How to Treat a Broken Femur

Experts say that because the femur bone is so crucial to walking and moving through your daily life, breaking it is often quite demoralizing.^{[1]XResearch source} A broken femur can be an extremely painful and inconvenient occurrence. If you have broken your femur, there are few things you can do to get yourself on the road to recovery, starting with surgery. Studies show that once surgery has been completed, you can manage your pain with medication, ensure proper healing at home, rehab your leg with physical therapy, and prevent future injury.^{[2]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}

Part 1

Part 1 of 5:

Treating a Broken Femur With Surgery

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1
Understand the different phases of surgical treatment and recovery. There are three phases of surgical treatment – acute, recovery and maintenance. The first priority when it comes to surgery is to rule out any other life threatening injuries and to stabilize the affected area.
- Acute Phase – surgical stabilization is necessary at this point as well as the restoration of limb alignment. Traction is administered for initial stabilization to take place. Inter-medullary nailing is the treatment of choice.
- Recovery Phase – the goal here is to encourage immediate weight bearing tolerance, improvement of hip and knee range of motion, and strengthening of the affected area. Gait training and crutch use is done in this phase. Low extremity aerobic training such as biking, swimming, and the use of an elliptical trainer is necessary for as long as it is tolerated.
- Maintenance Phase - in this phase, weight bearing is permitted once complete healing has been achieved. Activities that can be done here include 30 to 45 minutes of bike riding in a flat surface. Walking for 3 to 5 miles (4.8 to 8.0 km) per week is also encouraged. Running can be done after 3 weeks then gradual return to usual training regimen.
  - After surgery, physical therapy, discussed below, is needed in order to gradually restore function to the thighs. Usually, range of motion exercises and stretches are done to give strength to the broken femur. Gradual increase in physical activity is also considered.
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Be aware of when surgery will occur. If you are suffering from closed femoral fracture, the surgeon will wait until you become stable before conducting the surgery. However, for open fracture, an emergency surgery is done immediately to prevent infection.
- Surgery for a broken femur can last up to three or four hours.
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Look into internal fixation. Internal fixation is the choice surgery done to treat a broken femur. In this type of surgery, a cut is made to open the fracture, then internal fixator or special metal devices are used to hold the bone in place. Afterwards, a rod or a large nail is placed in the center of the femur to support the bone until it heals. Sometimes a plate is also placed next to the bone which is attached using screws in order to frame the outside of the leg.^{[3]XTrustworthy SourceJohns Hopkins MedicineOfficial resource database of the world-leading Johns Hopkins HospitalGo to source}
- Metal plates and screws will reduce the risk of further complications from occurring due to displacement.
4
Investigate external fixation to promote healing. For external fixation, the surgeon will cut an opening to surgically place metal pins and screws into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This bar holds the bones together, when the skin and muscles have been injured, to promote healing.^{[4]XTrustworthy SourceJohns Hopkins MedicineOfficial resource database of the world-leading Johns Hopkins HospitalGo to source}
- Pins are generally used when joints are not involved.
5
Consider intra-medullary nailing to stabilize the area. During intramedullary nailing, metal rods are inserted into the marrow canal of the bones through a small incision. They are then screwed to the bone at both ends. This procedure keeps the bone in its correct position during healing.
- This surgery provides strong, stable and full-length fixation.

Part 2

Part 2 of 5:

