Femur fracture

introduction

Of the Thigh bone (lat. femur) belongs to the most stable bones of the human body. Nevertheless, it can also occur in the area of ​​this bone Fractures (so-called thigh fracture) come.

At elderly patients can be Fractures of the thigh observed much more often than in young people. This fact is mainly due to the fact that during aging structural changes in the field of Bone structure can watch.
Due to these changes, the Resilience of the thigh bone are strongly influenced. Broken thighs become more likely.
In most cases a Femur fracture be corrected surgically.
One of the most common forms of femoral fracture is the so-called Femoral neck fracture. A Fracture of the bone however, it can often also be used in the Femoral shaft to be watched.
Furthermore, fractures of the thigh often occur directly on or near the Hip joint on. Also the bone parts near the knee joint can be severely damaged in an accident and break.

causes

In most cases the Cause of the femur fracture on one too big mechanical load.
Mostly this overload is caused by a strong Previous damage to the bone substance reinforced.
Especially for patients who are under pronounced osteoporotic changes suffering exists increased risk of a thigh fracture to suffer.
The stronger the changes in the bone substance, the less stress it can withstand and the faster a fracture can occur.
In pronounced cases, they are relatively sufficient little violence to provoke a broken thigh.
The most common cause of the Formation of a femur fracture in the area of Femoral head are so-called Rotational trauma or simple dislocations.
Of the Femoral neck fracture, i.e. the connection between the femoral head and the femoral shaft, breaks in most cases Fall.
Especially patients who respond directly to the lateral hip or on that stretched leg falls often suffer Femoral neck fracture.
This type of thigh fracture mainly affects older people through their bone substance osteoporotic changes has already become very unstable. In the majority of cases, fractures in the area of ​​the shaft can be traced back to strong violence.

Because of this, belong Accidents one of the most common causes of a femur fracture on the bone shaft. Often times, this type of fracture occurs along with Injuries to other structures on (Multiple trauma).
The femoral fracture of the lower bone near the knee is mostly caused by a car accident. This is classic for this form of fracture The knee joints hit the dashboard.

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Symptoms

Patients one Femur fracture usually have complain strong pain which increase in intensity under every load.
In addition, the Broken bone often a clear one Reduced movement caused.
Both the Mobility of the hip joint, as well as the Range of motion of the knee joint can be severely restricted at times. The affected leg is no longer stable, which becomes worse for the patient Walking and standing almost impossible.
In addition to the pain belong Swelling and extensive bruising one of the most common symptoms of a broken thigh.
At a displaced femoral fracture (so-called "Dislocated fracture") the affected leg clearly shows at the fracture site visible deformation on.
Also a noticeable one Shortening of the leg can be interpreted as an indication of the presence of a thigh fracture.

If the fracture occurs in the area of ​​the bone shaft, in many of the affected patients the broken ends penetrate the skin surface.
In medical terminology, one speaks of a so-called "open bone fracture".
With this type of bone fracture, the impaired soft tissue structures pose a particular risk.
Damage can be observed at the adipose tissue, muscle, tendon and ligament level.
The prognosis of an open thigh fracture is largely dependent on the extent of this soft tissue injury. If the femoral neck fracture is present, a rotation of the normal leg axis can often be determined.
The axis of the affected leg usually deviates significantly outwards. In addition, sensory disturbances can be caused by an injury to the smallest of nerve structures. Depending on the extent of this nerve damage, however, these sensory disturbances can quickly recede.
In the case of extensive nerve injuries, however, it is also possible that the symptoms persist permanently. Paralysis is also possible in the course of a thigh fracture.

Pain

Patients who suffer a fractured thigh almost always have it strongest pain. Often times, the pain is so great and debilitating that it overshadows any other symptoms. Depending on the exact localization of the thigh fracture, so-called compression pain, pain in the groin area or pain directly in the area of ​​the thigh can be predominant.
As Sprain pain the doctor describes pain that occurs when a part of the body is squeezed - here when the thigh is moved.

