Femoral Shaft Fractures (Thigh Bone Fracture)
What Is a Femoral Shaft Fracture (Thigh Bone Fracture)?
The femur (thigh bone) is the longest and strongest bone in the body. The long, straight section between the hip and the knee is called the femoral shaft; a fracture anywhere along this section is a femoral shaft fracture. Because this bone carries much of the body's weight, standing and walking usually become impossible when it breaks.
Because the femur is a strong bone, breaking it in a young, healthy person usually takes a high-energy injury. Femoral shaft fractures are serious injuries and the large majority are treated with surgery. For other problems around the hip and knee you can review the hip page.
Causes and Risk Factors
Femoral shaft fractures are seen in two different groups of patients; the mechanism differs in each and this affects treatment and recovery.
- High-energy trauma in young, healthy people: road-traffic and motorcycle accidents, pedestrians struck by a vehicle, falls from a height and gunshot injuries.
- Low-energy trauma in older patients with osteoporosis: even a simple fall can cause a fracture.
- Conditions that weaken the bone: a tumour, previous surgery or certain long-term medications can increase the risk of a fracture through the affected area.
Symptoms
Femoral shaft fractures usually present with obvious and severe symptoms; in most cases the diagnosis is apparent at the moment of injury.
- Sudden, severe thigh pain.
- Inability to bear weight on the injured leg.
- Deformity, angulation or shortening of the leg.
- Marked swelling and bruising; in an open fracture, a wound and bleeding at the skin.
Types of Fracture
Femoral shaft fractures are classified by the alignment of the bone ends, their relationship to the skin and the shape of the fracture line. This classification guides the surgical plan and the expected recovery.
- By alignment: stable fractures in which the fragments are correctly aligned, and displaced fractures in which the ends have shifted out of line.
- By relationship to the skin: closed fractures in which the skin is intact, and open fractures in which the bone has broken the skin and the risk of infection is higher.
- By shape: transverse, oblique, spiral (from a twisting force) and comminuted fractures in which the bone is broken into three or more pieces.
Emergency Assessment and First Aid
Because a femoral shaft fracture is a high-energy injury, the initial assessment is not limited to the bone. The fracture can cause significant bleeding and is often accompanied by other injuries, so the patient is assessed as a whole.
The first steps secure the circulation and breathing, monitor for blood loss, check the blood supply and nerves of the leg, and immobilise the leg appropriately (splinting). Pain is controlled before surgery, and in an open fracture antibiotics are started immediately to help prevent infection.
Diagnosis
Diagnosis is made by examination and imaging. Anteroposterior and lateral X-rays of the thigh show the location, type and degree of displacement of the fracture; the neighbouring hip and knee joints are also assessed.
Computed tomography (CT) may be used in comminuted fractures, for surgical planning or when an additional injury is suspected. When a fracture occurs after a low-energy fall in an older patient, the underlying bone weakness and general condition are assessed as well.
Surgical Treatment and Methods
The large majority of femoral shaft fractures are treated with surgery; surgery allows the bone to heal in correct alignment and makes early movement possible. Non-surgical treatment is used only in very young children and selected special situations. In patients whose general condition allows, the fracture is fixed as soon as possible; in an open fracture, wound cleaning and antibiotics take priority.
- Intramedullary nailing: the most commonly used method. A metal nail placed inside the canal of the femur fixes the fracture from within and provides a strong, stable fixation.
- Plate and screws: in fractures near the joint or of a particular shape where a nail is not suitable, the bone is fixed from the outer surface with a plate and screws.
- External fixator: usually a temporary method used in severe soft-tissue injury or in multiply injured patients until the situation stabilises.
Recovery and Rehabilitation
Femoral shaft fractures usually heal within a few months; the time depends on the type of fracture, whether it is open or comminuted, the patient's age and factors that impair healing such as smoking. Physiotherapy is an integral part of recovery.
Most patients are helped to their feet with a walker or crutches soon after surgery. The amount and timing of weight-bearing are increased gradually according to the type of fracture and the fixation used, following the doctor's advice. As the muscles strengthen and the bone heals, patients return to daily activities and a normal gait; the exact time varies from patient to patient.
Possible Complications
With correct treatment the results are usually good; nevertheless, as with any serious fracture, certain risks are kept in mind. These include infection (especially in open fractures), delayed union or non-union, a difference in leg length or alignment, clots related to immobility (deep vein thrombosis) and nerve or blood-vessel problems.
Protection against clots after surgery is part of the plan; the deep vein thrombosis page gives general information on this. Regular follow-up and rehabilitation are important in managing these risks.
When Should You See a Doctor?
Any suspected femoral shaft fracture is an emergency and needs assessment without delay.
- After an injury, go to the emergency department if there is severe thigh pain, deformity and an inability to bear weight.
- Do not delay if there is an open wound, marked bleeding or signs of nerve or blood-vessel injury such as coldness or numbness in the leg.
- After surgery, increasing pain, fever, drainage from the wound or one-sided calf swelling should be assessed.
For treatment and follow-up after a fracture you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within hip and knee surgery.