Managing a Broken Femur With Medication

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1
Use NSAIDS to reduce inflammation. NSAIDS contain analgesic, anti-inflammatory as well as antipyretic properties. These drugs act upon certain body chemicals to prevent the progress of inflammation during injuries.^{[5]XResearch source}
- Health care practitioners do not encourage intake of this drug for the first 48 hours of injury, to let the body follow its natural course of healing.
- The most commonly prescribed drugs to manage pain and swelling includes Celecoxib (Celebrex), Ibuprofen (Advil), and Naproxen (Aleve).
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Try analgesics as an alternate to NSAIDS. These medications ensure comfort, and manage pain and swelling. They also contain sedating properties that can ease the stress of dealing with pain.
- Acetaminophen (Tylenol) is usually the drug of choice.
3
Request prescription painkillers if the pain of your broken leg is intolerable. In the case of a broken femur, pain can be severe and NSAIDS and other light pain medications are often insufficient. During consultation, healthcare providers generally address pain and inflammation. Prescription drugs, such as stronger painkillers, can be given to ease the sensation of pain and lessen the degree of inflammation.^{[6]XResearch source}
- Examples of prescription painkillers are codeine and tramadol.
- These painkillers are only prescribed if simple painkillers do not reach the desired level of pain reduction.
- Stronger types of painkillers must be taken at their proper dosage to avoid addiction and dependence.
4
Consider using antibiotics. Antibiotics may be necessary to avoid infection. Especially in the case of open femoral fracture and directly after surgery, antibiotics may be used to prevent infection of the site. The physician will first obtain a wound culture by getting a sample of wound discharge and getting it analyzed.
- If an infection is found, the physician will prescribe the right antibiotic.
- Open femoral fractures may occur from trauma cause by skin opening in the wound area.

Part 3

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Maintaining the Healing Process While at Home

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1
Take good care while showering. When showering, make sure to cover your brace or immobilizer with a plastic bag to keep it dry. Also, be careful to not fall or further injure yourself.^{[7]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source}
- If an immobilizer is not present, carefully wash the incision site with soap and. Pat it dry gently afterwards. Remember not to rub the incision site or to put any kind of cream or lotion over it.
- Avoid falling by sitting on a stool while showering.
- Never soak in a tub or pool unless otherwise advised by the doctor.
- Install hand rails in the shower, near the tub or next to the toilet.
- Put a slip proof mat on the bathroom floor inside the shower and even in the tub.
2
Change the bandage incision daily to monitor it and refresh it. Change the bandage on a daily basis in order to expose the incision site to air and allow it to heal. Make sure that the wound looks healthy, and is not suffering from infection.
- Watch out for the presence of redness, excessive drainage and unnecessary opening of the wound.
3
Inform your health care team of your injury. Let your primary care physician and your dentist know that there are rods and pins in your leg. This will allow your doctor and dentist to take any possible metal in your system into consideration when they are treating you for other ailments.
- Note that antibiotics should be taken before any kind of dental work is done, to reduce the risk of infection.
- Antibiotics are a prophylactic therapy done for as long as pins and rods are inside your body.
The bed where you sleep in should be low enough to allow your feet to touch the floor. This will not only allow you to get in and out of bed without straining your femur, it also helps to prevent falls and other accidents from occurring.
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Set up your living area to accommodate you. Make sure that your house and frequented areas are set up to give you easy access and prevent falls. Also, make sure hazards are clear from trafficked areas in order to avoid accidents.^{[8]XResearch source}
- Remove loose cords, wires, and rugs from the areas where you usually walk.
- Do not keep small animals because you might accidentally step on them.
- Repair uneven flooring.
- Provide good lighting.
Individuals are advised to avoid contact with high temperatures such as hot baths, saunas and heat packs, because these can dilate blood vessels and increase incidents of bleeding. Although heat may feel good at first, it's potentially damaging effects need to be avoided.
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Immobilize the limb. Stability of the femur must be maintained to prevent additional damage to the area and its surrounding tissues. Immobilization can be achieved by putting a splint and bandage on the affected area. Extreme activities and the application of too much pressure in the injured area should also be avoided to prevent further damage to the affected area.
- Avoid massage and other manipulation of the affected area until healing is complete.
8
Apply a cold compress to reduce the risk of bleeding and swelling. Cold compress can usually be placed over the injured area to promote constriction of blood vessels that reduces the risk of bleeding and swelling. Compression also aids in stimulating the flow of lymph fluid, which carries important nutrients to the damaged tissues surrounding the injury.
- Lymph fluid also removes waste from cells and body tissues which are an important part of the tissue regeneration process. ^{[9]XResearch source(Hansen, K., 2013, June 6)}
The injured area should be kept elevated above the heart level. This action aids in proper blood circulation by promoting good venous blood return. Because the action of the veins is to return blood to the heart, elevating the injured area will allow gravity to aid venous blood return. ^{[10]XResearch source}

