What is Femoral Shaft Fracture?
A femoral shaft fracture is a crack or break anywhere along the long and straight section of the femur (thighbone) due to high-energy trauma or low-energy trauma in osteoporotic patients. The femur is the strongest and longest bone in the body. It connects with the pelvis at the top to form the hip joint and the tibia and fibula at the bottom to form the knee joint.
Types of Femoral Shaft Fracture
Femoral fractures are classified into different types based on the site of the fracture, pattern of the fracture, and whether the muscle and skin over the bone is ruptured by the injury.
In general, femoral shaft fractures can be divided into the following common types:
- Transverse fracture: This type of fracture occurs along the femoral shaft in a horizontal line pattern.
- Oblique fracture: In this type, the fracture occurs across the shaft in an angled line pattern.
- Spiral fracture: In this type, the fracture line surrounds the shaft and occurs as a result of a twisting force.
- Comminuted fracture: This type of fracture involves a splinter or break of bone into 3 or more pieces.
- Open fracture: This is also known as a compound fracture and is the most serious form of femoral shaft fracture in which the fracture causes the bone pieces to stick out through the skin to the outer environment resulting in serious injury to surrounding soft tissue structures, such as muscles, ligaments, and tendons.
Causes of Femoral Shaft Fracture
Some of the common causes of femoral shaft fractures include:
- High-energy trauma, such as motor vehicle collisions or contact sports
- Low-energy trauma in the elderly, such as a fall from standing
- Pedestrian versus automobile accident
- Falls from height
- Osteoporosis
- Mineral deficiency
- Gunshot trauma
- Direct blow to the femoral shaft
Signs and Symptoms of Femoral Shaft Fracture
Some of the signs and symptoms of femoral shaft fractures include:
- Swelling
- Difficulty walking
- Deformity
- Leg-length discrepancy
- Bleeding
- Pain
- Inability to bear weight
- Bruises
Diagnosis of Femoral Shaft Fracture
To diagnose a femoral shaft fracture, your doctor will review your symptoms and medical history and conduct a thorough physical examination to look for signs of swelling, bruises, rupture of the skin, or any other bone deformities. In order to confirm the diagnosis and obtain further information on the severity of the fracture, your doctor may recommend:
- X-rays: This study uses high electromagnetic energy beams to produce images of the bones and helps to detect whether the femur is intact or broken and the type of fracture and its location.
- CT scan: This scan uses special x-rays that produce images of the cross-section of your limb with clear images of any damage present that is not visible in an x-ray. It provides your doctor with crucial information about the severity of the fracture.
Treatment for Femoral Shaft Fracture
Surgery is the most preferred choice of treatment for femoral shaft fractures as most fractures require surgical intervention to heal. However, fractures in children until 5 years are sometimes treated with conservative measures such as a cast.
Conservative Treatment
- Casting: In this method, a spica cast is used to hold the fractured bone fragments in proper position until the bone heals. A cast is a covering made of plastic or fibre that encases the affected limb to stabilize the bone.
- Traction: This method is employed if a significant leg-length discrepancy is noted and involves placing the limb in a weight and counterweight system (traction) to ensure the bones are realigned properly to stabilize the bone.
Surgical Treatment
- External fixation: This method is performed in case you have multiple injuries. Your doctor will place metal screws and pins inside the bone which will be attached to a rod present outside the skin. This helps in stabilizing the bones.
- Intramedullary nailing: In this method, a rod is passed along the broken bone and intramedullary nails made of titanium are fixed above and below the femoral shaft to stabilize and heal it.
- Plates and screws: In this procedure, your doctor will reposition the fragmented bones and align them by fixing it with screws and metal plates. The plates and screws method is employed when intramedullary nailing is not a viable option.
After the surgery, your doctor will recommend physical therapy to strengthen the bone and surrounding muscles and to help ensure return to optimum function as quickly as possible. However, complete healing of most femoral shaft fractures takes around 3 to 6 months or longer.