Femoral Fracture

What is a Femoral Fracture?

A femoral fracture is a break in the femur (thighbone), the longest and strongest bone in the human body. This serious injury requires immediate medical attention and often surgical intervention.

Femoral Fractures: A Detailed Overview

The femur, or thigh bone, is the longest and strongest bone in the human body. It plays a crucial role in weight-bearing and mobility, serving as a vital structure that connects the hip to the knee. Fractures of the femur are significant injuries due to the bone’s strength, and they can result in varying degrees of mobility loss, depending on the type and location of the fracture.

Femur Anatomy and Impact of Fractures on Mobility and Function

The femur consists of:

• Proximal end: This includes the femoral head (ball of the hip joint), femoral neck, and the greater and lesser trochanters.
• Shaft: The long, straight part of the femur.
• Distal end: This connects to the knee and features the femoral condyles, which articulate with the tibia and patella.

Femoral fractures disrupt the normal function of the lower limb. The severity of the impact depends on the fracture’s location:

• Proximal fractures (closer to the hip) affect the hip’s mobility and stability, making weight-bearing difficult.
• Distal fractures (closer to the knee) can lead to issues with walking, especially when the knee joint is involved.
• Shaft fractures significantly affect mobility due to the compromised integrity of the entire leg.

In children, growth plate fractures can disrupt bone development and lead to long-term functional issues.

Classification of Femoral Fractures

1. Proximal Femoral Fractures (Hip)
   1. Located near the top of the femur, these fractures are typically caused by falls, direct trauma, or diseases that weaken the bone (like osteoporosis).
   2. Types:
      1. Femoral neck fractures: Occur just below the ball of the hip joint.
      2. Intertrochanteric fractures: These fractures occur between the greater and lesser trochanters (the bony prominences of the femur).
   3. Impact: These fractures are highly concerning in elderly individuals, as they can result in long-term immobility, increased risk of complications, and a loss of independence.
2. Femoral Neck Fractures
   1. Location: Just below the femoral head, within the hip joint.
   2. Cause: Often due to falls or trauma, particularly in older adults with weakened bones.
   3. Treatment: Depending on the severity, treatment can involve surgical fixation or hip replacement.
   4. Impact: Femoral neck fractures can disrupt the blood supply to the femoral head, potentially leading to avascular necrosis (death of bone tissue due to lack of blood flow).
3. Intertrochanteric Fractures
   1. Location: Between the greater and lesser trochanters.
   2. Cause: Typically caused by falls, especially in older individuals.
   3. Treatment: Surgical repair is common, involving the insertion of plates, screws, or nails.
   4. Impact: These fractures can impair walking and standing, but recovery can be quicker than femoral neck fractures if treated appropriately.
4. Subtrochanteric Fractures
   1. Location: Just below the lesser trochanter, often involving the upper femoral shaft.
   2. Cause: Typically due to high-impact trauma, such as motor vehicle accidents or severe falls.
   3. Treatment: Requires surgical intervention, often with long intramedullary nails to stabilise the bone.
   4. Impact: These fractures can be challenging to treat due to the force required to break the bone, and rehabilitation may be prolonged.
5. Femoral Shaft Fractures
   1. Location: In the long part of the femur, between the hip and knee.
   2. Cause: Typically the result of high-energy trauma such as car accidents or severe falls.
   3. Treatment: Often requires surgical intervention using metal rods, plates, or nails to stabilise the bone.
   4. Impact: These fractures cause significant difficulty with mobility, as the femur is vital for walking, running, and bearing weight.
6. Distal Femoral Fractures
   1. Location: Near the knee joint.
   2. Cause: Usually caused by direct trauma or falls.
   3. Treatment: Surgical fixation using plates or screws is typically required to realign the bone.
   4. Impact: These fractures often result in knee joint instability and loss of function, requiring physical therapy for recovery.
7. Supracondylar Fractures
   1. Location: Just above the femoral condyles (the bony structures at the knee).
   2. Cause: These are often seen in children due to falls or sports injuries.
   3. Treatment: These fractures typically require surgical intervention to align and stabilise the fracture.
   4. Impact: Supracondylar fractures can interfere with knee function, leading to stiffness and potential long-term joint problems.
8. Growth Plate Fractures in Children
   1. Location: In the cartilage (growth plate) areas of the femur.
   2. Cause: Typically the result of falls, sports injuries, or accidents.
   3. Treatment: These fractures require careful management to avoid disruption of growth and ensure the bone grows correctly.
   4. Impact: Growth plate fractures can lead to bone deformities or length discrepancies if not properly treated. Long-term functional issues can arise, affecting mobility and physical development.

Conclusion

Femoral fractures vary widely in terms of location, severity, and impact on mobility. The treatment strategy depends on the type of fracture, the patient’s age, and their overall health. While fractures in the femoral shaft or distal femur tend to require surgical intervention, fractures near the hip or knee are especially concerning due to their impact on walking and independence. Proper treatment, rehabilitation, and, in some cases, surgical intervention are essential for restoring function and mobility.

Prevalence and Demographics of Femoral Fractures

Femoral fractures, due to their severity and impact on mobility, are of significant clinical concern. The prevalence of femoral fractures varies based on age, gender, activity level, and underlying health conditions. Here is a detailed breakdown of the prevalence, demographics, and associated injury patterns:

Statistical Information on Occurrence

• Global Prevalence: Femoral fractures are relatively common, with estimates suggesting that they account for around 5-10% of all fractures treated in hospitals.
• Annual Incidence: In high-income countries, the incidence of femoral fractures is approximately 3-4 per 10,000 people per year, but it can vary by region, health infrastructure, and age demographics.
• Increased Incidence with Age: The incidence of femoral fractures increases significantly in older populations, particularly those over 65. This age group is especially susceptible to fractures due to factors such as osteoporosis, balance issues, and falls.

