Femoral Fracture
What is the femur bone?
Femur: The thigh bone, known as the femur, is your body’s longest and strongest bone. Femoral fractures usually occur due to significant trauma to the thigh bone, with motor vehicle collisions being the leading cause.
Femoral Shaft: The long, straight part of the femur bone. A femoral shaft fracture refers to a break anywhere along this bone’s length. Additionally, surgery typically serves necessary for healing.
What are Femoral Shaft Fractures?
Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone can align correctly (stable fracture) or become misaligned (displaced fracture). Additionally, the skin near the fracture can remain intact (closed fracture) or the bone can penetrate the skin (open fracture).
Doctors describe fractures to each other using classification systems. The classification system includees:
- The location of the fracture (the femoral shaft is divided into thirds: distal, middle, proximal)
- The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle)
- Whether the skin and muscle over the bone are torn by the injury
Common Types of Femoral Shaft Fractures
Transverse fracture: The break forms a straight horizontal line across the femoral shaft.
Oblique fracture: This type of fracture has an angled line across the shaft.
Spiral fracture: The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture.
Comminuted fracture: In this type of fracture, the bone has broken into three or more pieces. In most cases, the number of bone fragments corresponds with the amount of force needed to break the bone.
Open fracture: If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications—especially infections—and take a longer time to heal.
What are the symptoms of a femoral fracture?
Symptoms of a femoral fracture include:
- Immediate, severe pain
- Inability to put weight on the injured leg
- The injured area may look deformed—shorter than the other leg and no longer straight.
- Discoloration of the skin
What causes a femoral fracture?
- High-energy collisions typically cause femoral fractures in young people
- Motor vehicle or motorcycle accidents
- Being hit by a car while walking
- Falls from heights
- Gunshot wounds.
A lower-force incident, such as a fall from standing, may cause a femoral shaft fracture in an older person who has weaker bones.
How should a Doctor’s examination for a femoral break go?
Medical History and Physical Examination
Your doctor will need to know the specifics of how you injured your leg. For example, if you were in a car accident, it would help your doctor to know how fast you were going, whether you were the driver or a passenger, whether you were wearing your seat belt, and if the airbags went off. This information will help your doctor determine how you were hurt and whether you may be hurt somewhere else.
Your doctor should be aware of your medical history and current health conditions. For example high blood pressure, diabetes, asthma, or allergies. Your doctor will also ask you if you use tobacco products or are taking any medications.
After discussing your injury and medical history, your doctor will do a careful examination. He or she will assess your overall condition, and then focus on your leg. Your doctor will look for:
- An obvious deformity of the thigh/leg (an unusual angle, twisting, or shortening of the leg)
- Breaks in the skin
- Bruises
- Bony pieces that may be pushing on the skin
After the visual inspection, your doctor will feel along your thigh, leg, and foot looking for abnormalities and checking the tightness of the skin and muscles around your thigh. He or she will also feel for pulses. If you are awake, your doctor will test for sensation and movement in your leg and foot.
Imaging Tests
Imaging tests will provide your doctor with more information about your injury.
X-rays: The most common method for evaluating a fracture is through x-rays, which offer clear bone images. X-rays can indicate whether a bone is whole or fractured, along with the fracture type and location within the femur.
Treatment
Nonsurgical Treatment
Most femoral shaft fractures require surgery to heal. It is unusual for femoral shaft fractures to be treated without surgery. Very young children are sometimes treated with a cast.
Surgical Treatment
Timing of surgery: Doctors typically fix most femur fractures within 24 to 48 hours. Occasionally, doctors delay fixation until stabilizing other life-threatening injuries or unstable medical conditions. Upon hospital arrival, antibiotics are administered promptly to treat open fractures and reduce infection risk. During surgery, the open wound, tissues, and bone are cleaned.
For the time between initial emergency care and your surgery, your doctor may place your leg either in a long-leg splint or in traction.
The purpose is to preserve the alignment of your broken bones and maintain the length of your leg. Skeletal traction utilizes a pulley system of weights and counterweights to keep the broken bone fragments in place, straightening your leg and often alleviating pain.
External fixation
In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. A bar outside the skin connects the pins and screws. This device, a stabilizing frame, maintains the bones’ proper position.
External fixation typically serves as a temporary solution for femur fractures. Easily applied, external fixators are often used when patients have multiple injuries and aren’t ready for prolonged surgery to address the fracture. They offer effective temporary stability until the patient’s health permits the final surgery. Occasionally, external fixators remain until the femur fully heals, though this is uncommon.
Intramedullary nailing:
Currently, the method most surgeons use for treating femoral shaft fractures is intramedullary nailing. During this procedure, a specially designed metal rod is inserted into the canal of the femur. The rod passes across the fracture to keep it in position.
Plates and screws
In this procedure, surgeons first reposition (reduce) the bone fragments into their normal alignment. They secure them together using screws and metal plates affixed to the bone’s outer surface.
Plates and screws are preferred when intramedullary nailing is impractical, such as for fractures involving the hip or knee joints.
If you would like to speak to an orthopedic specialist in the DFW metroplex, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.
