What are the main causes of femur shaft fractures. How are femur fractures classified. What are the most common types of femoral shaft fractures. How are femur shaft fractures diagnosed and treated.

Understanding Femur Shaft Fractures: The Basics

The femur, also known as the thighbone, is the longest and strongest bone in the human body. Due to its robust nature, it typically requires significant force to break. Femur shaft fractures occur when there’s a break anywhere along the length of the femoral shaft, which runs from below the hip to where the bone begins to widen at the knee.

These fractures are serious injuries that almost always necessitate surgical intervention for proper healing. The severity and characteristics of femur fractures can vary greatly, depending on the force that causes the break.

Types of Femur Fractures

• Stable fracture: Bone pieces align correctly
• Displaced fracture: Bone pieces are out of alignment
• Closed fracture: Skin around the fracture remains intact
• Open fracture: Bone punctures the skin

Classification of Femur Fractures: A Comprehensive Guide

Medical professionals use specific classification systems to describe femur fractures. These classifications are based on several factors:

1. Location of the fracture
2. Pattern of the fracture
3. Condition of the surrounding skin and muscle

The femoral shaft is divided into thirds: distal, middle, and proximal. The fracture pattern can vary, with the bone breaking in different directions such as crosswise, lengthwise, or in the middle.

Common Types of Femoral Shaft Fractures Explained

Understanding the different types of femoral shaft fractures is crucial for proper diagnosis and treatment. Here are the most common types:

Transverse Fracture

This type of fracture features a straight horizontal line going across the femoral shaft. It’s a clean break that occurs perpendicular to the bone’s long axis.

Oblique Fracture

An oblique fracture is characterized by an angled line across the shaft. This type of break occurs at an angle to the bone’s long axis.

Spiral Fracture

In a spiral fracture, the fracture line encircles the shaft like the stripes on a candy cane. This type of fracture is typically caused by a twisting force applied to the thigh.

Comminuted Fracture

A comminuted fracture is one where the bone has broken into three or more pieces. The number of bone fragments often corresponds with the amount of force needed to break the bone.

Open Fracture

Also known as a compound fracture, an open fracture occurs when bone fragments stick out through the skin or when a wound penetrates down to the broken bone. These fractures often involve extensive damage to surrounding tissues and have a higher risk of complications, particularly infections.

Causes of Femoral Shaft Fractures: From High-Energy Collisions to Falls

The causes of femoral shaft fractures can vary depending on the age and circumstances of the individual. Understanding these causes can help in prevention and proper treatment.

High-Energy Collisions

In young people, femoral shaft fractures are frequently the result of high-energy collisions. The most common causes include:

• Motor vehicle or motorcycle crashes
• Pedestrian accidents (being hit by a car while walking)
• Falls from significant heights
• Gunshot wounds

Low-Force Incidents in Older Individuals

For older individuals with weaker bones, a lower-force incident can be sufficient to cause a femoral shaft fracture. A common example is a fall from standing height.

Recognizing the Symptoms of a Femur Shaft Fracture

Identifying the symptoms of a femur shaft fracture is crucial for seeking immediate medical attention. The primary symptoms include:

• Immediate, severe pain
• Inability to put weight on the injured leg
• Visible deformity of the leg (shorter than the other leg and no longer straight)

If you experience these symptoms following an accident or fall, it’s essential to seek medical help immediately.

Diagnosis of Femur Shaft Fractures: Medical History and Physical Examination

The diagnosis of a femur shaft fracture involves a thorough medical history and physical examination. This process helps doctors understand the nature of the injury and determine the most appropriate treatment plan.

