Let's learn about Broken Femur? Don't be afraid, let's talk!

Oh, imagine what it would be like if that big, strong bone in your leg, from your hip to your knee – the femur – broke! It can be a very painful experience. The femur is the longest, heaviest, and strongest bone in our body. So, for it to break, it would have to be a really big force, a really big accident. If you break a femur, it is essential to seek medical attention right away. Because it can take months to heal. So, let’s talk about this in a little more detail, shall we?

What is the femur? What happens when it breaks?

Simply put, the femur is the only bone in your thigh. As we mentioned earlier, it is the largest and strongest bone in our body. Therefore, it is not a trivial matter to break it. It is usually very rare to break it from a minor fall. It is most often broken by something like a major car accident, a fall from a height, or a gunshot wound.

However, especially for people over the age of 65, if they slip and fall even just while standing, their bones are less strong (especially if they have conditions like osteoporosis), so the chances of breaking this femur are higher.

Why is this femur fracture such a serious injury?

When you break a femur, it's not just like breaking an arm or a leg. There are a few things that can be a little more serious. Take a look:

• There can be a lot of bleeding: Especially if the bone fragments break through the skin (this is called an ``open fracture''), a lot of blood can escape from the body. Sometimes, bleeding can even occur internally.
• Shock: The body can go into shock due to excessive bleeding and pain.
• The hip bone can break: If the top part of the thigh bone, that is, near the hip joint, breaks, the hip bone can break along with it. This risk is higher in people with osteoporosis.
• Knee damage: If the lower part of the thigh bone, that is, near the knee, breaks, the knee can also be damaged. This is also common in people who have had knee replacement surgery or those who have osteoporosis.

How much pain does it feel if you break your thigh bone?

Oh my! That is a very painful thing. It is difficult to describe in words. But don't worry, after you are admitted to the hospital, the doctors will definitely give you the necessary medication to control your pain.

What are the symptoms of a broken femur?

If you fall or injure your hip in another accident, look out for these symptoms:

• The pain is unbearable .
• You can't even put your injured leg down or put weight on it .
• Sometimes, broken bone fragments can break through the skin and bleed . This is called an ``Open fracture``.
• Other times, bone fragments may protrude above the skin's surface and be visible, but do not break through the skin . This is called a ``closed fracture''.
• The thigh area is blue and bruises are visible .
• Some areas in the thigh area are swollen .
• The injured leg may appear slightly shorter than the other leg. The injured leg may also be turned outward (away from your body) .

Can you walk with a broken thigh bone?

Absolutely not. Once your femur is broken, you won't be able to put weight on that leg or stand on it. So don't even think about walking.

How do doctors diagnose this type of hip fracture?

When you go to the hospital, the doctors will first examine your injured leg carefully. Then, they will definitely do an `(X-ray)` test. Sometimes, a `(Computed Tomography scan)`, also known as a `(CT scan),` may also be done to see the nature of the fracture more clearly. It is from these tests that the doctors can determine exactly what kind of fracture (`(fracture type)`) you have.

There are several types of femur fractures:

• Transverse fracture: The bone is broken in a horizontal line across it.
• Spiral fracture: The bone is broken in a spiral shape.
• Oblique fracture: The bone has broken across the side.
• Comminuted fracture: The bone has broken into three or more pieces.
• `(Open or compound fracture)` (Open fracture): The bone has broken and the bone fragments have pierced the skin and come out.

How is a femur fracture treated?

First, to reduce pain and keep the broken bone from moving, doctors may put a splint, a type of board, around your hip, covering most of your leg. This is a temporary measure.

In addition, a treatment called `(traction)` is also used. This helps to keep the broken bones in proper alignment. There are two types of `(Traction)`:

• `(Weighted traction splints)`: This involves attaching a strap to your ankle, attaching weights to it, and slowly pulling it through a frame and pulley. This applies gentle pressure to the femur, helping to keep the bones aligned.
• Skeletal traction: In this, the doctor performs a minor operation and inserts a pin into your thigh bone (femur) or shin bone (tibia). Then, a weight is attached to the pin to keep your thigh bone straight.

Does every hip fracture require surgery?

Yes, absolutely. If you break your thigh bone, you will need surgery to make it heal properly. This surgery is usually done within 24 to 48 hours after you are injured and admitted to the hospital. Doctors mainly perform two types of surgery:

• `(Open Reduction and Internal Fixation - ORIF)`
• `(External fixation)`

What is this `(ORIF)` surgery?

In this procedure, the surgeon makes an incision near your hip or knee joint and realigns the broken bone fragments. Then, a metal device (e.g., a rod or plate) is inserted to stabilize the bone.

What metal instruments are used in this `(ORIF)` surgery?

• Rods: These are used in a surgical procedure called an intramedullary nail. The surgeon inserts these rods into your leg, through the medullary cavity (this is where the bone marrow is).
• Screws: To keep the previously mentioned stick or metal plate from moving, screws are placed on top and bottom of it.
• Metal plates: Similar to a splint, the surgeon places these metal plates on the outside of the bone and secures them with screws to stabilize the fracture.

So what is ``(External fixation)`` surgery?

This is also a surgery to stabilize the thigh bone. This involves inserting several metal pins (bolts/pins) into your thigh bone and attaching them to a frame (frame) on the outside of your leg. Sometimes, this procedure is used to temporarily stabilize the bone before ORIF surgery. Or, it can be used when the injury is too severe to perform ORIF surgery.

This ``(External fixation)`` surgery is performed under anesthesia. Surgeons drill holes in the undamaged bone above and below the fractured part of your thigh bone and insert rods into them. These rods are attached to a frame on the outside of your leg. The ``(ball-and-socket joints)`` in this frame allow the rods to be adjusted so that the broken bone fragments line up exactly.