Age Distribution

• Older Adults (65+ years):
  • The risk of femoral fractures increases dramatically with age, especially in people over 65. This is primarily due to osteoporosis and increased susceptibility to falls.
  • Femoral neck and intertrochanteric fractures are the most common types in elderly individuals.
  • In older people, these fractures often lead to long-term disability, immobility, and a decline in overall health.
  • About 80-90% of femoral fractures in this age group are due to low-energy trauma, such as falls from standing height.
• Younger Adults (18-40 years):
  • In younger individuals, femoral fractures are often caused by high-energy trauma, such as motor vehicle accidents, sports injuries, or falls from significant heights.
  • Shaft fractures are more common in this group due to the forces required to fracture the femur.
• Children and Adolescents:
  • Growth plate fractures are common in children and adolescents, particularly in the distal femur.
  • These fractures are often the result of sports-related injuries or falls.
  • While femoral fractures are less common in children compared to adults, they represent a significant concern for growth and development.

Gender Differences

• Women:
  • Femoral fractures are more common in women, particularly in the elderly population. This is largely due to the higher prevalence of osteoporosis in postmenopausal women, which weakens bones and makes them more susceptible to fractures.
  • Femoral neck fractures are particularly common among older women.
  • Studies show that women are twice as likely to suffer from hip fractures as men.
• Men:
  • While men also experience femoral fractures, their fractures tend to occur at younger ages and are more likely to be the result of high-energy trauma (such as motor vehicle accidents and sports injuries).
  • Men generally suffer from femoral fractures at a younger age compared to women, and these fractures are often more severe due to the nature of the injuries.

High-Risk Populations

• Elderly:
  • The elderly population, especially those with osteoporosis, balance issues, or a history of falls, is at the highest risk for femoral fractures. Osteoporotic fractures are a major concern, especially in women post-menopause.
  • Cognitive impairments such as dementia also increase the risk of falls, which can lead to femoral fractures.
• Patients with Osteoporosis:
  • Individuals with osteoporosis are more susceptible to fractures from low-impact falls. Osteoporosis is a significant risk factor, particularly for fractures of the femoral neck.
• Individuals with High-Energy Trauma:
  • Young adults, particularly those involved in high-energy accidents (e.g., car accidents, sports injuries), are at a higher risk of femoral shaft fractures.
  • Military personnel, athletes, and individuals involved in extreme sports or hazardous occupations are more prone to these types of injuries.
• People with Impaired Mobility:
  • Those with reduced mobility due to conditions such as stroke, neurological disorders, or arthritis are at increased risk for falls, resulting in femoral fractures.
• Obesity:
  • Obesity increases the mechanical load on bones and joints, which can contribute to an increased risk of fractures, especially in weight-bearing bones like the femur.

Seasonal Variations

• Winter (Cold Weather):
  • There is a marked increase in femoral fractures during the winter months, especially in regions that experience snow and ice. Slippery surfaces contribute to falls, particularly among older people, leading to a higher incidence of fractures.
  • The risk of falls and fractures is particularly high in colder climates where icy conditions prevail.
• Spring and Summer (Active Seasons):
  • In contrast, during spring and summer, the incidence of high-energy femoral fractures increases due to outdoor activities, sports, and travel. Young adults and adolescents are particularly susceptible to fractures caused by sports, cycling, and motor vehicle accidents during these months.
• Autumn (Transitional Period):
  • There is also a moderate increase in femoral fractures in the autumn months, largely due to outdoor activities like hiking, which can be hazardous for individuals with impaired mobility or balance.

Associated Injury Patterns

• Polytrauma:
  • Femoral fractures often occur in conjunction with other injuries, especially in high-energy trauma cases. In motor vehicle accidents, femoral shaft fractures are frequently accompanied by injuries to the pelvis, ribs, or other long bones, as well as internal organ damage.
• Hip Fractures:
  • In elderly patients, femoral fractures, particularly femoral neck and intertrochanteric fractures are often associated with other complications such as dislocations, soft tissue damage, or vascular injuries.
• Knee Injuries:
  • Distal femoral fractures, particularly supracondylar fractures, are often associated with knee joint damage, including ligament tears, dislocations, or meniscus injuries.
• Head Injuries:
  • In high-energy trauma cases, femoral fractures can be associated with head injuries such as concussions or traumatic brain injuries (TBI). These often occur due to the severity of the trauma, especially in car accidents or sports collisions.

Conclusion

Femoral fractures are common, especially in the elderly population, where they can have significant implications for mobility and quality of life. The incidence of these fractures is influenced by factors such as age, gender, underlying bone health, and seasonal conditions. High-risk populations include older people with osteoporosis, younger adults involved in high-energy activities, and those with mobility impairments. Recognising the demographic and seasonal patterns of femoral fractures can help in developing preventive strategies and improving outcomes for individuals at risk. Access Ortho treats patients of all ages. 

Symptoms and Causes of Femoral Fractures

Femoral fractures are serious injuries that can have significant effects on mobility, pain levels, and overall health. The symptoms and causes of these fractures vary depending on the type, location, and severity of the injury.

