A femur fracture is a condition that involves a broken thigh bone and usually happens due to a strong force or a major accident.
The femur consists of two femora connected to the pelvis via the hip joint and to the tibia via the knee joint. It is considered the longest and strongest bone in the body, which means that any extensive force such as vehicular accidents, gunshots, or falls can result in its fracture.
However, even a low-energy trauma with an underlying or pre-existing bone condition may result in a femur fracture, leading to long-term treatment and disability. A femur fracture is a serious injury that requires prompt diagnosis and management to ensure complete recovery.
Signs and Symptoms of Femur Fracture
The following signs and symptoms of femur fracture are usually localized to the affected extremity. They appear immediately after a femur fracture:
- Severe pain worsened by movement
- Tissue swelling or tenderness on some parts of the thigh
- Muscle spasms, numbness, or tingling sensations
- Bruising and protrusion of bone fragments from the skin for closed fractures
- Open wound with bleeding and discharge for open fractures
- Deformity or crooked appearance of the affected part
- Obvious shortening of the affected extremity
- Inability to move, stand or walk on the affected part
- Inability to put weight on the injured leg
- Infants or toddlers may cry excessively, refuse to crawl, or start limping
Causes of Femur Fracture
A femur fracture is usually caused by severe accidents such as:
- Falls. High-impact falls or even a low-force trauma can cause a femur fracture among old adults and children due to their weak and underdeveloped bones.
- Motor Vehicle Accident (MVA). This is the most common cause of femur fracture due to high-impact collision. This also includes being hit by a car while walking or crossing the street.
- Sports Injuries. An indirect or direct severe blow from competitive or recreational playing of a contact sport may result in a femur fracture.
- Penetrating Injuries. High-energy injuries such as gunshots can cause severe damage to the surrounding tissues and penetrate the bones causing fractures. This is considered as an open fracture that requires more time to heal especially with retained bullet fragments.
- Abuse. Traumatic violence is usually an isolated event that is associated with other injuries. Women and children are the most common victims of this abuse.
- Overuse. Stress fractures are caused by overuse or repetitive force on weight-bearing bones like long-distance running, jumping, and skating. This can also be seen among new military recruits who experienced a sudden increase in impact activity. Over time tiny cracks usually develop in the weight-bearing bones such as the femur and cause fractures.
- Underlying Medical Conditions. Osteoporosis is a silent disease that weakens the bones causing them to lose strength and break easily. Metabolic bone diseases such as rickets, Paget disease of bone, marble bone disease (osteopetrosis), osteomalacia, osteogenesis imperfecta, and fibrous dysplasia cause various deformities or abnormalities of bones.
Risk Factors to Femur Fracture
There are certain factors that increases the risk of sustaining a femur fracture such as:
- Age. Femur fractures are common among older adults as their bones tend to be weaker and brittle. This is also common among infants and children due to their weak and underdeveloped bones. Poor eyesight, coordination, and judgement of accidents also contribute to the risk with very old and young children.
- Weight. Being underweight or malnourished contributes to bone loss and increases risk of broken bones. Loss of muscle mass or deconditioning contributes to muscle and bone weakness.
- Degenerative Bone Disease. People with osteoporosis are prone to any kind of fracture even in the strongest weight-bearing bone such as the femur due to the loss of bone density.
- Metabolic Bone Diseases. Rickets, Paget disease of bone, marble bone disease (osteopetrosis), osteomalacia, osteogenesis imperfecta, and fibrous dysplasia increases the risk for femur fracture due to the reduction of total bone mass and bone mineral density from calcium metabolism disturbance.
- Repetitive motion. Performing repetitive physical activities such as marching, running, jumping, dancing, or skating increases the risk of femur fracture due to the impact on weight-bearing bones.
- Recreational or professional sports players. Participation in any contact sports greatly increases the risk of femur fracture from any direct or indirect severe blow that may happen while playing.
