A femoral fracture is a

bone fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a ''c ...

that involves the

femur The femur (; : femurs or femora ), or thigh bone is the only long bone, bone in the thigh — the region of the lower limb between the hip and the knee. In many quadrupeds, four-legged animals the femur is the upper bone of the hindleg. The Femo ...

. They are typically sustained in high-impact trauma, such as

car crashes A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collision, collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, Utility pole ...

, due to the large amount of force needed to break the bone. Fractures of the

diaphysis The diaphysis (: diaphyses) is the main or midsection (shaft) of a long bone. It is made up of cortical bone and usually contains bone marrow and adipose tissue (fat). It is a middle tubular part composed of compact bone which surrounds a centr ...

, or middle of the femur, are managed differently from those at the head, neck, and

trochanter A trochanter is a tubercle of the femur near its joint with the hip bone. In humans and most mammals, the trochanters serve as important muscle attachment sites. Humans have two, sometimes three, trochanters. Etymology The anatomical term ' ...

; those are conventionally called

hip fracture A hip fracture is a break that occurs in the upper part of the femur (thigh bone), at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually ...

s (because they involve the

hip joint In vertebrate anatomy, the hip, or coxaLatin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) (: ''coxae'') in medical terminology, refers to either an anatomical region or a joint o ...

region). Thus, mentions of femoral fracture in

medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...

usually refer implicitly to femoral fractures at the shaft or distally.

Signs and symptoms

Fractures are commonly obvious, since femoral fractures are often caused by high energy trauma. Signs of fracture include swelling, deformity, and shortening of the leg. Extensive soft-tissue injury, bleeding, and shock are common. The most common symptom is severe pain, which prevents movement of the leg.

Diagnosis

$Common fracture locations of femur$

Physical exam

Femoral shaft fractures occur during extensive trauma, and they can act as distracting injuries, whereby the observer accidentally overlooks other injuries, preventing a thorough exam of the complete body. For example, the ligaments and meniscus of the ipsilateral (same side) knee are also commonly injured.

Radiography

Anterior-posterior (AP) and lateral radiographs are typically obtained. In order to rule out other injuries, hip, pelvis, and knee radiographs are also obtained. The hip radiograph is of particular importance, because femoral neck fractures can lead to

osteonecrosis Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. Early on, there may be no symptoms. Gradually joint pain may develop, which may limit the person's abili ...

of the femoral head.

Classification

The fracture may be classed as ''open'', which occurs when the bone fragments protrude through the skin, or there is an overlying wound that penetrates to the bone. These types of fracture cause more damage to the surrounding tissue, are less likely to heal properly, and are at much greater risk of infection.

Femoral shaft fractures

Femoral shaft In human anatomy, the body of femur (or shaft of femur) is the almost cylindrical, long part of the femur. It is a little broader above than in the center, broadest and somewhat flattened from before backward below. It is slightly arched, so as t ...

fractures can be classified with the

Winquist and Hansen classification The Winquist and Hansen classification is a system of categorizing femoral shaft fractures based upon the degree of comminution Comminution is the reduction of solid materials from one average particle size to a smaller average particle size, by ...

, which is based on the amount of

comminution Comminution is the reduction of solid materials from one average particle size to a smaller average particle size, by crushing, grinding, cutting, vibrating, or other processes. Comminution is related to pulverization and grinding. All use m ...

Distal femur fractures

Fractures of the inferior or distal femur may be complicated by separation of the condyles, resulting in misalignment of the articular surfaces of the knee joint, or by hemorrhage from the large popliteal artery that runs directly on the posterior surface of the bone. This fracture compromises the blood supply to the leg (an occurrence that should always be considered in knee fractures or dislocations).

Treatment

A 2015 Cochrane review (updated in 2022) found that available evidence for treatment options of distal femur fractures is insufficient to inform clinical practice and that there is a priority for a high-quality trial to be undertaken. Open fractures must undergo urgent surgery to clean and repair them, but closed fractures can be maintained until the patient is stable and ready for surgery.

Skeletal traction

Available evidence suggests that treatment depends on the part of the femur that is fractured. Traction may be useful for femoral shaft fractures because it counteracts the force of the muscle pulling the two separated parts together, and thus may decrease bleeding and pain. Traction should not be used in femoral neck fractures or when there is any other trauma to the leg or

pelvis The pelvis (: pelves or pelvises) is the lower part of an Anatomy, anatomical Trunk (anatomy), trunk, between the human abdomen, abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also c ...

. It is typically only a temporary measure used before surgery. It is only considered definitive treatment for patients with significant

comorbidities In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring (that is, concomitant or concurrent) with a primary condition. It originates from the Latin term (meaning "sickness" ...

that contraindicate surgical management.

External fixators

External fixators can be used to prevent further damage to the leg until the patient is stable enough for surgery. It is most commonly used as a temporary measure. However, for some select cases it may be used as an alternative to intramedullary nailing for definitive treatment.

Intramedullary nailing

For femoral shaft fractures, reduction and intramedullary nailing is currently recommended. The bone is re-aligned, then a metal rod is placed into the femoral bone marrow, and secured with nails at either end. This method offers less exposure, a 98–99% union rate, lower infection rates (1–2%) and less muscular scarring.

Rehabilitation

After surgery, the patient should be offered physiotherapy and try to walk as soon as possible, and then every day after that to maximise their chances of a good recovery.

Outcomes

These fractures can take at least 4–6 months to heal. Since femoral shaft fractures are associated with violent trauma, there are many adverse outcomes, including

fat embolism Fat embolism syndrome occurs when adipose tissue, fat enters the blood stream (fat embolism) and results in symptoms. Symptoms generally begin within a day. This may include a petechia, petechial rash, decreased level of consciousness, and shortn ...

, acute respiratory distress syndrome (ARDS), multisystem organ failure, and shock associated with severe blood loss. Open fractures can result in infection, osteomyelitis, and sepsis.

Epidemiology

Femoral shaft fractures occur in a bimodal distribution, whereby they are most commonly seen in males age 15-24 (due to high energy trauma) and females aged 75 or older (pathologic fractures due to

osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk. It is the most common reason f ...

, low-energy falls). In Germany, femoral fractures are the most common type of fracture seen and treated in hospitals.

References

External links

{{Fractures Bone fractures Injuries of hip and thigh