THIGH-BONE (FEMUR) FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in the shaft of the femur (the large bone extending from the hip to the knee). This is a serious injury, but unusual in sports--the ankle, lower leg or knee will usually give way before the shaft of the femur does.
BODY PARTS INVOLVED
Femur (usually in the middle of the bone).
Soft tissue around the fracture site, including muscles, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Severe pain in the midthigh at the time of injury.
Swelling and bruising around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal leg contours.
Tenderness to the touch.
Numbness and coldness in the leg and foot beyond the fracture site if the blood supply is impaired.
CAUSES
Direct blow to the thigh.
Indirect stress caused by twisting or violent muscle contraction.
RISK INCREASES WITH
Contact sports.
Field and track events.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk products or calcium supplements.
Use appropriate protective equipment, such as thigh pads, for participation in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care.
Surgery to set the broken femur.
Traction (sometimes) for 6 to 8 weeks in a hospital, extended-care facility or at home.
Immobilization with a cast (sometimes).
Physical therapy and rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the ankle, knee, femur and pelvis.
POSSIBLE COMPLICATIONS
AT THE TIME OF FRACTURE:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissue. AFTER TREATMENT OR SURGERY:
Excessive bleeding.
Poor healing (non-union) of the fracture.
Impaired blood supply to the healing bone.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Shortening or deformity of the fractured femur.
Arrest of normal bone growth in children.
Infection introduced during surgery.
Problems caused by plaster casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 8 weeks. Healing is considered complete when there is no pain or motion at the fracture site, and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible, but don't move the injured leg to do so.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use a padded splint or backboard to immobilize the hip and leg before transporting the injured person to an emergency facility.
The doctor will set (realign) the broken bones with surgery or, if possible, without. Realignment should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary, either with traction or with a rigid hip-to-knee cast following surgery to pin bone fragments together.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heat lamp or heating pad so heat can penetrate the cast.
When the cast is removed, take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia to make joint manipulation possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen for mild pain.
Antibiotics to fight infection if necessary.
ACTIVITY
Exercise the uninjured leg and arms vigorously during recuperation. These muscle contractions promote fracture alignment and hasten healing.
Resume normal daily activities gradually after treatment. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises after clearance from your doctor when movement is comfortable.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a femur fracture. Call immediately if you have numbness or complete loss of feeling below the fracture site. This is an emergency!
Any of the following occur after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above or below the cast.
Blue or gray skin color beyond the cast, especially under the toenails.
Nausea or vomiting.
Constipation.
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