- Unsafe driving practices. Driving under the influence of alcohol or drugs and driving without a helmet, seatbelt, and safety gear greatly increases the risk of getting involved in a motor vehicle accident and sustaining a fracture.
Complications of Femur Fracture
Femur fractures can lead to serious medical complications depending on the extent of the injury, such as:
- Knee or ankle pain. This is common after sustaining a femur fracture due to ligament injury and anatomical relation.
- Osteomyelitis or bone infection. An open fracture can cause an infection due to the exposure of the bones to the skin or penetration of a foreign body into the bones.
- Poor or delayed healing. Healing any fracture may take weeks to months depending on its severity. Age and certain medical conditions may impair healing and recovery.
- Blood vessel or nerve damage. This is common in an open femur fracture where the bone fragments or foreign material damages the surrounding nerve and blood vessels.
- Compartment syndrome. This usually happens after a high-impact trauma such as a motor vehicle accident. It causes severe pain and swelling in the surrounding muscles from increased pressure limiting blood flow which may lead to permanent disability and possible death.
- Arthritis. Femur fractures that extend to the hip joint or knee joint may cause arthritis in the future. On the other hand, sustaining an injury with ongoing systemic inflammation such as arthritis can prolong healing time and recovery.
- Deformity or disfigurement. If the fracture extends up to the growth plate, especially in children, this may cause an unequal leg length.
- Nonunion. Study shows that the use of tobacco products causes a negative impact on the healing process resulting in nonunion of the bones.
Diagnosis of Femur Fracture
Femur fracture is considered a medical emergency. The following tests can help identify the exact location, extent, and severity of the injury are:
- Medical history. A complete information about the injury and how it happens can be helpful in the diagnosis. Past and present health conditions including medications, allergies, alcohol consumption, and tobacco use must also be disclosed.
- Physical exam. A complete physical exam must be done and focus on the affected leg. Open wounds, bruises, swelling, protrusions, perfusion, and deformities must be checked upon inspection. Tenderness, pulsations, and sensations must be checked upon palpation. Sensory and motor function tests must also be done to check the involvement of surrounding muscles and tissues.
- Imaging test. These tests will determine the exact location and extent of the damage.
- X-ray. This is the most common test performed to show the type of fracture and its location. To rule out joint involvement, positioning for femur AP view should include the entire femur along with the hip and knee joints.
- CT scan. Provide an immediate and clear picture of the bone and soft tissue structures. Determine the extent of the injury including very thin fracture lines that cannot be seen on x-ray. This is the safest imaging test for pregnant women, children, and individuals with implanted devices.
- MRI. This test can be helpful in determining the severity of the injury and involvement of surrounding muscles and soft tissues including ligaments, blood vessels, and nerve damage.
Treatment for Femur Fracture
Femur fracture is a medical emergency that requires immediate diagnosis and intervention. Treatment depends on the location, the pattern, and the extent of the damage including:
- Medications. This is used to prevent infection and relieve signs and symptoms.
- Analgesics. NSAIDs, acetaminophen, muscle relaxants, or topical medications are used for short-term pain relief promoting a speedy recovery. The primary care provider may prescribe a combination of these medications to minimize the need for opioids and narcotics.
- Antibiotics. Infection control measures especially for open fractures must be given to minimize the risk of acquiring an infection.
- Setting the leg or reduction. This procedure is usually done with displaced fracture. The bone fragments are repositioned to their normal alignment before applying a splint to allow the swelling to subside.
- Immobilization. A splint or cast is used to restrict the movement of the affected part allowing proper healing. Assistive devices such as walkers, crutches, or cane should be used to help the patient during ambulation.
- Traction. Used as a temporary intervention to realign broken bones and relieve muscle spasms and pressure until internal fixation can be done.
