says this is OK. Gently pat it dry. DO NOT rub the incision or put creams or lotions on it.
• Sit on a shower stool to avoid falling while showering.

DO NOT soak in a bathtub, swimming pool, or hot tub until your provider says it is OK.

Change your dressing (bandage) over your incision every day. Gently wash the wound with soap and water and pat it dry.

Check your incision for any signs of infection at least once a day. These signs include more redness, more drainage, or the wound is opening up.

Tell all of your providers, including your dentist, that you have a rod or pin in your leg. You may need to take antibiotics before dental work and other medical procedures to reduce your risk of getting an infection. This is more often needed early after the surgery.

Home Setup

Have a bed that is low enough so that your feet touch the floor when you sit on the edge of the bed.

Keep tripping hazards out of your home.

• Learn how to prevent falls. Remove loose wires or cords from areas you walk through to get from one room to another. Remove loose throw rugs. DO NOT keep small pets in your home. Fix any uneven flooring in doorways. Have good lighting.
• Make your bathroom safe. Put hand rails in the bathtub or shower and next to the toilet. Place a slip-proof mat in the bathtub or shower.
• DO NOT carry anything when you are walking around. You may need your hands to help you balance.

Set up your home so that you do not have to climb steps. Some tips are:

• Set up a bed or use a bedroom on the first floor.
• Have a bathroom or a portable commode on the same floor where you spend most of your day.

If you do not have someone to help you at home for the first 1 to 2 weeks, ask your provider about having a trained caregiver come to your home to help you. This person can check the safety of your home and help you with your daily activities.

Follow the instructions your provider or physical therapist gave you about when you can start putting weight on your leg. You may not be able to put all, some, or any weight on your leg for a while. Make sure you know the correct way to use a cane, crutches, or walker.

Be sure to do the exercises you were taught to help build strength and flexibility as you recover.

Be careful not to stay in same position for too long. Change your position at least once an hour.

When to Call the Doctor

Call your provider if you have:

• Shortness of breath or chest pain when you breathe
• Frequent urination or burning when you urinate
• Redness or increasing pain around your incision
• Drainage from your incision
• Swelling in one of your legs (it will be red and warmer than the other leg)
• Pain in your calf
• Fever higher than 101В°F (38.3В°C)
• Pain that is not controlled by your pain medicines
• Nosebleeds or blood in your urine or stools, if you are taking blood thinners

Alternative Names

ORIF – femur – discharge; Open reduction internal fixation – femur – discharge

References

McCormack RG, Lopez CA. Commonly encountered fractures in sports medicine. In: Miller MD, Thompson SR, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 13.

Rudloff MI. Fractures of the lower extremity. In: Azar FM, Beaty JH, Canale ST, eds. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017:chap 54.

Whittle AP. General principles of fracture treatment. In: Azar FM, Beaty JH, Canale ST, eds. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017:chap 53.

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Emergency Department Care

In addition to maintenance intravenous fluids, patients with femoral shaft fractures who are suspected of having significant blood loss should be resuscitated with crystalloids. Place a Foley catheter, and restrict all patients to taking nothing by mouth (NPO) until seen by an orthopedic surgeon. [33]

Fracture reduction and immobilization

Reduce fractures to near-anatomic alignment by using in-line traction, which reduces pain and helps prevent hematoma formation. Hold reduction by a traction device (eg, Hare, Buck) or long-leg posterior splint. Pneumatic splint may have additional benefits of reducing blood loss by direct pressure and tamponade of hematoma formation. Traction is often required to hold the femur out to length because of contraction of large muscle mass in the thigh.

Pain management

Pain management is the most significant intervention of the emergency physician. Use parenteral opiate-type analgesics to the extent that respiratory and circulatory parameters allow. Intravenous administration allows for the most reliable titration to pain relief while providing ready access for reversal agents (ie, naloxone) if necessary.

Infection prophylaxis

With open fractures, administer tetanus toxoid (unless given within 5 yr) and use antibiotics with excellent staphylococcal coverage and good tissue penetration. Often, a first-generation cephalosporin (ie, cefazolin sodium) is administered in combination with gentamicin.

Treatment in children

In children, femoral shaft fractures constitute approximately 4% of all long-bone fractures. The preferred treatment for diaphyseal shaft fractures in the first or second year of life is spica casting or traction. For children 3 years of age, these fractures can be treated operatively or nonoperatively. In children older than 3 years, elastic stable intramedullary nailing is standard treatment. [6, 9, 13, 14, 15, 16, 17, 34, 35, 36]

Depending on the stage of skeletal maturity, some adolescents may be treated with initial external fixation, intramedullary nailing, or compression screw plate fixation. [18, 19] In the presence of contraindications to surgery, this repair may be delayed for days without significant complications if leg length is maintained with traction. [20] ​Open fractures require immediate operative debridement followed by delayed intramedullary nailing. [21]

Complications

Complications include the following:

Hemorrhagic shock: Closed fractures of the femur can result in significant blood loss (eg, 1 L) within the thigh. Open fractures have the potential for even greater blood loss. Because of the high rate of associated injuries, actively seek out other sources of blood loss in patients with femur fractures and hypovolemic shock.

Neurovascular injury: Injuries to the neurovascular bundle are rare because of the large cushion of muscle protecting neurovascular structures. Compartment syndrome of the thigh does not occur often, and peroneal nerve contusion is seen occasionally.

Infection: While open fractures are at high risk of soft-tissue and bony infection, postoperative infection is rare following repair of closed fractures.

Respiratory demise: Fat embolism and adult respiratory distress syndrome (ARDS) can occur. Femur fractures at a level one trauma center have been associated with double the risk of developing ARDS (odds ratio [OR], 2.129; 95% confidence interval [CI], 1.382-3.278) [22] as compared to other patients admitted for musculoskeletal injury. The risk trends upward with delays in surgical repair greater than 24 hours.

