What is Femoral Shaft Fracture: Types, Causes, Treatment, Healing Time, Symptoms, Complications

Femoral Shaft Fracture, also known as broken thighbone, is the breakage of the shaft of the femur or thighbone. Femoral shaft is the elongated, straight part of the femur and any breakage or fracture along the length of this shaft is known as femoral shaft fracture. The femur is the strongest and longest bone in our body. As the femur is a very strong bone, it takes a lot of force to fracture or break it. Some of the cases where a person can incur a femoral shaft fracture are automobile accidents, which are one of the major causes of femoral shaft fracture.

The most common cause of femoral shaft fracture is some type of high-energy force or collision to the thigh, such as seen in motorcycle or motor vehicle accidents. Pedestrians getting hit by a car, falling from great heights etc. are some other causes of femoral shaft fractures. If a femoral shaft fracture occurs from a lower-force accident, such as a fall from a lower height, while standing etc., then this is commonly seen in older individuals who have weak bones.

Femoral Shaft Fractures differ depending on the force which causes its breakage. The pieces of the femoral shaft can be aligned or displaced. The femoral shaft fracture can be a closed fracture where the skin is intact; or an open fracture where the bone has pierced through the skin.

Femoral Shaft Fractures are classified depending on the following:

• The fracture location, as the femur is divided into 3 parts: the distal part, the middle part and the proximal part.
• The pattern of the fracture, such as the fracture of the femoral shaft can occur in different directions, e.g. length-wise, cross-wise or in the middle.
• If the skin and muscle above the femoral shaft is torn by the accident/injury.

Given below are some of the common types of Femoral Shaft Fractures:

Transverse Femoral Shaft Fracture: In this type of femoral shaft fracture, the break occurs in a straight horizontal line across the shaft of the femur.

Spiral Femoral Shaft Fracture: As the name indicates, the line of the fracture encircles the shaft resembling candy cane stripes. A twisting type of force to the femur or thigh causes a spiral fracture.

Oblique Femoral Shaft Fracture: In this type of femoral shaft fracture, there is an angled line across the shaft.

Comminuted Femoral Shaft Fracture: In this type of femoral shaft fracture, the femur is fractured in three or more pieces. Usually, the number of fragments of the bone corresponds with the degree of force required to break the femur.

Open Femoral Shaft Fracture: In this type of fracture of the femoral shaft, the bone is fractured such that the fragments of the bone stick out or pierce through the skin or there is a wound that penetrates down to the fractured bone. This type of fracture is known as an open or compound fracture and these types of fractures commonly are associated with increased damage to the surrounding muscles, ligaments and tendons. Patients with this type of fracture will be at an increased risk for complications, such as infections and open fractures also take longer time to heal.

• Patient experiences immediate and severe pain upon experiencing a femoral shaft fracture.
• Patient is not able to bear weight on the injured leg.
• There may be deformity or crookedness of the injured leg seen and it no longer appears straight.
• The injured leg appears shorter than the normal leg.

Medical history and physical examination of the patient is carried out. The doctor will ask patient questions regarding the accident or injury which has resulted in the fracture. Such as, if the patient was involved in a car accident, then the doctor will want to know the speed at which the vehicle was going and whether the patient was the passenger or the driver. It is also queried whether the patient was wearing a seat belt or if the airbags went off. All this information helps in determining the manner in which the patient was hurt or if there is some other injuries present elsewhere in the body.

It is also important to find out if the patient has other medical conditions, such as hypertension, asthma, diabetes or allergies and what medications the patient is taking. Careful physical examination is carried out where the patient’s overall condition, is assessed. When examining the injured leg, the doctor will check for any obvious deformity of the thigh or the leg; i.e. whether it is bent at an unnatural angle, or is twisted, or whether if the leg is shortened. The doctor will also check for any bruises, breaks in the skin and any bony fragments or pieces which have pierced through the skin. The doctor then feels along the thigh, leg and foot to check for any abnormalities, to check the pulses and assess the tightness of the muscles and skin around the injured thigh. The movement and sensation of the leg and foot are also checked.