Common Symptoms of Femoral Fractures

The symptoms of a femoral fracture depend on its location and severity but generally include:

1. Severe Pain:
   1. Pain is immediate and intense at the site of the fracture. This can be worsened by movement or attempts to bear weight on the injured leg.
   2. Pain may also radiate to the hip or knee, depending on the location of the fracture.
2. Swelling and Bruising:
   1. Swelling around the fracture site is common and may appear immediately after the injury.
   2. Bruising may also develop, particularly in the case of high-energy trauma.
3. Deformity:
   1. In cases of significant fractures (such as femoral shaft fractures), the leg may appear deformed or out of alignment. The limb may be shortened, rotated, or bent abnormally.
4. Inability to Move the Leg:
   1. Mobility is usually impaired, and individuals may be unable to move the leg or put weight on it due to pain and instability.
5. Numbness or Tingling:
   1. In some cases, nerve damage from the injury can lead to numbness, tingling, or weakness in the leg, particularly if the fracture damages nearby nerves or blood vessels.
6. Visible Open Wound (in open fractures):
   1. If the fracture is an open (compound) fracture, the bone may puncture through the skin, causing an open wound at the site.
7. Shock:
   1. In cases of severe trauma, shock may occur due to significant blood loss or the body’s response to the injury. Symptoms of shock include pale skin, rapid breathing, and a weak or rapid pulse.

Common Causes and Injury Mechanisms of Femoral Fractures

Femoral fractures can be caused by a variety of factors, often depending on the type of trauma or underlying health conditions. Below is a detailed explanation of common causes and mechanisms:

1. High-Energy Trauma

High-energy trauma refers to injuries caused by significant forces that result in the bone breaking. These forces can be from various activities that exert intense impact on the body, leading to fractures.

• Mechanism: A sudden, forceful impact or pressure can cause the femur to break. The energy from the impact exceeds the strength of the bone, resulting in a fracture.
• Examples:
  • Car accidents or crashes
  • Falls from great heights or accidents involving heavy machinery or equipment
  • Sports-related impacts (e.g., being hit by a vehicle in a race, or a high-impact fall during a contact sport)
• Impact: High-energy trauma typically leads to complex fractures (such as femoral shaft fractures) and may be accompanied by other severe injuries, including organ damage, traumatic brain injury, or fractures of other bones.

2. Motor Vehicle Accidents (MVAs)

Motor vehicle accidents are one of the most common causes of femoral fractures, especially in younger individuals. These accidents create immense forces that can cause severe injuries, including broken femurs.

• Mechanism: During a car crash, the femur may be subjected to direct impact from the vehicle’s interior or from a collision with another object. Alternatively, the force of deceleration or being ejected from the vehicle can cause bone fractures.
  • In head-on collisions, the femur may be compressed between the body and parts of the car, leading to fractures of the femoral shaft or distal femur.
  • In side-impact collisions, the femur may be crushed by the vehicle’s door or frame.
• Impact: These fractures often involve significant damage to surrounding tissues and can be accompanied by polytrauma (multiple injuries) that require complex medical management.

3. Falls from Height

Falls from a significant height, especially in high-risk environments or sports, can result in femoral fractures due to the impact with the ground or other surfaces.

• Mechanism: The force generated by falling from a height can cause the femur to fracture upon landing. This is particularly true for the femoral shaft or the distal femur, depending on how the body impacts the ground.
  • A fall from a ladder, a building, or during recreational activities such as skydiving or mountain climbing can lead to fractures.
  • Elderly individuals are also at high risk if they fall while walking, which can result in femoral neck fractures.

Impact: This type of fracture is often associated with other injuries such as spinal fractures, pelvic fractures, or head injuries, particularly in high-fall situations.

4. Sports Injuries

Sports injuries, especially in high-contact or high-impact sports, can result in femoral fractures. These are more common in younger individuals and athletes involved in intense physical activities.

• Mechanism: Sports-related femoral fractures often occur as a result of direct trauma or high-impact collisions, such as being tackled or struck by an object (e.g., a ball or a vehicle). They can also occur from twisting or pivoting motions that place excessive stress on the femur.
  • Common sports associated with femoral fractures include football, rugby, basketball, skiing, and cycling.
  • Athletes may experience femoral shaft or distal femoral fractures when colliding with another player or falling awkwardly during play.
• Impact: These fractures are often treated with surgical stabilisation and a period of rehabilitation. In some cases, athletes may return to full activity after recovery, depending on the severity.

5. Pathological Fractures

Pathological fractures occur when the bone breaks due to an underlying medical condition that weakens the bone, rather than as a result of direct trauma.

• Mechanism: In these cases, the bone is weakened by diseases like cancer, infections, or metabolic bone disorders. The femur is particularly vulnerable because it is a weight-bearing bone.
  • Examples include metastatic bone cancer (where cancer spreads to the bone), osteomyelitis (bone infection), and primary bone tumours like osteosarcoma.
  • Conditions like Paget’s disease of bone or fibrous dysplasia can also make the femur more susceptible to fractures.
• Impact: Pathological fractures may occur with minimal trauma and can be harder to treat due to the weakened state of the bone. Surgical intervention and management of the underlying disease are often required.

6. Stress Fractures

Stress fractures are small, hairline cracks in the bone that occur due to repetitive stress or overuse. These fractures are more common in athletes or individuals who engage in repetitive weight-bearing activities.

• Mechanism: Stress fractures typically develop gradually as the femur is subjected to repeated stress or overuse. In the case of the femur, these fractures are often seen in the femoral neck or shaft in athletes who run long distances, jump repeatedly, or perform high-impact activities.
  • Overuse leads to microtrauma in the bone that accumulates over time, eventually causing a stress fracture.
• Impact: Stress fractures can often be treated conservatively with rest and modified activity, but severe cases may require surgical intervention to promote healing and prevent further injury.

7. Osteoporotic Fractures

Osteoporotic fractures occur in bones weakened by osteoporosis, which leads to decreased bone density and increased fragility. Femoral fractures due to osteoporosis are common in older people, especially in postmenopausal women.

