Your ability to walk and enjoy full use of your legs is dependent upon the health of your thighbone or femur, which directs leg movement from your hips to your knees. While unmatched among bones in the human body in terms of strength and durability, the femur is most often broken during events involving significant impact, such as car crashes, blunt force trauma and high-distance falls. Due to the length of the femur, it can incur multiple types of injuries across various locations that involve different forms of fractures and may impair surrounding skin and tissue. Other causes of femur injuries can include long-term diseases such as osteoporosis and cancer.
Due to instantaneous leg destabilization and intense pain, femur fracture surgery is almost always recommended, and the nature of your procedure will be determined based upon the details of your injury, including whether the fracture: is distal (by the knee joint), middle (near the femur’s shaft), or proximal (on the hip joint); has occurred in multiple sections (comminuted) or has punctured the skin (open). The severity of the injury will be determined via physical and imaging examinations, with open fractures requiring more immediate wound-area cleansing and surgery than other types of breaks that don’t involve skin wounds, which generally are operated on within 1-3 days of the initial injury to allow for the development of a treatment plan. The nature of your procedure will vary based upon the severity and type of your injury, with the two most common surgical practices differing due to whether the bone can be readjusted or whether it requires guidance in order to heal properly. These procedures involve the placement of either a femur-sized artificial rod and plates and screws, or a plate and screws, into the fracture area to encourage correct bone recovery.
For those undergoing distal femur fracture repair surgery, the degree of damage to your skin and muscles near the break area will determine whether you will be affixed with an external fixator such as metal pins or screws that are inserted temporarily into your femur and shinbone and held together by an outside bar. Prior to surgery, these devices will be removed, and a metal rod will be inserted into the femur’s marrow canal for stability while prosthetic screws and plates are positioned to hold bone fragments together. Should the break be composed of many small pieces, a rod or plate will be placed at the ends of the fracture for bone stability, thereby allowing the fragments to form with the new bone. The type of break will also determine whether this treatment can be accomplished through one or multiple incisions. Should the fracture not heal in a normal time frame due to poor bone health or if the patient has already had a knee replacement, implants for the bone or knee, as applicable, may be utilized, as may bone grafts from the patient or a tissue bank.
Patients who have experienced femur shaft fractures and require surgery will be fitted with a leg splint or in skeletal traction that will alleviate pain and keep your leg straight and the broken bones stable prior to the procedure. To provide temporary stabilization until the patient is ready for surgery, a stabilizing external bar is sometimes affixed to metal pins or screws that have been inserted into the bone near the fracture area. The most common surgical treatment involves creating a small, hip- or knee-level incision and screwing a titanium rod in place that in turn sits in the marrow canal to position the fracture. Another option, commonly used when the break involves the hip or knee and the placement of a metal rod isn’t feasible, involves holding the bone pieces into place with artificial screws and plates on the bone’s outer surface.
Surgery to repair a proximal femur fracture near the hip joint will vary with the manner of break. A fracture near the femur’s head, which can also include damage to the hip socket, otherwise known as an intracapsular fracture, may be repaired through the insertion of one large screw and an artificial plate or several smaller screws, thereby increasing hip stability. Similar methods, and an attempted alignment through a large incision, may be employed with younger patients. Replacement of the parts of the hip, such as the ball and head, or the entire hip may also be required to avoid arthritis and ensure adequate blood flow in older patients. An intertrochanteric fracture occurs near the femur’s neck and a lower bone area and can be repaired through two treatment methods. The first involves affixing a prosthetic compression screw to the outside of the bone, which facilitates area healing and stabilization. The screwing of an artificial nail into the bone’s marrow canal via the hip’s neck and head also helps accomplish recovery and impaction in the fracture area. When a break occurs near a major connecting point for various hip muscles, a patient has suffered a subtrochanteric fracture. In most cases, this is treated with an intramedullary nail that is screwed into the hip or screws that secure the top of the femur, with additional stabilizing screws added as needed near the knee area. Your provider may in certain circumstances opt to use a plate and several screws instead of the intramedullary nail.
Did You Know? Hip fractures are most common in the elderly, with over 300,000 Americans age 65 and older hospitalized annually with broken hips. Women are most likely to be affected by hip fractures, as they are most likely to experience osteoporosis and falls, each of which are contributing factors to hip fractures.
Requiring a long-term healing period over a minimum of three to eight months or more (depending upon the severity of your injury and your type of surgery), rehabilitation from femur fracture surgery is centered on regular physical therapy and active leg usage. When recovering from distal femur fracture surgery, you will be working with a physical therapist and you may undertake passive knee movements including movement of your leg for you by a therapist or machine. Weight-bearing activities on your leg should only be undertaken with the approval of your physician and will likely only occur three months or more after your surgery. At this time, you will begin a regular physical rehabilitation program to help you regain leg mobility and strength. For femur shaft fracture surgery and proximal femur fracture surgery rehabilitation, leg motion and weight-bearing will be guided by your doctor’s recommendations and may even occur shortly after surgery is completed. During your recovery process, you will work closely with a physical therapist to encourage motion and flexibility.
In cases of each type of surgery, post-surgical medications, including anti-inflammatory drugs, will also be prescribed to help manage pain after your procedure. Those who had particularly severe breaks, or who are older, may experience slower healing timeframes and some complications, including working to avoid infection from skin wounds due to the fracture.