More delayed complications include permanent stiffness of the hip or knee, shortening of the extremity, or malrotation, resulting in permanent deformity and decreased performance.

Complications directly related to repair include (in order of increasing frequency) breakage of fixator hardware, nonunion, malunion, or delayed union.

Refracture has occurred at the initial injury site.

References

Salminen S, Pihlajamaki H, Avikainen V, Kyro A, Bostman O. Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma. 1997 Jul. 43(1):117-22. [Medline].

Hogan TM. Hip and femur. Hart RG, Rittenberry TJ, Uehara DT, eds. Handbook of Orthopaedic Emergencies. Publishers: Lippincott Williams & Wilkins; 1999. 307-8.

Starr J, Tay YKD, Shane E. Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures. Curr Osteoporos Rep. 2018 Aug. 16 (4):519-529. [Medline]. [Full Text].

Labronici PJ, Santos Filho FCD, Diamantino YLO, Loureiro E, Ezequiel MCDG, Alves SD. Proximal Femur Fracture and Vascular Injury in Adults-Case Report. Rev Bras Ortop (Sao Paulo). 2019 May. 54 (3):343-346. [Medline].

Medda S, Halvorson J. Diaphyseal Femur Fracture. 2019 Jan. [Medline]. [Full Text].

Roaten JD, Kelly DM, Yellin JL, Flynn JM, Cyr M, Garg S, et al. Pediatric Femoral Shaft Fractures: A Multicenter Review of the AAOS Clinical Practice Guidelines Before and After 2009. J Pediatr Orthop. 2019 Sep. 39 (8):394-399. [Medline].

Braten M, Helland P, Myhre HO, Molster A, Terjesen T. 11 femoral fractures with vascular injury: good outcome with early vascular repair and internal fixation. Acta Orthop Scand. 1996 Apr. 67(2):161-4. [Medline].

DiChristina DG, Riemer BL, Butterfield SL, Burke CJ 3rd, Herron MK, Phillips DJ. Femur fractures with femoral or popliteal artery injuries in blunt trauma. J Orthop Trauma. 1994 Dec. 8(6):494-503. [Medline].

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Rapp M, Kaiser MM, Grauel F, Gielok C, Illing P. Femoral shaft fractures in young children (

The femur is the strongest and thickest bone in the body. It connects the hip joint and the knee joint. It takes an extremely strong force to break a femur. Sport injuries, car accidents and falls are the most likely causes of a broken femur. The following steps will help you during the recovery process.

Understand that a patient with a broken femur often suffers from severe pain and is unable to walk. You can observe significant swelling, bruising and deformity at the site of fracture. In some cases, you feel that the bone in your leg is moving. Based on these symptoms, your physician will order X-rays of your leg.

Know the different kinds of breaks. In a simple fracture, the femur is broken into two pieces. In a more complex case, the femur is broken into three or more pieces. Sometimes, the fracture is open and the bone is exposed. In a pathological femur fracture, the bone is weak and can easily break.

Keep in mind that the recommended treatment for a broken femur is surgery. Surgery for a broken femur may last three to four hours. In most cases, a metal rod, also known as the intramedullary rod, is inserted into the thigh bone. The intramedullary rod is held in place by screws. The rod can be taken out later if necessary. Casts are only used for broken femur in children but rarely used for healthy adults. The main complication of surgery for a broken femur is infection, which occurs in less than 1 percent of cases. Another complication is that your body might reject the rod.

Keep in mind that you will need to stay in the hospital for two to four days after the surgery. The length of the hospital stay depends on whether you can walk with crutches. A physical therapist will help you to learn how to use the crutches before going home.

Understand you will be on crutches for two to three months following the operation. Your doctor will schedule visits at two weeks, six weeks, 12 weeks, 24 weeks and one year. During each visit, X-rays of your fracture(s) will be taken. Based on the X-rays, the doctor will make decisions on how much weight you can put on the injured leg.

Know that in the first two to three weeks after the surgery, you will be in a lot of pain. Take pain medication regularly according to your doctor’s recommendations. You can also use ice to relieve pain and reduce swelling. Elevating your leg also helps to relieve the pain.

Remember that physical therapy is very important in helping you to regain strength and mobility of your leg. Schedule appointments with your physical therapist at least once every two weeks. Understand that your physical therapist is also going to give you some exercises to do at home. The types of exercises will depend on the stage of your recovery. At the beginning of the recovery, the exercises will focus on getting your range of motion back, since your knee is going to be very stiff. When your broken bone shows some signs of healing, the exercises will focus on getting your muscle strength back.

In addition to physical therapy, you can try to do other exercises such as biking on a stationary bike or swimming. Walking in water is also a good exercise to rebuild muscle strength.

Listen closely and follow advice from your doctor and physical therapist. Be patient. You may damage your leg severely by doing too much too soon.

Keep in mind that in the worst case scenario, your broken bone might not heal. The probability of such event, also known as non-union, is 1 percent. Another surgery may be needed to take out the screws to accelerate bone growth.

A broken leg is a break or crack in one of the bones in your leg. It’s also referred to as a leg fracture.

A fracture may occur in the:

• Femur. The femur is the bone above your knee. It’s also called the thigh bone.
• Tibia. Also called the shin bone, the tibia is the larger of the two bones below your knee.
• Fibula. The fibula is the smaller of the two bones below your knee. It’s also called the calf bone.

Your three leg bones are the longest bones in your body. The femur is the longest and strongest.

