Broken Femur (Thigh Bone) | Diagnosis & Treatments

At Boston Children’s Hospital, the first step in treating broken legs in children is to form an accurate and complete diagnosis.

A doctor will use different diagnostic tests to get detailed images of your child’s fracture. Typical tests include:

  • X-rayA diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film; usually sufficient for the majority of fractures.
  • Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan(CT, CAT scan): A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.
  • Bone scanA painless  procedure that uses a radioactive substance to detect changes in joints and bones and determine the cause of unexplained pain

Non-surgical treatment for broken femur

Closed reduction surgery

Closed reduction surgery is a non-surgical procedure used to reduce and set the fracture. Using an anesthetic (typically given through an IV), the doctor realigns the bone fragments from outside the body and holds it in place with a spica cast.

Casting

After surgical treatment for a broken femur, children are usually put in a spica cast, which extends from mid-chest down the length of the affected leg and halfway down the other leg.

Post cast removal, the child may need a special brace and physical therapy exercises to strengthen the muscles and regain flexibility in the joints.

Type
Location
Uses
Unilateral hip spica cast
Applied from the chest to the foot on one leg
Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
One and one-half hip spica cast
Applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both legs to keep the hips and legs immobilized.
Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
Bilateral long leg hip spica cast
Applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs immobilized.
Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
Short leg hip spica cast
Applied from the chest to the thighs or knees.
To hold the hip muscles and tendons in place after surgery to allow healing.

Surgical options for broken femur

Since non-surgical treatment of a broken femur is generally ineffective for a child once they can walk, the following surgeries may be needed to put broken bones back into place:

  • Internal fixation: In severe or complicated fractures, a surgeon may insert metal rods or pins into the femur to hold the fractured bone in place while it heals.
  • External fixation: If internal fixation is not an option, metal pins can be put through skin into the fractured bone. These pins are attached to a bar that sits outside the skin on the child's thigh. The pins and bar hold bone fragments in place to allow for alignment and to help the bone heal.
  • Intramedullary nails or rods: For children who are older than 5 but don't yet have mature “adult” bones, the surgeon can make small incisions in the skin and insert flexible nails into the bone using miniaturized surgical tools and cameras. This type of procedure, known as “minimally invasive surgery” (MIS), results in less pain, less scarring and a quicker recovery time. These flexible nails realign the bone and hold it in place while still allowing growth and natural remodeling. This allows the child to begin walking right away.
  • In adolescence through adulthood, a rigid nail may be inserted. This also allows the patient to walk immediately. 
  • Both flexible and rigid nails can either remain in place permanently or be removed.