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Leg Fracture

LAug 19 04

 

What Is It?

Whenever a bone breaks or cracks, the injury is called a fracture. In the leg, fractures can occur almost anywhere along the straight shafts of the leg’s three long bones — the femur (the thighbone) or the tibia and fibula in the lower leg. When a fracture’s crack or break involves the knobby end portions of these bones that are part of the hip, knee and ankle joints, the fracture creates additional concerns. For the sake of simplicity, this article describes only fractures of the shafts of the three long leg bones.

Femoral Shaft Fractures
The femur is very strong, so it takes a large amount of force to fracture this bone in healthy people. Femur fractures generally occur in people who have suffered high-impact trauma, especially in automobile accidents, industrial accidents, falls from high places, or gunshot wounds to the thigh. If a femur fracture follows a low-impact bump or fall, this may be a sign that the femur has been weakened by an illness such as osteoporosis or cancer.

Femur fractures have the potential to cause dangerous, sometimes life-threatening complications, such as significant bleeding inside the thigh, with blood loss of one quart or more. A femur fracture also may trigger the formation of blood clots within the large veins of the thigh. If these clots break free and travel through the bloodstream, they eventually can lodge in the lungs, creating a life-threatening condition called a Pulmonary embolism.

Femur fractures occur in about three out of every 10,000 people in the United States each year. Among children, these fractures tend to happen because of a fall from a high place, such as a tree or the top of a slide. In adults, these injuries usually are related to motor vehicle accidents (either as a passenger or pedestrian) or to on-the-job trauma. There has been a significant rise in the number of femur fractures caused by gunshot wounds in recent years.

Tibial Shaft Fractures
The tibia (shinbone) is the larger of the two bones of the lower leg. Like femur fractures, tibia fractures often occur because of direct, high-impact trauma, especially during motor vehicle accidents. However, they also can result from a low impact, even in healthy people, if the lower leg is bent or twisted at just the right angle.

Of all the body’s long bones, the tibia is not only the most likely to be fractured, but it is also the most likely to break through the skin when it fractures. This greatly increases the risk of bacterial contamination and infection at the fracture site. It also may prevent normal healing. The sharp ends of a broken tibia can cut into nearby nerves and blood vessels, and cause serious damage to soft tissues inside the lower leg.

In 75 percent to 85 percent of patients with tibia fractures, the fibula (the thin bone at the outer side of the lower leg) is fractured as well. Doctors treat more than 185,000 lower leg fractures in the United States every year, including both tibia fractures and fibula fractures.

Fibula Fractures
The fibula runs parallel to the tibia on the outside of the lower leg, but is smaller. Most fibula fractures occur together with tibia fractures, and both injuries are usually the result of the same types of trauma. When a fibula fracture occurs alone it is usually because of a direct blow to the side of the leg, or an extreme sideways bend at the ankle or knee.

A fibula fracture that occurs alone generally causes few long-term complications. Rarely, when the segments of broken bone are separated significantly by the injury, one of the nerves to the foot may be injured, causing foot drop, a condition in which the foot hangs limp at the ankle and drags on the ground during walking.

Symptoms

If you have fractured the shaft of your femur, your symptoms may include:

  • Pain, swelling, tenderness and bruising in your thigh
  • Inability to bear weight on your injured leg
  • Inability to move your hip or knee on the affected side
  • Visible portions of the fractured bone, if the fracture causes a break in the skin

If you have fractured the shaft of your tibia, or both your tibia and fibula, you may see:

  • Pain, swelling, tenderness and bruising in your lower leg
  • Deformity in the shape of your lower leg
  • An abnormal alignment or positioning of your foot on the affected side
  • Visible portions of the fractured bone, if the fracture causes a break in the skin

A fibula fracture that occurs alone usually causes:

  • Localized swelling and tenderness at the fracture site, along the outside of the lower leg
  • Pain at the outside of the lower leg that becomes worse when you walk

Diagnosis

Your doctor will examine your injured leg, checking for swelling, deformity, abrasions, bruising and tenderness. To help determine whether a sharp edge of broken bone has damaged your leg’s blood vessels or nerves, the doctor also will feel the pulses along the length of your injured leg, and will check for normal skin feeling and muscle strength in your leg and foot. If the results of the physical examination suggest that your leg’s arteries or large veins may have been injured, the doctor will order specialized tests, called Doppler studies, to measure the leg’s blood flow more precisely.

Your leg will be X-rayed to confirm the location and severity of your fracture, and to check for less-obvious fractures and dislocations in nearby joints.

Expected Duration

A fracture of the femur or tibia can take many months to heal. Six months is a reasonable estimate of average healing time, although some fractures take longer.

Prevention

The best way to avoid fractures is to prevent accidents. Supervise children and encourage safe play, and drive carefully. For information about how to prevent work-related injuries in construction and other occupations, see the Additional Info section (below) to access the Web site of the U.S. government’s National Institute for Occupational Safety and Health (NIOSH). Prevention of osteoporosis can reduce the risk of related fractures.

Treatment

Femoral Shaft Fractures
In most cases, doctors prefer to repair the fracture surgically. Surgical repair usually requires a shorter hospital stay and creates less disability than other treatment methods, such as wearing a “full-leg-and-hip” plaster cast.

To repair your fracture, the surgeon will join the segments of your broken femur with a special metal rod that is inserted into the bone’s inner cavity. This rod will stabilize and reinforce the fracture site, allowing the femur to heal quickly and firmly. Once healing is complete, the metal rod may be removed or left in place.

After surgery, your recovery will involve a period of using crutches to avoid bearing weight on the leg followed by a program of physical therapy. The goal of physical therapy is to restore normal strength in your leg muscles, and normal range of motion in your leg joints. The entire process of healing and rehabilitation usually takes months.

Tibial Shaft Fractures
Treatment depends on the severity and location of your tibia fracture. If you have an uncomplicated fracture that is not near your knee or ankle, the doctor may be able to treat your injury by immobilizing your leg in a cast. More severe fractures usually have to be repaired surgically with a metal rod, wires, or plates and screws. If there is any break in the skin, you also will be given antibiotics intravenously (into a vein) to prevent infection. If you have not had a tetanus shot within the past 10 years, notify your doctor.

Once your fracture has healed enough, your doctor will prescribe a program of physical therapy to restore full strength and function in your injured leg.

Fibula Shaft Fractures
In general, fibula shaft fractures that occur without a tibia fracture can be treated without hospitalization. Your doctor probably will tell you to rest the injured leg, apply ice to the injured area, and take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others), to ease pain and relieve swelling. If bearing weight on your injured leg is very painful or if the fracture is near the ankle, the doctor may apply a cast and recommend that you use crutches temporarily.

When To Call A Professional

Seek emergency help if you have significant lasting pain and suspect you may have a leg fracture after a fall, a motor vehicle accident, or other trauma involving the leg.

Prognosis

The prognosis for leg fractures varies, depending on the type of fracture and its severity:

  • Femur shaft fractures — Almost 100 percent of all femur fractures heal well, and most patients are able to return to their normal activities after about six months of treatment and rehabilitation. Among elderly patients with weakened bones, the rate of repeat fractures is high, ranging from 1 percent to 15 percent.
  • Tibia shaft fractures — Tibia shaft fractures also have a good prognosis. As a rule, fractures that are closer to the knee tend to heal faster than those near the ankle. Fractures in children tend to heal faster than those in adults.
  • Fibula shaft fractures — Almost all fractures of the fibula shaft heal very well with no complications.

Johns Hopkins patient information

Last revised: December 7, 2007
by Sharon M. Smith, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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