Femoral fracture

Fractures of the femur (femoral fracture) can occur at the level of the hip, on the shaft (diaphysis) or on the knee.

If the bone breaks at any point on the central axis, it is called a femoral shaft fracture.
The long, middle part of the femur is called the femoral shaft or femoral shaft. The femur is the longest and strongest bone of the human body and is well supplied with blood; In addition, it is surrounded by muscles and therefore a pronounced force is necessary to break this bone shaft.

When the bone breaks, it is usually displaced by the muscles protecting it; this is common in femoral shaft fractures.

Complications from nerve and blood vessel injury are among the priorities when the patient arrives at the emergency room.
If there is significant bleeding, the blood supply to the surrounding tissues is significantly reduced.
Concomitant violation of soft tissues, nerves and blood vessels often occurs.
Open fractures have a high potential for infection.

The morbidity and mortality rates, i.e. incidence and deaths, have decreased in femoral shaft fractures; The reason for this is a different concept of immobilization after rupture.
Modern forms of therapy enable early mobilization and thus reduce the risk of complications associated with prolonged bedriddenness.


Classification of fractures

There are four typical femoral shaft fractures:

  • Type I – spiral or transverse fracture (displaced or undisplaced)
  • Type II – Longitudinal fracture (along the bone axis)
  • Type III – Debris fracture
  • Type IV – open fracture

In a very severe trauma, the bones can wedge into each other, which usually happens at the level of the femoral neck.Classification of femoral neck fractures

Medial or intracapsular femoral neck fracture (the most dangerous form)
The following forms can be distinguished:

  • Subcapital fracture (between joint head and neck)
  • Transcervical fracture
  • Mediocervical fracture

Lateral or extracapsular femoral neck fracture
These include:

  • Basecervical fracture, that is, at the base of the femoral neck.
  • Pertrochanteric fracture (the fracture line is located directly at the trochanter major).
  • Subtrochanteric fracture (the fracture line is below the trochanter major and minor).

Causes of a femoral fracture

Thigh shaft fractures in young people are usually caused by violent violence.
Most often this happens in a car or motorcycle accident.

Other common causes include:

  • pedestrian is hit by a car;
  • falls from a great height;
  • Injuries from firearms.

In older people suffering from osteoporosis, even a small accident with a small force can cause a femoral fracture, such as simply falling from a standing position.

A femoral shaft fracture is the result of a large mechanical load transmitted to the knee by a direct or indirect force.
Pathological fractures can occur even with relatively low mechanical stress.
Here, the bone may be weakened by osteoporosis, a bone tumor or metastases.
Bone cancer occurs predominantly at the lower (distal) end of the femur, i.e. at knee level.
In this case, a femoral fracture can occur even without a fall.

Signs and symptoms of femoral fracture

The symptoms of a femoral fracture are mainly limited to the femoral region. If there are other serious injuries or heavy bleeding in addition to the fracture, symptoms can be caused that should not be underestimated because they can endanger life.

The main symptoms are:

  • In general, a femoral fracture causes severe pain, deformation and inability to move.
  • Bleeding and bruising.
  • Deformation of the leg.
  • Inability to move the leg.
  • Muscle spasms.
  • Numbness or tingling.
  • Pain in the leg, hip or knee.
  • swelling.

Complications of a femoral fracture

The possible consequences and risks of a femoral fracture include:

Children and adolescents who suffer a fracture of the femur must be immobilized or operated; in any case, growth is interrupted or slowed down as long as the bone is not healed, so one leg may later be shorter than the other.

Diagnosis of a femoral fracture

Clinical examination and medical history

The doctor must be informed in detail about the course of the accident and all symptoms that are noticeable on the leg.
For example, in a car accident, he needs to know at what speed the accident occurred, was the injured person the driver or passenger, was he wearing a seat belt, was the airbag deployed, etc. The doctor must also be informed if the patient has other health problems, such as high blood pressurediabetesasthma or allergies, and what medications are being taken.

After the accident and medical history have been explained, a thorough investigation is carried out.
First, the general health of the patient is assessed, followed by a thorough assessment of the affected leg.

In doing so, the doctor will pay particular attention to the following:

  • A visible deformation of the leg or thigh (unnatural angular position, twisting, spreading of the hip or a shorter leg).
  • Skin injuries.
  • Bruises.
  • Bone fragments that press against the skin.

Care of the injured patient

First aid:

First of all, the vital functions and possible injuries in the chest area, head, abdomen and spine must be examined.
Life-threatening injuries must be treated promptly to save the patient’s life.
Creation of a fracture rail (Thomas rail or the equivalent of a drawer rail).

  • X-ray of the thigh.
  • Blood test, including blood grouping for a possible blood transfusion.
  • Special attention must be paid to reflexes and sensitivity of the leg.
  • Painkillers: an appropriate, intravenously administered pain therapy. Inhibition of the femoral nerve is usually very effective.

After a thorough examination, the thighs, lower legs and foot are palpated in search of abnormalities, the condition of the skin and muscles is examined and the reflexes are checked.
If the patient is conscious, the doctor checks the sensitivity and mobility of the leg and foot.

Differential diagnosis

Diagnostic imaging

Technical examination methods to better assess the fracture:

X-ray diagnostics: to evaluate a fracture, X-rays are usually taken, which provide clear images of the bones. The X-ray clearly shows whether a bone is broken or not.
The shape and location of the fracture are also recognizable.
It is possible that the fracture is not yet visible on the day of the accident, because the fracture edges have not yet distinguished themselves well from each other; but if the intake is repeated after 3 days, the bone condition is clearly visible.

Computed tomography (CT).

After the X-ray examination, the doctor can also perform a CT scan to get a further overview.
This examination shows cross-sectional images of the lower extremity.
The doctor thus receives important information about the severity of the fracture. On an X-ray, for example, the fracture lines are sometimes very thin and difficult to see.

Treatment of a femoral fracture

Treatment can be surgical or conservative.

For surgical therapy, the following treatment options are available:

  • Using an intramedullary nail to block the bone parts in the correct position.
  • Connection of the fragments by the use of screws, which are held in the correct position with the help of metal plates attached to the bone surface from the outside.
  • Connection of the bone parts by screws attached to an external fixation.

In the elderly, a hip fracture can be treated by using an artificial hip joint.
In some cases, an elderly patient is unable to operate due to other diseases because surgery could entail life-threatening risks; a wheelchair may be needed here.
After the operation, the surgeon can apply a cast, which must be worn for different lengths depending on the consolidation time.
To immobilize the femur, the cast also includes the pelvis.
Children are usually not operated on in the case of a shaft fracture, because the healing takes place quite quickly (45 days), here it is sufficient to bring the fracture by pulling in the longitudinal axis into an anatomically appropriate position (so-called reposition).

Physiotherapy and rehabilitation

After a fracture of the femur, the patient must immobilize the leg until the fracture is stable.
After the operation, physiotherapy exercises for the leg are necessary so that muscle strength and range of motion can be regained.
The first stage of rehabilitation provides for passive mobilization, after which active movements are performed and exercises in which the broken leg is loaded.

How long are the recovery times? The prognosis for recovery

It is not possible to give universal healing times because there are many variables, such as:

  • Severity of fracture
  • Age of the patient
  • Osteoporosis
  • Form of treatment (surgical intervention or immobilisation)

After an operation in which an external fixation has been used, the patient can walk again one day after the operation.
In other cases, the orthopedist decides, usually walking is possible again one month after the start of immobilization.

Read more: