Femur Fracture: Causes, Symptoms & Treatment

A femur fracture or femur fracture is a summary term for different types of fractures to the thigh bone. Treatment depends on where the fracture occurred, what damage it did to the bone, and whether tissue and nerves were also damaged.

What is a femur fracture?

A femoral fracture is the colloquial term for a break (fracture) of the bone in the thigh. This thigh bone (femur) is the strongest and the longest bone in the entire human skeleton. Viewed from top to bottom, it consists of a head, then follows at a slight angle the femoral neck, which in turn leads into the bone shaft. At the lower end is the articular surface for the knee joint. Since a fracture can occur at different points on the bone and each fracture site requires specific therapies, there are different medical names for the fractures depending on the site at which they occurred. A rough distinction is made between femoral neck fractures and femoral shaft fractures. Furthermore, there are fractures at the so-called rolling hills (trochanters), which are located at the upper side of the bone. Another way of differentiation is the type of fracture. In a fracture of the femur, the bone may break transversely or at an angle, it may splinter, break spirally, or there may be a comminuted fracture. We also differentiate between open and closed femoral fractures and between stable and unstable fractures.

Causes

The cause of a femur fracture is always force applied to the bone. Depending on what kind of force and in what form it has acted on the bone, the different variants of the femur fracture then occur. The uppermost part, the head, usually breaks in dislocations, i.e. in excessive rotations in the hip, so that the hip is often dislocated as well (hip head luxation). The fracture of the neck of femur often takes place in falls of elderly people. Their bones have not infrequently changed in structure due to osteoporosis, have become porous and can therefore no longer absorb the sudden force. Fracture at the bone shaft usually occurs when force is applied as part of several other injuries, such as in serious traffic accidents. This is called polytrauma (poly = many, trauma = injury). For example, a femur fracture at the lower end of the femur bone occurs when force is applied compressively to the bone from the front through the knee. This is typical in car accidents, when the affected person bumps the knee against the fittings.

Symptoms, complaints, and signs

A fracture of the femur is usually not noticeable by the first signs, because such a fracture occurs suddenly and by strong force. Such a fracture is, of course, associated with very severe pain that can affect the entire lower body. In many cases, a fracture of the femur is also visible from the outside. With the naked eye, a malposition of the bones can be detected under certain circumstances. However, the situation is different if there is only a hairline fracture. This is a small crack in the thigh that causes much less pain. A typical symptom of such a hairline fracture is constant pain when walking and running. As soon as the affected leg is loaded, stabbing pain is to be expected. A medical examination must take place in any case, otherwise permanent damage is to be expected. Often, severe swelling is also a clear sign of a fracture in the thigh. In addition, there may be internal bleeding that requires urgent medical attention. Thus, the following applies: a fracture of the femur can be diagnosed quite clearly due to the unambiguous symptoms. Of course, it also comes to considerable movement restrictions, so that the affected person can no longer walk properly by any means.

Diagnosis and course

The first symptom of a femur fracture is always pain. Because the bones are supplied with nerves, a fracture is extremely painful. In most cases, sufferers can no longer move because the pain is too severe. The leg is also unstable in the case of a femur fracture. In open fractures, the ends of the bone can spike out through the skin and the fracture can be clearly visible. There is a particular risk of infection here, as germs can enter the organism.Furthermore, swelling and bruising often occur on the skin over a closed femoral fracture. Since vessels also rupture during a fracture, this results in bleeding that causes the tissue to swell and can be seen as a blue discoloration on the skin. Other possible symptoms are nerve injuries that can lead to sensory disturbances or paralysis. The doctor first makes the diagnosis based on the symptoms and visible signs. X-rays can accurately determine the type of femur fracture, which is an important prerequisite for the choice of therapy.

Complications

Because the region around the femur has a very good blood supply, a massive hemorrhage can occur as a complication of a femoral neck fracture, resulting in a life-threatening state of shock. An open femur fracture carries the risk of infection from invading bacteria; in rare cases, pathogens spread through the body via the bloodstream and cause life-threatening blood poisoning (sepsis). Impaired bone healing can lead to deformities, the formation of a false joint (pseudarthrosis) and leg length discrepancy. In adults, this usually results in a shortening of the affected leg, while in children both growth disturbances and a lengthening of the injured leg are possible. As a rule, a femoral fracture must be treated surgically: Complications that may occur during or after surgery include nerve damage with paralysis or sensory disturbances, wound healing disorders, thrombosis or pulmonary embolism. Occasionally, circulatory disorders occur in the area of the femoral head, as a result of which tissue may die. Allergic reactions and the development of a painful Sudeck syndrome are also possible. In older age, the risk of possible consequential damage increases; prolonged confinement to bed can result in pneumonia or pressure ulcers (bedsores). In some cases, complete recovery can no longer be achieved, and the patient remains limited in mobility and in need of care.

When should you see a doctor?

