Femur Fracture

About Femur

The femur (Thigh Bone) is the longest and strongest bone in our body.
For this reason, it usually takes a lot of force to break it. And when it breaks, it takes a long time to heal.

What may cause a femur fracture?

Femur fractures are usually due to trauma or high-energy collision.

In childhood most fractures result from:

•   Falling
•   Trauma (car accident or contact sports, torsion or rotations)

In infants (0-1 year old) femur fractures are unusual, but can occur:

•   If babies have a condition that causes weak bones
•   In cases of a very difficult delivery
•   In cases of child abuse

In adults and older people who have weaker bones, the most common causes are:

• Falls from heights or from standing; sports
• Car accident

What are the different types of femur fractures?

A femur fracture can be stable when pieces of bone line up correctly or displaced when they are out of alignment.

A way to classify femoral fractures is considering the location of the break.

•   Proximal femur fracture (hip fracture): when the break is in the uppermost part of thigh bone next to the hip joint.
•   Femoral shaft fracture: when the break in the bone shaft.
•   Supracondylar femur fracture: when the break just above the knee joint.
•   Distal femur fracture: when the break is in the top part of the knee joint.

Also, when the skin around the fracture is intact, we have a closed fracture, while when the bone punctures the skin the fracture is called open fracture.

What are the signs and symptoms of a femoral fracture?

A broken femur usually causes immediate, severe pain.

Other signs are:

• difficulty in moving the leg
• inability to put weight on the injured leg, stand or walk
• Deformity (abnormal shape) of the leg

As written before, in open fractures, the bone may come through the skin and be visible.

Broken femur diagnosis

The doctor will make a physical examination searching for the signs described above.

An X-ray is mandatory to confirm clinical suspicion if more information is needed, the orthopedic surgeon might also order a CT scan.

How is a femur fracture treated?

The majority of broken femurs require surgery and the complete healing process can take up to six months. Nevertheless, the patient will be able to walk much earlier.

It is unusual to treat a broken femur without surgery. Only very young children are sometimes treated only with a spica cast.

Surgical Treatment

Most femur fractures are fixed within 24 to 48 hours.

Surgeries may be internal or external.

The most common surgery is called Intramedullary nailing.

In this procedure, the orthopedic surgeon inserts a specially designed metal rod (usually made of titanium) into the length of the bone, with screws above and below to hold the leg in correct alignment while the bone heals.

When the skin and muscles have been injured, external fixation is often used.

This is a kind of surgery in which metal pins or screws are placed into the bone above and below the fracture site and they are attached to a bar outside the skin.

Sometimes external fixators are often put on when a patient is not yet ready for a longer surgery.

To manage pain before and after surgery the doctor may suggest:

• acetaminophen
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• gabapentin poids
• muscle relaxants
• opioids

Complications and Recovery

As written before, a femur fracture can take up to to 6 months to completely heal. Some take even longer, especially if the fracture was open.

Among complications there are:

• Hip or knee pain if the femur is not set properly and a leg may become shorter than the other.
• Peripheral damage. A broken femur may also injure the muscles, tendons, ligaments, vessels and nerves of the leg.
• Surgical complications. Related to surgery such as infection and blood clots.

Physical therapy after surgery is always recommended to strengthen the muscles around the bone.

Anyway, this kind of surgeries is almost a routine for an orthopedic surgeon and most of the people fully recover from a broken femur and return to a normal lifestyle in a reasonable short time.

Prof. Nicola Portinaro’s experience.

Prof. Portinaro is has been treating femur fractures for more than 30 years.

He has personally performed more than 500 surgeries both in adults and child with different techniques as needed by the type of fracture.

Prof. Portinaro is one of the most qualified surgeons for femur and hip diseases and treatments.