Because it takes so much force to break it, a femur fracture is usually obvious. Fractures to the other two bones in your leg can be less obvious. Symptoms of breaks in all three might include:

• severe pain
• pain increases with movement
• swelling
• bruising
• leg appears deformed
• leg appears shortened
• difficulty in walking or inability to walk

The three most common causes of a broken leg are:

1. Trauma. A leg break could be the result of a fall, a vehicle accident, or an impact while playing sports.
2. Overuse. Repetitive force or overuse can result in stress fractures.
3. Osteoporosis.Osteoporosis is a condition in which the body is losing too much bone or making too little bone. This results in weak bones that are more likely to break.

The type and severity of a bone fracture depends on the amount of force that caused the damage.

A lesser force that just exceeds the bone’s breaking point may just crack the bone. An extreme force may shatter the bone.

Common types of broken bones include:

• Transverse fracture. The bone breaks in a straight horizontal line.
• Oblique fracture. The bone breaks in an angled line.
• Spiral fracture. The bone breaks a line encircling the bone, like the stripes on a barber pole. It’s usually caused by a twisting force.
• Comminuted fracture. The bone is broken into three or more pieces.
• Stable fracture. The damaged ends of the bone line up close to the position before the break. The ends don’t move with gentle movement.
• Open (compound) fracture. Fragments of bone stick out through the skin, or bone emerges through a wound.

How your doctor treats your broken leg depends on the location and type of fracture. Part of your doctor’s diagnosis is determining which classification the fracture falls into. These include:

• Open (compound) fracture. The skin is pierced by the broken bone, or bone emerges through a wound.
• Closed fracture. The surrounding skin isn’t broken.
• Incomplete fracture. The bone is cracked, but not separated into two parts.
• Complete fracture. The bone is broken into two or more parts.
• Displaced fracture. The bone fragments on each side of the break aren’t aligned.
• Greenstick fracture. The bone is cracked, but not all the way through. The bone is “bent.” This type typically occurs in children.

The primary treatment for a broken bone is to make sure the ends of the bone are properly aligned and then to immobilize the bone so it can properly heal. This starts with setting the leg.

If it’s a displaced fracture, your doctor may need to maneuver the pieces of bone into the correct position. This positioning process is called reduction. Once the bones are properly positioned, the leg is typically immobilized with a splint or cast made of plaster or fiberglass.

Surgery

In some cases, internal fixation devices, such as rods, plates, or screws, need to be surgically implanted. This is often necessary with injuries such as:

• multiple fractures
• displaced fracture
• fracture that damaged surrounding ligaments
• fracture that extends into a joint
• fracture caused by a crushing accident
• fracture in certain areas, such as your femur

In some cases, your doctor may recommend an external fixation device. This is a frame that’s outside your leg and attached through the tissue of your leg into the bone.

Medication

Your doctor may recommend over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil) to help reduce pain and inflammation.

In there’s severe pain, your doctor might prescribe a stronger pain-relieving medication.

Physical therapy

Once your leg is out of its splint, cast, or external fixation device, you doctor may recommend physical therapy to lessen stiffness and bring back movement and strength to your healing leg.

Your child has a break (fracture) in his or her thighbone (femur). The femur is a strong bone and is very hard to break. So a femur fracture is often the result of great force during severe trauma (such as a car accident, bad fall, or serious sports injury). Your child may have already been seen in an emergency room for initial treatment for the fracture. But further treatment is needed to help the leg heal. A child with a femur fracture is likely to be referred to an orthopedic surgeon (a surgeon specializing in bone and joint problems).

Note for parents of young children

Healthcare providers are trained to recognize a femur fracture as a sign of possible child abuse. Several healthcare providers may ask questions about how your child was injured. Healthcare providers are required by law to ask you these questions. This is done for protection of the child. Please try to be patient and not take offense.

Types of fractures

A bone can break in many ways. Here are some fracture types you may hear about:

Displaced fracture. The broken bone ends don’t line up).

Nondisplaced fracture. The broken ends are lined up.

Open fracture. The bone shows through the skin. These used to be called compound fractures.

Closed fracture. There is no break in the skin.

Comminuted fracture. The bone is broken into more than 2 pieces.

What are the signs and symptoms of a femur fracture?

Pain in the thigh

Swelling of thigh

The skin changes color (bruising)

Inability to walk

How is a femur fracture diagnosed?

A femur fracture is often diagnosed when the doctor examines the child. An X-ray (test that creates images of bones) will confirm the fracture. Because it takes great force to break the femur, more X-rays may be done to rule out fractures in nearby bones or to bones in other parts of the body.

How is a femur fracture treated?

The goal of treatment for a fracture is to hold bones together so they can heal. The best course of treatment for your child depends on your child’s age, the location of the fracture, and the type and severity of the fracture. Your child’s healthcare provider will explain the options to you and make recommendations. It generally takes 4 to 12 months for a femur fracture to heal completely.

Spica casting

A spica cast covers the child from waist to ankle. It keeps the thighbone and hip area completely still. This helps the bone heal correctly.

A spica cast is left on until the bone is healed, in about 8 to 12 weeks. The child may not be able to walk while the cast is in place.

After the cast comes off, the child may need to use crutches for 3 to 4 weeks while the leg regains strength if he or she is old enough (around age 6). Younger children may need to ride in a stroller or wagon or be carried until they are stronger..

This type of cast is mainly used in younger children.

Surgery to place fixation devices

Surgery can be done to place devices that hold the bones together while they heal. These are called fixation devices. This option lets children get back to school and other aspects of their life (with crutches or a walker) sooner than with casting. During surgery:

The fracture is reduced (the broken ends of bone moved back into line) if needed.

One of these types of fixations is then put into place:

Internal fixation. Long, flexible nails are placed inside the femur. These hold the broken bone in place while it heals. The nails are most often removed after the fracture has healed. In some cases, the nails are left in place.

