Thigh Bone Fractures: Treatment Options

Thigh Bone Fractures: Treatment Options

This video will discuss the treatment options for thigh bone fractures, both with and without surgery. The thigh bone, or femur, can be broken in many different areas. Depending on the area, the treatment options will vary. Here, the discussion will focus specifically on fractures to the middle portion of the bone, also known as the femoral shaft. The mainstay for the treatment of thigh bone fractures is surgery. However, treatment without surgery is occasionally required in situations when surgical resources are limited or when patients are too frail for surgery.

Long leg casting may be used for treatment in this circumstance. Before surgery became the mainstay of treatment, treatment without surgery consisted of splinting and traction. However, this came with significant complications. The Thomas splint was introduced in 1916 during World War I, which greatly improved the chance of patients recovering from this injury. It was not until 1939 that the tide began to shift to surgical treatment. It was then that the first stainless steel bone nail implant was made to treat these fractures. With these advances, femur shaft fractures are treated with much more success despite their serious nature.

Patients are treated in a hospital setting, almost always starting treatment in the emergency room. Emergency surgery may be required for fractures that have come through the skin or have damaged nearby vessels. A condition called compartment syndrome, in which there is an extreme buildup of pressure in the leg, also requires immediate surgery. To stabilize the injury emergently, an external fixator also may be needed, which uses pins in the bone attached to rods outside the leg to hold the bones in place until a final surgery can be performed. If emergent surgery is not required, femur fractures are treated within 24 to 36 hours for the best outcomes. Traction devices may be used during this period to stabilize the fracture.

Speaker1: Surgery for thigh bone fractures most often requires a bone nail. Bone nails are also called intramedullary nails. These are metal rods that sit within the center portion of the bone, called the medullary canal. They are often locked in place with screws, which aid in providing internal stability and support to a healing bone. They may be inserted either through the top of the thigh bone near the hip or the bottom of the thigh bone near the knee. Most often, nails are placed through the top of the thigh bone.

However, putting the nail through the bottom of the thigh bone may be preferred because of the patient's individual anatomy or situations where there are other injuries to the top of the thigh bone, such as a hip fracture. A plate and screws may be used in some circumstances when screws cannot be used because of existing implants, wires or flat suture may be used to anchor the fracture against the plate. Following surgery with bone nailing, patients will remain in the hospital for monitoring. Depending on the injury, the surgical team will determine if the patient can place weight on the leg immediately after surgery. One advantage of bone nails is that they are strong enough to allow immediate weight-bearing in most fracture types.

Physical therapy is ordered during the recovery process to assist with range of motion, strength, and walking. Bone nails typically stay with the patient for life. However, the nail and/or screws can be removed if necessary. One of these uncommon situations is if the bone does not heal and more surgery is needed. To improve healing and outcomes after surgery, it is important to stop smoking, eat a well-balanced diet, and control other conditions that may impact bone healing, such as diabetes.