Is physical therapy necessary after surgery?

Absolutely! You will need physical therapy throughout your recovery. This will strengthen your leg muscles, restore joint mobility, and help you walk normally again.

Do you provide painkillers?

Yes, your doctor will discuss your pain and prescribe appropriate pain medication.

What are the risks or complications that may arise from these surgeries?

As with any surgery, surgery for a hip fracture can have some complications. These include:

• Acute compartment syndrome (ACS): This is when pressure builds up in the muscles and blood flow to the muscles and tissues is reduced. This can lead to permanent muscle and nerve damage.
• Bone fragments not fitting together properly: This can cause the bone to heal incorrectly.
• Discomfort caused by inserted nails and screws.
• `(Fat embolism syndrome)`: In this, fatty particles can accumulate in the blood. Symptoms such as difficulty breathing and loss of consciousness can occur.
• Blood clots.
• Sharp edges of broken bone fragments can cut or damage blood vessels or nerves.
• Infection.

How should I take care of myself after surgery?

For the first two weeks, it is essential to have someone at home to help you. (Your doctor can help you find a trained caregiver to come to your home and help you.)

When you sleep, you should sleep upright with the broken leg elevated above your heart . Sleeping this way can help reduce swelling in the broken leg.

As you gradually recover, you will want to move around the house on your own. However, ask your doctor how much weight you can put on your leg. You may need to use a cane, crutches, or a walker. Your physical therapist will show you how to use them.

The most important thing is to be careful not to fall again! If you fall again, you can re-injure your femur. To minimize falls, do these things:

• If your bedroom and bathroom are upstairs, set up a temporary sleeping area and a portable commode downstairs. That way, you won't have to climb up and down the stairs.
• Remove things that you might get tangled in, such as wires on the floor or small rugs.
• Install handrails in the bathroom, whether in the bathtub or shower, or near the toilet.
• Install handrails on both sides of the stairs.
• Light your home well, whether by adding more lights or using brighter bulbs.
• Keep the things you use frequently in cabinets that are easy to reach without having to climb up a chair to get them.
• Place non-slip mats on the bathroom floor.

How long does it take to heal a broken thigh bone?

It can take four to six months to fully heal. Sometimes it can take longer, depending on the nature of the fracture, your age, and your overall health.

Why does it take so long to heal? Because a broken femur goes through a natural healing process. It has several stages:

• Days 1-5: When your thigh bone breaks, the blood vessels that supply it with blood also break. These broken blood vessels cause a ``hematoma,'' a blood clot, to form at the site of the fracture. This blood clot acts as a temporary framework and helps your bone heal. Your immune system responds to this injury by activating cells that remove damaged tissue and cells that stimulate healing.
• Days 5-11: Your body begins to build a network of cartilage between the broken bone fragments. It also begins to form new bone (woven bone).
• Days 11-28: That cartilage network gradually thickens. New blood vessels and more new bone are forming. As this process continues, your bone begins to repair itself again, eventually becoming normal bone. This entire process can take months, even years.

How can I prevent a broken femur?

Unfortunately, the events that cause a broken femur (such as car accidents, falls, gunshot wounds) are difficult for us to control.

However, people who are at higher risk of falling as they age (especially those over 65) need to be careful. They can fall and get injured even while just standing.

If you are over 65 and have a fear of falling, ask your doctor about your risk of falling. Tell him or her if you are taking any medications that make you feel sleepy or dizzy. Your doctor may recommend things you can do to reduce your risk. For example, they may recommend exercises that strengthen your legs and improve your balance.

When should I see my doctor?

You will be given follow-up appointments to see your doctor, starting two weeks after surgery, and every few weeks thereafter. Be sure to go to each appointment.

If you have any questions about the progress of your recovery or specific issues, such as pain management, be sure to talk to your doctor about them.

When should I call my doctor or seek emergency medical attention?

While recovering from a broken hip, if you have any of these symptoms , call your doctor immediately or go to the nearest hospital:

• Difficulty breathing or chest pain when breathing.
• Frequent urination or burning sensation when urinating.
• Redness or increased pain around the surgical wound.
• A pus-like fluid is leaking from the wound.
• Swelling in one leg (it will be red and feel warmer than the other leg).
• Calf pain.
• Fever over 101°F (38.3°C).
• A pain that your painkillers can't control.
• If it suddenly becomes difficult to walk or put weight on your leg.

What questions should I ask my doctor?

A broken hip is a serious injury that requires emergency medical treatment. After addressing your immediate needs, it's a good idea to ask your doctor these questions:

• Will I need more surgery?
• When should I start physical therapy?
• What should I do to control my pain?
• When will I be able to walk?
• When will I be able to go back to my office or workplace?

Can pain still occur years after a broken femur has been treated?

Unfortunately, yes. Even after your fracture heals, you may still have pain in that area. This is called chronic pain. There can be several reasons for this:

• Nerve damage from the original fracture or treatment.
• Scar tissue.
• Arthritis.
• Nonunion is the failure of the bones to fit together properly.

This chronic pain can be reduced or eliminated with physical therapy, exercise, and medication.

The most important things to remember (Take-Home Message)

Okay, so we've talked a lot about a broken femur. Remember, although this is a serious injury, with proper medical care and your dedication, you can recover well.

The secret to a speedy recovery is to follow medical instructions exactly, do physical therapy exercises as directed, and be patient.

If you have any further questions about this condition, don't hesitate to talk to your doctor. Wishing you a speedy recovery!

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