Broken Femur

What is a femur and what happens when it breaks?

Your femur — the leg bone between your hip and knee — is the longest, heaviest and strongest bone in your body. It takes tremendous force to break your femur. If you break your femur, you will need immediate medical help. Your broken femur can take months to heal.

Who is likely to break their femur?

Most people break their femur because they were in a car crash, they fell or they were shot. People age 65 and older have an increased risk for breaking bones, including their femurs, after falling down while standing.

Why is a broken femur a serious injury?

If you break your femur, you might:

• Lose blood if your fracture pierces your skin. You may lose more blood if your fracture pierces your skin than if it doesn’t pierce your skin.
• Go into shock.
• Break your hip if you break the upper part of your femur. (This is a common problem for people with osteoporosis.)
• Damage your knee if you break the part of your femur just above your knee. (This is a common problem for people with osteoporosis or people who have knee replacements.)

How painful is a broken femur?

Broken femurs can be very painful. Your healthcare provider will provide pain medication as part of your treatment.

What are the symptoms of a broken femur?

If you’ve fallen or been injured, here are signs you may have a broken femur:

• You’re in severe pain.
• You can’t put weight on your injured leg.
• Pieces of your femur break through your skin and you are bleeding. This is called an open fracture.
• Pieces of your femur push up against your skin but don’t pierce your skin. This is called a closed fracture.
• Your thigh is bruised.
• Parts of your thigh are swollen.
• Your injured leg may be shorter than your uninjured leg, and your injured leg may turn out, away from your body.

Can I walk on a broken femur?

If you have a broken femur, you won’t be able to put weight on your injured leg.

What causes broken femurs?

Most people break their femurs because of a car crash, a fall or from a gunshot. Elderly people can break their femur simply from a fall from standing.

How do healthcare providers diagnose broken femurs?

Providers diagnose broken femurs by examining your injured leg. They’ll also obtain X-rays and computed tomography scan (CT) scans. These tests help healthcare providers identify the type of broken femur. Broken femur types include:

• Transverse fracture: The break goes straight across your femur in a horizontal line.
• Spiral fracture: The break spirals around your femur.
• Oblique fracture: The break goes across your femur at an angle.
• Comminuted fracture: There are three or more broken pieces in your femur.
• Open or compound fracture: Your femur is broken and pieces of broken bone pierce your skin.

How do healthcare providers treat broken femurs?

Sometimes providers treat broken femurs with a splint that will cover your whole leg and goes up toward your hip. They do this as a temporary step to help with your pain and keep your broken femur still.

They may use traction to treat your broken femur. There are two types of traction. One type goes on the outside of your leg. The other type goes into your femur or your tibia. Here’s more information about traction to treat broken femurs:

• Weighted traction splints: Healthcare providers will place a strap on your ankle and use weights attached to a frame and pulley. The frame and pulley put gentle pressure on your femur.
• Skeletal traction: Your provider will do surgery to place a pin in your femur or tibia. Then they attach the pin to weights that keep your femur straight.

Are broken femurs always treated with surgery?

Yes. If you’ve broken your femur, your provider will do surgery so your broken bone will heal properly. You’ll probably have surgery 24 to 48 hours after you seek treatment for your injury. Providers typically do one of two types of surgery:

• Open Reduction and Internal Fixation (ORIF).
• External fixation.

What happens during ORIF surgery?

Your surgeon makes an incision at your hip or knee joint. Then they’ll line up the broken pieces and stabilize the femur with a piece of metal.

What kind of metal pieces are used in ORIF surgery?

Providers use a variety of metal pieces in ORIF surgery:

• Rods. Rods are used in a surgical procedure called an intramedullary nail. Your surgeon inserts the nail into your leg through your medullary cavity. Your medullary cavity is the section in the middle of your bone where your bone marrow is stored.
• Screws. Your surgeon places screws at the top and bottom of the rod or plate. This keeps the rod or plate in place
• Metal plates. Similar to splints placed on the outside of your leg, your surgeon will place metal plates flat against the bone to keep the fracture stable, using screws to keep the plates in place.

What is external fixation surgery to treat a broken femur?

External fixation is a surgery that stabilizes your broken femur by placing metal bolts in your femur. The bolts are secured to a frame on the outside of your femur. Your provider may do this surgery if you need ORIF but can’t have that surgery right away.

What does external fixation surgery involve?

• This surgery is done under anesthesia.
• Surgeons use drills to make holes in the undamaged areas around your broken femur. The holes hold bolts.
• The bolts connect to rods placed outside your body. These rods have ball-and-socket joints so the bolts can be adjusted to make sure the broken sections of your femur are aligned.
• The rods connect to a frame placed outside your femur.

Will I need physical therapy after my surgery?

You’ll have physical therapy throughout your recovery.

Will I receive pain medication?

Your healthcare provider will discuss your pain concerns and provide appropriate medication.

What are the risks or complications with broken femur surgery?

