The femur (thigh bone) is the longest and strongest bone in the body. However, it may be broken if subjected to strong forces as in car accidents and falls from heights. The shaft of the bone is the long cylindrical part of the bone, and fractures in this location is different from fractures in the upper part of the bone.
Fractures of the femoral shaft can be classified according to the shape of the fracture and amount of shattering. It can also be classified into closed fractures with intact overlying skin and open fractures in which a wound in the skin lead to the fracture site.
The symptoms of this fracture are very obvious as the patient suffers from severe pain and inability to move or stand on his affected limb. Also, swelling and bruising develop in the thigh with shortening of the affected limb compared to the sound limb.
X-rays are used to confirm the diagnosis and to determine the shape of the fracture which will help choose the appropriate method of treatment.
In adults, the vast majority of these fractures are treated surgically, as non-surgical treatment will require a long time with the patient lying in bed. This can lead to complications such as bed sores, venous thrombosis and stiffness of the knee. Also, the bone in these cases will heal in a deformed, shortened position.
Methods of fixation:
- Intramedullary nails (rods): This is the preferred method of treatment in most cases as it allows fracture fixation without the need to open a wound over the fracture site, thus maintaining the blood supply to the bone to allow faster union. It also allows early weight bearing.
In these cases a long rod is inserted into the medullary canal of the bone. Additional screws may be added in the upper and lower parts of the bone to maintain the length of the bone and prevent rotation of the fragments until healing takes place.
- Plates and screws: This is more suitable for patients aged below 18 years in which there is remaining growth. This may require making an incision over the fracture site.
- External fixators: Multiple pins are inserted through the skin into the bone above and below the fracture. These pins are connected outside of the body by a metal bar to maintain the position of the bone. External fixators are used mainly to treat open fractures.