If people experience pain in the thigh after a fall, a jerky movement, or an accident, immediate relief of the leg is necessary. If there is relief within a few minutes and a full recovery later, a doctor is not needed. If the pain persists, spreads, or increases in intensity, a physician must be consulted. Pain medications should only be taken after consulting a medical professional due to their numerous side effects. A doctor should be consulted if there are restrictions on movement, problems with locomotion or a decrease in physical resilience. If there are changes in the appearance of the skin, bruising or a visible abnormality of the skeletal system, a medical examination is needed. A doctor should be consulted if there is any pelvic obliquity, muscle problems or sensory disturbances. Swelling, sensitivity to pressure, and disturbances in blood flow are signs of a health condition that should be presented to a physician. If the leg cannot be loaded with the patient’s own body weight or if it is impossible to perform everyday tasks, a visit to the doctor is recommended. Since the chances of recovery from a fracture of the femur are highest if medical attention is received as soon as possible, a doctor should be consulted immediately at the first sign of an irregularity.

Treatment and therapy

Treatment of femoral fracture depends on the type of fracture. Especially in children and in people with a severe underlying disease, the fracture is often treated conservatively (without surgery) if it is somehow possible. Conservative treatment is also used for smooth and stable fractures. In this case, the bones are still in the original position on each other and are not displaced. In these cases, immobilization of the leg with the help of a splint or a cast is sufficient. In most cases, however, surgery is performed to restore the necessary stability to the bone, which is exposed to heavy loads in everyday life. Depending on the existing fracture, either under general or local anesthesia, the ends of the bone are rejoined and reinforced with screws, plates or intramedullary nails.In the case of complicated fractures at the upper head of the bone, it may also be necessary to insert an artificial hip joint. If the femoral fracture is a comminuted fracture in which bone material has been lost, it may be replaced with bone fragments from the pelvic bone.

Outlook and prognosis

The outlook after a femoral fracture depends on the extent and type of injury. For example, treatment of the fracture can take a long time. However, most patients experience problem-free fusion of the bones after both conservative therapy and surgery, so the prognosis is ultimately positive. The mobility of the affected person also rarely suffers from the injury. Nevertheless, a positive outcome of the treatment cannot be guaranteed in every case. This is especially true if adjacent structures have been affected by the fracture or if osteoporosis (bone loss) is present. Some patients may require a repeat operation. The prognosis is most favorable for a fracture of the femoral shaft. The healing process is positive in about 90 percent of all patients. After three to four months, the femoral fracture is over. There is no risk of permanent damage. The situation is less favorable, however, in the case of a femur fracture near the hip joint. If the injured leg can no longer be fully loaded so that the patient can become mobile again, there is often a need for care. If there is a femur fracture close to the knee joint, physiotherapeutic exercises are possible at an early stage. In most cases, the patient can put weight on the leg again after about twelve weeks. If there is a pertrochanteric femur fracture, the leg may even be loaded immediately after surgery.

Prevention

There is no way to prevent a fracture of the femur, as it usually happens due to sudden unexpected force during accidents and falls.

Aftercare

Movement is among the most important aftercare measures for a fracture of the femur. The extent to which movement can occur depends on the extent of the injury. If there is no pronounced comminuted fracture of the femur, gait training can begin a few days after surgery. For this, the patient uses forearm crutches and slowly increases the load. Because the inserted implants provide sufficient stabilization of the bone, no plaster cast is required. If intramedullary nailing is performed during the operation, some of the transverse screws are removed after about six to twelve weeks. Body weight can be used to compress the bone fragments. In this way, rapid healing of the fracture is possible. As a rule, the intramedullary nail remains in the bone for up to two years. In some cases, however, it is not removed at all as long as no discomfort is caused by it. Inserted plates can normally be removed after 1.5 to 2 years. If this is possible, physiotherapeutic exercises and weight-bearing begin shortly after the femur operation. Without these aftercare measures, the healing process would take much longer. A physiotherapist is responsible for monitoring the exercise program. He makes sure that there is no overloading of the bone. It usually takes twelve weeks before the affected leg can bear weight again.

What you can do yourself

In the case of a fracture of the femur, the affected person should take it easy and allow the body sufficient rest. Sporting activities are to be refrained from during the healing process. Loads are to be reduced and everyday life is to be adapted to the patient’s physical capabilities. Since locomotion is severely limited, temporary restructuring should be made in the performance of daily tasks and errands. Calling on the assistance of friends or relatives may be found to be very helpful. The musculoskeletal system should be less stressed overall and exertion of force should be avoided. Failure to do so may result in bone dislocation and complications within the healing process. The affected person should protect himself from incorrect postures or one-sided physical stress. Light balancing movements and exercises help to prevent possible muscle discomfort as well as damage to the skeletal system. For optimal recovery, obesity or severe weight gain should be avoided.To ensure that the body is not subjected to overexertion, a body weight that is within the BMI guidelines is recommended. As recovery progresses, a careful build-up of the muscles in the leg can begin in consultation with the attending physician. Due to the symptoms, care should be taken when stepping on the foot. There is an increased risk of accident and injury because the injured leg cannot be loaded with its own weight as usual.