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Femoral Fracture

What is the femur bone?

Femur: The longest and strongest bone in your body, better known as the thigh bone. The long, straight part of the femur is called the femoral shaft. The femur requires a lot of force to break it, usually, femoral fractures occur as a result of hard trauma to the thigh bone.  Motor vehicle collisions cause more femoral fractures than anything else.

Femoral Shaft: The long, straight part of the femur bone. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. This type of broken leg almost always requires surgery to heal.




What are the types of Femoral Shaft Fractures?

Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture).

Doctors describe fractures to each other using classification systems. Femur fractures are classified depending on:

  • 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

The most common types of femoral shaft fractures include:

Transverse fracture: The break is a straight horizontal line going 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.

Transverse femoral shaft fracture


Imaging Tests

Imaging tests will provide your doctor with more information about your injury.

X-rays: The most common way to evaluate a fracture is with x-rays, which provide clear images of bone. X-rays can show whether a bone is intact or broken. They can also show the type of fracture and where it is located within the femur.

Computerized tomography (CT) scans: If your doctor still needs more information after reviewing your x-rays, he or she may order a CT scan. A CT scan shows a cross-sectional image of your limb. It can provide your doctor with valuable information about the severity of the fracture. For example, sometimes the fracture lines can be very thin and hard to see on an x-ray. A CT scan can help your doctor see the lines
more clearly.


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: Most femur fractures are fixed within 24 to 48 hours.  On occasion, fixation will be delayed until other life-threatening injuries or unstable medical conditions are stabilized. To reduce the risk of infection, open fractures are treated with antibiotics as soon as you arrive at the hospital. The open wound, tissues, and bone will be cleaned during surgery.

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. This is to keep your broken bones as aligned as possible and to maintain the length of your leg.

Skeletal traction is a pulley system of weights and counterweights that holds the broken pieces of bone together. It k

eeps your leg straight and often helps to relieve pain.

External fixation of a femoral shaft fracture

External fixation: In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position.

External fixation is usually a temporary treatment for femur fractures. Because they are easily applied, external fixators are often put on when a patient has multiple injuries and is not yet ready for a longer surgery to fix the fracture. An external fixator provides good, temporary stability until the patient is healthy enough for the final surgery. In some cases, an external fixator is left on until the femur is fully healed, but this is not common.

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

Intramedullary nailing of a femoral shaft fracture

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.

Intramedullary nailing provides strong, stable, full-length fixation.

An intramedullary nail can be inserted into the canal either at the hip or the knee. Screws are placed above and below the fracture to hold the leg in the correct alignment while the bone heals.

Intramedullary nails are usually made of titanium. They come in various lengths and diameters to fit most femur bones.


X-rays of transverse fracture and intramedullary nailing

Plates and screws: During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with screws and metal plates attached to the outer surface of the bone.

Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend into either 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.