- Surgical procedure. Majority of femur fractures require surgery that should be done within 24 to 48 hours, such as:
- External fixation. This procedure is being used as a temporary fix to properly align the femur for additional surgery later. Metal pins or screws are inserted above and below the fractured femur, then anchored onto a fitted frame outside the body holding the femur.
- Internal fixation. This procedure is usually done with multiple bone fragments fractures to reassemble the bones. Plates are attached to the bones with screws until the healing is complete.
- Intramedullary nailing. A metal rod is inserted along the length of the femur shaft holding its proper alignment.
- Therapy. After months of immobility from a splint, a cast, or surgery, rehabilitation and physical therapy are needed to restore bone and muscle function.
- Physical Therapy. Physical re-education such as gait training will help the patient reduce stiffness and restore muscle strength and movements. The use of assistive devices such as braces, a cane, a walker, or a wheelchair help prevent falls and injury. Massage or manual therapy relieves muscle spasms and prevents atrophy.
- Rehabilitation exercises. This includes hip and knee range of motion exercises and aerobic exercises that may help restore muscle strength and flexibility.
Nursing Diagnosis for Femur Fracture
Nursing Care Plan for Femur Fracture 1
Nursing Diagnosis: Acute Pain related to femur fracture secondary to soft tissue injury as evidenced by swelling, limited range of motion, and verbalization of pain on an 8/10 pain scale.
Desired Outcomes:
- The patient will verbalize relief at a tolerable pain scale within 2 hours of nursing intervention.
- The patient will display decreased swelling and tenderness on the affected thigh.
- The patient will be able to perform an active range of motion without any pain.
| Nursing Interventions for Femur Fracture | Rationale |
| 1. Assess the patient’s level of pain using numeric rating scale (NRS) or FLACC pain scale every hour. Note the characteristics, nonverbal cues, and aggravating or relieving factors associated. | Numeric rating scale is the most reliable assessment for pain. FLACC is used for infants or non-verbal children. Pain assessment every hour can help determine the effectiveness of the treatment or progression of symptoms. |
| Assess the patient’s skin and surrounding muscles. Document the presence of bruising, extent of swelling, and tenderness on the affected part. | To determine the extent and severity of the injury, focusing the intervention on the affected part. Tracking the patient’s progress through accurate documentation can be beneficial to the nurse. |
| Assist the patient in immobilizing the extremity using bed rest, splinting, or traction. | Bed rest, splinting, and traction will all allow adequate tissue perfusion while waiting for the swelling to subside. |
| Encourage elevation and support of the affected extremity. | Elevation decreases edema and pain promoting venous return. Support the extremity with a pillow for comfort. |
| Educate the patient about proper cold compress application. | Cold compress can reduce swelling. Proper application must be done to prevent cold burns. |
| Administer pain medication before activity. | Relieving pain before any activity will promote compliance and participation |
| Assist the patient in performing passive ROM exercises while gradually increasing to active ROM exercises. | Gradual introduction of ROM exercises can aid in the resolution of inflammation while maintaining strength and mobility of both extremities. |
| Provide diversional activities and alternative comfort measures. | Diversional activities distract the patient from the pain. Comfort measures such as massage and position changes reduce muscle spasms and improve perfusion on the affected leg. |
Nursing Care Plan for Femur Fracture 2
Risk for Impaired Skin Integrity
Nursing Diagnosis: Risk for Impaired Skin Integrity related to traction pin insertion secondary to femur fracture.
Desired Outcomes:
- The patient will verbalize relief of itchiness and discomfort.