Any given surgery has potential complications or side effects. The complications or side effects from surgery for a broken femur are:

• Acute compartment syndrome (ACS). In this syndrome, pressure builds in your muscles so your blood can't get to your muscles and tissues. ACS can cause permanent muscle and nerve damage.
• Your femur’s broken ends don’t connect correctly, causing your femur to heal in an abnormal position.
• The nail and locking screws might irritate you.
• Fat embolism syndrome. Fat enters your bloodstream. Symptoms include losing consciousness or being short of breath.
• Blood clots
• Cut blood vessels or nerves damaged by small sharp pieces of bone from your broken femur.
• Infection.

How do I take care of myself after broken femur surgery?

You will need someone at home to help you during the first two weeks. (Your healthcare provider can help you find trained in-home care.)

You should sleep lying flat on your back with your broken femur elevated above the level of your heart. Sleeping like this can keep your broken femur from swelling.

As you recover, you’ll likely want to move around your home on your own. Ask your healthcare provider how much weight you can put on your leg. You may need to use a cane, crutches or a walker to get around. Your physical therapist will help you learn how to use them.

Be careful not to fall as you could reinjure your femur. Take the following precautions to decrease your risk of falling:

• If your bedroom and bathroom are on the upper floor, set up a temporary sleeping space and portable commode on the first floor so you don’t need to climb steps.
• Eliminate things you might trip over, such as loose cords and throw rugs.
• Install handrails in your bathtub or shower and near your toilet.
• Put railings on both sides of the stairs.
• Make sure your home has lots of light by adding more or brighter light bulbs.
• Keep items you use often in cabinets you can reach easily without using a step stool.
• Use non-slip mats in the bathtub and on shower floors.

How long does it take to recover from a broken femur?

It can take four to six months to fully recover from surgery.

Why does it take so long to recover from a broken femur?

Broken femurs go through stages of a natural healing process that can take four to six months. Here’s a breakdown:

• Days 1 to 5: When you break your femur, you also break the blood vessels that supply blood to your femur. Those broken blood vessels form a hematoma, or blood clot, at the point of your fracture. The blood clot makes a temporary frame that helps your femur to heal. Your immune system reacts to the injury, stimulating cells that remove damaged tissue and stimulate healing.
• Days 5 to 11: Your body begins to develop a network of cartilage connecting the lined up broken sections of your femur. Your body also starts developing woven bone, or new bone.
• Days 11 to 28: The cartilage network hardens while you develop new blood vessels and more new bone. While this continues, your bone beings to remake itself, eventually becoming normal bone. This process can last months to years.

How can I prevent breaking my femur?

Unfortunately, you probably can’t control events that may cause you to break your femur. People break their femurs in car crashes, falls or being shot.

What about people who might be at risk for falling because they are older?

There are ways to prevent falls by people who are age 65 and older and more likely to be injured in a fall, including falling down while standing.

If you are age 65 or older and concerned about falling, ask your healthcare provider to evaluate your risk for falling, including medications that may make you feel sleepy or dizzy. They’ll recommend steps you can take to reduce that risk. For example, they may recommend exercises that can strengthen your legs and improve balance.

When should I see my healthcare provider?

You’ll have regular follow-up appointments with your healthcare provider, starting two weeks after surgery and continuing every few weeks.

Be sure to talk to your provider if you have concerns about your progress or have specific concerns such as pain management.

When should I call my healthcare provider or seek emergency medical care?

Call your provider anytime you have the following as you recover from a broken femur:

• Shortness of breath or chest pain when you breathe.
• Frequent urination or burning when you urinate.
• Redness or increasing pain around your incision.
• Drainage from your incision.
• Swelling in one of your legs (it will be red and warmer than the other leg).
• Pain in your calf.
• Fever higher than 101°F (38.3°C).
• Pain that is not controlled by your pain medicines.
• Sudden difficulty with walking and putting weight on your leg.

What questions should I ask my healthcare provider?

A broken femur is a serious injury that requires immediate medical care. Once your immediate needs are addressed, here are some questions you should ask your healthcare provider:

• Will I need additional surgery?
• When should I start physical therapy?
• What should I do about managing my pain?
• When will I be able to walk?
• When can I go back to my office or worksite?

Can you experience pain years after your broken femur is treated?

Unfortunately, your femur can still hurt long after your fracture heals. There are many possible causes for this pain – called chronic pain. Possible causes include:

• Nerve damage from the initial fracture or treatment.
• Scar tissue.
• Arthritis.
• Nonunion. Your bones don’t heal.

Is there any cure for chronic pain caused by a broken femur?

Physical therapy, exercise and medication can ease or eliminate chronic pain.

A note from Cleveland Clinic

A broken femur is a serious injury that takes time to heal. You might feel as you are never going to recover completely. You may start to feel anxious and frustrated. You may even decide you want to hurry the healing process and end up with a setback. Talk to your healthcare provider about resources you can tap to help you stay on track.