Surgery for a Thighbone (Femur) Fracture (Flexible Nails, Plate, or Spica)

What this surgery is

The femur (thighbone) is the strongest bone in the body, so a femur fracture is a serious injury. Treatment depends mostly on your child's age and size:

• Young children (often under about 5–6 years): a body cast called a spica cast holds the hip and thigh still while the bone heals. See the “Body (Spica) Cast Care” sheet for day-to-day care.
• School-aged children: flexible (elastic) nails are usually slid inside the bone through small incisions and removed in a later surgery once healed.
• Older or larger children/teens: a plate and screws, or a rigid nail inside the bone, may be used.

Why it was done

A broken femur needs to be held in good alignment so the leg heals straight and equal in length to the other leg. The method chosen gives the best chance of a strong, straight heal for your child's age and size.

Activity & weight-bearing

• Follow your surgeon's weight-bearing instructions exactly — they will tell you how much, if any, weight your child can put on the leg.
• Use the walker, crutches, wheelchair, wagon, or stroller you were given. Younger children may need to be carried.
• Do not let your child stand or walk on the leg until your surgeon says it is okay.

Caring for the cast or incision

• Keep any cast clean and dry; keep incisions clean and covered as instructed.
• Keep the leg elevated and use ice over (not directly on) the area for the first 1–2 days to reduce swelling.
• Reposition your child every 1–2 hours at first to keep them comfortable and protect the skin.

Pain control

• Give acetaminophen and ibuprofen as directed; use any prescribed medicine exactly as directed.
• A stool softener and plenty of fluids and fiber help prevent constipation from pain medicine and reduced activity.

Call our office right away if you notice

• Fingers/toes that are cold, pale, gray, or blue, or that your child cannot move or wiggle
• Numbness, tingling, or burning that does not get better after raising the limb
• Pain that keeps getting worse and is not controlled by the prescribed medicine and elevation
• Fever of 100.4°F (38°C) or higher, or shaking chills
• Swelling that does not go down with rest and elevation
• Toes that are cold, pale, gray, or blue, or that your child cannot wiggle
• Redness, spreading warmth, swelling, or pus-like or foul drainage from an incision
• A cast that becomes wet, cracked, soft, soiled, too loose, or too tight, or a foul odor from inside it

Call 911 right away if your child has

• Trouble breathing or shortness of breath
• Chest pain
• A pale, gray, or bluish color to the lips or face that does not improve

Follow-up

Femur fractures generally take about 3–6 months to heal fully, though children return to many activities sooner. Your surgeon will follow healing with X-rays. After healing, a slight limp or mild leg-length difference can occur and usually improves with growth; tell your provider about any concerns. If flexible nails were used, they are usually removed 6–18 months later.

Learn more

For pictures and a family-friendly overview, see the OrthoKids resource linked on this page (OrthoKids: Femur fractures / Intramedullary nail). It is provided by pediatric orthopaedic surgeons.