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Therapy and surgery for femoral fracture
Non-surgical treatment
Most femoral shaft fractures are treated surgically.
Non-surgical treatment is rather uncommon, but in some cases it is done in young children who are fitted with a plaster cast.
For the treatment of femoral shaft fractures, intramedullary nails are used.
Early treatment and immobilization reduce the risk of complications.
The National Institute for Health and Clinical Excellence recommends evaluation by the physical therapist and lower limb mobilization the day after surgery, unless there are medical or surgical contraindications.
Patients should be mobilized regularly for at least half an hour a day.
Complications
Closed fractures can be accompanied by heavy bleeding, even if the swelling in the thigh is not visible from the outside.
This results in the following complications: fat embolism, deep vein thrombosis, pulmonary embolism, infection, shortened limb, rotation of the leg and lack of bone healing (consolidation).
Supracondylar fractures (near the knee)
Normally, fractures occur in the third of the femur near the knee (distal) as a result of direct, violent violence.
These are often debris and joint fractures with damage that reaches into the knee joint.
The bone fragment far from the body tends to shift backwards and can damage the popliteal artery.
Initially, the treatment is the same as for femoral shaft fractures, but if inhibition of the femoral nerve is not sufficient as an analgesic measure, additional anesthesia must be performed.
Treatment of undisplaced fractures: often a longitudinal pull with knee flexion at 30° is performed.
Displaced fractures with joint involvement must be fixed internally.
Shaft fractures
Operation times
If the skin around the fracture site is uninjured, the doctor waits with the operation until the vital signs are stable. Open fractures have a fracture point that is in direct contact with the external environment. They must be cleaned as quickly as possible and require immediate surgical intervention to prevent infection.
In the period between emergency care and surgery, the leg is positioned in a long splint or under longitudinal tension. In this way, the correct axis position of the injured bone and the leg length can be maintained.
Longitudinal pull treatment consists of a system of pulleys, weights and counterweights that hold the bone parts together.
A straight leg position is often helpful to relieve the pain.
SurgeryExternal fixation
In this surgical method, metal screws and pins are inserted above and below the breaking point.
The pins and screws are attached to a rod outside the skin.
This holding structure, a so-called external fixator, holds the bone in the correct position and thus enables healing.
As a rule, external fixation is a transitional treatment for femoral fractures.
Because screws and rods are easy to attach, they are often used when a patient has multiple injuries and is not yet able to undergo lengthy surgery.
A good external fixator will keep the bone stable until the patient is ready for the final procedure. In some cases, the outer holding device remains positioned until the femur is completely healed, but this doesn’t happen too often.
External fixation is often used for skin and muscle injuries to temporarily hold the bones together.
Surgery with intramedullary nails
The procedure currently used by most surgeons for the treatment of shaft fractures is intramedullary nailing.
A special metal rod is inserted into the medullary cavity of the femur. This rod crosses the fracture site and thus holds it in position.
The intramedullary nail can be inserted with the help of a small incision via both the hip-side and the knee-side medullary cavity.
Then it is screwed to the bone at both ends.
In this way, the nail and bones are held in the correct position during the healing process.
As a rule, the intramedullary nails are made of titanium alloys.
They are available in different lengths and diameters to adapt to the different femurs.
The intramedullary nailing provides a strong and stable fixation over the entire length.
Surgical treatment of plates and screws
In this procedure, the bone fragments are first brought into their normal anatomically appropriate position (reposition) and then held together by special screws and metal plates attached to the outside of the bone surface.
Plates and screws are often used where intramedullary nailing is not possible, such as fractures involving the hip or knee.
Healing time for femoral fracture
Most femoral shaft fractures take 4-6 months to heal completely. In some cases, healing times are also longer, especially in the case of open or debris fractures.
Many doctors prescribe exercise therapy in the first few days after surgery. It is extremely important to follow the doctor’s instructions so that there are no problems with the load on the injured leg.
In some cases, the doctor allows the patient to load the leg as much as possible after the procedure. Nevertheless, full loading is often not possible until the healing process has begun.
The instructions of the operating orthopedist must be strictly adhered to.
For the first attempts at walking, the use of forearm crutches or a walker may be necessary.
Physiotherapy for femoral fracture
Unfortunately, magnetic therapy does not have a high level of awareness among doctors and is rarely prescribed; it can shorten healing times by up to 50% because it accelerates the process of bone consolidation.
Since with long immobilization the lower limb loses muscle strength, especially the femoral quadriceps, it is important to carry out postoperative rehabilitation.
With rehabilitation, normal muscle strength and range of motion can be restored.
The physiotherapist teaches the patient physiotherapy exercises during the hospital stay.
He also shows him how to use forearm crutches or walkers.
Complications of femoral fracture
Along with femoral shaft fractures, other injuries and complications can also occur.
The broken bone ends often have sharp edges and can cut and injure the surrounding blood vessels or nerves.
Acute compartment syndrome may occur. This is a painful condition that occurs when the pressure in the muscles rises to dangerous levels.
The pressure hinders the blood supply and the nutrient and oxygen supply of nerve and muscle cells is impaired; if the pressure is not lowered immediately, permanent disability may be caused.
Compartment or lodge syndrome is a surgical emergency.
During surgery, the surgeon makes small incisions in the skin and muscle to release the pressure.
Open fractures bring the bone into direct contact with the external environment. Even with a thorough, surgical cleaning of bones and muscles, the bone can become infected.
Infection of the bones is difficult to treat; this often requires several operations and long-term antibiotic treatment.
Surgery-related complications
In addition to the general dangers of surgery, such as blood loss or reactions to anesthesia, there are the following risks:
- Infection.
- Injury to the nerves and blood vessels.
- Blood clot.
- Fat embolism (the bone marrow can get into the bloodstream and reach the lungs; this can also happen with non-surgically treated fractures).
- Poorly aligned bone fragments or impossibility to position the broken bone.
- Delayed consolidation (when the fracture heals very slowly or not completely).
- Irritation from the connecting material used (sometimes the nail or screw head can irritate the overlying muscles and tendons).
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