Thigh Bone Fractures: Overview

Thigh Bone Fractures: Overview

This video will provide an overview of breaks in the thigh bone, also called thigh bone fractures. The thigh bone, or femur, is the largest bone in the body. Its parts can be divided into several sections: the top, called the proximal portion; the shaft, or middle third; and the end, called the distal portion.

The thigh bone can be broken in any of these locations; however, the focus here will be on breaks in the middle portion of the bone, also called femoral shaft fractures. The thigh bone is not only the largest but also the strongest in the body. It is a powerful lever that allows for weight-bearing and movement. It helps form the hip and knee joints and is an attachment site for many muscles. Critical blood vessels and nerves surround the bone, complicating these injuries. Blood loss from a femoral shaft fracture can total more than 1.5 liters, equal to just over 6 cups.

Given the critical importance of the femur and nearby structures, early and expert management provides the best chance at a successful outcome. Femoral shaft fractures occur in 10 per 100,000 persons per year and are most seen in 2 age and gender distributions: young males and elderly females. In young patients, the most common causes are high-energy traumas such as motor vehicle accidents. In elderly patients, low-energy traumas, such as falls from a standing height in the setting of preexisting osteoporosis are often a cause.

Another type of thigh bone fracture that may occur in this population is an atypical femur fracture, or A F F. These fractures can occur in the shaft of the bone. AFFs generally occur without a fall or trauma and have been associated with the long-term use of certain osteoporosis medications. Despite the widespread use of these medications, the incidence of AFFs is low with their use. If a patient sustains a fracture because of poor bone quality, they are at higher risk for developing another.

Prevention strategies for low-energy femur fractures in elderly patients include fall prevention measures such as removing tripping hazards and installing grab bars for support. Other beneficial prevention measures are smoking cessation, regular balance and strength training, and ensuring appropriate calcium and vitamin D intake. Traditional thigh bone fractures may present with classic symptoms of pain, bruising, or swelling. The injured leg may appear shorter than the noninjured side.

As their name suggests, atypical fractures may present differently. Thigh pain, that is worse with walking, may be present for weeks, indicating a fracture has occurred or is soon to occur. This is called an impending fracture. X-rays should be considered in this situation as subtle changes may be seen in the edge of the bone, indicating that a fracture could occur and treatment is needed. If a femur fracture is suspected, this requires immediate medical attention in the emergency department.

An x-ray is ordered to confirm the diagnosis of a femur fracture. Additional imaging, such as a CT scan may be ordered ahead of surgery. MRI imaging may be ordered in the setting of a suspected atypical femur fracture or to identify other soft-tissue injuries to nearby joints. Once the diagnosis is confirmed, a treatment plan will be discussed.