Femur bone fractures are serious injuries that have far-reaching consequences. For the young and agile you need your thigh bone to run, jump and climb. While for the older, more fragile, you need your thigh bone for your independence when walking. Your femur is the longest and strongest bone in your body. In isolation a femur would make a fair weapon in prehistoric Flinstone battles used as a club or bat. A broken thigh bone is the result of a high force injury in the young or a bad fall in the older population. Femur fracture treatment includes surgical intervention. Physiotherapy is needed during femur fracture recovery.

An average build man of 176 cm weighing 90 kg will have a femur of 48 cm long and a diameter of 2.5 cm. Your femur can support 10 times your own body weight and even more when you do regular weight training.

Your femur is arguably the most important bone in your body, as it articulates with both your hip and your knee. Seen from the front in a skeleton model the golf ball like protrusion is called the femoral head, connected to the femoral neck at an angle that connects to the femoral shaft all the way down to the two condyles that are part of your knee joint.

Structurally your femur is designed to hold your body weight in standing. It stabilises your pelvis and hip to your knee when you move and transfer forces from the ground up when you jump, run and land. Your femur is an attachment site for many of your hip muscles, quadriceps, hamstring, adductors and gastrocnemius. Ligaments attach your femur to your acetabulum and tibia inside of your hip and knee joints.

Physiologically your femur contains bone marrow and stem cells and during childhood years contributes to blood production too.

Bones are elastic to a certain degree, which means that the tissue allows for some shape change, but much less than ligaments or muscles. A growing child’s bones would be more elastic than an adult’s. When the load applied exceeds the elastic capacity, tissue failure occurs. If the force from a fall or collision is greater than what your bone strength can absorb, it breaks.

Your bone density as well as the angle, movement direction and force determine if you end up with a femur fracture.

Your femur is the longest, heaviest and strongest bone in your body. It takes large forces to fracture this strong bone. Certain conditions, like osteoporosis, increase your risk of a broken thigh bone.

The following sporting disciplines have a higher incidence of femur fractures:

• racing (car or motorcycle)
• cycling
• rock climbing
• horse riding
• gymnastics
• base jumping
• parashooting

Even if you lead a less risky life, motor vehicle accidents, gun shot wounds or falling from a height can also cause a broken thigh bone.

Bruising, swelling, deformity and lack of movement after a fall or other trauma needs to be assessed as soon as possible.

Stress fracture

Femur stress fractures are tiny cracks in your femur bone caused by repetitive force, mostly from overuse. This will not necessarily be seen on a standard X-ray. Thigh pain of gradual onset that increases with training load can be caused by a femur stress fracture.

Avulsion fracture

Femur avulsion fractures occur when a muscle contraction is so forceful that a piece of the femur is pulled away from the bone.

Different types femur fractures

Femur fractures are classified by their location or pattern. To describe the location of a femur fracture the bone is divided into thirds, to indicate a distal (closer to your knee), middle, or proximal (closer to your hip) broken thigh bone.

The fracture pattern also describes the severity of your injury. Length, spiral, transverse or oblique indicate how the femoral shaft was fractured. A comminuted femur fracture describes when the bone has broken into three or more pieces.

Fractures in general are also described as stable or displaced, indicating if the fractured bone has moved, or open or closed, indicating if the skin has broken.

Our physiotherapists can distinguish a femur fracture from a stress fracture or avulsion fracture with a clinical evaluation. To determine the exact location and extent of your femur fracture you will need X-rays. We understand the physiological healing stages bone goes through. The rest of you don’t have to sit around and wait for your broken thigh bone to heal, we can give you alternative movement and exercise ideas that you can pursue throughout your recovery. By understanding your recovery you will be able to make responsible decisions. This enables you to avoid compensatory pathologies, like developing sciatica because you were limping too long.

X-rays show the integrity and alignment of your thigh bone. Transverse, spiral, oblique or comminuted femur fractures can be visualised on a standard AP view.

Your physiotherapist can refer you to get X-rays taken if necessary.

CT imaging shows cross-sections of your body, like flipping through a book when looking at a standing body from above. This can be used to determine any other damage to nerves or blood vessels if you suffered a femur fracture.

An MRI scan can image all of the structures in your thigh, including soft tissue, blood vessels and nerves. Your specialist may order this expensive image if you have any combined injuries from a traumatic incident. This may determine your doctor’s surgical plan.

Bone is living tissue and can heal. Osteoblasts, like Bob the Builder, and osteoclasts, like Pacman, are bone cells that continuously do maintenance work, by breaking down older cells and replacing them with newer cells.

