Broken Femur: Symptoms, Types, Causes and Treatment

A broken femur—commonly known as a femoral fracture—is one of the most serious bone injuries and often has a profound impact on mobility, independence, and overall health. Spanning from the hip to the knee, the femur is the longest and strongest bone in the human body, so breaking it typically requires considerable force or, in some cases, underlying bone weakness. Understanding the symptoms, types, causes, and treatment options for femoral fractures is essential for timely diagnosis, effective management, and optimal recovery.

Symptoms of Broken Femur

A broken femur is rarely subtle. The symptoms are often dramatic and demand immediate medical attention. Early recognition of these signs can be life-saving and help prevent complications.

Symptom	Description	Associated Factors	Source(s)
Severe Pain	Intense, localized pain in thigh	Worsens with movement	7 8
Inability to Walk	Unable to bear weight or stand	Immediate after injury	7 8 9
Deformity	Visible bending or shortening	Swelling, abnormal angulation	7 8
Swelling	Rapid and prominent swelling	Often with bruising	7 8
Bruising	Discoloration around injury site	May extend to hip or knee	7 8
Crepitus	Grinding or grating sensation	Felt on moving limb	7
Shock Symptoms	Pale, clammy skin, rapid pulse	Particularly with severe trauma	8 9

Table 1: Key Symptoms

Understanding the Symptoms

Severe Pain and Inability to Bear Weight

The most immediate and recognizable symptom is excruciating pain at the site of the fracture. Because the femur is critical for standing and walking, even attempting to move or stand usually intensifies the pain. Most individuals with a broken femur cannot put any weight on the affected leg 7 8 9.

Deformity and Swelling

A broken femur is often accompanied by obvious deformity. The thigh may look bent at an unnatural angle or appear shorter than the uninjured leg. Swelling develops rapidly, sometimes within minutes, and may be accompanied by extensive bruising 7 8.

Other Signs: Bruising, Crepitus, and Shock

Bruising is common and can extend from the hip down to the knee due to tracking of blood. Crepitus—a grinding or crackling sensation—may be felt if the broken bone ends rub against each other. In cases of high-energy trauma or significant blood loss, symptoms of shock (pale, cool skin, rapid pulse, low blood pressure) may develop and represent a medical emergency 8 9.

Special Considerations in Children and Elderly

In children, refusal to walk or use the leg may be the only sign, especially in very young or non-verbal children 6 9. In elderly patients, symptoms may be less dramatic but are still significant, and minor trauma can result in a fracture due to weakened bone 8.

Types of Broken Femur

Femur fractures can be classified in several ways, depending on their location, pattern, and associated injuries. Understanding the types helps guide treatment and prognosis.

Type	Description/Location	Typical Patient/Mechanism	Source(s)
Proximal (Hip)	Neck, intertrochanteric, subtrochanteric	Elderly (falls), some children	5 6 8
Shaft	Middle segment	Young adults (high energy trauma)	7 8 9 14
Distal (Near Knee)	Supracondylar, condylar	Older adults, post-surgery	2 10 12
Periprosthetic	Around prosthetic implants	Patients with hip/knee replacements	1 4 10
Open vs Closed	Bone exposed (open) or not	High-energy trauma	8 9
Comminuted	Multiple bone fragments	Severe trauma, gunshot	3 8

Table 2: Femur Fracture Types

Overview of Femur Fracture Types

Proximal Femur Fractures (Hip Region)

These fractures include the femoral neck, intertrochanteric, and subtrochanteric regions. They are most common in older adults, especially women, due to osteoporosis and falls from standing height 5 6 8. In children, hip region fractures occur but are less frequent 5 6.

• Femoral Neck: Just below the ball of the hip joint; high risk for complications like avascular necrosis 5.
• Intertrochanteric: Between the neck and shaft; usually from falls.
• Subtrochanteric: Just below the lesser trochanter; often from high-energy trauma 3.

Shaft (Diaphyseal) Fractures

These occur in the long, straight part of the femur and are especially common in younger adults and children, often due to high-energy mechanisms like car accidents or, in some regions, gunshot injuries 7 8 9 14. Shaft fractures may be:

• Transverse: Straight across the bone
• Oblique/Spiral: Angled or twisting pattern
• Comminuted: Bone is shattered into several pieces 3 8

Distal Femur Fractures (Near the Knee)

Fractures near the knee, including supracondylar and condylar fractures, are more common in older adults and can occur after knee replacement surgery (periprosthetic) or from direct trauma 2 10 12.

Periprosthetic Fractures

These occur around existing prosthetic implants, such as after hip or knee replacement. They are increasingly common as the number of joint replacements rises, and they present unique treatment challenges 1 4 10.

Open vs Closed and Comminuted Fractures

• Open (compound) fractures involve a break in the skin and are at higher risk for infection.
• Closed fractures do not break the skin.
• Comminuted fractures are those where the bone is broken into several pieces, usually from severe trauma 3 8.

Causes of Broken Femur

The femur's strength means it usually takes substantial force to break it. The causes of femur fractures vary by age, activity, and region.

