What is a femur?
The femur, the thigh bone, is the longest, largest, and strongest bone in the human body [1, 2]. It is a critical component of the human musculoskeletal system, crucial in supporting the body's weight and facilitating movement [2].
The femur has a complex structure, which includes the proximal epiphysis, femoral head, fovea capitis, neck, greater and lesser trochanters, and proximal shafts [3]. The proximal epiphysis of the femur articulates with the acetabulum of the pelvic bone and forms the hip joint [3].
The femur's internal architecture comprises two major trabecular systems arranged along the lines of compressive and tensile stresses, reflecting the biomechanical demands of weight-bearing [4].
The femur is also a significant bone in forensic medicine and anthropological studies, as it can provide valuable information about an individual's stature, sex, age, and ancestry [3].
What happens when you break your femur?
When you break your femur, you are going to experience immediate, severe pain [2]. This is typically accompanied by an inability to put weight on the injured leg. The wounded leg may appear shorter than the uninjured one and seem crooked [2].
A broken femur is usually the result of a severe accident, with vehicle accidents being one of the leading causes [2]. Older adults can fracture their femur from a fall, as their bones tend to weaken [2]. In some cases, the fracture may be so close to the hip that it's referred to as a hip fracture instead of a femur fracture [2].
Treating a broken femur
The healing process for a broken femur is typically lengthy, taking up to six months and going through four phases: the body starts the healing process, experiences inflammation, regenerates with new bone growth, and remodels with mature bone being replaced by newly formed bone [4]. Most broken femurs require surgery and medication, with the most common surgery being intramedullary nailing, which involves inserting a rod into the length of the bone with screws above and below to hold it in place [2].
Treating a broken femur involves a combination of surgical and non-surgical methods, depending on the severity and location of the fracture.
In the early stages of osteonecrosis (Bone death) of the femoral head, medullary decompression using the forage biopsy technique can help normalise intramedullary pressure and prevent bone death [1]. Flexion osteotomy may be indicated for advanced stages, while total arthroprosthesis is the only solution for Ficat stage 4 cases [5].
A minimally invasive technique using concentrated bone marrow aspirate and platelet-rich plasma has been used to treat pre-collapse osteonecrosis of the femoral head. This technique involves decompressing the femoral head and injecting adult mesenchymal stem cells and platelet-rich plasma into the area of osteonecrosis [6].
For the nonunion neck of the femur, a popular surgical treatment is the valgus intertrochanteric osteotomy. This procedure optimises conditions for fracture healing by converting shear forces across the fracture site into compressive forces [7].
Several surgical methods can be employed in cases of aseptic femoral shaft nonunion. These include exchange nailing for hypertrophic nonunion, exchange lateral plating for nonunion with obvious malformation, and augmentation plating to improve the success rate of nailing for femoral shaft nonunion. The Ilizarov and induced membrane techniques are also used for bone nonunion, especially with complicated or significant segmental bone defects [8].
In the case of femoral metastases, various types of endoprostheses and osteosynthetic devices can be used depending on the lesion site [9].
For complex femoral deformities in patients with polyostotic fibrous dysplasia and coxa vara, stabilisation with an interlocking cervical diaphyseal nail is recommended after correcting all femoral deformities [10].
Can a broken femur lead to death?
Yes, it is possible to die from a broken femur, although it is not the fracture itself that is typically fatal but the complications that can arise from it. A fracture of the femur, particularly in the neck of the femur, is a leading cause of injury-related mortality in the elderly population [11].
The 30-day mortality rate following hip fracture surgery is reported to be 8.7% [11]. The most common causes of death following such a fracture include pneumonia, sepsis, and acute myocardial infarction [11].
Risk factors for mortality include male gender, increasing age, admission source other than the patient's own home, admission haemoglobin of less than ten g/dL, a history of myocardial infarction, concomitant chest infection during admission, increasing Charlson comorbidity score, and liver disease [11].
It's important to note that the mortality rate can vary depending on the patient's overall health, age, and other medical conditions. For example, one study found that the mortality rate was 6% among patients aged 75 years and older who were hospitalised due to a proximal femur fracture [12].
In conclusion, while a broken femur can be a severe and potentially life-threatening injury, particularly in older adults, the risk of death can be influenced by a variety of factors, including the patient's overall health and the presence of other medical conditions.