Femoral Fractures
Introduction:
Did you know that the femur is the largest and strongest bone in your body? Located in your upper leg, the average femur is able to withstand up to 6,000 pounds of pressure– about 30 times as much as your body applies on it at any given time! With all this being said, it seems like breaking the femur would be a hard feat to manage; but believe it or not, over 60,000 people break this bone every year! In this article, we will be going over all you need to know about the femur, how it is broken, and how you can fix it.
Function and Structure:
The femur is arguably one of the most important bones in the body when it comes to movement. Due to its size and ability to withstand high amounts of force, the femur is the perfect support for the legs tasked with holding the entire human body up! The femur is also the location of 21 muscle origins and insertions, which makes it a vital anchor to movement in the hips and knees.
The femur is the anchor for many muscles.
The femur is also one of the most unique bones in the body. As a result of its size and specific duties, the femur has the most bony landmarks out of any bone in the skeletal system, with ten primary ones that take on the role of anchors for origins and insertions of the muscles.
Here are a few of the important landmarks of the femur.
While we could dive deep into the anatomy of every part of the femur and how it connects to whole-body movement, we will focus on the important parts that are the most likely to become injured. Here are the five most important:
Head: this is the ball at the top of the femur that connects to the hip. This allows for an extended range of motion for joints like the elbow, rather than hinge joints which only allow for limited motion.
Neck: the neck is the connecting area of the femur’s head and shaft, and is the location where a majority of femur fractures occur, specifically in older people and those who suffer from osteoporosis (weak bones).
Trochanters: these are the attachment sites for crucial muscles such as the glutes and the iliopsoas. As a result of these sites sticking out, they also lead to some of the most common fractures.
Shaft: the shaft is the long part of the bone that connects the proximal and distal ends. It is known for having the most painful breakages in the body.
Condyles: these are the little balls at the distal end of the femur that create the joint connecting to the lower leg.
Types of Fractures:
Along with being the biggest bone in the body, the femur is also the most complicated bone when it comes to fractures. There are a lot of kinds of femoral fractures, so let's get a quick run down on each one, including the description, mechanism of injury (MOI), and the sports in which fracture is most likely to occur.
Femoral Neck Fractures:
Degrees of neck fractures.
Description: Femoral Neck Fractures are when the head of the femur is broken and/or displaced from the rest of the femur. These fractures result in high levels of pain in movement as well as avascular necrosis, where the fracture can stop blood flow from reaching the rest of the leg. This is the most common fracture seen in older patients suffering from osteoporosis.
MOI: Falling, landing on the hip, car accidents, osteoporosis, excessive rotational forces.
Seen in:
Soccer: the nature of the high-intensity sport as well as the excessive turning and using of the hip joint lead this injury to be common.
Basketball: twisting and quick movements applying pressure onto the neck can lead to fractures, as well as any high-impact falls onto the hardwood of the court.
Football: high-intensity of tackles to the hip can lead to the fracturing of the neck
Intertrochanteric & Subtrochanteric Fractures:
Trochanteric fractures are not fun.
Description: Intertrochanteric fractures are breaks in between the greater and lesser trochanters. Subtrochanteric fractures are breaks that occur under the lesser trochanter and above the shaft. These fractures often come with many muscle strains because these landmarks are insertion points for muscles such as the iliopsoas and the gluteal muscles.
MOI: Direct blows to the area, osteoporosis, falling, car accidents.
Seen in:
Higher impact sports like hockey, football, and rugby, although the nature of this fracture and its location cause it to be seen less often in sports and more often in accidents and elderly.
Femoral Shaft Fractures:
The different kinds of shaft fractures
Description: Shaft fractures are probably the last in mind when you hear someone say they broke their femur. These are the least common fractures to occur because of the inward curve that the femur has, which helps to transmit pressure toward the ends of the bone. These fractures are often the most painful because of the amount of force that it takes to cause them. There are multiple types of shaft fractures, including:
Transverse: A horizontal fracture line across the shaft.
Oblique: An angled fracture line that runs diagonally across the bone.
Spiral: A fracture that twists around the shaft, often caused by rotational forces.
Comminuted: The bone is shattered into three or more pieces.
Greenstick: Fractures in young bones that result in the bending of the bone.
MOI: Direct and high-impact trauma to the middle of the bone. Most common in car accidents.
Seen in:
High-impact sports such as rugby, football, and hockey.
Compensatory and Stress Fractures:
Compensatory fracture is the term used for when compensation from one injury results in another injury. This is a common case in the femur because it is the major weight bearer and a central part in movement. Any injuries in the ankle, foot, or other leg that can result in a change in normal activity (aka compensation) to alleviate pain can lead to secondary fractures in the femur.