Part 4

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Rehabbing a Broken Femur With Physical Therapy

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1
Try physical therapy to regain your strength after surgery. Individuals suffering from a broken femur are encouraged to try exercises that may aid in strengthening the femur and restore its normal function. These exercises can be utilized to divert sensations of pain and regulate proper circulation of blood to different parts of the body, including the affected parts around the femur.^{[11]XResearch source}
- You should discuss the suitability of all exercises with your physical therapist before trying them.
- Generally, the following exercises must be performed 3 times a day, provided that they do not contribute to increased pain:
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Do hip and knee bends to strengthen the muscles. Doing hip and knee bends will increase the flexibility of your quadriceps and hamstrings, helping to restore mobility and function.^{[12]XResearch source}
- Lie on a flat surface with the head elevated 30 to 45 degrees on a pillow.
- As far as is possible and comfortable, bend the affected knee towards the chest.
- Return to your starting position.
- Repeat this 10 to 20 times provided that there is no pain increase.
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Try static quadriceps contraction. This is a low-stress exercise that is good as a starting point for strengthening.
- Lie on a flat surface with a towel under the affected leg.
- Start by tightening the front thigh muscles (quadriceps) by pushing the knee in a downward motion into the towel. Hold for 5 seconds.
- Place the middle and pointer finger on the inner quadriceps in order to feel the tightening of muscles. This will make sure that proper tightening is accomplished.
- Repeat tightening the front thigh muscles and holding them for 5 seconds for 10 repetitions.
4
Know that exercise will help the healing process. Exercise and muscle movement promotes good blood circulation and oxygen distribution to the affected area. This will speed up the repair of the damaged tissue around the femur. This is because oxygen is essential for maintaining cellular integrity, function, and repair when tissues are injured. ^{[13]XResearch source(Youn, B., 2000/2001)}
- Most femoral fractures take four to six months to completely heal.
- Even with proper treatment, the length of recovery will depend on the severity of the fracture and the presence of other injuries to the body.

Part 5

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Preventing Further Injury

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Eat foods that are rich in calcium such as green leafy vegetables and make it a habit to regularly drink milk. Consume vitamin D supplements to help strengthen your bones. This will ensure that you do not re-break your femur.^{[14]XTrustworthy SourceHarvard Medical SchoolHarvard Medical School's Educational Site for the PublicGo to source}
Especially if you are training for a big event, wear protective equipment to ensure that you do not break a bone. Also, make sure that you take short breaks in between your training period to help your bones recover from the pressure, strain and exhaustion.
Do not overtrain because it can cause too much strain on the femur and your other bones as well. Alternate exercises so that your bones have a period to rest. You can alternate running with non-impact activities such as cycling and swimming.^{[15]XResearch source}

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Do I need to put ointment on where my stitches were taken out?
Janice Litza, MD
Board Certified Family Medicine Physician
Dr. Litza is a Board Certified Family Medicine Physician based in Racine, Wisconsin. With over 25 years of educational and professional experience, she has extensive experience providing full-spectrum Family Medicine, including obstetrics, newborn care, and hospital medicine. She is currently the Residency Program Director for Family Medicine at Ascension. Dr. Litza received her MD from the University of Wisconsin-Madison School of Medicine and Public Health and has completed additional fellowship training in Integrative Medicine through the University of Arizona.
Janice Litza, MD
Board Certified Family Medicine Physician
Expert Answer
It's best to let it heal by keeping clean and dry and avoid sun exposure to the fresh skin. Sometimes putting Vitamin E oil or Aquaphor can help with healing and itching from the scabs. Antibiotic and hydrogen peroxide are not recommended.
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