Overview

The femur bone runs from the hip to the knee and is the longest and strongest bone in the body. It usually requires a great deal of force to break the femur bone.

A femur fracture is usually caused by direct trauma to the bone. Trauma includes:

• falls
• blows
• collisions
• severe twists

Risk factors that increase your chances of fracturing your femur include:

• advancing age
• postmenopause
• decreased muscle mass
• certain diseases that weaken bones, such as osteoporosis or cancer
• participation in certain contact sports, such as football

Diagnosis

The doctor will ask about your symptoms, physical activity, and how the injury occurred, and will examine the injured area.

Tests may include x-rays, which use radiation to take a picture of structures inside the body, especially bones. X-rays are used to look for a break in the bone.

Treatment Options

Treatment will depend on the severity of the injury. Treatment involves:

• putting the pieces of the bone back in position, which may require anaesthesia and/or surgery
• keeping the pieces together while the bone heals itself

Devices that may be used to hold the bone in place while it heals include:

• a cast which is rarely used and only in young patients
• a metal plate with screws (requires surgery)
• a rod down the middle of the bone (requires surgery)
• metal pins that cross the bone, with a frame on the outside of the leg that holds the pins and the fractured bone in place (requires surgery)

Your doctor will order additional x-rays while the bone heals to ensure that the bones have not shifted position. A fractured femur is a serious injury that takes three to six months to heal.

When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises. Do not return to sports until your leg is fully healed and your thigh muscle strength is back to normal.

Prevention

To help prevent femur fractures:

• Do not put yourself at risk for trauma to the femur bone.
• Eat a diet rich in calcium (pdf file) and vitamin D.
• Build strong muscles to prevent falls and to stay active and agile.
• Always wear a seatbelt when driving in a car.
• Wear proper padding and safety equipment when participating in sports or activities.

How can I prevent a femoral fracture?

Since femoral fractures are nearly always results of falls or other accidents, there is not much that can be done to prevent them. However, there are steps you can take to aid in the prevention of fractures:

• Eat a diet rich in calcium and vitamin D.
• Build strong muscles to prevent falls and stay agile.
• Wear proper padding and safety equipment when participating in sports or activities.

Improving sports performance

The key to improving sports performance after recovering from a femoral fracture is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.

The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.

Benefits derived from stretching include:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• decreased risk of lower-back pain
• reduced stress
• enhanced enjoyment

Rehabilitation exercises

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.

When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises.

Remember: Do not return to sports until your leg is fully healed. The major objectives of rehabilitation from a femoral fracture are to improve the strength of the leg and gradually increase pain-free range of motion.

Exercise will keep your joints from becoming stiffer, and it strengthens the muscles surrounding the joints. Strong muscles provide needed support, making movement easier and reducing pain.

The exercises below will help you accomplish this. To get the most out of these exercises and get you back in the game as quickly as possible, you should gradually increase the number of repetitions and sets as pain allows.

• Unloading the knee
  Put a light weight (5 to 10 pounds) on your ankle and sit in a position that allows the leg to dangle (on a bench, tall stool, edge of bed). Hold for 5 to 15 minutes, 1 to 3 times a day. Repeat for the other knee.
• Knee extension
  Sit in a chair and rest your foot on another chair across from you so that the knee is slightly raised. Gently push the raised knee toward the floor using only leg muscles. Hold the stretch for 5 to 10 seconds, then rest a minute. Repeat 10 times. Do every day up to 3 times a day.
• Alternative knee extension exercise
  Sit on the floor or bed with your legs extended, and place a rolled-up towel underneath your Achilles tendon. Gently push your raised knee toward the floor. Hold the stretch for 5 to 10 seconds, then rest a minute; repeat 10 times. Do every day up to 3 times.
• Knee flexion
  While sitting, loop a long towel underneath your foot. Gently pull on the towel with both hands to bend the knee, raising your foot 4 or 5 inches off the floor. Hold for 5 to 10 seconds, rest a minute, and repeat 10 times. Do with both knees every day, up to 3 times a day.

Strength-building exercises

• Quadriceps sets
  While sitting in a chair, straighten your leg and hold. Repeat 5 to 10 times. Do the exercises with both knees, up to 3 times each day.
• Alternative quadriceps exercise
  Lie on a flat, firm surface with legs extended. Then raise one leg 1 foot off the surface and use it to trace a "T" pattern in the air. To start, repeat 5 to 10 times. Do the exercises every day, up to 3 times each day.
• Wall slide
  Leaning with your back against a wall, bend your knees 30 degrees, sliding down the wall, then straighten up again. Move slowly and smoothly. Keep your feet and legs parallel, and center your kneecap over your second toe. Repeat 5 to 10 times, 1 to 3 times a day.
• Resisted knee extension
  If the wall slide exercise is painful, then use a piece of rubber exercise tubing such as Thera Band. Loop the tubing around the bottom of your foot, hold onto the ends while in a sitting position, and bend your knee about 30 degrees (maximum). Straighten your knee against the resistance of the tubing, pushing as hard as is reasonably comfortable. Hold. Do 5 to 10 repetitions, 1 to 3 times per day.

Rehabilitation after surgery

Keep in mind that if your femoral fracture requires surgery the soft tissue needs time to heal before exercise can begin.

A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.

Finally, patients develop speed and agility through sport-specific exercise routines.

The ultimate goal of surgery for a femoral fracture is to put the pieces of bone together so that they heal themselves. This will help provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the leg feels and by comparing the strength and stability of the injured and uninjured leg.

How long will the effects of my injury last?

Because a femoral fracture is a very serious injury, and requires extensive physical therapy, it usually takes 3 to 6 months to heal. You may safely return to your sport or activity when the bones are healed and you have full strength and range of motion in the injured leg compared to the uninjured leg.

When can I return to my sport or activity?

Some may be ready for full participation in 3 to 4 months, others not for 6 to 8 months or more. Of course, time for return to activity is much longer if surgery is necessary.

Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your femoral fracture recovers, not by how many days or weeks it has been since your injury occurred.