Cause	Description/Mechanism	At-Risk Groups	Source(s)
High-Energy Trauma	Car accidents, falls from height, gunshots	Young adults, men	6 7 8 9
Low-Energy Trauma	Falls from standing height	Elderly, women (osteoporosis)	8
Pathological	Bone weakened by disease (e.g., cancer, osteoporosis)	Elderly, cancer patients	8 13
Child Abuse	Non-accidental injury	Infants, toddlers	6
Periprosthetic	Around joint replacements	Post-arthroplasty patients	1 4 10
Sports/Direct Blow	Contact sports, direct blow	Adolescents, athletes	7 8

Table 3: Causes of Femur Fracture

Breakdown of Causes

High-Energy Trauma

The most frequent cause in younger adults and children is high-energy trauma, such as:

• Motor Vehicle Collisions: The single most common cause in the young 6 7 8 9.
• Falls from Height: Especially construction accidents or high-level falls.
• Gunshot Injuries: Particularly in regions with higher rates of violence; in Somalia, gunshots are the leading cause of shaft fractures in men 8.

Low-Energy Trauma

In the elderly, especially women, simple falls from standing height can cause a femur fracture due to osteoporosis, particularly in the hip region 8.

Pathological Fractures

Bones weakened by diseases such as cancer or severe osteoporosis can fracture with minimal trauma or even spontaneously 8 13.

Child Abuse

For children under two years old, a significant percentage of femur fractures are due to non-accidental trauma, making it crucial to consider abuse in these cases 6.

Periprosthetic Fractures

These occur around prosthetic implants, often due to minor trauma in the setting of previous surgery, bone weakening, or implant loosening 1 4 10.

Sports and Direct Blows

Contact sports or direct blows to the thigh can cause fractures, particularly in adolescents and young athletes 7 8.

Treatment of Broken Femur

Treating a broken femur is complex and depends on the fracture type, patient age, overall health, and presence of associated injuries. Prompt and effective management is crucial for optimal recovery and to prevent complications.

Treatment	Indication/Use	Key Points	Source(s)
Surgical Fixation	Most adults, severe fractures	Intramedullary nail, plates	13 14 12
Non-Operative	Young children, stable fractures	Casting, traction	5 6 9 2
External Fixation	Open, unstable or polytrauma	Temporary stabilization	8 13
Pain Management	All cases	Opioids, nerve blocks	11
Rehabilitation	All cases	Early mobilization, PT	14 13 12

Table 4: Femur Fracture Treatments

Treatment Approaches Explained

Surgical Fixation

• Intramedullary Nailing: The gold standard for most femoral shaft fractures in adults. A metal rod is inserted into the marrow canal of the femur, providing strong, stable fixation and enabling early mobilization 14. Closed nailing is preferred for better outcomes and fewer complications 14.
• Plates and Screws: Often used for fractures near joints (proximal or distal femur) or in cases where nailing is not feasible 13. Double plating may offer benefits in complex or periprosthetic fractures, especially in polytrauma patients 13.
• Special Considerations: For periprosthetic fractures (around joint replacements), options include long-stem prostheses, cerclage wiring, or revision surgery depending on fracture type and implant stability 1 4 10 13.

Non-Operative Management

• Children: Non-surgical treatment (traction, casting, spica cast) is preferred in children under 4-5 years, as they heal rapidly and have excellent bone remodeling potential 5 6 9.
• Adults: Limited to stable, non-displaced fractures or patients who are not surgical candidates due to medical comorbidities 2 12.

External Fixation

Used as a temporary measure in cases of open fractures, severe soft tissue injury, or polytrauma to stabilize the limb before definitive surgery 8 13.

Pain Management

Effective pain control is essential. In addition to strong pain relievers (opioids), regional nerve blocks such as the fascia iliaca compartment block have shown effectiveness and can be administered even in prehospital settings by trained providers 11.

Rehabilitation

Early mobilization and physical therapy are vital for regaining function and preventing complications such as blood clots, muscle wasting, and joint stiffness. The method of fixation influences the speed and extent of rehabilitation, but in general, surgical fixation allows for earlier movement and weight-bearing 14 13 12.

Special Considerations

• Elderly Patients: Require careful risk assessment for surgery and aggressive prevention of complications such as pressure sores and pneumonia 12.
• Complications: Nonunion, infection, malunion, and implant failure are potential risks, and the choice of fixation method can influence these outcomes 13 12 10.

Conclusion

A broken femur is a major injury that requires prompt recognition and expert management. Understanding the symptoms, types, causes, and treatment options is crucial for patients, families, and healthcare providers.

Key Points:

• Symptoms: Severe pain, inability to bear weight, deformity, swelling, and shock are hallmarks of femur fracture.
• Types: Location and pattern matter—proximal, shaft, distal, periprosthetic, open/closed, and comminuted types each have unique features and challenges.
• Causes: High-energy trauma is most common in the young, while low-energy falls dominate in the elderly; child abuse must be considered in infants and toddlers.
• Treatment: Most adults require surgical fixation; children often heal well with non-operative care. Rehabilitation and pain control are essential for optimal recovery.

By staying informed, recognizing the warning signs, and seeking timely medical care, patients with broken femurs can achieve the best possible outcomes—even after such a dramatic injury.