To aid this physiological maintenance crew your femur fracture needs to be well aligned. This ensures that your osteoblasts will form a straight bridge to gap your femur fracture with callus formation. Callus is the temporary scaffolding that later becomes bone cells, good and strong as new! By walking too soon, without the necessary brace or backslab, you risk malunion. This is when the bone heals in an abnormal position and can lead to other issues later in life.

Non-union described when a fracture fails to heal within the normal time frame. This can happen due to delayed intervention or other metabolic conditions. More than a third of femoral neck fractures fail to unite if the injury caused displacement.

Avascular necrosis can occur when the blood supply to the femoral head is compromised. With femoral neck injuries up to 30% of people develop avascular necrosis. Tissue death leads to pain and limited movement, and finally collapse of the femoral head that results in a leg length discrepency.

Possible postoperative complications

The following postoperative complications are medical emergencies and require immediate treatment:

• infection
• compartment syndrome
• blood clots

Severe pain, swelling and redness should be checked by your doctor.

Malalignment and non-union

Routine checks by your surgeon and X-rays are required to keep track of your femur fracture healing and should not be missed. If for any reason healing happens at an angle or takes longer than anticipated your doctor needs to know so that the necessary investigations can be made.

Missed knee ligament injuries

With the high forces of a femur fracture, the knee ligaments could have been injured. Let your physiotherapist or doctor know if you experience knee pain during your femur fracture recovery.

Misuse of pain medication 

Pain medication has side effects, from being slightly bothersome, like constipation or heartburn, to drowsiness and addiction. Use only as prescribed.

Our physiotherapists can distinguish between stress, avulsion and femur fractures with a clinical evaluation. We understand how joints, muscles and nerves have to work in harmony to ensure stable and safe movement. Everything in your body is connected and can influence the function of other structures further away, maybe not immediately, but continued misuse can lead to problems later. We can provide the best treatment for your femur bone fracture. Our physiotherapists provide guidance and answers to your questions, while we implement an effective and structured plan of action for your 5th femur fracture recovery.

A femur fracture can take between 3 – 6 months to heal. It greatly depends on the severity of the fracture, other injuries and surgical intervention. You will need to do your exercises twice a day to maintain muscle tone, improve range of motion and later increase strength and endurance. Weekly physiotherapy for your femur fracture treatment is recommended to avoid complications.

• Your doctor will prescribe oral medication for pain relief, which can include anti-inflammatories, analgesics, opioids or muscle relaxants.
• An orthotist will supply you with crutches, braces or back slab if required. You will be taught to walk with crutches, with or without weightbearing, depending on your surgeon’s recommendation before you are discharged from the hospital. Make sure that you are confident climbing stairs with your crutches before being faced with them in the real world.
• Healing bones is hard work and requires nutrients, now is not the time to diet/fast. A dietician can give you guidance on what to include in your meals or supplementation.

Most femoral fractures require surgical intervention as soon as possible after the injury. This ensures that young, healthy patients recover faster while avoiding unnecessary bedrest and further complications for elderly patients.

Your unique circumstances will guide your orthopaedic surgeon’s decision about which surgical option is suitable for you.

External fixation

With multiple traumatic injuries, like a motor vehicle accident or gunshot wound, your femur fracture may not be the priority. External fixation can be used to stabilise the femur above and below the fracture site, with screws attached to a rod on the outside. At the same time, other interventions are prioritised or you regain strength. This is mostly a temporary intervention until other internal fixation options can be considered.

Open reduction with internal fixation

An intramedullary nail can be inserted from the hip above or the knee below. This ensures alignment of the bone ends, while “bridging the gap”. Intramedullary nails are usually stabilised with screws into the femur and nail itself.

A plate and screws can also be used to stabilise the fracture.

Hardware can be removed once the femur fracture has healed completely or left in place.

Total hip replacement

Total or partial hip replacement surgery may be needed if blood supply was compromised with your thigh bone fracture.

• Femur stress fracture

Thigh pain related to training intensity can cause tiny cracks in your femur known as a stress fracture.

• Avulsion fracture

A forceful muscle contraction can cause a bone fragment to break away from the attachment site and cause pain on specific movements.

• Osteoarthritis

Morning pain and stiffness that improve as you start to move is a telltale sign of osteoarthritis.

• Greater trochanteric bursitis

Hip bursitis is commonly accompanied by pain caused by compression, such as lying on one’s symptomatic side, or muscle contraction, such as climbing stairs or walking up a hill.

• Lumbar pathology

Discogenic pathology of the lumbar spine with resultant radiculopathy can cause hip pain or referral to the front of the thigh.

• broken thigh bone
• femur bone fracture
• supracondylar femur fracture
• femur shaft fracture
• neck of femur fracture