Femur and Tibia Shaft Fractures

Patient information — Dr Christopher Spelman, Orthopaedic Surgeon

Overview

The shaft is the long, straight middle portion of a bone. Fractures of the shaft of the thigh bone (femur) or shin bone (tibia) are significant injuries, usually caused by high-energy trauma such as a car accident or a fall from height, though in older people with weaker bones they can occur with lesser injuries. They cause severe pain, deformity and inability to walk, and require prompt treatment.

Initial care

These fractures are first stabilised and assessed, including checking the circulation and nerves in the limb and looking for other injuries. An open fracture (where the bone has broken the skin) is an emergency requiring urgent antibiotics and surgery to clean the wound. The leg is usually splinted, and pain is managed, before definitive surgery.

Treatment

The great majority of femoral and tibial shaft fractures in adults are treated surgically. The standard operation is intramedullary nailing – a metal rod is passed down the hollow centre of the bone and locked with screws at each end. This holds the bone to length and alignment while allowing early movement and, for many patients, early weight-bearing, without a large incision at the fracture itself. Some fractures are better suited to a plate and screws, and certain tibial fractures can be treated in a cast or brace. Open fractures are managed with a combination of wound care and fixation.

Recovery

Recovery depends on the bone, the fracture and any other injuries. Nailing allows early mobilisation, and bony healing typically takes around three to six months, with physiotherapy to restore strength and movement. Return to full activity and sport is later and is guided by healing on x-ray.

What the evidence shows

Intramedullary nailing is a highly successful treatment for femoral shaft fractures, with union rates reported between about 85% and 100% (commonly around 95% or higher in modern series). Tibial shaft fractures also do well with nailing, though the tibia’s more exposed position and poorer soft-tissue envelope mean complications such as delayed healing are somewhat more common than in the femur.

Complications

Shaft fractures are serious injuries, and recognised complications include:

●      Delayed or non-union – slow or failed healing, more common in the tibia, in open fractures and in smokers, sometimes requiring further surgery.

●      Malalignment – the bone healing with a slight bend or rotation, or a small length difference.

●      Infection – particularly with open fractures.

●      Blood clots (deep vein thrombosis and pulmonary embolism) – the risk is significant with lower-limb fractures, so preventive measures are used.

●      Knee or hip pain around the nail, and hardware that is occasionally removed.

●      Fat embolism and, with high-energy injuries, associated injuries – which is why these patients are assessed thoroughly.

Summary

Femoral and tibial shaft fractures are major injuries that are usually treated with an intramedullary nail, which has high union rates and allows early movement. Open fractures need urgent care. Dr Spelman manages upper and lower limb trauma across all ages and will explain your specific injury, its treatment and recovery.