Femur Fracture | Causes, Treatments, and Risks
Leg fractures are uncommon and occur at a rate of about one case per 10,000 population per year. For those people under 25 years and older than 65 years, the rate increases to three 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? | Understanding the Injury
In this article:
- Femur Break Explained
- Types of Femur Fractures
- Causes Of Thigh Bone Fractures
- Risk Factors
- Broken Femur Complications
- Cracked Femur Symptoms
- Three Stages of Femur Fracture Pain
- Femur Bone Break Pain Scale
- Treatment Of A Femur Injury
- Femur Bone Fracture Recovery
The femur is the longest and strongest bone in the body. At its most proximal end is the head of the femur, 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. When there is a break along the femur, it is called a femoral shaft.
The range of this type of broken thigh bone 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 those seen in car 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 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 bone breaks require a blood transfusion, up to three units of blood. It can be very dangerous or fatal in elderly patients.Types of Femur Fractures
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. A femoral neck fracture occurs a few inches from the hip joint.
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
The complications can be life-threatening. Some complications include the following:
- Shock or circulatory collapse
- Persistent deformity
- Infection in an open fracture
The YouTube video below by Dr. Nabil Ebraheim explains two classification systems of the broken femur.Cracked Femur Symptoms
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 in 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 injury 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.Diagnosis of a Femur Fracture
If the doctor thinks that someone has a femur fracture based on the symptoms discussed above, he or she will do a physical exam. This physical exam is designed to look for other signs of a femur fracture. Some of the physical exam maneuvers that the physician might perform include:
- Visible Deformities: The first step is to inspect the femur and look for any visible signs of deformity.
- In some cases, the femur fracture might be evident if a part of the bone is sticking out through the skin. This is called an open fracture. In other cases, the doctor might notice a bulge underneath the surface, indicating a possible fracture.
- Rotation of the Leg: In some situations, a femur fracture might cause the leg to rotate to one side or the other. The doctor will look at the feet, knees, and hips to see if the injured leg is turned to one side or the other.
- Shortening of the Leg: In a complete femur fracture, the injured leg might appear shorter than the other. When the bone breaks in two, the muscles of the hip pull on the wounded fragment, shortening it when compared to the other side. This shortening often indicates that a severe femur fracture is present.
- Looking for Complications: The doctor will also look for possible complications stemming from the femur fracture. It will be necessary for the doctor to check the pulses in the leg to make sure that none of the blood vessels have been damaged. The doctor will also look for signs of numbness or tingling that could indicate possible nerve damage.
Once the doctor has completed his or her physical exam, imaging tests might be next. These images are relevant because they are used to not only identify a potential femur fracture but also diagnose possible complications. There are several types of imaging scans that the doctor might order. These include:
- X-ray: This is the fastest type of image and will probably be the first test ordered. X-rays are inexpensive and have a low amount of radiation exposure. The doctor will probably take multiple x-rays from different angles to make sure that no fracture has been missed.
- CT Scan: If the doctor needs a more detailed image, he or she might order a CT scan. This is an x-ray in three dimensions and can take a look at the tissue around the fracture site. This will help the surgeon plan his or her approach if surgery is needed to repair the femur. While a CT scan is also relatively quick, it does come with a high amount of radiation exposure.
- MRI: An MRI scan is the most detailed imaging procedure available and uses no radiation. Unfortunately, an MRI also takes a long time to complete. An MRI can be used to look for damage to the blood vessels and nerves around the femur but, because of the time it takes, this is often postponed until the patient is stable. Furthermore, anyone with metal inside their body (such as a hip or knee replacement) may not be able to receive an MRI scan.
Using a combination of physical exam findings and imaging modalities, the doctor will be able to diagnose a femur fracture. In addition to identifying the fracture sites, the physician will also need to look for any potential complications, type the femur fracture, and decide whether or not surgery is required to repair the break. With the diagnosis completed, the next step is to fix the femur fracture.
Pain is the body’s instinctive response to a femur injury. Both the fracture and injuries to the soft tissues near the fracture site can cause pain, bruising, swelling, and redness. There are three stages of pain from a broken femur:
- Acute Pain – occurs immediately after a broken bone.
- Sub-Acute Pain – occurs in the first several weeks while the bone and soft tissues are healing.
- Chronic Pain – continuous pain after the soft tissues and fracture have already healed.
A broken thighbone can cause some or all of these types of pain. Some people may experience acute pain and sub-acute pain but may not have any chronic pain. Others may only suffer acute pain.Femur Bone Break Pain Scale
Since everyone feels pain differently, the level of chronic pain can’t be measured in a screening. To get a better understanding of a person’s pain, doctors often rely on a pain scale. A common type of pain scale is a number chart ranging from 0 to 10.
- From 0 to 3 – No pain to moderate pain. Pain that is easy to manage and does not interfere with most daily activities.
- From 4 to 6 – Uncomfortable pain to distressing pain. Pain that is more noticeable and interferes with many normal activities. It becomes gradually important to seek treatment.
- From 7 to 10 – Unmanageable pain to debilitating pain. Pain that no longer allows you to engage in daily activities. You need stronger medications, potential surgery, and support from a caregiver.
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 using IV narcotics until the patient is more stable. If the fracture is open, antibiotics must be given to prevent severe infection in the bone. Tetanus vaccination is also given. IV fluids are given to maintain normal blood pressure, and a Foley catheter is placed to monitor the intake and output.Femur Bone Fracture Recovery
It usually takes about six weeks for a broken bone to heal. The healing process depends on where the fracture is, whether surgery is needed and if there were any complications. If you’ve had surgery, the healing process might be longer. Full recovery can take anywhere from three months to a year. The fracture needs to be protected for the first three months, so that means you crutches will be required to avoid putting weight on the injured leg.Femur Fracture FAQs
Q: How will I know for sure that I've fractured my femur?
A: The first indication that you have fractured your femur is the tremendous pain in your thigh. The symptoms of a femur fracture may also include bruising, tenderness and swelling on the injured leg. You won't be able to bear weight, move your knee or hip on the injured leg. If the fracture causes a break in the skin, you may see visible portions of the fractured bone. An X-ray will confirm the severity and location of your fracture.
Q: How long does it take to recover from a broken femur bone?
A: As mentioned above, it can take three months to 12 months for a full recovery depending on the severity of the fracture and if surgery is needed. Some may take longer than a year to recover if the fracture was open or broken in multiple places.
Q: Can you walk with a broken thigh bone?
A: It is difficult for anyone to walk with a broken femur. However, some people can begin walking again with the help of a physical therapist within the first few days of the injury or surgery. Physical therapy will help you restore joint motion, normal muscle strength, and flexibility.
Q: How do you fix a fractured femur?
A: 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, metal plates and screws can be used to connect the bone fragments. In other cases, an external fixator is used to keep the bones in the proper position until the bone heals.
Q: Do they cast a broken femur?
A: For a broken femur, doctors will typically do surgery and insert a rod and pins to treat the fracture. However, if surgery is not needed, you can expect to be in a body cast from six weeks to three months, depending on the displaced fracture.
If you have been injured in an accident, please call me for free and friendly advice at 916-921-6400 or 800-404-5400.
Photos by: depositphotos.com, Pixabay.com
Editor's Note: This page has been updated for accuracy and relevancy. [cha 10.15.19]
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