External fixation. This is used when internal fixation is not the best option. Metal pins are put through skin into the fractured bone. These pins are attached to a bar that sits outside of the skin on the child’s thigh. The pins and bar hold the fractured bone in place while it heals. The pins and bar are removed after the fracture has healed.

Plates and screws. A small metal plate is placed across the femur fracture and held in place by screws. The plate and screws are sometimes removed after the fracture has healed.

Traction, then spica casting

In rare cases, traction may be needed before casting is done. Traction uses a system of ropes, pulleys, and weights attached to metal pins placed into the leg bone. The system gently pulls on the leg bones to help them line up straight.

Traction is done in the hospital. It is in place continuously for up to 2 weeks. The child must remain in bed during this time.

When traction is complete, the child is put into a spica cast to hold the realigned bone in place while it heals completely.

What are the long-term concerns?

After a fracture heals, don’t worry about getting your child to walk right away. Your child will start walking on the leg again when he or she is ready. Walking too soon can cause further damage to the leg.

When the child starts walking again, he or she may limp or walk awkwardly. This may last for up to a year. But it almost always goes away.

After the bone has healed, physical therapy may be recommended to help strengthen the leg. Your child’s healthcare provider can tell you more.

Just after the fracture heals, the leg may not look straight. But the bone is still going through a process called remodeling. During remodeling, the repaired bone slowly reshapes itself. Most angles or bends in the bone straighten out during this stage. This process takes 1 to 3 years.

In some cases, the fractured thighbone may grow faster than the uninjured thighbone in the other leg. This results in a slightly longer leg on the injured side (called a leg-length discrepancy). If this is the case with your child, the provider can discuss it with you.

To treat a child’s fractured femur, the pieces of bone are realigned and held in place for healing. Treatment depends on many factors, such as your child’s age and weight, the type of fracture, how the injury happened, and whether the broken bone pierced the skin.

How is a child’s femur fracture treated without surgery?

In some thighbone fractures, the doctor may be able to move the broken bones back into place without surgery. In a baby under 6 months old, a brace (called a Pavlik Harness) may be able to hold the broken bone still enough for successful healing.

Spica casting

A thighbone fracture before and immediately after treatment with a spica cast. The femur will remodel over time so that it appears normal.

In children between 7 months and 5 years old, a spica cast is often applied to keep the fractured pieces in correct position until the bone is healed. There are different types of spica casts, but, in general, a spica cast begins at the chest and extends all the way down the fractured leg. The cast may also extend down the uninjured leg, or stop at the knee or hip. Your doctor will decide which type of spica cast is most effective for treating your child’s fracture.

Your doctor will sedate your child for the closed reduction, and apply a spica cast immediately (or within 24 hours of hospitalization) to keep the fractured pieces in correct position until healing occurs.

When a bone breaks and is displaced, the pieces often overlap and shorten the normal length of the bone. Because children’s bones grow quickly, your doctor may not need to manipulate the pieces back into perfect alignment. While in the cast, the bones will grow and heal back into a more normal shape. In general, for the best results, the broken pieces should not overlap more than 2 cm when in the cast. The growth of the femur may be temporarily increased by the trauma. The mild shortening from the overlap will resolve.

Traction

If the shortening of the bones is too much (more than 3 cm) or if the bone is too crooked in the cast, it may be helpful to put the leg in a weight and counterweight system (traction) to make sure the bones are properly realigned.

How is a child’s femur fracture treated with surgery?

In some more complicated injuries, the doctor may need to surgically realign the bone. Today, doctors are treating pediatric femur fractures with surgery more often than in previous years. There are many benefits to treating a femur fracture with surgery including being able to move sooner, faster rehabilitation, and less time spent in the hospital.

In children between 6 and 10 years old, flexible intramedullary (inside the bone) nails are often used to stabilize the fracture.

(Left) Preoperative X-ray of a child with a fracture through the midshaft of the left femur. (Right) Postoperative X-ray of the same child shows that the fracture was treated with internal flexible nailing to restore stability and allow early mobilization.

Occasionally, the broken bone has too many pieces and cannot be treated successfully with flexible nails. Other options that can lead to successful outcomes in this situation include:

• A plate with screws that “bridges” the fractured segments
• An external fixator — this is often used if there has been a large open injury to the skin and muscles

External fixation is often used to hold the bones together when the skin and muscles have been injured.

Prolonged traction with a pin temporarily placed into the thighbone

As the child nears the teenage years (11 years to skeletal maturity), the most common treatment choices include either flexible intramedullary nails or a rigid locked intramedullary nail. The rigid nail is particularly useful when the fracture is unstable. Both types of nails allow for the child to begin walking immediately.

A rigid, locked intramedullary nail is often used for femur fractures in adolescents who are nearly full grown.

How long will it take a child to recover from a fractured femur?

Generally, children who fracture their femur will heal well, regain normal function, and have legs that are equal in length. The intramedullary nails may need to be removed following healing if they cause irritation of the skin and tissues underneath.

Sometimes, children will require further treatment, either early on or in subsequent years, if their legs are different lengths, unacceptable angulation of the healed bone, abnormal rotation of the healed bone, infection, or (rarely) if a thighbone fracture persists (nonunion).

These problems can nearly always be resolved with further treatment.

Find out what happens when a child’s thigh bone (femur) is broken and needs an operation to heal it

What is it?

Your child’s thigh bone (femur) is broken. This is the long bone running from the hip to the knee. Fractured means exactly the same as broken. There is no difference between a fractured bone and a broken bone.

Children’s femur fractures heal up very quickly, but may lead to shortening if the bone ends override. The bone ends may heal at the wrong angle. The bone ends can usually be kept in line while they heal by pulling on the leg (traction).

Traction is made up of strings that run from your child’s leg, via pulleys, to weights at the end of the bed. X-rays are taken to check the position of the bone ends and to show healing. The weights are changed as needed to keep the bones properly lined up.

