eMedicine Specialties > Sports Medicine > Lower Limb

Femur Injuries and Fractures: Follow-up

Author: Douglas F Aukerman, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Division of Sports Medicine, Penn State University
Coauthor(s): John R Deitch, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Team Physician, Penn State University; Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopaedic Surgery, Wishard hospital; William Ertl, MD, Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma
Contributor Information and Disclosures

Updated: Oct 30, 2008

Follow-up

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In cases of traumatic femoral fractures, schedule a clinic follow-up visit at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. The femoral fracture should be healed by 3 months. Once bony union is complete, treatment is focused on muscle rehabilitation. Progressive strengthening of all lower extremity musculature is initiated and continued until strength is 95% of the contralateral extremity.

Sports-specific rehabilitation is initiated once strength has been regained. The athlete should be back to preinjury status at 1 year postinjury. Long-term symptoms include hamstring weakness, limited standing and walking (39%), some intermittent pain (37%), and inability to return to preinjury work (9%).

For femoral stress fractures, a minimum time of 6 weeks is necessary for bone healing to occur before the patient is able to resume activities. The athlete should resume activities in a very gradual fashion over the course of several weeks. If symptoms recur during training, the athlete should return to the previous phase of treatment for a minimum of 3 weeks.

Complications

  • Complications following traumatic femoral fractures
    • Refracture
    • Hardware failure
    • Prominent hardware
    • Neurologic injury
    • Peroneal nerve palsy - Most commonly due to traction
    • Pudendal nerve injury - Due to compression at the perineal post
    • Sciatic nerve injury
    • Vascular injury
    • False aneurysm
    • Atrioventricular fistula - Requires angiogram
    • Compartment syndrome
    • Nonunion - Rate of 1%
    • Delayed union
    • Malunion
    • Heterotopic ossification
    • Infection
  • Complications following femoral stress fractures
    • Progression to a complete fracture
    • Refracture
    • Nonunion

Prevention

Femoral stress fractures can be prevented or minimized by proper training techniques. Gradual increase in activity intensity and duration allow the body to respond to the increase load stresses. Maintaining proper footwear and not allowing footwear to break down, adequate rest periods in training, and good nutrition are also important aspects of prevention.

Prognosis

Of posttraumatic diaphyseal femur fractures, 95% heal with antegrade femoral nailing. Malunion and infection rates are low (less than 1%).

Surgical management is rarely needed to treat femoral stress fractures; however, surgical stabilization is recommended for recalcitrant cases.

Miscellaneous

Medicolegal Pitfalls

  • Failure to address conditions that may accompany femur fractures and injuries
  • Missed fractures or dislocations due to concentration on the obvious pain and deformity of the femur

Related Medscape topic:
Resource Center Medical Malpractice and Legal Issues

 


More on Femur Injuries and Fractures

Overview: Femur Injuries and Fractures
Differential Diagnoses & Workup: Femur Injuries and Fractures
Treatment & Medication: Femur Injuries and Fractures
Follow-up: Femur Injuries and Fractures
Multimedia: Femur Injuries and Fractures
References
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References

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  8. Schmal H, Strohm PC, Mehlhorn AT, Hauschild O, Südkamp NP. [Management of ipsilateral femoral neck and shaft fractures] [German]. Unfallchirurg. Sep 6 2008;epub ahead of print. [Medline].

  9. Mutty CE, Jensen EJ, Manka MA Jr, Anders MJ, Bone LB. Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department. Surgical technique. J Bone Joint Surg Am. Oct 2008;90 suppl 2 pt 2:218-26. [Medline].

  10. Sanders DW, MacLeod M, Charyk-Stewart T, et al. Functional outcome and persistent disability after isolated fracture of the femur. Can J Surg. Oct 2008;51(5):366-70. [Medline]. [Full Text].

  11. Thomas HO. Diseases of the Hip, Knee, and Ankle Joints. Liverpool, England: T. Dobb & Co; 1875.

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Further Reading

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Keywords

femur injuries and fracture, femoral shaft fracture, diaphyseal fracture of the femur, femoral stress fracture, femur fracture, femoral neck stress fracture, femur injury, femur stress fracture, femoral diaphyseal fracture, broken leg, leg fracture, fractured femur, femur trauma, leg trauma, fractured leg

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Contributor Information and Disclosures

Author

Douglas F Aukerman, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Division of Sports Medicine, Penn State University
Douglas F Aukerman, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

John R Deitch, MD, Assistant Professor, Department of Orthopedics and Rehabilitation, Team Physician, Penn State University
John R Deitch, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Pennsylvania Orthopaedic Society
Disclosure: Nothing to disclose.

Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopaedic Surgery, Wishard hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

William Ertl, MD, Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma
Disclosure: Nothing to disclose.

Medical Editor

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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