• Mechanism: Osteoporosis causes bones to become brittle and fragile. A fall from standing height or even minor trauma can lead to a femoral fracture in individuals with advanced osteoporosis.
  • Femoral neck fractures are the most common type in elderly individuals with osteoporosis.
  • Intertrochanteric fractures can also occur, though they are slightly less common.
• Impact: Osteoporotic fractures often lead to prolonged recovery times, decreased mobility, and increased risk of complications. Preventive measures, such as medication, exercise, and dietary adjustments, are essential for managing osteoporosis and preventing fractures.

Conclusion

Femoral fractures can be caused by a variety of factors, ranging from high-energy trauma (motor vehicle accidents and falls from height) to low-energy injuries in individuals with underlying conditions like osteoporosis. Understanding the mechanisms behind these fractures helps in preventing them and ensures appropriate treatment is provided based on the cause and severity of the injury. 

Risk Factors for Femoral Fractures

Several factors increase the likelihood of experiencing a femoral fracture. These risk factors may stem from age, medical conditions, lifestyle choices, and previous injuries:

1. Advanced Age

• Impact: Older adults, especially those over 65, are at higher risk for femoral fractures, particularly due to osteoporosis, frailty, and an increased likelihood of falls.

2. Osteoporosis

• Impact: Osteoporosis weakens bones, making them more susceptible to fractures, even from low-impact falls or minor trauma. Older women post-menopause are particularly at risk due to hormonal changes that affect bone density.

3. High-Impact Activities

• Impact: Engaging in high-impact or high-risk activities like contact sports, motor vehicle accidents, or extreme sports significantly increases the risk of femoral fractures due to the high forces involved in such activities.

4. Medical Conditions Affecting Bone Strength

• Impact: Conditions like Paget’s disease, rheumatoid arthritis, or chronic kidney disease can weaken bones, making them more prone to fractures. These conditions can also interfere with the body’s ability to heal fractures effectively.

5. Previous Fractures

• Impact: Having a prior history of fractures, particularly in the lower extremities, increases the risk of re-injury or developing complications, as the bones may not heal completely or properly.

6. Medications Affecting Bone Density

• Impact: Certain medications, such as corticosteroids, can lead to decreased bone density over time, increasing the risk of fractures. Long-term use of these drugs can weaken bones and impair healing after an injury.

Complications of Femoral Fractures

Femoral fractures can lead to several complications, which can affect recovery and long-term function:

1. Blood Loss

• Impact: Femoral fractures can cause significant blood loss due to the large blood vessels near the femur. This may result in hypovolemic shock and require immediate intervention to stabilise the patient.

2. Fat Embolism

• Impact: A fat embolism occurs when fat from the bone marrow enters the bloodstream, potentially travelling to the lungs, brain, or heart. This can cause serious complications, such as respiratory distress, confusion, or even death.

3. Compartment Syndrome

• Impact: Compartment syndrome is a condition in which swelling from the fracture compresses nerves, blood vessels, and muscles, leading to ischemia (lack of blood flow). It is a medical emergency and can result in permanent muscle and nerve damage.

4. Neurovascular Injury

• Impact: The femur is in close proximity to important nerves and blood vessels, such as the femoral nerve and artery. A femoral fracture may cause damage to these structures, leading to nerve damage, loss of sensation, or difficulty moving the leg.

5. Delayed Union or Nonunion

• Impact: Delayed union refers to a fracture that takes longer than expected to heal, while nonunion refers to a complete failure of the bone to heal. This can lead to prolonged pain and disability, requiring further intervention like surgery or bone grafting.

6. Malunion

• Impact: Malunion occurs when the bone heals in an abnormal position, leading to deformity and functional impairment. This may require corrective surgery to realign the bone properly.

7. Post-Traumatic Arthritis

• Impact: A femoral fracture, particularly around the hip or knee joint, can lead to post-traumatic arthritis. This occurs when the joint becomes damaged during the fracture, leading to inflammation, pain, and reduced joint mobility.

8. Deep Vein Thrombosis (DVT)

• Impact: Immobilisation after a femoral fracture increases the risk of developing DVT, a condition where blood clots form in the veins, particularly in the lower extremities. These clots can travel to the lungs, causing a life-threatening pulmonary embolism.

9. Infection

• Impact: In open fractures (where the bone pierces the skin), there is a risk of infection. Infections can complicate healing, cause systemic illness, and may require further surgical intervention or long-term antibiotics.

Conclusion

The risk factors for femoral fractures highlight the importance of prevention, especially for vulnerable populations such as older people and those with osteoporosis. Understanding the potential complications of femoral fractures is crucial for early detection and treatment, as they can significantly impact recovery and long-term mobility.

Diagnosis and Assessment of Femoral Fractures

The diagnosis and assessment of femoral fractures involves a thorough clinical examination and the use of various diagnostic tools to accurately determine the location, severity, and type of fracture. Proper diagnosis is crucial for selecting the appropriate treatment and ensuring optimal recovery.

Diagnostic Process

1. Initial Trauma Assessment – at the time of injury

• Purpose: The initial trauma assessment aims to evaluate the overall condition of the patient and assess the severity of injuries. This includes checking for life-threatening injuries and stabilising the patient as needed.
• Steps:
  • Airway, Breathing, Circulation (ABC): Ensure the patient has a clear airway, is breathing properly, and has stable circulation.
  • Assessment of other injuries: Femoral fractures often occur alongside other serious injuries (e.g., pelvic fractures, head injuries, or chest trauma), so a comprehensive trauma evaluation is necessary.