In young children, sticky tape is used on the skin to fix the traction to the leg (skin traction). Often the strings are led upwards for traction.

In older children (10 to 14 years) skin traction cannot usually be used. Instead we use skeletal traction. Your child would be given a general anaesthetic and have a metal pin passed through the leg below the knee. The traction strings are attached to this pin.

Your child is kept in traction until the bone begins to feel solid and there are signs of healing on the X-ray. Occasionally the broken bone can be fixed by passing two flexible metal rods up inside the bone. This is called intra-meddlary nailing. The rods are usually removed once the bone has healed.

Children generally take one week for each year of their age to heal their breaks, up to a maximum of 12 weeks. For example, a five year old child will be in hospital for at least five weeks.

The operation

Your child will have a general anaesthetic, will be completely asleep and will not feel any pain. A nick is made in the skin on each side of the bone below the knee. A special steel pin is pushed through the bone and is fitted to the traction strings. Then your child is woken up. The operation takes about 20 minutes. There are no stitches in the skin.

Before the operation

A temporary skin traction and a splint are put on your child’s leg. These will keep it still whilst your child is waiting to have his or her operation.

If you are staying in with your child, you will be shown where you will sleep.

Your child must have nothing to eat or drink for about six hours before the operation. This means not even a sip of water. Your child’s stomach needs to be empty so that the anaesthetic can be administered safely.

On the ward, your child will be checked for past illnesses and will have special tests to make sure he or she is well prepared and can have the operation as safely as possible. You will have the operation explained to you and will be asked to fill in an operation consent form.

Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.

Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.

Before the operation and as part of the consent process, you may be asked to give permission for any ‘left over’ pieces to be used for medical research that have been approved by the hospital. It is entirely up to you to allow this or not.

Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.

After – in hospital

Your child’s leg should not hurt much after it has been put in traction. If it does, he or she will be given painkillers to ease the pain.

Your child will be able to drink again two to three hours after the operation provided he or she is not feeling sick. Your child should be able to eat normally the next day.

Your child will have the appropriate support by the physiotherapists whilst in bed to make sure that they are able to move around as much as possible. Your child will need help getting back on his or her feet.

Your child will regain hip, knee and ankle movement on his or her own.

It may take two or three months for your child to regain full movement of the leg. Your child will be in hospital for at least one week for every year of his or her age (aged five years = five weeks).

Your child will be given an appointment to visit to the orthopaedic outpatient department after leaving the hospital. An X-ray will be taken to check that the break is healing satisfactorily.

If your child is of school age, he or she will be given lessons by teachers on the ward. The traction pin in a teenager is taken out on the ward. However, children are usually given a brief general anaesthetic in the operating theatre for this.

After – at home

Your child will not be able to do sports until advised by the doctors. Your child may swim as soon as he or she is out of bed. Your child’s leg will continue to improve for up to six months.

Possible complications

As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs. The tests that your child will have before the operation will make sure that he or she can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

There is a small risk for minor infection in the area where the pins enter the skin but this can be treated quickly with antibiotic tablets.

There is a much smaller risk (less than 1 per cent) of infection deeper in the leg and on the bone especially close to the area of the fracture or, even worse, of an infection spreading in your child’s bloodstream. If this happens, your child will need to stay in hospital and have the infection treated by getting intravenous antibiotics (through a small plastic tube placed in one of their veins).

There is also a very small chance that one of the blood vessels or the nerves of the leg can be damaged during the operation and this might require another operation to fix the problem. The bone may not heal in a perfect position. It may be a little bent at first. If bent, the bone will become straighter as it grows. The younger the child, the more the bone will straighten. This is known as remodelling.

The growth of the thigh bone may be upset. Surprisingly, the injured leg may end up a little longer than the other leg. This is because fracturing the bone increases its blood supply. This in turn increases the bone’s growth.

If the healing of the fractured area is not as strong as expected (and this happens rarely), your child will be more prone to have further fractures in the same bone in the future.

Also rarely, the blood supply to a certain area of the bone can be affected because of the fracture and the operating procedure and this can result in necrosis (death) of the bone. If this happens, it is a serious complication and your surgeon will offer you further advice.

General advice

These notes should help your child through his or her recovery. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little.

If you have any queries or problems, please ask the doctors or nurses.

What is a broken femur?

A broken femur is a break in the thighbone. The femur is the longest, largest, heaviest, and strongest bone in the body. It makes standing and walking possible.

Because of the femur’s strength and size, femur fractures tend to occur only when the thighbone comes under significant force. Although great force is needed to break the thighbone, femur fractures in childhood are not uncommon.

If your child has any of symptoms of a broken bone, seek medical care immediately. If you see the bone poking out through the skin, do not move your child and call 911 right away.

Where is the femur?

The leg has three long bones — the femur, tibia, and fibula — as well as a fourth bone, the patella, also known as the kneecap. The femur extends from the pelvis to the knee. The tibia and fibula are in the lower leg.

What are the different types of femur fractures?

One way to classify a broken femur is by the location of the break, which can occur in several locations.

• A proximal femur fracture (hip fracture) is a break in the uppermost part of thighbone, next to the hip joint.
• A femoral shaft fracture is a break in the middle of the bone or narrow part of the femur. This type of fracture almost always requires treatment in the operating room.
• A supracondylar femur fracture is a break just above the knee joint and commonly occurs when the foot is planted and force is placed on the leg above the knee.
• A distal femur fracture is a break in the top part of the knee joint. This type of fracture can extend into the knee joint and disturb the cartilage and growth plate of the knee. A fracture in this area often requires surgical intervention to properly realign the bones.

What are the symptoms of a broken femur?

