Understanding Femoral Shaft Fractures: Causes, Treatment, and Recovery

Doctor Examination

A thorough examination is essential for diagnosing and understanding a femoral shaft fracture.

Medical History and Physical Examination

To properly evaluate your injury, your doctor needs detailed information on how the injury occurred. For example, if it happened in a car accident, knowing specifics such as your speed, whether you were driving or a passenger, seat belt usage, and airbag deployment helps determine the mechanics of the injury and assess if other injuries may be present. Additionally, your doctor will want to know about any pre-existing health conditions, including allergies, asthma, diabetes, or high blood pressure, and will ask about your use of tobacco products and any medications. Following a discussion of your medical history, your doctor will conduct a thorough physical exam, focusing on your leg. They will look for:

• Visible deformities in the thigh or leg, such as unusual angles, twisting, or shortening.
• Open wounds or breaks in the skin.
• Bruising or bony fragments pressing against the skin.

Your doctor will also palpate along the thigh, leg, and foot to:

• Identify any irregularities.
• Assess skin and muscle tightness around the thigh.
• Check for pulses.
• Test sensation and movement in the leg and foot (if you are conscious and alert).

Imaging Tests

Imaging tests provide critical details about the injury.

• X-rays: The primary method for assessing fractures, X-rays offer clear images of dense structures, such as bones. They reveal whether the bone is intact or broken, the fracture type, and its exact location within the femur.
• Computerized Tomography (CT) Scans: If X-rays do not provide enough information, a CT scan may be ordered. CT scans create cross-sectional images of the limb, offering a detailed view that can reveal the severity of the fracture and detect subtle fractures that may not appear clearly on X-rays, such as thin fracture lines.

 

X-ray shows a transverse fracture of the femur. The break is a straight horizontal line across the shaft.

 

Treatment Options

Nonsurgical Treatment

In most cases, surgery is required to treat femoral shaft fractures effectively. It is rare for these fractures to heal without surgical intervention. Young children may sometimes be treated with a body cast; for more information, refer to resources on femur fractures in children. An external fixator is a temporary treatment often used when a patient has multiple injuries and is not ready for a longer surgical procedure. This device, which provides immediate stability to the fractured femur, consists of metal rods and pins that secure the bones in place from outside the body. Although an external fixator can remain on until the bone heals, it is generally used only temporarily until the patient is ready for definitive surgery.

Intramedullary Nailing

Intramedullary nailing is currently the preferred method for treating femoral shaft fractures. This procedure involves inserting a specially designed metal rod, or nail, into the femur's canal. The nail spans the fracture site, stabilizing the bone and promoting proper alignment during healing.

Surgical Treatment

Timing of Surgery

Femoral shaft fractures are typically treated within 24 to 48 hours. However, surgery may be delayed if other life-threatening injuries or unstable medical conditions require immediate attention. Open fractures are treated with antibiotics upon hospital arrival to lower the infection risk, and the wound, surrounding tissue, and bone are thoroughly cleaned during surgery. Between the initial emergency care and surgery, the doctor may place the injured leg in a long-leg splint or traction to maintain bone alignment and leg length. Skeletal traction involves a system of weights and counterweights that keep the leg straight and help relieve pain by holding the fractured bones together.

External Fixation

In some cases, metal pins or screws are surgically inserted into the bone above and below the fracture. These pins and screws connect to a stabilizing bar outside the skin, which holds the bones in proper alignment until the fracture can be permanently fixed.  

Intramedullary Nail Placement

The intramedullary nail can be inserted at either the hip or knee end of the femur. Screws positioned above and below the fracture maintain proper alignment as the bone heals. Intramedullary nails are typically made of titanium and come in various sizes to fit different femur dimensions.  

Plates and Screws

In some situations, such as when a fracture extends into the hip or knee joint, intramedullary nailing may not be an option. Instead, the fractured bone fragments are realigned (reduced) and secured using screws and metal plates placed along the outer bone surface. This method effectively stabilizes complex fractures, particularly near joint areas.