The femur, often referred to as the thigh bone, is the body’s longest and strongest bone. It links the hip to the knee. A femur fracture means the bone has broken. The distal femur is the lower part of the thigh bone, which broadens in a shape like an upside-down funnel. The bottom of this area is covered with smooth and slippery articular cartilage that helps protect the bone and reduce friction during movement. A break in the distal femur can damage the cartilage on the knee and may result in arthritis.
Types
- Distal femur fracture: The distal femur is the lower part of the thigh bone that widens out, much like the opening of a funnel. A fracture in the distal femur occurs when the thigh bone breaks near the area above the knee joint.
- Femoral shaft fracture: A femoral shaft fracture is a type of break that happens anywhere along the long, straight portion of the femur.
- Proximal femur fracture: A hip fracture or proximal femur fracture is a break in the proximal end of the thigh bone near the hip.
Femur fractures can result from high-energy injuries like falling from a height or being involved in a car accident. Individuals with osteoporosis, bone tumors, infections, or a history of knee replacement are at a higher risk of experiencing a femur fracture. In older adults, even a minor fall from a standing position can lead to a fracture because bones tend to weaken and become more fragile as one ages.
All of a sudden, there is severe pain, along with swelling and bruising, which are the main signs of a broken femur. The area is tender when touched, there is a visible change in the shape of the limb, and the affected leg looks shorter than the other one.
The process of diagnosing a femur fracture requires looking at the patient's medical history, such as any previous injuries, performing a detailed physical exam, and utilizing imaging tests to confirm the diagnosis. The doctor will check the soft tissues near the joint to look for any damage to nerves or blood vessels. Several X-rays and other imaging techniques, like CT and MRI scans, may be performed to determine where the fracture is located and how serious it is.
The treatment of a fracture depends on how serious the break is, the patient's overall health, and their way of living.
Non-surgical treatment involves keeping the broken area still using casts or braces to avoid putting weight on it and to support the healing process. X-rays are regularly taken to monitor how well the injury is healing. The patient can start to bear weight and move the area slowly, based on the type of injury and their overall health condition.
Surgical treatment is used to realign a broken bone. The use of modern technology and specialized materials has helped improve the results of surgery, even for older patients. Depending on how severe the break is, options such as external or internal fixation, or a knee replacement, may be needed. The timing of the surgery plays a key role in achieving a better outcome.
Timing of surgery
In most cases, the surgery is delayed for a few days to develop an effective treatment plan and for preparation of the patient. With most distal femur fractures the surgery can be delayed unless the fracture is open to the environment.
External fixator
An external fixator is employed when the surrounding soft tissues are severely damaged, as the use of plates and screws may pose risks. The external fixator assists in maintaining proper alignment of the bones until the surgical procedure is carried out.
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 for femur fractures can be carried out using two primary techniques: intramedullary nailing or the application of plates and screws. In intramedullary nailing, a sturdy metal rod is carefully inserted into the marrow canal of the femur to stabilize and hold the fractured pieces in position. Alternatively, in the plate and screw method, the broken bone fragments are first realigned and then secured with screws and plates that are fixed to the outer surface of the bone. In cases of comminuted fractures, where the bone has shattered into multiple fragments, rods or plates may be placed at the ends of the fracture without interfering with the smaller pieces, thereby maintaining the bone’s shape and strength during healing. For elderly patients, or those with weak bone quality, bone grafting may be considered to support faster recovery. In severe or complex cases, knee replacement may also serve as an effective option.
Knee replacement
Artificial implants may be used to replace the fractured segments of the bone and joint.
Rehabilitation
Rehabilitation for a femur fracture is influenced by several factors including the patient's age, overall health, and the nature of the fracture. Since the femur is part of a weight-bearing joint, a fracture in this area can lead to long-term issues such as reduced knee movement, joint instability, and chronic arthritis. Therefore, a rehabilitation plan is started along with the treatment. This plan includes guidance on weight-bearing activities, knee movement exercises, and the use of support devices like braces.