2. Neurovascular Examination

• Purpose: A neurovascular examination assesses the function of nerves and blood vessels near the site of injury, ensuring that there is no significant damage.
• Steps:
  • Motor and sensory function: Check for any signs of nerve damage by assessing the motor strength and sensory function in the lower extremity (e.g., asking the patient to move the foot or toes and checking for sensation).
  • Distal pulses: Palpate the femoral, popliteal, posterior tibial, and dorsalis pedis pulses to evaluate blood flow. A lack of pulses may indicate vascular injury.

3. Pain Assessment

• Purpose: Pain is a key indicator of the severity of a femoral fracture and guides treatment decisions.
• Steps:
  • Pain level: Ask the patient to rate the pain using a scale (e.g., 1 to 10).
  • Pain location: Determine whether the pain is localised to the femur or radiating to other areas (such as the hip or knee).
  • Pain with movement: Assess the pain response when attempting to move the affected leg or apply pressure to the injury site.

4. Range of Motion Testing

• Purpose: Assessing the range of motion helps to determine the severity of the fracture and identify any accompanying joint injuries.
• Steps:
  • Active and passive movement: Gently attempt to move the leg (both actively, if the patient is able, and passively). Restricted movement or pain during these tests can indicate a more severe fracture.
  • Joint involvement: Check if there is any limitation in movement at the hip or knee joint, which could suggest an associated joint injury.

5. Leg Length Comparison

• Purpose: Leg length discrepancy is a sign of femoral shaft fractures or dislocation injuries.
• Steps:
  • Visual inspection: Compare the lengths of the injured and uninjured legs to see if there is a noticeable difference.
  • Measurement: Measure the leg lengths from the anterior superior iliac spine to the medial malleolus on both sides to check for a discrepancy.

6. Rotational Alignment Check

• Purpose: Assessing the alignment of the femur is crucial to determining the type and severity of the fracture.
• Steps:
  • Leg rotation: Gently rotate the leg to check for abnormal positions. A femoral fracture, especially in the femoral shaft, may cause the leg to externally rotate or appear out of alignment.

Diagnostic Imaging

Several imaging modalities are used to confirm the presence and type of femoral fracture. The choice of imaging depends on the fracture’s complexity and location.

1. X-rays (Multiple Views)

• Purpose: X-rays are the first-line diagnostic tool for identifying femoral fractures and evaluating their severity.
• Steps:
  • AP (Anteroposterior) and Lateral Views: These two standard views provide a comprehensive assessment of the femur. In some cases, additional oblique views may be used.
  • Benefit: X-rays help identify the type of fracture (e.g., transverse, oblique, comminuted) and assess alignment, angulation, and displacement.

2. CT Scans

• Purpose: CT scans are often used to assess complex fractures, particularly in the femoral neck or when the fracture is not clearly visible on X-rays.
• Steps:
  • Detailed assessment: CT scans provide more detailed cross-sectional images of the bone and can help visualise fractures that involve multiple fragments, joint involvement, or subtle bone injuries.
  • Benefit: Useful for preoperative planning, especially in complex fractures, and to detect any associated soft tissue injuries.

3. MRI for Specific Cases

• Purpose: MRI is generally reserved for specific cases where soft tissue or bone marrow involvement is suspected, such as stress fractures or occult fractures not visible on X-rays.
• Steps:
  • Assessment of soft tissues: MRI provides detailed images of the bone, cartilage, muscles, ligaments, and nerves. It is particularly useful for diagnosing stress fractures, bone bruising, or damage to nearby structures like the hip joint.
  • Benefit: MRI is also valuable in cases of suspected nonunion or complications after treatment.

4. Bone Scans (When Needed)

• Purpose: Bone scans may be used to detect fractures that are not visible on X-rays, particularly in the case of stress fractures, or to assess bone healing.
• Steps:
  • Radioactive tracer: A small amount of radioactive material is injected into the bloodstream, which is absorbed by the bone. Areas with high activity (fractures or infections) will appear as hot spots on the scan.
  • Benefit: Useful for detecting occult or stress fractures in the femur, especially in athletes or individuals with undiagnosed pain.

5. Angiography (If Vascular Compromise)

• Purpose: If there is a suspicion of vascular injury (e.g. if pulses are absent or the fracture is near major arteries), angiography may be performed to assess blood flow to the limb.
• Steps:
  • Contrast dye: A contrast dye is injected into the blood vessels to provide detailed images of blood flow.
  • Benefit: Angiography helps identify any blockages, tears, or ruptures in the femoral artery or other blood vessels, allowing for prompt intervention to restore circulation.

Conclusion

Accurate diagnosis of femoral fractures is essential for selecting the appropriate treatment and preventing complications. The diagnostic process includes a thorough clinical examination (trauma assessment, neurovascular check, pain assessment, etc.) followed by diagnostic imaging such as X-rays, CT scans, MRIs, or angiography, depending on the injury’s complexity. Proper assessment ensures that fractures are identified early and treated effectively to optimise recovery.

Most femoral fractures due to complications will need to be assessed and treated in an inpatient hospital setting. 

