Broken Femur (Thighbone) | Symptoms & Causes
What are the symptoms of a broken femur?
- difficulty moving the leg
- inability to stand or walk
- pain or swelling in the thigh, possibly with bruising
- deformity (abnormal shape) of the thigh
- bone pushing out through the skin — sign of a severe fracture
What causes femur fractures?
Bones break when there’s more force applied to a bone than it can absorb. Fractures can occur from a fall, trauma, or direct blow.
Most childhood femur fractures result from:
- falling, for instance, from stairs or a jungle gym
- moderate to severe trauma that may happen in a car accident or during contact sports
Femur fractures in infants (up to 1 year old) are unusual, but can be caused by:
- osteogenesis imperfecta and other medical conditions that cause weak bones
- a very difficult delivery
- child abuse
Broken Femur (Thighbone) | Diagnosis & Treatments
How is a broken femur diagnosed?
A doctor will use different diagnostic tests to get detailed images of your child’s fracture. Typical tests include:
- x-ray
- magnetic resonance imaging (MRI)
- computed tomography scan (CT, CAT scan)
- bone scan
How is a broken femur treated?
Your child’s treatment for a broken femur will depend on their age and how seriously the bone is broken. Some broken femurs can be treated with reduction and casting, while others require an operation and fixation.
Closed reduction
A closed reduction is a procedure to manipulate and set (reduce) the fracture. Using an anesthetic, typically given through an IV, the doctor realigns the bone fragments from outside the body.
Casting
After reduction or surgery, your child will be put in a spica cast to hold the bone in place while it heals. If your child has surgery, the spica cast will also hold the hip or thigh muscles in place while they heal.
Types of spica casts used to treat broken femurs:
From left: unilateral hip spica, one and one-half hip spica, and bilateral long leg hip spica cast
- Unilateral hip spica cast — starts at the chest and extends down to the ankle of the injured leg, leaving the uninjured leg free from a cast.
- One and one-half hip spica cast — starts at the chest and extends down to the ankle of the injured leg and to the knee of the other leg. Sometimes a bar is placed between both legs to keep the hips and legs immobilized and aid in lifting the child.
- Bilateral long leg hip spica cast — starts at the chest and extends to the ankles of both legs. Sometimes a bar is placed between the legs to keep the hips and legs from moving.
Once the cast is removed, your child may need a brace and physical therapy to strengthen their muscles and regain flexibility in their joints.
What are the surgical options for a broken femur?
Depending on the severity of the fracture, the surgeon may recommend one of the following procedures.
- Internal fixation: In severe or complicated fractures, a surgeon may insert metal rods or plate and screws into the femur to hold the fractured bone in place while it heals.
- External fixation: If internal fixation is not an option, metal pins can be inserted through skin into the fractured bone. These pins are attached to a bar that sits outside the skin on the child's thigh. The pins and bar hold the bone fragments in place and the bone in alignment while it heals.
- Intramedullary nails or rods: The surgeon may make small incisions in the skin and insert nails into the bone. The nails realign the bone and hold it in place while still allowing growth and natural remodeling.
How we care for broken femurs at Boston Children’s Hospital
Every year the Orthopedics and Sports Medicine Center at Boston Children’s Hospital treats thousands of children, adolescents, and young adults with fractures of all complexities. Our pediatric expertise allows for precise diagnosis of conditions related to the growing musculoskeletal system and development of optimal care plans.
Our Orthopedic Urgent Care Clinic treats patients with orthopedic injuries that require prompt medical attention but are not serious enough to need emergency room care. We offer urgent care services in four locations — Boston, Waltham, Peabody, and Weymouth.