Fracture of thigh bone – femur (in a child)

Find out what happens when a child's thigh bone (femur) is broken and needs an operation to heal it

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What is it?

Your child's thigh bone (femur) is broken. This is the long bone running from the hip to the knee. Fractured means exactly the same as broken. There is no difference between a fractured bone and a broken bone.

Children's femur fractures heal up very quickly, but may lead to shortening if the bone ends override. The bone ends may heal at the wrong angle. The bone ends can usually be kept in line while they heal by pulling on the leg (traction).

Traction is made up of strings that run from your child's leg, via pulleys, to weights at the end of the bed. X-rays are taken to check the position of the bone ends and to show healing. The weights are changed as needed to keep the bones properly lined up.

In young children, sticky tape is used on the skin to fix the traction to the leg (skin traction). Often the strings are led upwards for traction.

In older children (10 to 14 years) skin traction cannot usually be used. Instead we use skeletal traction. Your child would be given a general anaesthetic and have a metal pin passed through the leg below the knee. The traction strings are attached to this pin.

Your child is kept in traction until the bone begins to feel solid and there are signs of healing on the X-ray. Occasionally the broken bone can be fixed by passing two flexible metal rods up inside the bone. This is called intra-meddlary nailing. The rods are usually removed once the bone has healed.

Children generally take one week for each year of their age to heal their breaks, up to a maximum of 12 weeks. For example, a five year old child will be in hospital for at least five weeks.

The operation

Your child will have a general anaesthetic, will be completely asleep and will not feel any pain. A nick is made in the skin on each side of the bone below the knee. A special steel pin is pushed through the bone and is fitted to the traction strings. Then your child is woken up. The operation takes about 20 minutes. There are no stitches in the skin.

Before the operation

A temporary skin traction and a splint are put on your child's leg. These will keep it still whilst your child is waiting to have his or her operation.

If you are staying in with your child, you will be shown where you will sleep.

Your child must have nothing to eat or drink for about six hours before the operation. This means not even a sip of water. Your child's stomach needs to be empty so that the anaesthetic can be administered safely.

On the ward, your child will be checked for past illnesses and will have special tests to make sure he or she is well prepared and can have the operation as safely as possible. You will have the operation explained to you and will be asked to fill in an operation consent form.

Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.

Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.

Before the operation and as part of the consent process, you may be asked to give permission for any 'left over' pieces to be used for medical research that have been approved by the hospital. It is entirely up to you to allow this or not.

Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.

After – in hospital

Your child's leg should not hurt much after it has been put in traction. If it does, he or she will be given painkillers to ease the pain.

Your child will be able to drink again two to three hours after the operation provided he or she is not feeling sick. Your child should be able to eat normally the next day.

Your child will have the appropriate support by the physiotherapists whilst in bed to make sure that they are able to move around as much as possible. Your child will need help getting back on his or her feet.

Your child will regain hip, knee and ankle movement on his or her own.

It may take two or three months for your child to regain full movement of the leg. Your child will be in hospital for at least one week for every year of his or her age (aged five years = five weeks).

Your child will be given an appointment to visit to the orthopaedic outpatient department after leaving the hospital. An X-ray will be taken to check that the break is healing satisfactorily.

If your child is of school age, he or she will be given lessons by teachers on the ward. The traction pin in a teenager is taken out on the ward. However, children are usually given a brief general anaesthetic in the operating theatre for this.

After – at home

Your child will not be able to do sports until advised by the doctors. Your child may swim as soon as he or she is out of bed. Your child's leg will continue to improve for up to six months.

Possible complications

As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs. The tests that your child will have before the operation will make sure that he or she can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

There is a small risk for minor infection in the area where the pins enter the skin but this can be treated quickly with antibiotic tablets.

There is a much smaller risk (less than 1 per cent) of infection deeper in the leg and on the bone especially close to the area of the fracture or, even worse, of an infection spreading in your child's bloodstream. If this happens, your child will need to stay in hospital and have the infection treated by getting intravenous antibiotics (through a small plastic tube placed in one of their veins).

There is also a very small chance that one of the blood vessels or the nerves of the leg can be damaged during the operation and this might require another operation to fix the problem. The bone may not heal in a perfect position. It may be a little bent at first. If bent, the bone will become straighter as it grows. The younger the child, the more the bone will straighten. This is known as remodelling.

The growth of the thigh bone may be upset. Surprisingly, the injured leg may end up a little longer than the other leg. This is because fracturing the bone increases its blood supply. This in turn increases the bone's growth.

If the healing of the fractured area is not as strong as expected (and this happens rarely), your child will be more prone to have further fractures in the same bone in the future.

Also rarely, the blood supply to a certain area of the bone can be affected because of the fracture and the operating procedure and this can result in necrosis (death) of the bone. If this happens, it is a serious complication and your surgeon will offer you further advice.

General advice

These notes should help your child through his or her recovery. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little.

If you have any queries or problems, please ask the doctors or nurses.

This content is imported from Third party. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

Based on a text by Surgery Door

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