1. Femur Fractures Are High-energy Injuries
The thigh bone, or femur, is a very strong bone, and a great deal of energy is required to break it. That is why most femur fractures occur with motor vehicle accidents or falls from height. The signs of a femur fracture are usually pretty obvious: The patient is generally in a great deal of pain and cannot walk. The leg is swollen and shortened, as the powerful thigh muscles pull on the bone pieces.
2. Associated Hip and Knee Injuries Are Possible
Because these are such high-energy injuries, there can also be other fractures associated with a femur fracture. There may be a hip fracture, specifically a femoral neck fracture. There can also be ligament injuries to the knee, including the ACL (anterior cruciate ligament).
3. Treatment Varies by Age
The treatment ranges from a harness to surgical placement of a metal rod inside the bone. Very young infants can be treated with something as simple as a pillow splint or a Pavlik harness. The Pavlik harness is usually used to treat congenital hip problems. It consists of a strap around the chest, which is connected to straps that hold the hips in a certain range of motion. It also can serve the purpose of holding the thighs still while the femur heals.
4. Children Can Be Treated with Traction or a Cast
Older children are too big for a Pavlik harness and can be treated with traction, followed by a hip spica cast. The traction is either with a pin or with sticky tape. Using pulleys and weights, the hip and femur are flexed up and held in place until the fracture begins to heal. Once there is evidence of healing, a hip spica cast may be put on. This involves wrapping the leg in a cast. To prevent movement of the hip, the cast is extended around the waist.
5. Most Patients Are Treated with Surgery
Rarely, external fixation may be used. This involves a series of pins sticking out of the skin, which are then joined by crossbars. This hold the fracture stable until the bone is healed. This can be an option for severe injuries which are contaminated or for children with open growth plates. Another option for children is flexible nails. These are titanium rods that are placed into the canal of the bone to hold the bones still. They are later removed when the bone is healed.
Adults usually have either plating or an intramedullary rod placed. The rod is placed either through the buttocks region or through the knee joint. It crosses the fracture and realigns the bone, and it usually is permanent. Another option is a plate and screws, depending on the location of the fracture.
