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. Depending on the location of the fracture, thighbone fractures can be categorized into:

• Distal femur fracture: The distal femur is part of the femur bone that flares out like the mouth of a funnel. A distal femur fracture is a break in the 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, the long, straight section of the femur bone.
• Proximal femur fracture: A hip fracture or proximal femur fracture is a break in the proximal end of the thighbone near the hip.

Femur fractures may be caused by high-energy injuries such as a fall from a height or a motor vehicle accident. Patients with osteoporosis, bone tumor or infections, or a history of knee replacement are more prone to femur fractures. In the elderly, even a simple fall from a standing position 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 the patient’s medical history, including the history of any previous injury, complete physical examination and imaging studies. The doctor 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 the severity of the fracture, medical condition of the patient and the patient’s lifestyle. It can be done by non-surgical or surgical methods.

Non-surgical treatment comprises of immobilizing the fracture 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 the condition of the patient.

Surgical treatment is considered to realign the fractured bone. The use of advanced technology and special materials have 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. 

• External fixator: An external fixator is used when the surrounding soft tissue is severely damaged, as the use of plates and screws may be harmful. The external fixator maintains the alignment of the bone till surgery. Once the patient is prepared for surgery, the surgeon removes the external fixator and places internal fixation devices into the bone during surgery.
• Internal fixator: Internal fixation may be performed using 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 fragment 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, i.e. the bone has broken into many pieces, plates or rods may be used at the end 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 used to improve the healing.
• Knee replacement: Knee replacement may be considered in complicated fractures or those with poor bone quality. Artificial implants are used to replace the fractured segments of the bone and joint.

Rehabilitation of the femur fracture depends upon several factors such as age, general health of the patient 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, which comprises of instructions on weight-bearing, knee movements and the use of external devices such as braces.