However, some patients also report of unbearable knee pain after a broken thigh. They are most likely suffering from a fracture near the knee.
But no matter where it occurs - one thing is common to all pain from a fractured thigh: The pain that the person concerned has to suffer is so severe that independent movements, for example when walking, are impossible. A sufficiently strong, efficient pain therapy should therefore be started even before the final therapy so that the patient does not suffer longer than necessary.

diagnosis

The Diagnosis of the femur fracture is divided into several sections.
The first step in diagnosis is the detailed Doctor-patient conversation (Anamnese).
During this conversation will be specific questions regarding the course of the accident and the existing complaints posed.
Then follows a physical examination in which the affected leg is inspected for abnormalities.
In addition, both the Hip, as well as the Knee joints examined in side-by-side comparison.
If you suspect that There is a fractured thigh become X-rays of the thigh.
In this context, it is important to take a picture from the front as well as a picture from the side.
The reason for this is the fact that Broken bones occasionally cannot be recognized as such from a single level.
In some cases, the Carry out further imaging examinations makes sense.
To assess the bony structures, the production of a computed tomographic recording (short: CT). Soft tissue defects can best be done by means of Magnetic resonance imaging (short: MRT).
Possible differential diagnosis of the Femur fracture in the Femoral head or femoral neck area is the dislocation (Dislocation) of the hip joint. The symptoms of other diseases of the hip or knee joint can also be similar to the symptoms of a broken thigh.

Conservative therapy

The treatment of a femur fracture is divided into operational and non-operational (conservative) activities.

In some cases it will be non-surgical treatment methods preferred to surgical correction of the femoral fracture. This is above all with children the case.
But even if Previous illnesses of the affected patient make an operation particularly risky, one is done Treatment of the femur fracture usually conservative.
In most cases it will be the thigh over several weeks (6 to 8) with a plaster stabilized.
Also the implementation of a so-called Extension treatment belongs to the non-operative therapy options.
In the case of extension treatment fractured leg over several weeks with the help of a certain device stretched.
That way, the Bone fragments brought into a correct position to each other and can a renewed bony connection build up.

Operative therapy

A Femur fracture must isurgically in most cases be treated.
Only in this way can in the area of ​​the break ends one sufficient high stability being constructed.
Surgical correction of the femur fracture will be under general or regional anesthesia carried out.
In addition, the Blood flow to the leg in the case of a thigh fracture near the knee joint by applying a tight cuff throttled and thus one prevents greater blood loss become.
During the surgical procedure, the Fragments again in an optimal position brought together. For this purpose, Fremnants in the form of screws or plates used.
Also the installation of a so-called Intramedullary nails may be necessary depending on the location of the femoral fracture.
This intramedullary nail is inserted into the Bone marrow cavity brought in.
In some cases an additional fixation of the intramedullary nail through a cross bolt.
A femoral fracture near the hip joint must be fixed with special elements. In this context, so-called are particularly suitable Gamma nails, dynamic hip screws or special Angle plates.
If the femoral head is directly affected and severely damaged, it may Insertion of an artificial hip joint be necessary. This is especially true at severely damaged bone substance (For example, if there is a pronounced arthrosis) the case.
In addition, the Correction of a fractured thigh through a so-called External fixator respectively. This device is a specially made one for broken bones Connection structure the aoutside the body is applied and fixed in the bone with screws.
After the operation you usually need a Drainage tube into the surgical field be introduced. Be that way Blood and wound fluid intercepted. The drainage can usually be removed after a few days. That in the bones brought in foreign material can either be left in place or removed in another operation after the femoral fracture has healed.
Which option is best for each patient depends on several factors and should start with the attending physician be discussed.

Time to heal a femur fracture

The therapy of choice for femoral fractures is usually one OP. However, even after an operative correction and the fixation of the fractions, everything is not immediately back to the way it was before. Depending on the type and severity of the fracture and the age and bone structure of the patient, it will pass several weeks to months until complete healing is achieved. The cooperation of the patient and the occurrence of possible complications also influence the healing time.
Ideally, it should be done as soon as possible after an operation physiotherapy exercises and loads are started, as long immobilization not only hinders the healing process, but also significantly prolongs it. The training program is planned and controlled by an experienced physiotherapist so that the bones are never overwhelmed and hindered in their healing process.

After about 12 weeks should the previously broken Leg resilient again be. Almost all femoral fractures heal over a period of 3-4 months completely without residual defects out. Half a year can easily pass before the last break is no longer noticeable.

The last question that remains is the question of the material processed during an operation. How long should it stay in the bone? The operative fixation was done with the help of a Intramedullary nails can already do some of the cross struts removed after 6-12 weeks become. The patient's own body weight then helps to further stabilize the fracture.
Everything else like the intramedullary nail itself or also Plate fixation can be after about Remove again 1.5 to 2 years. However, this fixation material can remain in the body for the rest of its life as long as it does not cause any discomfort. Even years after a thigh fracture, stabilization material can remain in the thigh without any problems.