Most femoral fractures are treated surgically. Depending on the location and course of the break, the fractures are fixed with plates, screws or nails, or hip prostheses are inserted. Sometimes, not enough bone is available in the region of the fracture.
Femur fractures are divided into: Femoral head fractures, femoral neck fractures and femoral shaft fractures. Femur fractures are the most common type. Older people are typically affected by osteoporosis, e.g. after a fall on their side.
Metal plates, screws or nails are generally used for the surgical treatment of femur fractures. This method of fixing fractures with metal parts is called osteosynthesis. Total hip prostheses are usually inserted for older patients with a femoral head or femoral neck fracture.
What preparations are carried out before the procedure?
Before the surgery, the precise location and course of the fracture are visualised on an X-ray. Depending on the fracture, computed tomography may also be required.
Before the intervention, the usual clarifications before surgery, such as blood tests, blood pressure measurements and an ECG, are carried out. The patient should pause any blood-thinning medications and have an empty stomach for the surgery.
How is the operation performed?
The surgical method used is decided based on the X-rays and the patient’s general condition. The intervention can be performed under general anaesthesia or spinal anaesthesia. The bone is then exposed in the area of the fracture. The broken femur is straightened and bone fragments are fixed together into the correct position. Metal plates, intramedullary rods, dynamic hip screws or special nails for the upper (proximal) part of the femur are used. If too little bone material is available to fix the fractures due to bone loss or a pronounced fracture, bone tissue is removed elsewhere, e.g. from the hip bone, and inserted into the femur. In some cases, an [artificial hip joint] has to be used for severe femoral head fractures or even femoral neck fractures.
Once the fracture has been fixed in place, a drainage tube is often inserted to drain out fluid from the wound. The surgical wound is then closed. Depending on the procedure, the surgery takes 1 to 2 hours.
What is the success rate of this procedure?
The breaks are stabilised and the bones generally heal well with surgical treatment. Early mobilisation is important, particularly in the case of older people, so they do not lose the ability to walk.
What are the possible complications and risks of this procedure?
Operations on femur fractures are low-risk and usually proceed without any serious complications. As with all surgery, in exceptional cases the operation may lead to infections, nerve damage, post-operative haemorrhaging or blood clots. In rare cases, the patient can have limited movement in their hip joint. Older people run the risk of losing the ability to walk.
What happens after the operation?
Physiotherapy exercises are begun soon after the operation. The drainage tubes are removed after 1 to 2 days. Postoperative pain is treated with painkillers. During the hospital stay of approx. six weeks, the patient may put some weight on the leg with the help of crutches. They may not put their full weight on their leg until it has healed fully; this will take approx. 6 to 8 weeks. The healing process is monitored with regular follow-up checks.
The screws or plates used during the osteosynthesis are not usually removed as long as they do not cause any complaints.
