The femur (thigh bone), extending from the hip to the knee, is the strongest and longest
bone in the human body. Because it is so strong, in relatively young people it usually requires a great deal of kinetic force to break the femur shaft. That often happens in truck, car and motorcycle crashes. In older people with weaker bones, however, a fall may be sufficient to fracture of the femur, especially the neck of the femur where it joins the pelvis.
In our decades of representing badly injured Georgians, we have handled numerous femur fracture cases. In one such case arising from a truck wreck, the jury in a conservative rural county surprised everyone with a verdict of $2,345,940.17. This was three times the highest previous verdict in the history of the county up until then and nearly a million dollars more than the $1.3 million we had requested in closing argument. It reminded people of the 1982 movie, “The Verdict.” This verdict was broken down as follows: compensatory damages: $1,742,845.70, attorney fees due to the defendant trucking company’s bad faith in violating mandatory safety rules, $580,948.57, expenses of litigation due to bad faith, $22,145.90. Medical expenses were $112,228. The highest offers from defendant’s insurance company were $100,000 the week before trial and $400,000 on third day of trial. It came from meticulously presenting the details of the injury without appearing to overreach and giving the jury a method to reach their own conclusion.
Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture).
Femur fractures are classified depending on:
- The location of the fracture (the femoral shaft is divided into thirds: distal, middle, proximal
- The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle)
- Whether the skin and muscle over the bone is torn by the injury
The most common types of femoral shaft fractures include:
- Transverse. In this type of fracture, the break is a straight horizontal line going across the femoral shaft.
- Oblique. This type of fracture has an angled line across the shaft.
- Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture.
- Comminuted. In this type of fracture, the bone has broken into three or more pieces. The number of bone fragments corresponds with the amount of force needed to break the bone.
- Open. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications—especially infections—and take a longer time to heal.
- Any or all of these diagnostic criteria may be combined in a single injury.
Femur Fracture Diagnosis
Physical examination, combined with imaging by X-ray, CT and MRI, is used to diagnose a femur fracture and determine the exact location and pattern of fracture.
If feasible, tell the doctor should be informed how the injury occurred. The physician will look for:
- Bony pieces that may be pushing on or through the skin
- Deformity of the thigh/leg, such as an unusual angle, twisting, or shortening of the leg.
- Breaks in the skin
After inspecting the leg visually, the doctor will feel the thigh, leg, and searching for abnormalities and tightness of the muscles and skin of the thigh, and checking pulses. If the patient is awake, the physicians tests for sensation and movement in the leg and foot.
Treatment for femur fracture may vary based on the type and location of the break and may often include:
Setting the leg
A displaced fracture may require the broken bones to be realigned, prior to splinting of casting of the leg. Depending on the degree of displacement, surgical or nonsurgical methods may be used to manipulate the bones back into position.
Severe or multiple fractures may require external fixation, which uses an outer metal rod and pins to hold the bone or bones in place until they heal.
- Open Reduction and Internal Fixation (“ORIF”) involves surgery and use of fixation devices, including an intramedullary rod or “nail” through the center of the bone, secured with various types of metal plates and screws, is used often to stabilize the broken femur during healing. This hardware is usually left in the leg permanently though sometimes it may be removed or replaced. Advantages of intramedullary nailing include quicker return to weight bearing, enhanced rehabilitation, and a high bone union and fusion rate compared with external fixation. But there are also potential disadvantages including increased risk of fat embolism, increased rates of infection and blood loss, and potential impediment to obtaining correct alignment. We have handled injury cases in which intramedullary fixation failed. In one case involving a femur shattered into several pieces, a small town hospital did not have the exact length of intramedullary rod immediately available. It was necessary to repeat the surgery a year later, and the patient had a permanent limp and a degree of permanent impairment in his occupation.
- Immobilization through a splint or cast. Whether or not there is surgical fixation of the fracture, femur fracture treatment usually involves use of splints or casts. A college friend had a femur fracture in football. He spent his senior year in a full leg cast. While his dreams of going to the NFL were as shattered as his leg, but he chose graduate school and ultimately returned as president of the college.
- Pain medication. Femur fractures are extremely painful. Physicians and patients must be aware of the delicate balance between pain control and risk of narcotic dependency or addiction. We know one severely injured person who was sent home with a huge quantity of hydrocodone but within a few days weaned himself off potentially addictive drugs because he needed to resume brain work, switched to over-the-counter Tylenol, and “sucked it up” for several months of recovery.
- Physical therapy. Most patients recovering from femur fractures are prescribed months of physical therapy (“PT”) to restore normal muscle strength, range of motion, and flexibility. Patients often jokingly refer to physical therapists as “physical terrorists” because the process can be quite painful, but it’s a good pain that helps recover function.
- Maximum medical improvement after a femur fracture usually takes about 4 to 6 months but sometimes can take a year or two.
Permanent Impairments after Femur Fracture
In preparing for settlement or trial of femur injury cases, we typically obtain from the physician an impairment rating under the American Medical Association Guides to Evaluation of Permanent Impairment. Physical impairment as rated under this system is not the same thing as occupational disability. A person with a relatively low impairment rating may be completely disabled from a physically demanding occupation. But a person with the same physical impairment rating may be fully capable of doing an office job. In the context of femur injuries, the determination of physical impairment involves complex tables and formulas that rate factors such as limb length discrepancy, gait derangement, muscle strength and atrophy, range of motion, arthritis, nerve injury, complex regional pain syndrome, and reduction of blood circulation. When appropriate, we also consider evaluation by a vocational rehabilitation expert to evaluate real-world disability.
Wilderness First Aid for Femur Fractures
Most of the femur fracture injuries we see are the result of motor vehicle collisions on streets and highways. These initially addressed by emergency medical personnel who can quickly stabilize the fracture and transport the patient by ambulance to a hospital. But if a femur fracture occurs in a remote wilderness setting beyond the reach of immediate emergency medical services, it is important to have someone in the group trained in wilderness first aid. One of our lawyers was trained years ago on how to set a displaced femur fracture in the wilderness using sticks tied off with bandanas, jackets, or t-shirts. We pray that it never becomes necessary to utilize that training.
If you or a loved one has suffered a femur fracture in a truck, car or motorcycle crash, contact us online or call us at 404-253-7862.
Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.
Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.