Femur Shaft Fractures (Broken Thighbone)

Your thighbone (femur) is the longest and strongest bone in your body. Because the femur is so strong, it usually takes a lot of force to break it. Car crashes, for example, are the number one cause of femur fractures.

The long, straight part of the femur is called the femoral shaft. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture.

Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly or be out of alignment (displaced), and the fracture may be closed (skin intact) or open (the bone has punctured the skin).

Doctors describe fractures to each other using classification systems. Femur fractures are classified depending on:

• The location of the fracture (the femoral shaft is divided into thirds: distal, middle, proximal)
• The pattern of the fracture (for example, the bone can break in different directions, such as cross-wise, length-wise, or in the middle)
• Whether the skin and muscle above the bone is torn by the injury

The most common types of femoral shaft fractures include:

Transverse fracture. In this type of fracture, the break is a straight horizontal line going across the femoral shaft.

Oblique fracture. This type of fracture has an angled line across the shaft.

Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture.

Comminuted fracture. In this type of fracture, the bone has broken into three or more pieces. In most cases, the number of bone fragments corresponds with the amount of force required to break the bone.

Open fracture. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture.

Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications — especially infections— and take a longer time to heal.

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

Most femoral shaft fractures require surgery to heal. It is unusual for femoral shaft fractures to be treated without surgery. Very young children are sometimes treated with a cast. 

Timing of surgery. If the skin around your fracture has not been broken, your doctor will wait until you are stable before doing surgery.

Open fractures, however, expose the fracture site to the environment. They urgently need to be cleansed and require immediate surgery to prevent infection.

For the time between initial emergency care and your surgery, your doctor will place your leg either in a long-leg splint or in skeletal traction. This is to keep your broken bones as aligned as possible and to maintain the length of your leg.

Skeletal traction is a pulley system of weights and counterweights that holds the broken pieces of bone together. It keeps your leg straight and often helps to relieve pain.

External Fixation. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.

External fixation is usually a temporary treatment for femur fractures. Because they are easily applied, external fixators are often put on when a patient has multiple injuries and is not yet ready for a longer surgery to fix the fracture. An external fixator provides good, temporary stability until the patient is healthy enough for the final surgery. In some cases, an external fixator is left on until the femur is fully healed, but this is not common.

Intramedullary Nailing. Currently, the method most surgeons use for treating femoral shaft fractures is intramedullary nailing. During this procedure, a specially designed metal rod is inserted into the marrow canal of the femur. The rod passes across the fracture to keep it in position.

An intramedullary nail can be inserted into the canal either at the hip or the knee through a small incision. It is screwed to the bone at both ends. This keeps the nail and the bone in proper position during healing.

Intramedullary nails are usually made of titanium. They come in various lengths and diameters to fit most femur bones.

Plates and Screws. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone.

Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend into either the hip or knee joints.

The information found on this site is for general orthopedic purposes only. In a medical emergency please dial 911 or go to your nearest Emergency Room.