While stress fractures are less common in the femur in comparison to the tibia or metatarsals, due to the amount of pressure that is applied into the femur, which could be coupled with a deficiency in bone density, stress fractures still can occur. These usually happen from long, grueling stances of hard work, so the best preventative measure against stress fractures is to ensure recovery in between workouts and take care of your injuries early.
Signs, Symptoms, and Diagnosis:
Maybe you found this article in hopes of diagnosing yourself with any pain you may be experiencing. Luckily, femoral fractures are pretty distinguishable and have a lot of symptoms that you may experience, so here’s a list of the common signs that indicate a broken femur:
Severe pain: This may come as a big shock (or not), but breaking your femur hurts. A lot. This may not always be super distinguishable, however, because some injuries like stress fractures compound over a long period.
Compensation: If you begin to favor one leg when doing normal activities such as walking, it is a good sign to get it checked up before it gets worse.
Swelling and Bruising: Along with other deformities, these signs are usually noticeable and indicators of serious injury.
Abnormal popping or grinding: Also known as crepitus, if you can hear sounds from the area, those probably shouldn’t be there.
Tenderness: Broken femurs can result in tears in muscles.
Decreased Range of Motion: inability to fully rotate the hip joint as you normally would be able to.
Numbness or Tingling: severe femoral fractures can result in nerve damage.
Each of these symptoms also s with avascular necrosis, which is a serious injury that could eventually lead to infection and, in some rare cases, amputation. It is important that, once you experience multiple of these symptoms, you visit a medical professional as soon as possible to be diagnosed and come up with a recovery plan. Unfortunately, because there are so many different types of femoral fractures, it can be hard to diagnose which kind you may have, so very often doctors will request an x-ray or MRI to confidently diagnose and treat the injury.
Treatments:
Femoral fractures are serious injuries that can put you out of the game for a long period. Once you’re diagnosed with a fracture, it’s time to work on getting healthy again. In most cases, femoral fractures will need surgery, but let’s explore the non-surgical route. Right off the bat, a medical professional will want to immobilize the leg to encourage natural healing. This can be done by a large cast that almost resembles a large diaper. These casts are super chunky and uncomfortable, but they will allow for the leg to repair itself– if that is still a possibility.
Patient with femoral fracture cast.
Of course, the patient is going to be in lots of pain, so pain medication is almost always prescribed. More likely than not, it will take surgery to repair the bone. For transverse displacements, external fixation can be used to pull the bones back into place to heal. This is done by putting rods into the bone and essentially working like braces work on teeth to realign the bone. This is a temporary solution, however, because it doesn’t directly allow for the bone to fuse again.
Example 1 of external fixation and intramedullary nailing.
Example 2 of external fixation and intramedullary nailing.
After external fixation, the most common form of surgery is intramedullary nailing. This procedure involves the surgeon running a metal rod down and through the bone, securing each piece together. This allows the bones to fuse back together. It’s important to note that these surgeries are for midshaft fractures and that there are other forms of surgery to treat other fractures. The downside is that each surgery is very expensive, so sometimes people are not able to afford these vital surgeries.
With or without surgery, the next step after the initial healing process will be the long road of recovery and physical therapy. Therapists will do their best to strengthen any muscles that were injured or weakened from lack of use, as well as correct any compensation that was experienced during the injury.
Conclusion:
Femur fractures are no such thing to take lightly and can put you out of the game for a long time. Because of the complications and severity of these injuries, you must seek help from a medical professional as soon as possible after experiencing these symptoms so that they can diagnose and treat you in the best way. If you suffer a femoral fracture, know that it will be a long process of treatment and recovery, but know that you CAN keep stepping through the pain.
Works Cited
Brouhard, Rod. “The Anatomy of the Femur.” Verywell Health, 16 Nov. 2021, www.verywellhealth.com/femur-anatomy-4587598.
Cleveland Clinic. “Broken Femur: Causes, Symptoms, and Treatment.” Cleveland Clinic, 18 Jan. 2022, my.clevelandclinic.org/health/diseases/22299-broken-femur.
Crumbie, Lorenzo. “Femur.” Kenhub, 19 July 2022, www.kenhub.com/en/library/anatomy/femur.
Lowe, Jason. “Femur Shaft Fractures (Broken Thighbone) - OrthoInfo - AAOS.” Aaos.org, 2010, orthoinfo.aaos.org/en/diseases--conditions/femur-shaft-fractures-broken-thighbone.
Sikka, Robby, et al. “Femur Fractures in Professional Athletes: A Case Series.” Journal of Athletic Training, 15 Apr. 2015, meridian.allenpress.com/jat/article/50/4/442/112395/Femur-Fractures-in-Professional-Athletes-A-Case.