Special Considerations for Femoral Fractures

When managing femoral fractures, specific patient groups require tailored approaches due to their unique needs and risks:

• Older Patients: The older population are at increased risk for femoral fractures, especially due to osteoporosis and falls. Treatment often focuses on stabilising fractures while addressing underlying conditions such as frailty, cognitive decline, and comorbidities.
• Children with Growth Plate Involvement: Fractures involving the growth plate (physis) in children require careful attention, as improper healing can impact future bone growth and lead to deformities or leg length discrepancies.
• Athletes: Athletes may experience fractures due to high-impact activities. Early and precise diagnosis is essential for proper rehabilitation to ensure athletes can return to their sport without long-term complications or decreased function.
• Multiple Trauma Patients: Individuals with multiple injuries, including femoral fractures, require a comprehensive, multidisciplinary approach to address all injuries simultaneously, often prioritising life-threatening conditions before orthopaedic treatment.
• Pathological Fracture Patients: Fractures in patients with underlying diseases like cancer or osteoporosis require careful management, as the bone may be weakened, complicating treatment. These fractures often need surgical intervention and careful post-operative care.
• Osteoporotic Patients: Osteoporotic patients have fragile bones, increasing the risk of fractures from low-impact trauma. Treatment for these fractures often involves surgical fixation, along with medications to improve bone density and prevent future fractures.

Each patient group requires specific management strategies to optimise recovery and minimise long-term complications. The orthopaedic team at Access Ortho will consider all aspects of a patient’s health and lifestyle when assessing an injury. 

Management and Treatment of Femoral Fractures

The management and treatment of femoral fractures vary based on the fracture’s type, location, and the patient’s overall health. A comprehensive approach includes emergency stabilisation, pain management, and possibly surgical intervention, with the goal of restoring mobility and function while minimising complications.

Treatment Options

1. Emergency Stabilisation

• Purpose: Immediate stabilisation is crucial to prevent further damage and reduce pain.
• Approach:
  • Immobilisation: The leg is often immobilised using a splint or traction to control movement and minimise the risk of further injury.
  • Transport to a medical facility: Once stabilised, the patient is typically transported to a hospital for further evaluation and treatment.

2. Pain Management

• Purpose: Effective pain control is essential to manage discomfort and allow for necessary examinations and procedures.
• Approach:
  • Analgesics: Pain relief medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids, are administered as needed.
  • Regional anaesthesia: In some cases, a femoral nerve block or epidural anaesthesia may be used for better pain control, particularly before surgery.

3. Surgical Intervention

• Purpose: Surgical treatment is often required for displaced fractures, fractures in certain locations (e.g., femoral neck), or when the patient is unable to bear weight.
• Approach:
  • Internal Fixation Methods: The primary aim is to realign the fracture and provide support while the bone heals.
    • Intramedullary Nailing: A long metal rod is inserted into the femoral canal to hold the bone fragments in place. This is commonly used for femoral shaft fractures.
    • Plate and Screw Fixation: Metal plates and screws are used to hold the bone together, particularly for fractures of the femoral neck or intertrochanteric region. This method allows for rigid fixation and alignment.

Arthroplasty (Hip Replacement): In cases of severe femoral neck fractures, especially in elderly patients with osteoporosis, total hip replacement (arthroplasty) may be necessary to restore function and mobility, especially when the fracture is unlikely to heal properly with fixation alone.

4. Conservative Management in Select Cases

• Purpose: Not all femoral fractures require surgery, especially if the fracture is non-displaced, stable, and the patient is in good overall health condition.
• Approach:
  • Immobilisation: In non-displaced or stable fractures, the leg may be immobilised with a cast or brace to allow for healing over time.
  • Follow-up: Regular follow-up imaging and clinical evaluation are necessary to ensure proper healing and detect complications early.

Conclusion

The treatment of femoral fractures is multifaceted and depends on the specific characteristics of the fracture and the patient’s condition. While surgical intervention is often required for displaced or complex fractures, conservative management may be appropriate in select cases. Pain management and emergency stabilisation are essential components of the initial treatment, ensuring the patient’s comfort and safety during recovery. The team at Access Ortho will guide patients on the treatment required for their injury. Patients with open wounds, blood loss, deformed limbs, extreme pain or sensory changes should be taken to the nearest hospital emergency department for care. 

Prevention of Femoral Fractures

Reducing the risk of femoral fractures involves implementing strategies to prevent falls, maintain bone health, and address risk factors associated with weak bones. Here are key prevention strategies:

• Fall Prevention: Implementing measures like improving home safety (e.g., removing tripping hazards), installing grab bars, and using proper footwear can help prevent falls, particularly in older adults.
• Bone Health Maintenance: Ensuring adequate intake of calcium and vitamin D, along with lifestyle choices like avoiding smoking and excessive alcohol consumption, supports bone strength and helps prevent fractures.
• Regular Exercise: Weight-bearing exercises, strength training, and balance exercises can improve bone density and reduce the risk of falls by enhancing muscle strength and coordination.
• Safety Equipment Use: Wearing protective gear during high-risk activities (e.g., sports or cycling) can reduce the chance of injury and fracture.
• Regular Health Screenings: Regular bone density tests, especially for those at risk (e.g., postmenopausal women or individuals with osteoporosis), can help detect bone thinning early and allow for intervention.
• Medication Review: Regularly reviewing medications, particularly those that affect bone density (e.g., corticosteroids), allows for adjustments to prevent adverse effects on bone health.

By integrating these strategies into daily life, individuals can significantly reduce their risk of femoral fractures and maintain overall bone health.

Recovery and Prognosis for Femoral Fractures

Recovery from a femoral fracture can take several months and involves multiple stages, from the initial healing phase to full functional recovery. The timeline and milestones of recovery will vary depending on the fracture type, surgical or non-surgical treatment, the patient’s age, and overall health. Patients must be guided by their medical team throughout the recovery process.

Recovery Timeline

1. Acute Hospital Phase

• Duration: 1-2 days (or more depending on the severity)
• Focus: Initial stabilisation and pain management.
  • Treatment: Emergency care, including pain relief, fracture stabilisation, and diagnostic imaging.
  • Intervention: Surgical procedures (e.g., internal fixation, nailing) may be performed if necessary.