Importance of Detailed Injury Information

Why is it crucial for doctors to know the specifics of how the injury occurred? Detailed information about the incident helps doctors determine the force of impact and potential for additional injuries. For example, in the case of a car accident, important details include:

• Vehicle speed at the time of impact
• Whether the patient was the driver or a passenger
• Use of seat belts
• Deployment of airbags

Medical History Assessment

Doctors also need to know about the patient’s overall health condition. This includes information about:

• Pre-existing health conditions (e.g., high blood pressure, diabetes, asthma)
• Allergies
• Use of tobacco products
• Current medications

Physical Examination Process

During the physical examination, the doctor will assess the patient’s overall condition before focusing on the injured leg. The examination includes:

1. Visual inspection for obvious deformities, skin breaks, bruises, or protruding bone pieces
2. Palpation along the thigh, leg, and foot to check for abnormalities and assess skin and muscle tightness
3. Pulse check
4. Tests for sensation and movement in the leg and foot (if the patient is conscious)

Imaging Tests for Femur Shaft Fractures: Beyond the Physical Exam

While the physical examination provides valuable information, imaging tests are crucial for a definitive diagnosis and treatment planning for femur shaft fractures.

X-rays: The Primary Diagnostic Tool

X-rays are the most common and effective way to evaluate a femur fracture. They provide clear images of bone, offering several key pieces of information:

• Confirmation of whether the bone is intact or broken
• Type of fracture
• Location of the fracture within the femur

A typical x-ray for a femur shaft fracture might show a transverse fracture, appearing as a straight horizontal line across the femur.

Additional Imaging Techniques

While x-rays are usually sufficient, in some cases, doctors may require additional imaging tests for a more detailed view of the fracture or to assess damage to surrounding tissues. These may include:

• CT (Computed Tomography) scans: Provide detailed cross-sectional images of the bone and surrounding soft tissues
• MRI (Magnetic Resonance Imaging): Offers detailed images of soft tissues, which can be useful in assessing ligament or muscle damage

Treatment Options for Femur Shaft Fractures: From Emergency Care to Long-Term Recovery

The treatment of femur shaft fractures typically involves a combination of emergency care, surgical intervention, and long-term rehabilitation. The specific treatment plan depends on the severity and type of fracture, as well as the patient’s overall health and age.

Emergency Care

Immediate care for a femur shaft fracture focuses on stabilizing the patient and preventing further injury. This may include:

• Immobilization of the leg to prevent movement of the broken bone
• Administration of pain medication
• Treatment of any open wounds to prevent infection
• Monitoring of blood flow and nerve function in the affected leg

Surgical Intervention

Most femur shaft fractures require surgery for proper healing. The most common surgical treatments include:

1. Intramedullary Nailing: A metal rod is inserted into the center of the femur to hold the broken pieces of bone in proper position.
2. External Fixation: External metal pins or screws are placed into the bone above and below the fracture site. These pins are then connected to a bar outside the skin to hold the bones in place.
3. Plate and Screw Fixation: A plate is attached to the outer surface of the bone with screws.

Post-Surgery Recovery and Rehabilitation

After surgery, the focus shifts to promoting healing and restoring function. This phase typically includes:

• Pain management
• Physical therapy to restore strength and range of motion
• Gradual weight-bearing exercises as healing progresses
• Regular follow-up appointments to monitor healing

The recovery period for a femur shaft fracture can be lengthy, often taking several months to a year for complete healing and return to normal activities.

Complications and Long-Term Prognosis of Femur Shaft Fractures

While most femur shaft fractures heal successfully with proper treatment, complications can occur. Understanding these potential issues is crucial for patients and caregivers.

