A fractured thigh (medical term: femoral fracture), is a serious injury to the femur and is usually treated with surgery. Depending on the position and severity of the fracture, the fracture may be stabilised using plates, screws or nails. In certain cases – particularly in the case of severe fractures or those that occur near a joint – it may also be necessary to use a hip prosthesis.
Femoral fractures at a glance
Femoral fractures can affect different parts of the femur: from the femoral head (femoral head fracture) to the femoral neck (femoral neck fracture) and the femoral shaft (femoral shaft fracture) to the section near the knee joint (distal femoral fracture).
Femoral neck fractures are most common – typically in older people with bone loss (osteoporosis), for example after a fall to the side. Younger patients are also occasionally affected, usually as a result of high-speed trauma such as traffic accidents or serious sports injuries.
Treatment goal
The aim of the femoral fracture operation is to quickly restore the patient’s stability, mobility and ability to walk. Depending on the type of fracture, the fracture is treated either by osteosynthesis – i.e. fixation with plates, screws or intramedullary nails – or by implanting an artificial hip joint.
Surgical procedure
The choice of surgical method depends both on the exact location of the fracture and on the patient’s general state of health. The intervention is performed either under general anaesthesia or under spinal anaesthesia.
During the surgery, the thigh bone in the area of the fracture is exposed, the fracture is carefully aligned and the bone fragments are fixed in the correct position. Depending on the type of fracture, different methods are used – such as metal plates, intramedullary nails, dynamic hip screws or special nails for the upper (proximal) part of the thigh.
If there is not enough stable bone material available due to a severe comminuted fracture (where the bone has splintered or fragmented) or advanced bone loss, then the body’s own bone tissue – from the hip bone, for example – can be removed and transplanted into the femur.
In the case of severe femoral fractures near the hip joint – such as femoral head or femoral neck fractures – it may be necessary to use an artificial hip joint (endoprosthesis), especially in older patients.
At the end of the surgery, a drainage device is often inserted to drain wound fluid (exudate) in a controlled manner. The wound is then closed. Depending on the procedure, the duration of the intervention is usually between 1 and 2 hours.
Preparation and precautions
Before the surgery, the exact position and course of the fracture is determined using X-ray imaging. In more complex cases, computed tomography (CAT scans) may also be required to assess the fracture in greater detail.
Prior to the intervention, the usual preoperative examinations are carried out, including a blood test, blood pressure measurement and an electrocardiogram (ECG). Blood-thinning medications must be discontinued in good time in consultation with the attending doctor. It is also important to have an empty stomach before the intervention – i.e. not to eat for at least 6 hours and not to drink for 2 hours.
Aftercare and recovery
Physiotherapeutic mobilisation begins shortly after the intervention in order to promote mobility and prevent complications. Any wound drainage tubes are usually removed after one to two days. Postoperative pain is treated with targeted painkillers.
During their hospital stay, which lasts about 6 days, the patient practises walking step by step with partial weight bearing, using walking aids. The patient’s full weight must not be put on the leg until it has healed, i.e. after approx. 6 to 8 weeks. The healing process is monitored by regular follow-up checks.
Implants such as screws or plates that have been inserted during an osteosynthesis procedure usually remain in the body and only need to be removed if they cause discomfort.
Potential complications
Surgery for femoral fractures is generally considered low-risk and generally takes place without serious complications. As with any surgical intervention, however, certain risks cannot be completely ruled out. These include infections, secondary bleeding, blood clots and, in rare cases, damage to nerve structures. Restricted mobility of the hip joint may also occur in rare cases and there is a risk, particularly in older patients, that the ability to walk may not be fully restored after the intervention.
Questions about the treatment of a fractured thigh
Does a femoral fracture always have to be operated on?
Often an operational intervention is necessary to enable stable healing and rapid mobilisation. Conservative treatment can only be considered for very stable, non-displaced fractures or for patients for whom surgery would carry a high risk.
How long does it take to recover from a fractured thigh?
The healing time after a thigh fracture is usually around 6 to 8 weeks. For more complex fractures or older people, recovery can take longer. How quickly people regain full mobility depends heavily on their individual state of health and the rehabilitation they undergo.
How long do you stay in the hospital after a fractured thigh operation?
An inpatient stay after a thigh fracture usually lasts between 5 and 7 days. This is usually followed by a rehabilitation phase – either outpatient or inpatient – in order to rebuild mobility in a targeted manner.
When can you drive again after a fractured thigh?
Driving a car after a thigh fracture is only permitted once putting weight on the leg has become painless and once the leg has regained sufficient capacity to react – as a rule, at the earliest 6 to 8 weeks after the operation. Medical approval is recommended.
How long are you unable to work after a fractured thigh?
The duration of incapacity for work following a thigh fracture depends on the patient’s occupation, type of fracture and the healing process. In the case of physically demanding activities, incapacity to work can last several months, while it may be possible to return to office work after just a few weeks.
