Femur Shaft Fractures (Broken Thighbone)-OrthoInfo - AAOS
Copyright 2011 American Academy of Orthopaedic Surgeons
Femur Shaft Fractures (Broken Thighbone)
Your thighbone (femur) is the longest and strongest bone in your body.  Because the    femur is so strong, it usually takes a lot of force to break it.  Car crashes, for    example, are the number one cause of femur fractures.
The long, straight part of the femur is called the femoral shaft. When there is a    break anywhere along this length of bone, it is called a femoral shaft fracture.
The femoral shaft runs from below the hip to where the bone begins to widen at the       knee.
Types of Femoral Shaft Fractures
Femur fractures vary greatly, depending on the force that causes the break. The pieces    of bone may line up correctly or be out of alignment (displaced), and the fracture    may be closed (skin intact) or open (the bone has punctured the skin).
Doctors describe fractures to each other using classification systems. Femur fractures    are classified depending on:
The location of the fracture (the femoral shaft is divided into thirds: distal, middle,       proximal)
The pattern of the fracture (for example, the bone can break in different directions,       such as cross-wise, length-wise, or in the middle)
Whether the skin and muscle above the bone is torn by the injury
The most common types of femoral shaft fractures include:
Transverse fracture. In this type of fracture, the break is a straight horizontal line going across the    femoral shaft.
Oblique fracture. This type of fracture has an angled line across the shaft.
Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane.  A twisting    force to the thigh causes this type of fracture.
Comminuted fracture. In this type of fracture, the bone has broken into three or more pieces. In most    cases, the number of bone fragments corresponds with the amount of force required    to break the bone.
Open fracture. If a bone breaks in such a way that bone fragments stick out through the skin or    a wound penetrates down to the broken bone, the fracture is called an open or compound    fracture. Open fractures often involve much more damage to the surrounding muscles,    tendons, and ligaments. They have a higher risk for complications — especially infections—    and take a longer time to heal.
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Cause
Femoral shaft fractures in young people are frequently due to some type of high-energy    collision. The most common cause of femoral shaft fracture is a motor vehicle or motorcycle    crash. Being hit by a car as a pedestrian is another common cause, as are falls from    heights and gunshot wounds.
A lower-force incident, such as a fall from standing, may cause a femoral shaft fracture    in an older person who has weaker bones.
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Symptoms
A femoral shaft fracture  usually causes immediate, severe pain. You will not be able    to put weight on the injured leg, and it may look deformed — shorter than the other    leg and no longer straight.
Doctor Examination
Medical History and Physical Examination
It is important that your doctor know the specifics of how you hurt your leg.  For       example, if you were in a car accident, it would help your doctor to know how fast       you were going, whether you were the driver or a passenger, whether you were wearing       your seat belt, and if the airbags went off.  This information will help your doctor       determine how you were hurt and whether you may be hurt somewhere else.
It is also important for your doctor to know whether you have other health conditions       like high blood pressure, diabetes, asthma, or allergies. Your doctor will also ask       you about any medications you take.
After discussing your injury and medical history, your doctor will do a careful       examination. He or she will assess your overall condition, and then focus on your       leg. Your doctor will look for:
An obvious deformity of the thigh/leg (an unusual angle, twisting, or                shortening of the leg)
Breaks in the skin
Treatment
Nonsurgical Treatment
Most femoral shaft fractures require surgery to heal. It is unusual for femoral shaft       fractures to be treated without surgery. Very young children are sometimes treated       with a cast. For more information on that, see Pediatric Thighbone (Femur) Fracture Pediatric Thighbone (Femur) Fracture (topic.cfm?topic=A00424).
Surgical Treatment
Timing of surgery. If the skin around your fracture has not been broken, your doctor will wait until       you are stable before doing surgery. Open fractures, however, expose the fracture       site to the environment. They urgently need to be cleansed and require immediate surgery       to prevent infection.
For the time between initial emergency care and your surgery, your doctor will place       your leg either in a long-leg splint or in skeletal traction. This is to keep your       broken bones as aligned as possible and to maintain the length of your leg.
Skeletal traction is a pulley system of weights and counterweights that holds the       broken pieces of bone together. It keeps your leg straight and often helps to relieve       pain.
External fixation. In this type of operation, metal pins or screws are placed into the bone above and       below the fracture site. The pins and screws are attached to a bar outside the skin.       This device is a stabilizing frame that holds the bones in the proper position so       they can heal.
External fixation is usually a temporary treatment for femur fractures.  Because they       are easily applied, external fixators are often put on when a patient has multiple       injuries and is not yet ready for a longer surgery to fix the fracture. An external       fixator provides good, temporary stability until the patient is healthy enough for       the final surgery.  In some cases, an external fixator is left on until the femur       is fully healed, but this is not common.
External fixation is often used to hold the bones together temporarily when the skin          and muscles have been injured.
Intramedullary nailing. Currently, the method most surgeons use for treating femoral shaft fractures is       intramedullary nailing. During this procedure, a specially designed metal rod is inserted       into the marrow canal of the femur. The rod passes across the fracture to keep it       in position.
An intramedullary nail can be inserted into the canal either at the hip or the knee       through a small incision. It is screwed to the bone at both ends. This keeps the nail       and the bone in proper position during healing.
Intramedullary nails are usually made of titanium. They come in various lengths and       diameters to fit most femur bones.
Intramedullary nailing provides strong, stable, full-length fixation.
Plates and screws. During this operation, the bone fragments are first repositioned (reduced) into their       normal alignment. They are held together with special screws and metal plates attached       to the outer surface of the bone.
Plates and screws are often used when intramedullary nailing may not be possible,       such as for fractures that extend into either the hip or knee joints.
(Left) This x-ray shows a healed femur fracture treated with intramedullary nailing. (Right) In this x-ray, the femur fracture has been treated with plates and screws.
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Recovery
Most femoral shaft fractures take 4 to 6 months to completely heal.  Some take even    longer, especially if the fracture was open or broken into several pieces.
Pain Management
Pain after an injury or surgery is a natural part of the healing process. Your doctor       and nurses will work to reduce your pain, which can help you recover faster.
Medications are often prescribed for short-term pain relief after surgery or an injury.       Many types of medicines are available to help manage pain, including opioids, non-steroidal       anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination       of these medications to improve pain relief, as well as minimize the need for opioids.
Be aware that although opioids help relieve pain after surgery or an injury, they       are a narcotic and can be addictive. Opioid dependency and overdose has become a critical       public health issue in the U.S. It is important to use opioids only as directed by       your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to       your doctor if your pain has not begun to improve within a few days of your treatment.
Weightbearing
Many doctors encourage leg motion early in the recovery period. It is very important       to follow your doctor's instructions for putting weight on your injured leg to avoid       problems.
In some cases, doctors will allow patients to put as much weight as possible on the       leg right after surgery. However, you may not be able to put full weight on your leg       until the fracture has started to heal. It is very important to follow your doctor's       instructions carefully.
When you begin walking, you will most likely need to use crutches or a walker for       support.
Physical Therapy
Because you will most likely lose muscle strength in the injured area, exercises during       the healing process are important. Physical therapy will help to restore normal muscle       strength, joint motion, and flexibility.
A physical therapist will most likely begin teaching you specific exercises while       you are still in the hospital.  The therapist will also help you learn how to use       crutches or a walker.