Potential Complications

Some complications that may arise during the treatment and recovery of femur shaft fractures include:

• Infection: Particularly a risk in open fractures
• Malunion: Improper healing of the bone, leading to deformity
• Nonunion: Failure of the bone to heal
• Compartment Syndrome: A painful condition caused by pressure buildup in the muscles
• Blood Clots: Can develop due to immobilization during recovery
• Fat Embolism: Fat from the bone marrow enters the bloodstream, potentially causing serious complications

Long-Term Prognosis

The long-term outlook for patients with femur shaft fractures is generally positive, especially with advances in surgical techniques and rehabilitation protocols. However, several factors can influence the prognosis:

1. Age of the patient
2. Overall health and presence of other medical conditions
3. Severity and type of fracture
4. Timeliness and quality of treatment
5. Adherence to rehabilitation protocols

Most patients can expect to regain significant function and return to their normal activities, although this process may take several months to a year. Some patients may experience residual effects such as:

• Slight leg length discrepancy
• Mild persistent pain or stiffness
• Reduced range of motion in the hip or knee

Regular follow-up with orthopedic specialists and continued physical therapy can help address these issues and improve long-term outcomes.

Prevention Strategies: Reducing the Risk of Femur Shaft Fractures

While not all femur shaft fractures can be prevented, certain strategies can help reduce the risk of these serious injuries. Prevention approaches differ based on age group and common causes.

For Younger Individuals

Since high-energy collisions are the primary cause of femur shaft fractures in younger people, prevention strategies focus on safety measures:

• Always wear seat belts when in a vehicle
• Follow traffic safety rules, especially when driving or riding motorcycles
• Wear appropriate protective gear during high-risk sports or activities
• Be cautious when working at heights and use proper safety equipment
• Practice gun safety to prevent accidental shootings

For Older Individuals

For older adults, who are more susceptible to fractures from low-force incidents, prevention strategies focus on maintaining bone health and reducing fall risk:

1. Regular exercise to maintain strength and balance
2. Adequate calcium and vitamin D intake for bone health
3. Regular bone density screenings
4. Home safety modifications to prevent falls (e.g., removing tripping hazards, installing handrails)
5. Regular vision check-ups
6. Medication review to assess for drugs that might increase fall risk

General Prevention Strategies

Some prevention strategies are beneficial for individuals of all ages:

• Maintain a healthy diet rich in calcium and vitamin D
• Engage in regular weight-bearing exercises
• Avoid smoking and excessive alcohol consumption, which can weaken bones
• Be cautious on slippery or uneven surfaces
• Use proper techniques when lifting heavy objects

By implementing these prevention strategies, individuals can significantly reduce their risk of experiencing a femur shaft fracture. However, it’s important to remember that accidents can still happen, and prompt medical attention is crucial if a fracture is suspected.

Femur Shaft Fractures (Broken Thighbone) – OrthoInfo

Your thighbone (femur) is the longest and strongest bone in your body. Because the femur is so strong, it usually takes a lot of force to break it. Motor vehicle collisions, for example, are the number one cause of femur fractures.

The long, straight part of the femur is called the femoral shaft. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. This type of broken leg almost always requires surgery to heal.

The femoral shaft runs from below the hip to where the bone begins to widen at the knee.

Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture).

Doctors describe fractures to each other using classification systems. Femur fractures are classified depending on:

• The location of the fracture (the femoral shaft is divided into thirds: distal, middle, proximal)
• The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle)
• Whether the skin and muscle over the bone is torn by the injury

The most common types of femoral shaft fractures include:

Transverse fracture. In this type of fracture, the break is a straight horizontal line going across the femoral shaft.

Oblique fracture. This type of fracture has an angled line across the shaft.

Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture.

Comminuted fracture. In this type of fracture, the bone has broken into three or more pieces. In most cases, the number of bone fragments corresponds with the amount of force needed to break the bone.

Open fracture. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications—especially infections—and take a longer time to heal.

(Left) An oblique fracture has an angled line across the shaft.  (Right) A comminuted fracture is broken into three or more pieces.

Femoral shaft fractures in young people are frequently due to some type of high-energy collision. The most common cause of femoral shaft fracture is a motor vehicle or motorcycle crash. Being hit by a car while walking is another common cause, as are falls from heights and gunshot wounds.

A lower-force incident, such as a fall from standing, may cause a femoral shaft fracture in an older person who has weaker bones.