2. Initial Post-Operative Period

• Duration: 2-6 weeks
• Focus: Wound healing, pain control, and initial mobility.
  • Pain Management: Use of pain medications to control discomfort, especially post-surgery.
  • Initial Immobilisation: A cast, brace, or traction may be used to immobilise the leg while bone healing begins.
  • Limited Movement: Restricted movement to allow for the early stages of healing.

3. Rehabilitation Phases

• Duration: 6 weeks to several months, depending on the fracture type and healing.
• Focus: Restoration of strength, flexibility, and mobility.
  • Early Rehab (6-8 weeks): Includes gentle exercises focusing on range of motion and preventing stiffness.
  • Mid Rehab (2-4 months): More intensive strengthening exercises, balance training, and gradual progression toward weight-bearing activities.

4. Weight-Bearing Progression

• Duration: Gradual over several weeks to months.
• Focus: Gradual reintroduction of weight-bearing activities to ensure proper bone healing.
  • Non-weight-bearing: Initially, patients may be advised to avoid putting weight on the affected leg to allow bone healing.
  • Partial Weight-Bearing: After the initial healing phase, partial weight-bearing exercises are introduced, often with the aid of crutches or walkers.
  • Full Weight-Bearing: Once the bone has sufficiently healed and the medical team approves, patients progress to full weight-bearing, usually after 6-12 weeks depending on fracture severity.

5. Return to Activities timeline

• Duration: 3-6 months (or longer, depending on the fracture and individual recovery).
• Focus: Gradual return to normal activities and eventually sports or high-impact activities.
  • Light Activities: Low-impact activities like walking or cycling are typically allowed after 2-3 months.
  • Moderate to Intense Activities: Patients may return to more intense activities (e.g., running, sports) after 4-6 months, contingent on healing and rehabilitation progress.

Rehabilitation Milestones

Key progress markers help guide the patient’s recovery process and ensure the fracture heals properly.

1. Pain Management Goals

• Initial Goal: Control post-surgical or post-injury pain using medications and techniques such as ice or physical therapy modalities.
• Progression: Gradual reduction of pain medications, with the aim of managing pain with over-the-counter options (e.g., NSAIDs) once healing advances.
• Final Goal: Complete absence of pain during normal movement and activities, with only occasional discomfort during intense physical exertion.

2. Range of Motion Targets

• Early Stage: Aim to achieve passive range of motion exercises within the first few weeks to prevent joint stiffness.
• Mid Stage: Gradual increase in active range of motion, especially in the hip, knee, and ankle joints.
• Final Goal: Full range of motion in the hip and knee, with no limitation in basic movement patterns (e.g., walking, bending, and squatting).

3. Weight-Bearing Stages

• Non-Weight-Bearing: Initially, the patient may be advised to avoid weight-bearing activities to allow initial fracture healing.
• Partial Weight-Bearing: Introduce partial weight-bearing with assistive devices like crutches or walkers, typically after 2-4 weeks, depending on the fracture type.
• Full Weight-Bearing: Full weight-bearing is typically reached within 6-12 weeks but depends on the type of fracture, the patient’s age, and bone quality.

4. Strength Benchmarks

• Early Stage: Gentle isometric exercises to prevent muscle atrophy, particularly in the quadriceps, hamstrings, and calf muscles.
• Mid Stage: Progressive strengthening exercises, including leg lifts, squats, and resistance training.
• Final Goal: Full strength recovery, with the ability to perform functional movements (e.g., walking, climbing stairs) without pain or weakness.

5. Functional Recovery Goals

• Early Stage: Achieve the ability to perform basic daily activities (e.g., standing, sitting, walking short distances) with assistive devices.
• Mid Stage: Improve the ability to perform moderate daily activities (e.g., shopping, light housework).
• Final Goal: Return to pre-injury or baseline functional level, with the ability to engage in work and recreational activities without limitations.

Conclusion

Recovery from a femoral fracture is a gradual process, often requiring several months for full rehabilitation. The patient’s healing timeline and milestones will depend on factors like fracture severity, age, and overall health. It is crucial that patients follow the guidance of their medical team throughout their recovery to ensure proper healing and avoid complications. This guide offers general recovery milestones, but each individual’s treatment plan should be customised based on their unique circumstances. The team at Access Ortho will discuss individual recovery goals and timelines with all patients. 

Fracture Clinic Information

What is a Fracture Clinic?

A fracture clinic is a healthcare facility or service specifically designed to manage fractures and musculoskeletal injuries. Access Ortho is a private fracture clinic staffed by orthopaedic specialists, including surgeons, orthopaedic nurse practitioners, and support staff, all dedicated to ensuring the best outcomes for individuals suffering from broken bones, sprains and strains. The clinic is a hub for both the initial and ongoing management of fractures, including assessment, treatment planning, and rehabilitation.

For femoral fractures, it’s important to note that if the injury involves an open wound, significant blood loss, severe deformity, or changes in sensory function, the patient should initially attend an emergency department. These conditions require urgent, stabilising care to address potential complications, such as infection or severe bleeding.

Specialised Care Services at a Fracture Clinic

A fracture clinic provides comprehensive care through each phase of treatment, from diagnosis to long-term recovery.

