Shoulder Pain and Weakness Due to Rotator Cuff Muscle/Tendon Or Biceps

Femur Fractures

General

The femur is the thigh bone which extends from the hip joint down to the knee joint. The femur is a very strong bone and tremendous force may be required to cause fracture of the femur. The femur is the largest and strongest bone in the body.

Femur fractures are caused by a great force being applied to the femur, either a bending force or a twisting force. The most common causes of femur fractures in the United States are motor vehicle accidents and falls from a height. Lower energy injuries may cause a femur fracture if the bone has been weakened by conditions such as osteoporosis, infection, or tumor, and when this happens it is referred to as a “pathologic fracture”. Femur fractures are divided according to anatomic location.

. Fractures at the upper end of the femur are referred to as “hip fractures”, and they are discussed in another area in this website. . Fractures of the femoral shaft involve the long tubular portion of the femur between the upper end and the lower end of the femur, and these are the fractures generally requiring higher energy for occurrence. . Fractures of the femur just above the knee are referred to as “supracondylar femur fractures;” see more information below.

Treatment

Fractures of the femoral shaft are usually treated with surgery. The most common treatment is to insert a metal rod down the hollow tubular center of the thigh bone and this is called an intramedullary rod. This procedure aligns and reconnects the two ends of the bone, and may be used when there is significant shattering of the bone. Usually the rod is secured in place with screws passing through the femur and the rod, both above and below the level of the fracture. The rod remains in place until after healing, and it can be removed later if it bothers the patient.

Alternative treatments for femur fracture include using a plate and screw fixation applied through a surgical incision or an external fixator. The external fixator is a bar that is located above the surface of the skin and there are screws attached to the bar which go through the skin and into the bone that hold the fracture into position. Different kinds of fractures may best be treated with either a rod, a plate, or an external fixator, and different surgeons have individual preference on which appliance to use to fix the fracture.

Surpacondylar Femur Fractures

Supracondylar femur fractures are fractures involving the bone just above the knee joint. Often the fracture extends into the cartilage surfaces of the knee joint, and must be treated in such a way that the normal contour of the cartilage of the joint is restored as well as possible. In this way, the probability of patients having later arthritis in the involved joint is reduced.

Supracondylar femur fractures are more likely in patients who have osteoporosis and in patients who have had prior artificial knee replacement surgery. Such patients have bone which is often weaker than in normal patients, and therefore is more likely to fracture.

Femur Fractures

High energy crashes, such as motorcycle accidents, may also result in supracondylar femur fractures in individuals with normal bone strength.

The treatment of supracondylar femur fractures is often with surgery and is tailored to the exact pattern of the fracture and the overall surgical risk for the patient. Orthopedic appliances for this fracture include rods inserted from the knee end of the femur, plates with locking screws, screws used alone, and external fixators. Some are treated most effectively without surgery by putting the entire leg in a long cast. The treating surgeon judges what treatment will give the best outcome for the patient.

Risks

The risks of surgery on femur fractures include but are not limited to infection, nerve and blood vessel injury, bleeding, failure to achieve union of the bone fragments, blood clots (deep venous thrombosis), and blood transfusions. Also, malrotation of the femur is a risk.

Postoperative Instructions

Management of the patient during the healing period is adjusted to the severity of the injury and the method of treatment. Generally, patients treated with intramedullary rods can be mobilized on crutches with toe-touch or partial weight bearing, and progress their weight bearing on the foot as the fracture heals. The treating surgeon will monitor the healing observed on x-ray pictures taken on visits to the surgeon’s office and will make recommendations to the patient based on the progressive healing of the fracture. Generally, the duration from injury to healing is three to six months.

Femur Fractures in Children

Fractures of the femur or thigh bone in children are relatively common and usually occur in the mid portion of the shaft of the femur bone. They may occur as a result of a high energy injury such as a motor vehicle accident or a twisting injury when falling off of a bed. Other causes include contact sports and child abuse.

The symptoms of a thigh bone fracture are usually obvious. The child experiences severe pain and deformity and disability, is unable to walk, and the pain is often made worse by movement.

Treatment

Treatment of thigh bone fractures in children include: . Placing the child into a hip spica cast. . Use of surgical pinning. . Use of external fixator.

Children between the ages of newborn and seven years are often treated in a spica cast, which is a body cast from just below the armpits, down to the toes on the side of the broken leg, and to just above the knee on the side of the unbroken

Femur Fractures

leg. It is cut out at the groin, to allow for elimination of body wastes and for cleaning. In young children, the duration of casting may be as short as two months and as long as four months in older children. A second method for treating femur fractures is surgical pinning; putting flexible pins down the hollow tube of bone thus holding the bones aligned end-to-end. This is somewhat similar to the intramedullary rodding described above, except that these pins are kept away from the growth areas at the ends of the bones.

A third method of treatment, used especially in older children who have not yet finished growing, is to use an external fixator. The external fixator is a bar device running along side of the thigh above the level of the skin and has screws attached to it which penetrate the skin and anchor into the thigh bone above and below the fracture. The duration of external fixation can be as long as four to five months, as the patient gradually increases his or her activity and is able to walk on the affected extremity.

The risks of femur fractures in children include shortening, malrotation, and imperfect alignment of the femur bone. Small amounts of imperfect rotation, length, and alignment are tolerated very well and not noticed by the patient but, if the surgeon decides that the position of the fracture observed at follow-up appointments is imperfect, he might recommend repositioning the fracture.