Femoral fracture

A femoral fracture refers to a break in the thigh bone, also known as the femur. The femur is the strongest and longest bone in the human body, extending from the hip to the knee. Because of its strength, it usually takes a significant force, such as a high-impact accident, to fracture it. Femoral fractures are considered serious injuries, often requiring urgent medical attention, surgical intervention, and prolonged rehabilitation (1). These fractures can occur at different levels of the femur: proximal (near the hip), shaft (middle portion), or distal (near the knee), and the severity varies depending on the type and cause. Understanding the symptoms, causes, risk factors, diagnostic methods, and treatment options is essential for effective management and recovery (2).

Symptoms

The symptoms of a femoral fracture depend on the type and severity of the break, but common signs include

• Severe pain: Sudden, intense pain in the thigh immediately following trauma.
• Inability to bear weight: Most patients cannot stand or walk after the injury.
• Swelling and bruising: Rapid swelling and bruising around the thigh.
• Deformity: The leg may appear shorter, rotated outward, or visibly misaligned.
• Tenderness: Extreme sensitivity when the thigh is touched or moved.
• Limited mobility: Difficulty or inability to move the affected leg.
• Open wounds: In open fractures, bone may protrude through the skin, increasing the risk of infection.

Prompt medical attention is crucial as femoral fractures can cause complications, including internal bleeding, blood clots, or damage to surrounding muscles, nerves, and blood vessels (2).

Causes

Femoral fractures typically result from high-impact trauma, but the underlying cause varies by age, activity level, and bone health (3). Common causes include

• High-energy accidents: Car or motorcycle crashes, falls from great heights, or sports-related injuries often cause femoral shaft fractures.
• Falls in older adults: Even a minor fall can result in a femoral fracture, particularly near the hip, due to osteoporosis or weakened bones.
• Direct blows: A strong direct impact to the thigh, such as from a heavy object, can break the femur.
• Bone disease: Conditions like osteoporosis, bone cancer, or other metabolic disorders weaken bone strength, making fractures more likely (3).
• Stress fractures: Although rare in the femur, repetitive stress in athletes or military recruits can cause small cracks that may progress into complete fractures.

Risk Factors

Certain factors increase the likelihood of sustaining a femoral fracture (1). These include

• Age: Older adults are more susceptible due to decreased bone density and balance issues.
• Osteoporosis: A major risk factor, particularly in postmenopausal women and elderly men.
• High-risk activities: Contact sports, skiing, or activities involving speed and height raise the risk of trauma.
• Gender: Women, especially after menopause, have a higher risk due to bone density loss.
• Chronic medical conditions: Diseases like diabetes, rheumatoid arthritis, or cancer can compromise bone integrity.
• Poor nutrition: Deficiencies in calcium, vitamin D, or protein can weaken bones.
• Substance use: Smoking and excessive alcohol intake reduce bone density and healing capacity.
• Previous fractures: A history of fractures increases the chance of future ones, especially if bone health is compromised (2).

Diagnosis

Diagnosing a femoral fracture involves a combination of physical examination and imaging tests.

• Medical history and examination: The doctor assesses the mechanism of injury, symptoms, and physical condition of the leg (1).
• X-rays: The primary diagnostic tool, X-rays show the location, type, and extent of the fracture.
• CT scan or MRI: Used when fractures are complex, involve joints, or when soft tissue and nerve involvement is suspected.
• Bone scans: Occasionally used in cases of stress fractures or underlying bone disease.
• Vascular assessment: Since femoral fractures can injure nearby blood vessels, circulation in the leg is checked.

Early and accurate diagnosis is critical to prevent complications and to plan appropriate treatment (4).

Treatment Options

Treatment for a femoral fracture depends on the type, location, and severity of the break, as well as the patient’s overall health (1).

Emergency Care

• Immobilization: Splints or traction are applied to stabilize the leg and reduce movement.
• Pain management: Strong painkillers are often required due to the severity of pain.
• Fluid replacement: Severe fractures may cause blood loss, requiring intravenous fluids or transfusion.

Surgical Treatment

Most femoral fractures require surgery because the bone is large and bears significant weight (3). Surgical options include

• Intramedullary nailing: A metal rod is inserted into the marrow canal of the femur to align and stabilize the bone. This is the most common method for femoral shaft fractures.
• Plates and screws: Used when the fracture is near a joint or if nailing is not suitable.
• External fixation: Metal pins and rods outside the body stabilize the bone temporarily, often in open fractures with severe soft tissue injury.
• Hip replacement: In older adults with proximal femoral fractures, partial or total hip replacement may be necessary.

Non-Surgical Treatment

Rarely, in less severe or non-displaced fractures, conservative treatment with traction, braces, or casts may be attempted, although this is less common (2).

Rehabilitation

Post-surgery, rehabilitation is essential:

• Physiotherapy: Exercises to restore strength, flexibility, and mobility.
• Weight-bearing progression: Gradual increase in walking and activity as healing progresses.
• Assistive devices: Crutches, walkers, or canes may be needed during recovery (3).
• Long-term follow-up: Regular imaging to monitor healing and prevent complications.

Living With or Prevention

Recovering from a femoral fracture is a lengthy process, often taking several months. Patients may experience muscle weakness, stiffness, and psychological challenges during recovery. Following medical advice, attending physiotherapy, and maintaining a healthy lifestyle are key to regaining full function (4).

Living With a Femoral Fracture

• Adherence to rehab: Consistent physiotherapy speeds up recovery.
• Pain management: Medications, ice, and activity modification help manage discomfort.
• Diet: High-protein foods, along with calcium and vitamin D, promote bone healing.
• Mental health support: Coping with immobility and long recovery may require counseling or support groups (4).

Prevention

While not all fractures can be prevented, certain measures can reduce the risk

• Fall prevention: Use of assistive devices, removing household hazards, and improving lighting in elderly homes.
• Bone health: Adequate calcium and vitamin D intake, weight-bearing exercises, and treatment of osteoporosis.
• Protective gear: Wearing seatbelts, helmets, and sports protection to minimize traumatic injury.
• Lifestyle changes: Quitting smoking and reducing alcohol consumption improve bone strength.

References

1. Yao ZY, Fan SY, Zhao WQ, Huang JF. The History of Classification Systems for Periprosthetic Femoral Fractures: A Literature Review. Orthop Surg. 2024 Aug;16(8):1816-1831. doi: 10.1111/os.14149. Epub 2024 Jun 30. PMID: 38946014; PMCID: PMC11293929.
2. Roberts VJ, Meeson RL. Feline Femoral Fracture Fixation: What are the options? J Feline Med Surg. 2022 May;24(5):442-463. doi: 10.1177/1098612X221090391. Epub 2022 Apr 11. PMID: 35404170; PMCID: PMC11104039.
3. Fu F, Liu B, Pu H, Wang Y, Zhang P, Wei S, Gu H, Zhang Q, Ye H. Global Trends in the Incidence and Primary Causes of Femoral Fractures, Excluding Femoral Neck Fractures: A Global Epidemiological Study. Risk Manag Healthc Policy. 2025 Jan 11;18:117-129. doi: 10.2147/RMHP.S498918. PMID: 39816786; PMCID: PMC11734506.
4. Miettinen S, Sund R, Törmä S, Kröger H. How Often Do Complications and Mortality Occur After Operatively Treated Periprosthetic Proximal and Distal Femoral Fractures? A Register-based Study. Clin Orthop Relat Res. 2023 Oct 1;481(10):1940-1949. doi: 10.1097/CORR.0000000000002638. Epub 2023 Apr 10. PMID: 37036391; PMCID: PMC10499103.