Leg fractures are uncommon and occur at a rate of about one case per 10,000 population per year. For those people less than 25 years and older than 65 years, the rate increases to 3 cases per 10,000 population each year. Such injuries are more common in young males and include fractures sustained in motorcycle, motor vehicle, recreational vehicle or gunshot wounds. The incidence of this type of fracture goes up in patients who are elderly.What is a Femur Fracture?
The femur is the longest and strongest bone in the body. At its most proximal end is the head of the femoral, which connects to the pelvic bones. At the most distal end, the femoral condyles form the knee joint along with the tibia and fibula in the lower leg.
The range of this type of fracture is wide. There can be nondisplaced fractures caused by stress on the one hand. On the other are severely comminuted fractures with a large amount of soft-tissue injury. These are caused by high energy impact injuries such as are seen in motor vehicle accidents.
Repetitive stress on a leg that has areas of weakness, such as is seen in metastatic disease, metabolic bone disease or bony tumors can create nondisplaced stress fractures. These might not be recognized on plain film x-ray.
Regardless of the origin of the fracture, fractures of the femoral shaft and the neck of the femur are often treated with intramedullary nails or plates so as to bring together the ends to a reasonable approximation. These treatments are a far cry from the historical treatment of these types of fractures, which included casting and traction. The older types of treatments included risk factors such as pulmonary thrombosis, deep vein thrombosis or joint stiffness.
The leg has a great blood supply. Bleeding can happen because of a fracture that can lead to a significant blood supply. In fact, nearly 40 percent of isolated femur fractures require a blood transfusion, up to three units of blood. It can be very dangerous or fatal in elderly patients.
The type of fracture depends on where the forces come from. If there is a significant perpendicular force, this can result in a transverse fracture. An axial force can go up and cause a fracture to the knee or the hip. Rotational forces cause spiral or oblique fractures. The higher the energy, the higher the incidence of comminuted fractures.Causes of Femur Fractures
The most common causes of this type of fracture are accidents, such as motor vehicle accidents, all-terrain vehicle fractures, motorcycle fractures and other vehicle fractures. It takes a great deal of force to break a leg; this is why motor vehicle accidents and falls from a great height cause these types of fractures. In other cases, the leg can fracture secondary to osteoporosis or to cancers and other tumors of the bone. In those cases, the bone is more likely to fracture. Fractured femurs take a long time to heal—up to six months even if treated correctly.Risk Factors
There are several risk factors for having a fractured femur. People with these fractures need to be aware of their risks. They include:
- Having metastatic cancer of any type
- Driving while intoxicated or under the influence of certain drugs
- Not wearing seat belts while riding in a vehicle
- Driving above the speed limit or recklessly
- Having osteoporosis
- Being a participant in an extreme sport or a contact sport
- Symptoms of a Femur Fracture
Most of the symptoms of this fracture are located in the area of the fracture in the thigh bone. It can be a life-threatening injury if it is associated with severe blood loss or a multi-system injury. Common fracture symptoms include:
- Internal bleeding or bruising in the thigh bone
- Intense pain in the thigh
- Deformity of the thigh
- Inability to move the thigh
- Spasms of the thigh muscles
- Tingling or numbness of the area
- Swelling of the leg
There are additional signs and symptoms associated with this life-threatening fracture. These include:
- Confusion or loss of consciousness
- Uncontrollable bleeding
- Being unable to move the leg
- Having low blood pressure
- Fragments of bone protruding through the skin
- Extreme pain in the thigh
Because most cases of femur fracture are displaced and foreshortened, the fracture can easily be seen on an anterior-posterior and lateral plain film x-ray. If there is a nondisplaced fracture or if there is suspicion of a tumor or cancer in the bone, a CT scan or MRI scan of the thigh can be done to see the pathology of the bone around the area of the fracture.
In diagnosing this fracture, the doctor needs to assess the pulses and neurological findings below the site of the injury. The fracture can impinge upon or rupture the femoral artery, therefore injuring the blood supply to the distal leg. Numbness or tingling in the lower leg can mean a major nerve has been damaged.Treatment of a Femur Fracture
In the emergency department, the patient receives an IV and blood products if necessary. The fracture is immobilized under traction because the leg will almost always be foreshortened. Traction and reduction reduce the pain to a great degree. A pneumatic splint may need to be used because it can cut down on blood loss from the fracture.
Pain management is given by means of IV narcotics until the patient is more stable. If the fracture is open, antibiotics must be given in order to prevent severe infection in the bone. A tetanus vaccination is also given. IV fluids are given to maintain a normal blood pressure and a Foley catheter is placed to monitor the intake and output.
Most femoral shaft fractures are treated with surgery. Commonly, a metal rod is put down the center of the bone. The rod is known as an intramedullary rod. The rod is fixed in place by screws placed above and below the rod. In less common cases, a plate and screws can be used to connect the bone fragments. In still other cases, an external fixator is used to keep the bones in the proper position until the bone heals.Complications
The complications can be life-threatening. Some complications include the following:
- Shock or circulatory collapse
- Persistent deformity
- Infection in an open fracture
I'm Ed Smith, a Sacramento bone fracture lawyer. Femur fractures can be difficult and lengthy to recover from. Recovery leads to time away from work, lost wages, and suffering. If you or a loved one has suffered a fracture as a result of someone else's negligence contact me today for free friendly advice. My office can be reached at 916.921.6400.
For 35 years, I’ve helped individuals and families in Northern California obtain just and fair compensation for their injuries. The wide range of injury cases I handle includes traumatic injuries such as brain injuries, bone fractures, and loss of a loved one through wrongful death.
Feel free to browse my Verdicts and Settlements page to look over my past cases.
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