A femoral shaft fracture usually causes immediate, severe pain. You will not be able to put weight on the injured leg, and it may look deformed—shorter than the other leg and no longer straight.

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Medical History and Physical Examination

It is important that your doctor know the specifics of how you hurt your leg. For example, if you were in a car accident, it would help your doctor to know how fast you were going, whether you were the driver or a passenger, whether you were wearing your seat belt, and if the airbags went off. This information will help your doctor determine how you were hurt and whether you may be hurt somewhere else.

It is also important for your doctor to know if you have any other health conditions, such as high blood pressure, diabetes, asthma, or allergies. Your doctor will also ask you if you use tobacco products or are taking any medications.

After discussing your injury and medical history, your doctor will do a careful examination. He or she will assess your overall condition, and then focus on your leg. Your doctor will look for:

• An obvious deformity of the thigh/leg (an unusual angle, twisting, or shortening of the leg)
• Breaks in the skin
• Bruises
• Bony pieces that may be pushing on the skin

After the visual inspection, your doctor will feel along your thigh, leg, and foot looking for abnormalities and checking the tightness of the skin and muscles around your thigh. He or she will also feel for pulses. If you are awake, your doctor will test for sensation and movement in your leg and foot.

Imaging Tests

Imaging tests will provide your doctor with more information about your injury.

X-rays. The most common way to evaluate a fracture is with x-rays, which provide clear images of bone. X-rays can show whether a bone is intact or broken. They can also show the type of fracture and where it is located within the femur.

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

Reproduced from JF Sarwak (ed): Essentials of Musculoskeletal Care, ed 4. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2010.

Computerized tomography (CT) scans. If your doctor still needs more information after reviewing your x-rays, he or she may order a CT scan. A CT scan shows a cross-sectional image of your limb. It can provide your doctor with valuable information about the severity of the fracture. For example, sometimes the fracture lines can be very thin and hard to see on an x-ray. A CT scan can help your doctor see the lines more clearly.

Nonsurgical Treatment

Most femoral shaft fractures require surgery to heal. It is unusual for femoral shaft fractures to be treated without surgery. Very young children are sometimes treated with a cast. For more information on that, see Thighbone (Femur) Fractures in Children.

Surgical Treatment

Timing of surgery. Most femur fractures are fixed within 24 to 48 hours.  On occasion, fixation will be delayed until other life-threatening injuries or unstable medical conditions are stabilized. To reduce the risk of infection, open fractures are treated with antibiotics as soon as you arrive at the hospital. The open wound, tissues, and bone will be cleaned during surgery.

For the time between initial emergency care and your surgery, your doctor may place your leg either in a long-leg splint or in traction. This is to keep your broken bones as aligned as possible and to maintain the length of your leg.

Skeletal traction is a pulley system of weights and counterweights that holds the broken pieces of bone together. It keeps your leg straight and often helps to relieve pain.

External fixation. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position.

External fixation is usually a temporary treatment for femur fractures. Because they are easily applied, external fixators are often put on when a patient has multiple injuries and is not yet ready for a longer surgery to fix the fracture. An external fixator provides good, temporary stability until the patient is healthy enough for the final surgery. In some cases, an external fixator is left on until the femur is fully healed, but this is not common.

External fixation is often used to hold the bones together temporarily when the skin and muscles have been injured.

Intramedullary nailing. Currently, the method most surgeons use for treating femoral shaft fractures is intramedullary nailing. During this procedure, a specially designed metal rod is inserted into the canal of the femur. The rod passes across the fracture to keep it in position.

Intramedullary nailing provides strong, stable, full-length fixation.

An intramedullary nail can be inserted into the canal either at the hip or the knee. Screws are placed above and below the fracture to hold the leg in correct alignment while the bone heals.

Intramedullary nails are usually made of titanium. They come in various lengths and diameters to fit most femur bones.