Imaging Tests such as x-rays are commonly done to evaluate a fracture. X-ray helps in detecting whether the bone is broken or intact along with showing the type of fracture and its location in the femur. CT (Computed Tomography) scan can also be done to find out more information as a CT scan reveals cross-sectional image of the limb, which provides more detailed and accurate information about the severity of the femoral shaft fracture.

Surgery is needed for majority of the femoral shaft fractures. It is nearly impossible to treat femoral shaft fractures without any surgery. Children who are very young may be treated with a cast.

If the skin surrounding the femoral shaft fracture is not broken or pierced, then surgery is postponed till the patient is more stable. However, if there is an open femoral shaft fracture, then the fracture site gets exposed to the outside environment and it requires immediate surgery for treatment and prevention of infection.

The following surgical procedures are used for fixing femoral shaft fractures:

Intramedullary Nailing of Femoral Shaft Fracture: Intramedullary Nailing is the most current and widely used method for fixing femoral shaft fractures. In this procedure, a customized metal rod is inserted into the marrow canal of the femur which passes across the fracture and helps in keeping it in position. Intramedullary nailing is a good treatment option for fixing femoral shaft fractures, as they provide strong and stable full-length fixation of the femoral shaft.

External Fixation of Femoral Shaft Fracture: In this surgical procedure, screws or metal pins are placed into the bone above and below the site of femoral shaft fracture. These screws and pins are attached to a bar located outside the skin, which acts as a stabilizing device to hold the bones in correct position so that they can heal in the right alignment. This is usually a temporary treatment for femoral shaft fractures, as this treatment can be used easily and are often applied when the patient has multiple injuries and is not a good candidate for longer surgery for fixing the fracture. External fixation is a good option in such cases as it provides temporary, but good stability till the time the patient has stabilized for the final surgery. Sometimes, the external fixator is left till complete healing of the femur has been achieved.

Plates & Screws for Femoral Shaft Fracture: In this procedure, the fractured bone fragments are first repositioned or brought back into their normal alignment and then held together using special metal plates and screws that are attached to the external surface of the bone. This procedure is commonly used when intramedullary nailing is not feasible, such as in cases where the fracture has extended into the hip joint or knee joint.

Pain Management in Femoral Shaft Fracture: Pain is a common part of the healing process and medications, such as NSAIDs, opioids are prescribed to manage pain after the surgery. Local anesthetics can also be used. It should be born in mind that opioids, although help in relieving pain, can be addictive as they are a narcotic, so should be used with care.

Weight bearing should be done upon the advice of the doctor. Patient will most likely need to use walker or crutches when beginning to walk after the surgery.

Physical Therapy is an important part of the recovery process and should be done as soon as the patient is able. Patient loses muscle strength in the fractured region from lack of use of the muscles and immobility during the healing process. Physical therapy helps in restoring normal muscle strength, joint flexibility and mobility.

Other than the risks, which are present with any surgery, such as blood loss, infection and problems with anesthesia, other complications from surgery for femoral shaft fracture include: blood clots, injury to blood vessels and nerves, fat embolism, malalignment of the fractured bone fragments, nonunion or delayed union of the fracture and hardware irritation.

• The ends of the fractured bones of the femoral shaft can be sharp and may tear or cut the surrounding nerves or blood vessels.
• Patient can develop acute compartment syndrome, which is a painful condition which occurs when pressure builds up within the muscles to dangerous levels leading to diminished blood flow, which in turn prevents oxygen and nourishment from reaching the muscle cells and nerves. This is a medical emergency, which if not treated immediately, can result in permanent disability.
• Infection is a major complication in case of open fractures where the fractured bone is exposed to the outside environment. Infection of the bone is difficult to treat and usually requires multiple surgeries along with long-term antibiotics.

It takes around 4 to 6 months for majority of the femoral shaft fractures to heal. In some patients, healing time may be even longer, especially if there is an open femoral shaft fracture or if the bone has been fractured into several fragments.