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Your child has a fracture (break) in his or her femur (thighbone). The femur is a strong bone and is very hard to break. So a femur fracture is often the result of great force during severe trauma (such as a car accident, bad fall, or serious sports injury). Your child may have already been seen in an emergency room for initial treatment for the fracture. But further treatment is needed to help the leg heal. A child with a femur fracture is likely to be referred to an orthopaedic surgeon (a surgeon specializing in bone and joint problems).
Health care providers are trained to recognize a femur fracture as a sign of possible child abuse. Several health care providers may ask questions about how your child was injured. Health care providers are required by law to ask you these questions. This is done for protection of the child. Please try to be patient and not take offense.
A bone can break in many ways. Here are some fracture types you may hear about:
The fracture may be displaced (the broken bone ends do not line up) or nondisplaced (the broken ends are lined up).
The fracture can be open (bone shows through the skin). These used to be called “compound” fractures. Or, the fracture can be closed (there is no break in the skin).
The fracture may be comminuted (bone broken into more than two pieces).
Pain in the thigh
Swelling of thigh
Discoloration of the skin (bruising)
Inability to walk
A femur fracture is often diagnosed when the doctor examines the child. An X-ray (test that creates images of bones) will confirm the fracture. Because it takes great force to break the femur, more X-rays may be done to rule out fractures in nearby bones or to bones in other parts of the body.
The goal of treatment for a fracture is to hold bones together so they can heal. The best course of treatment for your child depends on your child’s age, the location of the fracture, and the type and severity of the fracture. Your child’s doctor will explain the options to you and make recommendations. It generally takes 4-12 months for a femur fracture to heal completely.
A spica cast covers the child from waist to ankle. It keeps the thighbone and hip area completely still. This helps the bone heal correctly.
A spica cast is left on until the bone is healed, in about 8-12 weeks. The child may not be able to walk while the cast is in place.
After the cast comes off, the child may need to use crutches for 3-4 weeks while the leg regains strength if he or she is old enough (around age 6). Younger children may need to ride in a stroller or wagon or be carried until they are stronger..
This type of cast is mainly used in younger children.
Surgery can be done to place devices that hold the bones together while they heal. These are called fixation devices. This option lets children get back to school and other aspects of their life (with crutches or a walker) sooner than with casting. During surgery:
The fracture is reduced (the broken ends of bone moved back into line) if needed.
One of these types of fixations is then put into place:
Internal fixation: Long, flexible nails are placed inside the femur. These hold the fractured bone in place while it heals. The nails are most often removed after the fracture has healed. In rare cases, the nails are left in place.
External fixation: This is used when internal fixation is not an option. Metal pins are put through skin into the fractured bone. These pins are attached to a bar that sits outside of the skin on the child’s thigh. The pins and bar hold the fractured bone in place while it heals. The pins and bar are removed after the fracture has healed.
Plates and screws: A small metal plate is placed across the femur fracture and held in place by screws. The plate and screws are removed after the fracture has healed.
In rare cases, traction may be needed before casting is done. Traction uses a system of ropes, pulleys, and weights attached to metal pins placed into the leg bone. The system gently pulls on the leg bones to help them line up straight.
Traction is done in the hospital. It is in place continuously for up to 2 weeks. The child must remain in bed during this time.
When traction is complete, the child is put into a spica cast to hold the realigned bone in place while it heals completely.
After a fracture heals, don’t worry about getting your child to walk right away. Your child will start walking on the leg again when he or she is ready. Walking too soon can cause further damage to the leg.
When the child starts walking again, he or she may limp or walk awkwardly. This may last for up to a year. But it almost always goes away.
After the bone has healed, a course of physical therapy may be recommended to help strengthen the leg. Your child’s doctor can tell you more.
Just after the fracture heals, the leg may not look straight. However, the bone is still going through a process called remodeling. During remodeling, the repaired bone slowly reshapes itself. Most angles or bends in the bone straighten out during this stage. This process takes 1 to 3 years.
In some cases, the fractured thighbone may grow faster than the uninjured thighbone in the other leg. This results in a slightly longer leg on the injured side (called a leg-length discrepancy). If this is the case with your child, the doctor can discuss it with you.