• Initial Assessment: Upon attending the clinic, the first step is a thorough evaluation, which includes a physical examination, diagnostic imaging (X-rays, CT scans, etc.), and a discussion of treatment options.
• Treatment Planning: Based on the assessment, a tailored treatment plan is devised. This could include conservative management (e.g., casting or bracing) or surgical intervention, depending on the nature and severity of the fracture.
• Regular Monitoring: After the initial treatment, patients are scheduled for follow-up appointments to monitor healing progress, adjust treatment as needed, and prevent complications like infection or misalignment.
• Rehabilitation Coordination: Fracture clinics often coordinate rehabilitation with physiotherapists to help restore function and strength. Rehabilitation may involve mobility exercises, strength training, and guidance on a gradual return to activity.
• Long-Term Follow-Up: For many patients, especially those with complex or severe fractures, long-term follow-up ensures that healing progresses correctly and that any issues are promptly addressed.

When to Attend a Fracture Clinic

You should attend a fracture clinic under the following circumstances to ensure proper recovery and avoid complications:

• If you are unsure whether you have a fracture, sprain, or strain: If you’re uncertain about the nature of your injury, it’s advisable to attend a fracture clinic for an assessment. No referral is necessary.
• If you have already seen your GP or the emergency department (ED) and know you have a fracture that doesn’t require surgery or you’re uncertain if it does: If your injury has been diagnosed but you’re unsure about whether surgery is needed, the fracture clinic can provide specialised advice and treatment options.
• For follow-up care after conservative management: If your fracture has been treated conservatively (e.g., with a cast or brace), follow-up visits to the fracture clinic are essential to monitor healing and make adjustments if needed.
• Rehabilitation Monitoring: Regular visits will help ensure your rehabilitation is progressing as expected, allowing adjustments to be made to your therapy as needed.
• Complication Assessment: If there are signs of complications, such as delayed healing, the fracture clinic is the place for prompt intervention.
• Return to Activity Clearance: The fracture clinic will assess your healing progress and provide clearance to return to normal activities, helping to minimise the risk of re-injury.

Access Ortho

Access Ortho is an excellent option for individuals seeking specialised care for fractures. Access Ortho is a private fracture clinic offering a range of services, including initial fracture assessments,  treatment planning, casting, splinting and bracing, follow-up care, and referral to rehabilitation if required. Our team is dedicated to providing expert care for all types of fractures, including femoral fractures, with personalised treatment plans and ongoing support to ensure optimal recovery.

For more information or to book an appointment, call 1300693722.

Conclusion

Fracture clinics play a pivotal role in ensuring that individuals with fractures, such as femoral injuries, receive the specialised care they need for optimal recovery. Access Ortho provides a comprehensive range of services, from initial assessments to long-term follow-up care, ensuring patients can confidently return to their normal activities. Always ensure that more complex cases, such as open fractures or significant trauma, are initially seen in the emergency department before attending a fracture clinic for follow-up if suitable.

Frequently Asked Questions

How long does a femoral fracture take to heal?

The healing time for a femoral fracture varies depending on the severity and treatment. Typically, it takes 6 to 12 weeks for the bone to heal sufficiently, with full recovery (including strength and mobility) potentially taking 3 to 6 months or longer. Healing time can be longer in older adults or if complications arise.

What type of surgery is needed for a femoral fracture?

Surgical treatment depends on the fracture type. Common procedures include:

• Intramedullary nailing: A metal rod is inserted into the bone to hold it in place.
• Plate and screw fixation: A metal plate is attached to the bone to stabilise it.
• Arthroplasty: Joint replacement in cases of severe hip fractures.

When can I start walking after a femoral fracture?

Walking can usually begin after 6 to 12 weeks, depending on the type of fracture and healing progress. Weight-bearing is gradually introduced, with some individuals initially using crutches or walkers. Your medical team will guide you on the appropriate timing based on your specific case.

Will I need physiotherapy after surgery?

Physiotherapy is typically recommended after femoral fracture surgery to regain strength, mobility, and function. Rehabilitation exercises focus on improving range of motion, strength, and balance, with gradual progress towards normal activities.

What are the signs of complications I should watch for?

Signs of complications include:

• Increased pain or swelling
• Signs of infection (redness, warmth, fever)
• Delayed or poor healing (lack of progress in bone healing)
• Misalignment of the bone
• Numbness or tingling (indicating nerve damage). If you notice any of these symptoms, contact your healthcare provider immediately.

How long will I be in the hospital?

Hospital stays vary depending on the fracture severity and whether surgery is required. Typically, you may stay in the hospital for 1 to 3 days following surgery. However, the stay may be longer if there are complications or additional medical needs.

When can I return to work or sports?

Returning to work or sports depends on the nature of your work and the severity of your fracture.

• Light work may be resumed in 6 to 8 weeks.
• Heavy or physical work may take 3 to 6 months.
• For sports, return may take 4 to 6 months, or longer, depending on healing and rehabilitation progress. Always consult with your doctor before resuming activities.

Will I need a walking aid during recovery?

A walking aid such as crutches, a walker, or a cane may be necessary during recovery, especially in the early stages. These aids help you move safely and reduce the load on the healing bone. The need for a walking aid will decrease as strength and mobility improve.

How can I prevent complications during healing?

To prevent complications:

• Follow your doctor’s advice on activity restrictions and weight-bearing.
• Keep follow-up appointments to monitor healing.
• Maintain good nutrition, including adequate calcium and vitamin D.
• Avoid smoking and limit alcohol, as both can slow healing.
• Perform physiotherapy exercises to enhance recovery.

What long-term problems might I experience?

In some cases, long-term issues can arise, such as:

• Chronic pain or stiffness in the hip or knee.
• Decreased mobility or difficulty with weight-bearing activities.
• Post-traumatic arthritis due to joint damage.
• Nerve damage (e.g., numbness or weakness in the leg).
• Nonunion or malunion (improper bone healing) requiring additional treatment.

Your healthcare provider will monitor for these and guide you through management strategies.