- The patient will perform techniques that can help in preventing skin breakdown.
| Nursing Interventions for Femur Fracture | Rationale |
| Assess the insertion site and surrounding tissue for the presence of bleeding, discoloration, rashes, or presence of foreign bodies. | Provides information about the skin condition and what might be the cause of the discomfort. |
| Assess the position of the traction device. | Misalignment of the traction device may cause skin breakdown. |
| Educate the patient and significant others about the proper and frequent cleaning of the insertion site. | Frequent cleaning of the insertion site minimizes the risk of infection maintaining skin integrity. |
| Encourage frequent position changes. Assist and educate the patient and significant others to use a trapeze if possible. | Frequent changing of position minimizes the risk of skin breakdown. The use of trapeze reduces the risk of abrasions of bony prominence. |
| Encourage the use of protective padding under the leg. | Minimizes the pressure on the bony prominences preventing pressure ulcers. |
| Assess and palpate taped tissues daily. Document the skin characteristic and presence of pain, if any. | Moisture may accumulate under the taped area and may cause skin irritation. |
| Assist the patient in the application of corticosteroid cream or calamine lotion as prescribed. | This may provide temporary relief for itchiness and must be used for short-term only. |
| As per protocol, skin traction should be removed every 24 hours. Assess and document the site. | Removal of skin traction daily maintains the patient’s skin integrity. Proper documentation help in monitoring progress. |
Nursing Care Plan for Femur Fracture 3
Nursing Diagnosis: Impaired Physical Mobility related to use of immobilization devices secondary to femur fracture as evidenced by reluctance to move and limited range of motion.
Desired Outcomes:
- The patient will be able to verbalize the familiarity and purpose of the immobilization device.
- The patient will be able to demonstrate a range of motion exercises on the affected extremity.
| Nursing Interventions for Femur Fracture | Rationale |
| Assess the patient’s knowledge and perception of immobilization devices. | This will help the nurse plan appropriate approaches to mobility, and supplemental information needed by the patient. |
| Assess the patient’s mobility and perception of immobility. | Observing the patient’s ambulation may help the nurse plan appropriate action and interventions to use on the patient. The patient may be restricted by fears resulting in physical limitations. |
| Educate the patient about the purpose and restrictions of the immobilization device. Provide materials such as educational brochures, pictures, and videos. | Brief and adequate information will help the patient understand his/her condition. Educational materials will give the patient a clear picture and demonstration during different situations. |
| Assist the patient with passive and active range of motion exercises of both extremities. | Facilitates adequate tissue perfusion, maintains muscle tone, preserves joint mobility, and prevents muscle atrophy from disuse. |
| Encourage frequent repositioning with the use of trochanter, trapeze, or footboard. | Frequent changing of position decreases the risk of skin complications, the trochanter and trapeze aid in changing of positions. Footboard prevents foot drop while lying. |
| Encourage ambulation as tolerated. Educate the patient about the proper use of assistive devices such as walkers, canes, and crutches, | Ambulation prevents a lot of complications and promotes healing. Encourage ambulation with the help of these assistive devices. |
| Educate significant others about proper support and assistance during the use of assistive devices and ROM exercises. | Immobilization devices requires long-term treatment, it is important to have adequate support from family members to promote consistency and compliance with the treatment plan. This can also prevent accidental injury. |
| Encourage gradual resumption of regular activities of daily living. | Gradual resumption of activity will prevent sudden pressure on the affected part while slowly regaining regular muscle functions. |
| Refer the patient to a physical therapist after gaining consent. | Activities are planned by trained physical therapists according to the patient’s functional capacity. |
| Educate the patient and significant others about warning signs and symptoms to report. | This facilitates prompt intervention preventing further complications. |
Nursing Care Plan for Femur Fracture 4
Nursing Diagnosis: Risk for Infection related to possible inadequate primary defenses (i.e. impaired skin integrity) secondary to femur fracture from an MVA.
Desired Outcomes:
- The patient will be able to maintain skin integrity, free from infection and purulent discharge.
- The patient will be able to demonstrate infection control measures.
Nursing Care Plan for Femur Fracture 5
Nursing Diagnosis: Risk for Falls related to loss of skeletal integrity secondary to femur fracture.
Desired Outcomes:
- The patient will be able to demonstrate safety precautions to prevent falls.
- The patient will be able to perform activities of daily living with the help of assistive devices to prevent falls.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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