(Left) This x-ray, taken from the side, shows a transverse fracture of the femur. (Right) In this front view x-ray, the fracture has been treated with intramedullary nailing.

Plates and screws. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with screws and metal plates attached to the outer surface of the bone.  

Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend into either the hip or knee joints.  

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Most femoral shaft fractures take 3 to 6 months to completely heal. Some take even longer, especially if the fracture was open or broken into several pieces or if the patient uses tobacco products.

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.

Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medications are available to help manage pain. These include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, muscle relaxants, opioids, and topical pain medications. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Some pain medications may have side effects that can impact your ability to drive and do other activities. Your doctor will talk to you about the side effects of your pain medications.  

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.

Weightbearing

Many doctors encourage leg motion early on in the recovery period. It is very important to follow your doctor’s instructions for putting weight on your injured leg to avoid problems.

In some cases, doctors will allow patients to put as much weight as possible on the leg right after surgery. However, you may not be able to put full weight on your leg until the fracture has started to heal. Be sure to follow your doctor’s instructions carefully.

When you begin walking, you will probably need to use crutches or a walker for support.

Physical Therapy

Because you will most likely lose muscle strength in the injured area, exercises during the healing process are important. Physical therapy will help to restore normal muscle strength, joint motion, and flexibility. It can also help you manage your pain after surgery.

A physical therapist will most likely begin teaching you specific exercises while you are still in the hospital. The therapist will also help you learn how to use crutches or a walker. 

Complications from Femoral Shaft Fractures

Femoral shaft fractures can cause further injury and complications.

• The ends of broken bones are often sharp and can cut or tear surrounding blood vessels or nerves, though this is very rare.
• Acute compartment syndrome may develop. This is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. Unless the pressure is relieved quickly, permanent disability may result. This is a surgical emergency. During the procedure, your surgeon makes incisions in your skin and the muscle coverings to relieve the pressure.
• Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics.
• Occasionally, the ligaments around the knee can be injured during a femoral shaft fracture. If you have knee pain after surgery, tell your doctor.

Complications from Surgery

In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of surgery may include:

• Infection
• Injury to nerves and blood vessels
• Blood clots
• Fat embolism (bone marrow enters the blood stream and can travel to the lungs; this can also happen from the fracture itself without surgery)
• Malalignment or the inability to correctly position the broken bone fragments
• Delayed union or nonunion (when the fracture heals slower than usual or not at all)
• Hardware irritation (sometimes the end of the nail or the screw can irritate the overlying muscles and tendons)

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Broken Femur (Thighbone) | Boston Children’s Hospital

How is a broken femur diagnosed?

A doctor will use different diagnostic tests to get detailed images of your child’s fracture. Typical tests include:

• x-ray
• magnetic resonance imaging (MRI)
• computed tomography scan (CT, CAT scan)
• bone scan

How is a broken femur treated?

Your child’s treatment for a broken femur will depend on their age and how seriously the bone is broken. Some broken femurs can be treated with reduction and casting, while others require an operation and fixation.

Closed reduction

A closed reduction is a procedure to manipulate and set (reduce) the fracture. Using an anesthetic, typically given through an IV, the doctor realigns the bone fragments from outside the body.

Casting

After reduction or surgery, your child will be put in a spica cast to hold the bone in place while it heals. If your child has surgery, the spica cast will also hold the hip or thigh muscles in place while they heal.

Types of spica casts used to treat broken femurs:

From left: unilateral hip spica, one and one-half hip spica, and bilateral long leg hip spica cast

• Unilateral hip spica cast — starts at the chest and extends down to the ankle of the injured leg, leaving the uninjured leg free from a cast.
• One and one-half hip spica cast — starts at the chest and extends down to the ankle of the injured leg and to the knee of the other leg. Sometimes a bar is placed between both legs to keep the hips and legs immobilized and aid in lifting the child.
• Bilateral long leg hip spica cast — starts at the chest and extends to the ankles of both legs. Sometimes a bar is placed between the legs to keep the hips and legs from moving.