• difficulty moving the leg
• inability to stand or walk
• pain or swelling in the thigh, possibly with bruising
• deformity (abnormal shape) of the thigh
• bone pushing out through the skin — sign of a severe fracture

What causes femur fractures?

Bones break when there’s more force applied to a bone than it can absorb. Fractures can occur from a fall, trauma, or direct blow.

Most childhood femur fractures result from:

• falling, for instance, from stairs or a jungle gym
• moderate to severe trauma that may happen in a car accident or during contact sports

Femur fractures in infants (up to 1 year old) are unusual, but can be caused by:

• osteogenesis imperfecta and other medical conditions that cause weak bones
• a very difficult delivery
• child abuse

How is a broken femur diagnosed?

A doctor will use different diagnostic tests to get detailed images of your child’s fracture. Typical tests include:

How is a broken femur treated?

Your child’s treatment for a broken femur will depend on their age and how seriously the bone is broken. Some broken femurs can be treated with reduction and casting, while others require an operation and fixation.

Closed reduction

A closed reduction is a procedure to manipulate and set (reduce) the fracture. Using an anesthetic, typically given through an IV, the doctor realigns the bone fragments from outside the body.

Casting

After reduction or surgery, your child will be put in a spica cast to hold the bone in place while it heals. If your child has surgery, the spica cast will also hold the hip or thigh muscles in place while they heal.

Types of spica casts used to treat broken femurs:

From left: unilateral hip spica, one and one-half hip spica, and bilateral long leg hip spica cast

• Unilateral hip spica cast — starts at the chest and extends down to the ankle of the injured leg, leaving the uninjured leg free from a cast.
• One and one-half hip spica cast — starts at the chest and extends down to the ankle of the injured leg and to the knee of the other leg. Sometimes a bar is placed between both legs to keep the hips and legs immobilized and aid in lifting the child.
• Bilateral long leg hip spica cast — starts at the chest and extends to the ankles of both legs. Sometimes a bar is placed between the legs to keep the hips and legs from moving.

Once the cast is removed, your child may need a brace and physical therapy to strengthen their muscles and regain flexibility in their joints.

What are the surgical options for a broken femur?

Depending on the severity of the fracture, the surgeon may recommend one of the following procedures.

Internal fixation: In severe or complicated fractures, a surgeon may insert metal rods or plate and screws into the femur to hold the fractured bone in place while it heals.

External fixation: If internal fixation is not an option, metal pins can be inserted through skin into the fractured bone. These pins are attached to a bar that sits outside the skin on the child’s thigh. The pins and bar hold the bone fragments in place and the bone in alignment while it heals.

Intramedullary nails or rods: The surgeon may make small incisions in the skin and insert nails into the bone. The nails realign the bone and hold it in place while still allowing growth and natural remodeling.

How we care for broken femurs at Boston Children’s Hospital

Every year the Orthopedics and Sports Medicine Center at Boston Children’s Hospital treats thousands of children, adolescents, and young adults with fractures of all complexities. Our pediatric expertise allows for precise diagnosis of conditions related to the growing musculoskeletal system and development of optimal care plans.

Our Orthopedic Urgent Care Clinic treats patients with orthopedic injuries that require prompt medical attention but are not serious enough to need emergency room care. We offer urgent care services in four locations — Boston, Waltham, Peabody, and Weymouth.

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What is a fractured femur?

A fractured femur is a breakage in the thigh bone (femur), the longest, strongest and heaviest bone in the human body. The strength and size of the femur means that under typical circumstances, a large force or extensive trauma is needed in order to result in a fracture. Motor vehicle accidents and falls are examples of common accidents that result in a fractured femur. Conversely, femur fractures that occur after low-energy trauma suggest the presence of some type of underlying bone condition. A fractured femur in a child may be a sign of child abuse.

Symptoms of a fractured femur can include severe pain, bleeding, deformity of the leg, tissue swelling, and being unable to move your leg. Blood loss can be severe and may lead to hypovolemic shock. In some cases, bone fragments may protrude from the skin. Fractures of the femur are commonly associated with traumatic circumstances that may result in injuries to other areas of the body as well.

Treatment of a broken femur involves restoration of the normal anatomical position of the bone fragments, referred to as reduction of the fracture. The exact methods used for treatment depend upon the individual situation and must take into account the extent and nature of the break as well as the treatment of any other injuries. Both surgical and nonsurgical treatment options may be considered.

A fractured femur is an emergency situation. Seek immediate medical care (call 911) for serious symptoms, such as trauma followed by the inability to move your leg, severe pain, swelling, bleeding, or deformity.

What are the symptoms of a fractured femur?

Symptoms of a fractured femur are primarily localized to the area of the thigh. If other injuries or severe bleeding are associated with the fracture, these conditions may also produce symptoms, some of which may be life threatening.

Common symptoms of a fractured femur

Typically, a fractured femur results in intense pain, deformity, and inability to move the leg. Common symptoms include:

• Bleeding or bruising
• Deformity of the leg
• Inability to move the affected leg
• Muscle spasms
• Numbness or tingling
• Severe pain
• Swelling

Serious symptoms that might indicate a life-threatening condition

A fractured femur is an emergency that can in some cases be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

• Confusion or loss of consciousness for even a brief moment
• Heavy or uncontrollable bleeding
• Inability to move the leg
• Low blood pressure (hypotension)
• Protruding fragments of bone through the skin
• Severe pain

What causes a fractured femur?

Accidents are the most common cause of fractured femur. A relatively strong force is required to break this sturdy bone in otherwise healthy individuals, so motor vehicle accidents and high impact falls are among the most common causes. The fracture can occur anywhere along the bone. Most ‘hip fractures’ are actually fractures of the neck of the femur. Certain conditions, such as osteoporosis or cancer that has invaded the bone marrow, can make involved bones more susceptible to breakage. Traumatic injuries are rarely an isolated event and often occur with other injuries – external or internal.

