Femur, fracture of

The symptoms, treatment, and possible complications of a fracture of the femur (thigh-bone) depend on whether the bone has broken across its neck (the short section between the top of the shaft and the hip joint) or across the shaft. Fracture of the neck of the femur, often called a broken hip, is very common in elderly people, especially in women with osteoporosis, and is usually associated with a fall. In a fracture of the neck of the femur, the broken bone ends are often considerably displaced; in such cases there is usually severe pain in the hip and groin, making standing impossible. Occasionally, the broken ends become impacted. In this case, there is less pain and walking may be possible. Diagnosis is confirmed by X-ray. If the bone ends are displaced, an operation under general anaesthesia is necessary, either to realign the bone ends and to fasten them together, or to replace the entire head and neck of the femur with an artificial substitute (see hip replacement). If the bone ends are impacted the fracture may heal naturally, but surgery may still be recommended to avoid the need for bed rest. Complications include damage to the blood supply to the head of the femur, causing it to disintegrate. Osteoarthritis may develop in the hip joint after fracture of the femur neck itself. However, immobility and the need for surgery in the elderly may result in complications, such as pneumonia, that are not directly related to the fracture site. Fracture of the bone shaft usually occurs when the femur is subjected to extreme force, such as that which occurs in a traffic accident. In most cases, the bone ends are considerably displaced, causing severe pain, tenderness, and swelling. Diagnosis is confirmed by X-ray. With a fractured femoral shaft there is often substantial blood loss from the bone. In most cases, the fracture is repaired by surgery in which the ends of the bone are realigned and fastened together with a metal pin. Sometimes the bone ends can be realigned by manipulation, and surgery is not necessary. After realignment, the leg is supported with a splint and put in traction to hold the bone together while it heals. Complications include failure of the bone ends to unite or fusion of the broken ends at the wrong angle, infection of the bone, or damage to a nerve or artery. A fracture of the lower shaft can cause permanent stiffness of the knee.