Sports Medicine
Sports Injury Prevention & Rehabilitation

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Femoral Shaft Fracture

(Also known as Fractured Femoral Shaft)
What is a femoral shaft fracture?
A femoral shaft fracture is a condition characterized by a break in the shaft of the femur (thigh bone).
The femur is the anatomical name given to the long bone of the thigh. It is the largest and strongest bone in the body.
Following a fall or due to a direct blow to the thigh, stress is placed on the femur. If these forces are excessive and beyond what the femur can withstand, a break in the shaft of the bone may occur. When this occurs the condition is known as a femoral shaft fracture and can vary from a small undisplaced fracture to a severe displaced (and/or comminuted) fracture with obvious deformity.

Cause of a femoral shaft fracture
Due to the strength of the femoral bone, a femoral shaft fracture usually requires a large amount of force. This typically occurs due to a fall (usually from a height, and often onto a hard surface) or due to a direct blow to the femur such as a motor vehicle accident. Occasionally a femoral shaft fracture may occur with minimal force in patients who have weakened bones due to other conditions such as osteoporosis or malignancy.

Signs and symptoms of a femoral shaft fracture
Patients with a femoral shaft fracture typically experience a sudden onset of sharp, intense thigh pain at the time of injury. In severe cases, particularly involving a displaced fracture of the femur, weight bearing will be impossible. Pain is usually quite severe and may be felt on the front, back or sides of the thigh. In less severe cases, pain may settle quickly with rest, leaving patients with an ache at the site of injury which may be particularly prominent at night or first thing in the morning. Occasionally patients may experience symptoms in the hip, buttock, knee, lower leg, ankle of foot.
Patients with a femoral shaft fracture may also experience swelling, bruising and pain on firmly touching the affected region of the thigh. Pain may also increase during certain movements of the hip or knee, when sitting or when attempting to stand or walk (particularly up hills or on uneven surfaces), or, when attempting to run. In severe femoral fractures (with bony displacement), an obvious deformity may be noticeable. Occasionally patients may also experience pins and needles or numbness in the thigh, knee, lower leg, ankle or foot.

Diagnosis of a femoral shaft fracture

A thorough subjective and objective examination from a doctor is essential to assist with diagnosis of a femoral shaft fracture. An X-ray is usually required to confirm diagnosis and assess the severity. X-rays taken should include the entire length of the femur, as well as the hip and knee, as these structures may also have been affected at the time of injury. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of the injury.

Treatment for a femoral shaft fracture
For those femoral shaft fractures that are displaced, treatment typically involves anatomical reduction (i.e. re-alignment of the fracture using traction and careful manipulation under anaesthetic) followed by surgical internal fixation to stabilize the fracture (using rods or plates and screws). This may be followed by the use of a protective splint or brace, plaster cast, and/or crutches for a number of weeks. Sometimes a femoral fracture may be managed with an external fixation device, or sometimes, conservatively with a continuous weighted traction device over a number of weeks.
  • For those fractures that are not displaced, treatment may involve the use of crutches and a protective splint or brace, or, plaster cast immobilization and the use of crutches, followed by the use of a protective splint or brace for a number of weeks. The orthopaedic specialist will advise the patient as to which management is most appropriate based on a number of factors, including the location, severity and type of femoral shaft fracture.
  • Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed, rehabilitation and mobilization can progress as guided by the orthopaedic surgeon and the treating physical therapist.
  • One of the most important components of rehabilitation following a femoral shaft fracture is that the patient rests sufficiently from any activity that increases their pain (crutches are often required). Activities which place large amounts of stress through the femur should also be avoided, particularly excessive weight bearing activities such as running, jumping, standing or walking excessively (especially up hills or on uneven surfaces), lifting or carrying, or, sitting on a chair with the thigh hanging over the edge. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities and weight bearing is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physical therapist.
  • Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the femoral shaft fracture altogether.
  • Patients with a fractured femur should perform pain free flexibility, strengthening and balance exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as balance, soft tissue flexibility and strength are quickly lost with inactivity. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
  • In the stages following confirmation of fracture healing, manual "hands-on" treatment from a therapist, such as massage, trigger point release techniques, dry needling, joint mobilization, stretches and electrotherapy, can assist with improving range of movement, pain and function, and assist with hastening return to sport or activity.
  • In the final stages of rehabilitation for a femoral shaft fracture, a gradual return to activity or sport can occur as guided by the treating physical therapist provided there is no increase in symptoms. This may involve a gradual return to running program followed by acceleration, deceleration and change of direction drills before commencing training and eventually match play.

Prognosis of a femoral shaft fracture
Patients with a femoral shaft fracture usually make a full recovery with appropriate management (whether surgical or conservative). Depending on the severity of the fracture (and the type of activity), return to activity or sport usually occurs between 3-12 months. This should be guided by the treating physical therapist and specialist. In patients with severe injuries involving structural deformity or damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged.

Physical therapy for a femoral shaft fracture

Physical therapy treatment is vital in all patients with a femoral shaft fracture to hasten healing and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • dry needling
  • the use of a protective brace
  • the use of crutches
  • exercises to improve strength, flexibility, core stability and balance
  • hydrotherapy
  • education
  • activity modification advice
  • a graduated return to running / activity plan
  • footwear advice

Other intervention for a femoral shaft fracture
Despite appropriate physical therapy management, some patients with a femoral shaft fracture do not improve adequately and may require other intervention. The treating physical therapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, periods of plaster cast immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured femur. Occasionally, patients with fractures that are initially managed without surgical intervention may require surgery to stabilize the fracture and a bone graft to aid fracture healing.