Even with appropriate treatment, healing of a fractured femur can take up to six months.

What are the risk factors for a fractured femur?

A number of factors increase the risk of a fractured femur. Not all people with risk factors will get fractured femur. Risk factors for fractured femur include:

• Age over 65
• Deconditioning (loss of muscle mass, muscle weakness)
• Driving while intoxicated or under the influence of drugs
• Frailty (general weakness, fatigue, loss of muscle mass and strength)
• Metabolic bone disease
• Metastatic (widespread) cancer
• Not wearing seat belts while driving or riding in a car
• Osteoporosis
• Participating in extreme or contact sports
• Severe kidney disease
• Tendency to fall

Reducing your risk of a fractured femur

You may be able to lower your risk of a fractured femur by:

• Driving safely using appropriate restraints
• Improved nutrition
• Safeguarding your living environment to eliminate risk of accidental falls
• Taking appropriate precautions when participating in contact or extreme sports
• Treating osteoporosis

How is a fractured femur treated?

Treatments for a fractured femur are based upon realignment of the fragments of the broken bone so that healing can take place. In some cases, dependent upon the location and extent of the fracture as well as the presence of associated injuries, surgical implantation of plates, rods, or screws may be necessary to help hold the bone fragments in place. Casting and traction are also common treatments.

Pain control and infection control may require the administration of pain-relieving medications and antibiotics.

Treatments for a fractured femur

A number of both surgical and nonsurgical treatment options are available. Medications may also be used to help relieve your symptoms. Treatments for a fractured femur include:

• Antibiotics, particularly if the skin is broken and the possibility for infection is high
• Bed rest
• Casting of the affected limb
• Pain control medications
• Surgically implanted fixation devices such as plates, rods or screws
• Traction

What are the potential complications of a fractured femur?

Complications of a fractured femur can be serious, even life threatening in some cases. If the fracture has broken through the skin, the possibility for infection is increased. Severe injuries with profuse bleeding may lead to circulatory collapse or shock. Poor healing of the fracture can result in deformity or disfigurement, or the need for further surgery.

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of fractured femur include:

• Anemia
• Chronic pain or discomfort
• Deformity
• Infection
• Long-term disability
• Numbness
• Paralysis
• Shock
• Venous thrombosis

More Articles

1. Diet After Bone-Fracture Surgery
2. What Are the Treatments for a Broken Sternum?
3. Diet to Improve Healing of Bone Fractures
4. Is There a Specific Diet to Help Heal a Broken Femur
5. Diet for Healing a Broken Ankle

• Consume Proper Nutrition
• Get Plenty of Rest
• Seek Medicinal Treatment
• Change Lifestyle Habits

Although the time required to heal a bone fracture depends upon the health and age of the patient as well as the severity of the fracture, it generally takes several weeks to several months to heal, reports American Academy of Orthopaedic Surgeons 1. Recovery from a fractured bone can be frustrating and time consuming, but nutrition, rest, medical treatment and lifestyle habits may play a part in speeding up the healing of a fractured bone.

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Consume Proper Nutrition

When your fractured bone is healing, it requires more energy while it is mending. To fuel this extra energy, your body needs more calories. The amount of caloric intake increase your body needs to heal a fractured bone depends upon your size, weight and the severity of the break. For example, an injured, bedridden patient may need three times more calories than he normal does while mending a fractured bone, explains Osteoporosis Nutritionist Dr. Susan E. Brown, Ph.D.

Not only is it important to increase your caloric intake during your fractured bone recovery phase, but it is important to ingest more protein and calcium in your diet. Calcium and protein are important building blocks of bones, which are needed in your bone healing process. A daily multivitamin will help to provide additional vitamins such as vitamins B6, C, D and K as well as the minerals zinc and copper. Your doctor can provide you with specifics dietary changes necessary during your recovery.

• When your fractured bone is healing, it requires more energy while it is mending.
• The amount of caloric intake increase your body needs to heal a fractured bone depends upon your size, weight and the severity of the break.

Get Plenty of Rest

Diet After Bone-Fracture Surgery

Some minor bone fractures such as stress fractures heal with rest, according to Penn State Milton S. Hershey Medical Center 3. Avoid the activity that caused the fracture. Your doctor may have placed a cast, brace or splint on the fractured bone to keep it immobilized. You may need the aid of crutches or a wheel chair to keep your fractured bone from moving. In some cases, you may need bed rest to properly heal the fracture.

• Some minor bone fractures such as stress fractures heal with rest, according to Penn State Milton S. Hershey Medical Center 3.
• In some cases, you may need bed rest to properly heal the fracture.

Seek Medicinal Treatment

Along with rest, ice packs may be used to reduce swelling. Your doctor may tell you to use anti-inflammatory drugs to help relieve pain and calm the inflammation causes by the bone fracture. In some bone fractures, exercise is recommended to provide increased circulation and flow of nutrients to the healing fracture. Speak with your doctor to advise you on the types of exercise you can do to help heal your fracture. For severe or open fractures, surgery may be necessary.

How to Treat a Dog With a Broken Leg

With dogs, as with human beings, all bones are subject to breakage, but leg fractures are by far the most common. It is important to remember that dogs have a high pain tolerance and often a dangling leg seems to cause no pain. Therefore, don’t be afraid to handle the fractured limb (but be gentle!). The dog will let you know if it hurts.

Some signs to look for include a leg that looks misshapen, hangs limply, cannot support body weight, and is swollen. Also watch out for signs of shock, which include pale or white gums, a rapid heartbeat, or rapid breathing.

To provide proper care for your dog’s broken bone, use the following tips.

Step 1: Restrain the dog if necessary.