Once the cast is removed, your child may need a brace and physical therapy to strengthen their muscles and regain flexibility in their joints.

What are the surgical options for a broken femur?

Depending on the severity of the fracture, the surgeon may recommend one of the following procedures.

• Internal fixation: In severe or complicated fractures, a surgeon may insert metal rods or plate and screws into the femur to hold the fractured bone in place while it heals.
• External fixation: If internal fixation is not an option, metal pins can be inserted through skin into the fractured bone. These pins are attached to a bar that sits outside the skin on the child’s thigh. The pins and bar hold the bone fragments in place and the bone in alignment while it heals.
• Intramedullary nails or rods: The surgeon may make small incisions in the skin and insert nails into the bone. The nails realign the bone and hold it in place while still allowing growth and natural remodeling.

How we care for broken femurs at Boston Children’s Hospital

Every year the Orthopedics and Sports Medicine Center at Boston Children’s Hospital treats thousands of children, adolescents, and young adults with fractures of all complexities. Our pediatric expertise allows for precise diagnosis of conditions related to the growing musculoskeletal system and development of optimal care plans.

Our Orthopedic Urgent Care Clinic treats patients with orthopedic injuries that require prompt medical attention but are not serious enough to need emergency room care. We offer urgent care services in four locations — Boston, Waltham, Peabody, and Weymouth.

Treatment of a hip fracture company blog

Description of the disease, symptoms and causes, methods of treatment.

Fracture of the hip joint is a rare traumatology, mainly found in elderly people. When metabolic processes are adequate at a young age, the strong ligamentous-muscular frame of the thigh makes fractures rare in this area. In old age, dystrophic changes are observed, just leading to fractures with strong blows, etc.

Features of the blood supply make a hip fracture dangerous in terms of further treatment. Almost immediately, the blood supply to bone fragments stops, which is fraught with their complete resorption and the formation of a significant defect. It is for this reason that the treatment of a hip fracture is often performed surgically. The presence of modern instruments allows performing operations with minimal traumatism, facilitating the task of surgeons and the suffering of the patient.

Conservative treatment

In the event that the patient can potentially not endure anesthesia, or if he moved in a wheelchair before the injury or, depending on the type of fracture, conservative treatment of a hip fracture is prescribed. Considering some risk of transition of stable fractures into “unstable” ones, which are characterized by displacement of bone fragments, the doctor prescribes periodic radiography of the damaged area of ​​the bone.

If a patient, as prescribed by a doctor, is forced to stay in bed for a long time, then it is necessary to carefully monitor his condition, which will avoid complications due to prolonged immobilization. Complications include infections, bedsores, pneumonia, thrombosis, and malnutrition.

The main treatment for hip fractures is surgery.

Surgery for broken bones of the hip joint

The type of operation depends on the type of fracture. The operation is performed under general anesthesia with the placement of an endotracheal (endotracheal) tube or under spinal anesthesia.

If a hip fracture occurs, the fragmented ends can sometimes be regrouped and secured with internal fixation. But a hip fracture that cuts off blood flow to the femoral head can eventually lead to aseptic necrosis. Therefore, some doctors believe that total hip arthroplasty is the best choice.

If the fracture occurs in an area of ​​the outer upper femur (intertrochanteric area) that has a good blood supply, it is usually successfully treated with internal fixation. Please note that such treatment of a hip fracture is both promising and allows you to return to your previous lifestyle in a short time. The duration of hospitalization is minimal.

Internal fixation

Patients with hip fractures who have strong bones and normal blood supply to the femur can be treated with internal fixation surgery. During this operation, the broken ends of the bones are aligned and fixed in place with small metal devices. When the broken parts of the femur are aligned, the fracture heals faster than on its own.

