Thighbone (Femur) Fracture

The femur or thighbone is the longest and strongest bone in the body, connecting the hip to the knee. A femur fracture is a break in the femur.

Types

• Proximal femur fracture: A hip fracture or proximal femur fracture is a break in the proximal end of the thighbone near the hip.
• Femoral shaft fracture: A femoral shaft fracture is a break that occurs anywhere along the femoral shaft, long, the straight part of the femur.
• Distal femur fracture: The distal femur is lower part of the femur bone that flares out like the mouth of the funnel and articulates with the knee. A distal femur fracture is a break in thighbone that occurs just above your knee joint.
• Femoral shaft fracture: A femoral shaft fracture is a break that occurs anywhere along the femoral shaft, long, straight part of the femur.
• Proximal femur fracture: A hip fracture or proximal femur fracture is a break in the proximal end of the thigh bone near the hip.

Femur fractures may be caused by high energy forces such as a fall from a height or a motor vehicle accident. Other conditions such as osteoporosis, bone tumour or infections, or a history of knee replacement increase your risk of femur fractures. In the elderly, even a simple fall while standing may result in a fracture as the bones tend to become weak and fragile with advancing age.

Sudden, severe pain along with swelling and bruising are the predominant symptoms of femur fracture. The site is tender to touch with a visible physical deformity and shortening of the leg.

The diagnosis of femur fracture is based on your medical history, including history of previous injuries, complete physical examination and imaging studies. Your physician will evaluate the soft tissue around the joint to identify any signs of nerve or blood vessel injury. Multiple X-rays and other imaging studies such as CT and MRI scans may be ordered to identify the location and severity of the fracture.

The management of the fracture is based on its severity, your medical condition and lifestyle.

Nonsurgical treatment comprises of immobilising the fractured site with the help of casts or braces to prevent weight-bearing and help in the healing process. X-rays are taken at regular intervals to assess the healing process. Weight-bearing and movement are initiated gradually, depending on the nature of the injury and your condition.

Surgical treatment is considered to realign the fractured bone. The use of advanced technology and special materials has improved the surgical outcome even in older patients. External or internal fixation or a knee replacement may be required depending on the extent of the fracture. The timing of the surgery is an important factor in improving the surgical outcome.

Timing of surgery

In most cases, the surgery is delayed for a few days to develop an effective treatment plan and for preparation. With most distal femur fractures, the surgery can be delayed unless the fracture is open to the environment.

External fixator

An external fixator is fixed when the surrounding soft tissue is severely damaged. The external fixator maintains the alignment of the bone till surgery.

Once you are ready for surgery, your surgeon removes the external fixator and places internal fixation devices into the bone during surgery.

Internal fixator

The internal fixation may be performed by implanting intramedullary nailing, or plates and screws. In intramedullary nailing, a metal rod is inserted into the marrow canal of the femur to keep the fractured fragments in position. In the plate and screw method, the bone fragments are realigned and held together with screws and plates, attached to the outer surface of the bone. If the fracture is of the comminuted type or the bone has broken into many pieces, plates or rods may be inserted at the ends of the fracture without disturbing the smaller pieces. The plate or rod will maintain the shape or strength of the bone till it heals. In elderly patients and those with poor bone quality, bone grafting may be implanted to improve healing. Knee replacement may also be considered in complicated fractures or those with poor bone quality.

Knee replacement

Knee replacement may also be considered in complicated fractures or those with poor bone quality. Artificial implants may be inserted to replace the fractured segments of the bone and joint.

Rehabilitation

Rehabilitation of the femur fracture depends upon several factors, such as age, your general health and the type of fracture. As the femur fracture usually involves the weight-bearing joint, it may cause long-term problems such as loss of knee motion or instability and long-term arthritis. Hence, a rehabilitation program is initiated along with the treatment, comprising of instructions on weight-bearing, knee movements and the use of external devices such as braces.