Your Orthopaedic Connection: Pediatric Thighbone (Femur) Fracture

Pediatric Thighbone (Femur) Fracture

The thighbone (femur) is the largest and strongest bone in the body. It can break when a child experiences a sudden forceful impact.

Take your child to the emergency room right away if you think he or she has a broken thighbone. Explain exactly how the injury occurred. Tell the doctor if your child had any disease or other trauma before it happened. The doctor will give your child pain relief medication and carefully examine the leg including the hip and knee.

Diagnosis

The pattern of the fracture may vary. The pieces of bone may be aligned correctly (straight) or out of alignment (displaced), and the fracture may be closed (skin intact) or open (bone piercing the skin). An open fracture is rare. Your doctor will need X-rays to see the pattern of the break. Your child's healthy leg may also be X-rayed for comparison.

An orthopaedic surgeon may check for any damage to the growth area (growth plate) near the end of the femur, which enables the child's bone to grow. If needed, surgery may help to restore the growth plate's function and regular X-rays may be taken for many months to track the bone's growth.

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Risk Factors/Prevention

Common causes of pediatric femur fractures include:

Falling hard on the playground
Taking a hit in contact sports
Being in a motor vehicle accident
Child abuse

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Symptoms

A thighbone fracture is a serious injury. It may be obvious that the thighbone is fractured because the patient typically experiences severe pain and disability. A child with a thighbone fracture is unable to walk, will have limited range of motion, and the pain will be made worse by movement and swelling. A child with a thighbone fracture may also have other serious injuries.

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Treatment

Reduction (Realign the Bone) and Immobilization

Left, Preoperative X-ray of a child with a fracture through the midshaft of the left femur. Right, Postoperative X-ray of the same child shows that the fracture was treated with internal flexible nailing to restore stability and allow early mobilization.

To treat a child's thighbone fracture, the pieces of bone are realigned and held in place for healing. Treatment depends on many factors, such as your child's age/weight, the type of fracture, how the injury happened, whether the broken bone pierced the skin, and if there was also an injury to the child's head.

General guidelines for reduction while a patient is under a general anesthetic:

Your doctor may be able to manipulate certain thighbone fractures back into place without an operation (closed reduction). In some patients, it may helpful to put the leg in a weight and counterweight system (traction) before the bones are realigned.
To treat more complicated injuries, the doctor may need to surgically realign the bone and use an implant to stabilize the fracture.

General guidelines for immobilization:

A very young child may only need a cast to treat a femur fracture. Occasionally, an external or internal device may be used if the break was displaced.
Older children (greater than 7 years old) and adolescents usually need an internal device to manage their femur fractures, or rarely an external device.

Traction and Spica Casting

A child with a thighbone fracture typically stays in the hospital for several weeks with the leg in a traction device. When the thighbone fracture begins to heal, your child gets a plaster or fiberglass hip cast (spica cast) to immobilize the leg in the correct position.

Early Spica Casting - Certain infants and small children can be fitted with a spica cast immediately or within 24 hours of hospitalization.
External Devices - An external frame is used to immobilize the thighbone fracture. It is anchored by surgical pins placed above and below the fracture site. Pin care is done at home.
Internal Devices - The thighbone fracture is immobilized internally with a rod, a nailing system, or a plate secured directly in the bone.

When the external immobilization device is removed, rehabilitation exercises may be needed to restore range of motion and flexibility. The doctor may want to see the child again after the thighbone fracture heals to make sure healing is satisfactory.

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Last reviewed and updated: September 2007

Reviewed by members of the Pediatric Orthopaedic Society of North America

AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.