For patients with weakened bones due to osteoporosis, total hip replacement is often considered the best choice.

In very rare cases, when only a few surgical screws are required to fix bone fragments, the operation is performed under local anesthesia with the patient heavily sedated. The choice of the best method for fixing bone fragments is based on the exact location of the fracture and the experience of the surgeon with certain systems that are used to treat such bone injuries.

Intra-articular (intracapsular) fracture.

In case of a fracture in the head or neck of the femur, the purpose of the operation is to fix the articular cartilage on the damaged or displaced head. Often, these injuries are also combined with fractures in the acetabulum. When planning treatment, the surgeon must take this fact into account.

Access to an intra-articular fracture is carried out either in front or behind the femur. In some cases, for a full examination of the fracture area and fixation of fragments, access to the bone is carried out from two sides. The treatment of a hip fracture with this technique requires wearing special fixative underwear, corsets, etc. for some time. In general, the patient experiences practically no discomfort, and postoperative complications are rare.

With true intra-articular fractures of the femur, fixation of fragments is possible either with the help of separate surgical screws (percutaneous osteosynthesis), or with the help of one large screw connected to the plate. Such a compression fixation screw ensures the stability of the fracture by applying additional pressure to the bone fragments. Sometimes, for greater stability, the design is supplemented with a second screw.

Hip fracture. Symptoms, complications, rehabilitation ortoped-klinik.com

• How is a hip fracture treated?
• Diagnosis: Why is a hip fracture not immediately noticed?
• Soft tissue injuries due to hip fracture
• Symptoms: pain in the hip joint

The femur is connected to the hip joint through the femoral neck. Osteoporosis reduces bone density and, in the event of falls, increases the likelihood of fractures. © peterschreiber.media, Adobe Stock

Due to slippery weather in winter, elderly people often fall on their hips. After they see a doctor, they are usually diagnosed with fracture of the femoral neck , i.e. damage to the bony junction between the femoral shaft and the femoral head. Fraction is determined by specialists immediately. Injuries to the articular cartilage, ligaments and articular surfaces also require a thorough examination. The specialists of the Gelenk Clinic for the treatment of femoral neck fractures are Dr. Rinio and Dr. Markvas.

medical inquiry

How is a hip fracture treated?

Falling on the hip joint causes fracture of the femoral neck which is the connecting link between the femur bone and the hip joint.

Fracture types: The femoral neck can fracture in several places: just below the head of the femur (subcapital), medially (transcervical) or distally (lateral) © bilderzwerg, Adobe Stock

Hip fractures are most common in patients over 65 years of age. After a fall, patients feel a strong stabbing pain in the thigh. In some cases, the femoral neck does not break completely, and sometimes strong muscles hold the bone fragments. For some patients, such fractures are associated with certain risks. Some patients are at risk of death.

Why is hip fracture more common among older patients?

The piercing cold and snow are not only elements of winter entertainment: Elderly people should be especially careful at this time of the year. In winter, dangerous situations lie in wait for them almost everywhere – whether it be puddles on the streets, a slippery entrance to the front of a house or stairs. Even in their own apartment, elderly patients are at risk – because they can slip due to melted snow on their shoes. The risk of hip fracture after a fall increases osteoporosis . This disease is characterized by a decrease in bone density.

Complications in the elderly due to immobility after hip fracture

• thrombosis
• urinary tract infections
• pneumonia
• constant complaints

In addition to icy conditions and uneven floors, dangerous falls can be caused by circulatory disorders, dizziness, loss of consciousness and balance disorders.

Diagnosis: Why is a hip fracture not immediately noticed?

If you feel pain in your hip joint after a fall, contact a hip specialist in Germany immediately. Remember: hip fracture does not immediately lead to gait disturbances. Often it seems to us that the leg is still able to withstand the load, but we realize that we can no longer lift it properly. After a hip fracture, the leg may appear to be slightly twisted. In addition, patients feel pain, as strong ligaments and muscles still hold the fracture. Only an x-ray can clarify the situation.