Step 1a: Approach the dog slowly, speaking in a reassuring tone of voice.

Step 1b: Slip a leash around the dog’s neck, then place the leash around a fixed object. Pull the dog against this object and tie the leash so the dog cannot move its head.

Step 1c: Muzzle the dog to protect yourself.

Step 2: Examine the leg and determine if the fracture is open (wound near the break or bone protruding from the skin) or closed (no break in the skin).

Step 3: If the fracture is closed, proceed to Step 4. If the fracture is open:

Step 3a: Flush the wound thoroughly with clean water.

Step 3b: Cover the wound with a sterile bandage, clean cloth, or sanitary napkin.

Step 3c: DO NOT attempt to splint the fracture. Hold a large folded towel under the unsplinted limb and transport the dog immediately to the veterinarian.

Step 4: If the broken limb is grossly misshapen or the dog appears to be in great pain when you attempt to splint, stop and proceed to Step 5. Otherwise, proceed to splint the bone.

Step 4a: Use any splint material available — sticks, newspaper, magazine, or stiff cardboard. The object is to immobilize the limb not reset it.

Step 4b: Attach the splints to the fractured leg with torn strips of cloth or gauze.

Step 4c: Tape or tie the strips firmly but not so tightly that circulation may be impaired.

Step 4d: Transport the dog immediately to the veterinarian.

Step 5: If the broken limb is grossly misshapen or the dog appears to be in great pain when you attempt to splint, hold a large towel under the unsplinted limb for support and transport the dog immediately to the veterinarian.

Be prepared for burn injuries to your pet by checking the tips in the next section.

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The word fracture refers to any type of break in a bone, including small cracks as well as injuries that snap a bone into two or more pieces. The bones in the knee include the patella, or kneecap, and parts of the femur and tibia; a knee fracture can involve one or more of these bones. In most cases, the damage caused by such an injury is too serious to self-treat, and failing to get expert medical care can lead to complications. Anyone with this type of injury should seek medical attention as soon as possible. There are some simple self-care measures that can be taken while waiting for treatment, such as stabilizing the knee and applying an ice pack, but these are not a substitute for professional care.

A diagram of the knee.

Causes and Symptoms

Injuries to the bones in the knee can occur in several ways, such as a car accident, a direct blow to the knee, or falling, such as off a ladder or chair, or down stairs. Repeated stress of the knee joint can sometimes cause fractures, particularly in older people. These stress injuries typically affect the ends of the tibia or femur that connect with the kneecap, and they are less likely to affect the kneecap itself.

The most common signs of a knee fracture are pain, swelling, and bruising of the affected joint. A person with this injury will typically have trouble standing on the injured leg, and might have go into shock. Symptoms of shock include chills, pale skin, nausea, and vomiting. In some cases, the leg might appear to be crooked or shorter than normal.

Non-Medical Care

Depending on the circumstances, there might be some waiting time before a healthcare provider can examine the injury, and during this time, taking appropriate self-treatment measures can help prevent further damage. The injured person should not attempt to walk, but instead sit and elevate the leg, if possible, to help reduce swelling. If elevation causes the pain to worsen, this step can be avoided.

Compression bandages may be helpful in treating a knee fracture.

Applying ice to the injury can also reduce swelling. An effective home-made ice pack is ice placed in a sturdy plastic bag, or simply a package of frozen vegetables, such as peas or corn. If the skin is broken, ice should not be applied directly, to prevent the wound getting wet. An ice pack can be used for 15 to 20 minutes per session, with a gap of at least an hour between sessions.

A bag of frozen vegetables may help reduce knee fracture swelling.

Stabilizing the knee joint is another good way to help prevent further injury. A splint, compression bandage, or regular bandage can help provide the necessary stabilization. If anything is wrapped around the joint, care must be taken to ensure that it is firm but not tight, especially if the knee continues to swell.

Professional treatment of a knee fracture often involves X-rays.

It is best not to eat anything while waiting to be examined, and to drink only small amounts of water. This is a precautionary measure in case surgery is needed. Pain medication can be taken, but any drugs used must be reported during a medical examination, again as a pre-surgery precautionary measure.

Medical Treatment

In most cases, professional treatment is carried out in a hospital, or perhaps a doctor’s office or clinic. The knee is examined and X-rayed to determine the exact nature of the bone breakage, and treatment depends on how extensive the damage is. A relatively minor fracture might only require that a cast or knee brace be worn for four to six weeks, followed by a gradual return to the individual’s previous fitness level once it is removed.

Serious fractures might require surgical treatment before a cast or brace is put on. When a bone is shattered into several pieces, surgery is performed to restore the bone to as near its original shape as possible. If necessary, the bone pieces are held in place with metal rods or pins, which provide additional stability while the bone is regrowing. In some cases, a person might need to wear a cast or brace for a few extra weeks.

Rehabilitation

A person wearing a cast or brace might be provided with crutches to help reduce the weight the injured knee must bear. Moderate pain is normal after a bone fracture, particularly in cases where surgery is needed. Typical medications that might be prescribed include ibuprofen or another anti-inflammatory, and pain management drugs such as acetaminophen and codeine.

Depending on the nature of the injury, a healthcare provider might recommend physical therapy after the cast or brace is removed, and perhaps even while it is still on. Initial exercises often include leg lifts to strengthen the thigh muscles to reduce strain on the knee. Once the brace or cast is removed, exercises typically focus on strengthening the knee joint and improving its range of motion. In cases of severe injury, it might be six months to a year before the knee is back to normal; on rare occasions, the joint might not ever fully heal.

Gel ice packs can be contoured slightly to the bend of the knee, which makes them ideal for treating the swelling around the fracture.

Tricia has a Literature degree from Sonoma State University and has been a frequent wiseGEEK contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.