What is a Femur Shaft Fracture?

A Femur Shaft occurs with a break of the thigh bone (the femur). Medically known as a Femoral Shaft Fracture, the shaft of the femur refers to any part of this long bone between right under the hip joint to just above the knee joint as the femur begins to widen. This area of the thigh bone is called the diaphysis, or middle of the femur. When the very top portion of the femur, the head or neck of the femur, is broken, this is considered a hip fracture. If the femur is broken at the lower end, the part that articulates with the knee joint, this will be considered a knee fracture. A femoral shaft fracture is managed and treated very differently than a hip or knee fracture.

A common tool used to categorize a femoral shaft fracture is the Winquist and Hansen Classification System. This system classifies a femoral shaft fracture based on the amount of comminution of the bone. A comminuted fracture is one in which the bone is broken in two or more places. The classification types are:

● Type 0: no comminution
● Type II: a small butterfly fragment that covers less than 25% of width of the bone. A butterfly fragment refers to a break in a bone in two oblique lines that meet forming a wedge piece of bone, resembling the wings of a butterfly
● Type III: larger butterfly fragment, covering up to 50% width of the bone
● Type IV: comminuted break with a large butterfly fragment of greater than 50% width of the bone
● Type V: severe comminution of the femoral shaft

Femur Shaft Fracture Causes

The causes of a Femur Shaft fracture are from a force being applied to the thigh that is stronger than the bone is able to withstand. This is generally the result of a high-impact collision. These causes may include:

● Falls, particularly in older individuals with other medical conditions that can lead to a weakening of bones, such as Osteoporosis
● Motor vehicle accident
● Direct trauma to the femur
● High impact and contact sports
● In children, child abuse is a possible cause

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Symptoms of a Femur Shaft Fracture

The symptoms of a Femoral Shaft Fracture may be one or all of the following:

● Severe pain in the thigh
● Swelling, erythema (reddening of skin) and warmth of the skin
● Possible visible deformity of femur/thigh
● A ‘pins and needles’ sensation that may extend down the leg into the feet and toes if nerves are involved
● Inability to bear weight on the affected leg
● In severe breaks, the bone may poke through the skin

Treatment for a Femur Shaft Fracture

The only way to definitively confirm if you have broken a bone in the thigh is through imaging techniques, starting with an x-ray of the area. After an initial consultation with your orthopedic surgeon, an x-ray will be ordered if a fracture is suspected. If it is confirmed that you have broken a bone in the femur, an MRI or CT scan of the femur may be ordered in order to look at the area in greater detail and determine if there was any soft tissue damage caused by the injury.

With a fracture, immobilization is key to allow for healing of the tissues. The majority of Femoral Shaft Fractures will require surgical intervention. Your thigh will be placed in the proper position in the case of a displaced fracture, and then will be placed in a cast or splint in order for healing to take place. Often, a reduced femoral shaft will be placed in a temporary, stabilizing a device called an external fixator. This device holds the femur in a proper position to allow for appropriate healing of tissues.

After a period of time and your doctor is confident that enough healing has occurred, your cast will be taken off and a course of physical therapy will be ordered to restore range of motion, strength, and function of the thigh.
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