Eating foods rich in calcium and vitamin D helps maintain a good and stable bone structure. Quitting alcohol and nicotine is essential to optimize bone density. Age-appropriate environments, such as bathroom grab bars and walking sticks, can reduce the chance of falls resulting in a hip fracture.

Treatment and care for a hip fracture

Treatment of the hip joint is carried out on an individual basis and is based on individual factors that the orthopedist necessarily discusses with the patient. The exact location of the fracture, general condition, weight, general physical fitness, as well as biological age and underlying diseases such as osteoporosis play a decisive role in the choice of treatment.

The aim of the specialists of Gelenk Clinic is to stabilize the site of the injured area as soon as possible. Depending on the site of damage, the femoral neck is fixed or replaced with a total endoprosthesis.

Recommendations for osteosynthesis:

• Injury duration no more than a day
• No fracture displacement
• Good quality bone structures
• No signs of arthrosis
• The patient is debilitated, bedridden or has dementia
• Young patient age
• At the age of 40 to 65 years, the choice of treatment approach is more thorough

Surgeons rarely choose a conservative method of treating a hip fracture. This technique prevents stress on the site of damage to the joint, usually by constant adherence to bed rest. After some time, the leg can be mobilized with the help of therapeutic exercises. During conservative treatment, it is necessary to regularly undergo x-rays. However, in most cases, Gelenk Clinic surgeons choose surgical treatment of a hip fracture. In some cases, the operation is performed with the preservation of the femoral head, and sometimes the specialist chooses the method of surgical replacement of this element of the thigh. Endoprosthetics helps the patient overcome all postoperative difficulties in a short time. After this operation, the patient will be able to perform certain loads on the hip joint the very next day. Bed rest will not be required. Physiotherapy begins immediately after the operation. Thus, the patient acquires the usual mobility in a few sessions.

The treatment of a hip fracture with arthroplasty is recommended mainly for patients of mature age. In some cases, partial arthroplasty may be sufficient. If there are signs of arthrosis, only total hip arthroplasty is performed.

Recommendations after osteosynthesis

• mobilization of the hip joint on the same day
• young patients: postoperative partial load up to 6 weeks
• elderly patients: leg mobilization with full load
• Gentle foot position to relieve swelling
• observation of the result of the operation up to 3 days
• physiotherapy care and muscle building training after 6 weeks
• after 5 months: cycling and swimming allowed
• six months later: more intense sports

Recommendations after arthroplasty

• if possible, joint mobilization on the day of surgery
• do not bend your hip more than 90 degrees (right angle)
• do not make adductive movements. avoid internal rotations for dorsal access and external rotations for anterolateral
• thrombosis prophylaxis until full mobility is restored (45 weeks)
• observation of the result of the operation up to 3 days
• for the first 6 weeks – physiotherapy, gait training and muscle building training
• after 5 months: cycling or swimming

Sequelae of soft tissue injury due to hip fracture

Image of an inflamed joint capsule. Falls on the hip joint can lead to long-term injuries and arthrosis without a fracture. © Gelenk Clinic

Fractures of the femoral neck are not the only ones that have severe consequences in the lives of patients. Often, patients do not pay due attention to damage to soft tissues, cartilage, ligaments and the articular lip.

A fall on the hip joint can tear or roughen the articular cartilage. Increased friction in the joint can cause dangerous cartilage degeneration and arthrosis of the hip joint. Classical x-ray examination is not able to diagnose such cartilage injuries. However, modern techniques such as magnetic resonance imaging allow the attending orthopedist to clearly recognize such injuries.

Symptoms: Pain in the hip joint

Treating injuries after a fall at an early stage can prevent some chronic diseases and even arthrosis of the hip joint (coxarthrosis). Specialists of Gelenk Clinic in Germany recommend not to delay the treatment.