Lower Limb Fracture

Lower limb fractures are breaks or cracks in the bones of the leg, including the hip, thigh bone, shin bone, calf bone, ankle, and foot. These injuries can happen to anyone through falls, car accidents, or sports activities, and they require immediate medical care to heal properly.

Table of contents

• What is a lower limb fracture?
• Bones of the lower limb
• Causes and risk factors
• Signs and symptoms
• Types of fractures
• Diagnosis
• Treatment options
• Recovery and healing
• Living with a fracture

lower extremity fractures, fractures of the lower extremity, lower extremity fracture, fractures of the lower limb

What is a lower limb fracture?

Lower limb fractures are breaks or cracks in the bones of the lower limbs, including the hip, femur (thigh bone), tibia (shin bone), fibula (calf bone), and bones of the foot^[1]. These fractures can result from various causes such as trauma, falls, sports injuries, or underlying medical conditions like osteoporosis (a condition that weakens bones)^[1].

A fracture is the medical term for a broken bone. When you break a bone, it means that force hitting your bone was stronger than the bone could handle^[2]. The break can be a small crack or it can shatter the bone into many pieces^[5].

Open fractures of the lower limb are the most common open long bone injuries. Open fractures of the tibia are specifically the most common open long bone fractures, with an annual occurrence of 3.4 per 100,000 people^[6]. The mean age of those who sustain open tibial fractures is 43.3 years, most frequently occurring in young adult males and elderly females^[6].

• Hip
• Femur (thigh bone)
• Tibia (shin bone)
• Fibula (calf bone)
• Foot bones
• Ankle

Bones of the lower limb

Your lower limb contains several important bones that work together to support your body weight and allow you to walk and move^[5]. The main bones include the femur in your thigh, which is the strongest and longest bone in your body, the tibia in your lower leg (also called the shin bone), and the fibula which runs alongside the tibia^[13]. Your foot contains many smaller bones that help with balance and movement.

The femur is so strong that it usually takes severe trauma to break it^[13]. The tibia and fibula work together in your lower leg, and it’s common to break both bones during the same injury^[13].

Causes and risk factors

High energy trauma is the primary cause of lower limb fractures, with over 50% of cases being caused by road traffic accidents or falls from a great height^[6]. Common causes also include motor vehicle accidents, sports injuries, and falls^[2][5].

The most common way to break a lower leg bone is through a fall, which can cause a direct blow or a rotational force to the bone^[7]. In older children, sports injuries and motor vehicle accidents are common causes^[7].

Some people are at higher risk for lower limb fractures. These risk factors include advancing age, as the risk increases with age when bones weaken^[9]. More than 70% of fractures in the lower limb occur in women^[9]. People with osteoporosis or osteopenia are much more likely to experience bone fractures, especially from falls, because these conditions weaken bones and make them break more easily^[13].

Other risk factors include having a family history of broken bones, arthritis (especially osteoarthritis and rheumatoid arthritis), and certain lifestyle factors like smoking, alcohol use, lack of exercise, and poor nutrition^[9].

Signs and symptoms

The symptoms of a lower limb fracture depend on which bone is broken and how severe the injury is^[2]. When the thigh bone (femur) is broken, it is usually obvious because it takes so much force to break this strong bone^[2]. However, a break in the shin bone (tibia) or the bone that runs alongside it (fibula) may be less obvious^[2].

Most broken legs will look visibly different than usual. You will probably notice swelling, discoloration, or bruising near the fracture^[13]. Common signs and symptoms include^[2]:

• Severe pain, which may worsen with movement
• Swelling and tenderness
• Bruising
• Obvious deformity or shortening of the affected leg
• Inability to walk or put weight on the leg
• A bump that is not usually on your leg

In children, especially toddlers who break a leg, they may start limping or simply stop walking, even if they cannot explain why^[2]. The child will favor the injured leg and not want to bear weight on it^[7].

With tibial shaft fractures, there will be localized swelling and tenderness with or without visible deformity^[7]. For some types of fractures called toddler’s fractures, physical findings may be subtle with minimal swelling and tenderness^[7].

Types of fractures

Bone fractures vary depending on the force involved and are classified into different types based on the location of the fracture, the pattern of the fracture, and exposure of the fracture site^[5]. There are many different types of lower limb fractures^[3].

Fractures can be classified by their pattern or shape^[5]:

• Transverse fracture: The break occurs as a straight, horizontal line going across the bone shaft
• Oblique fracture: The break occurs as an angled line across the bone shaft
• Spiral fracture: A type of fracture caused by a twisting force with a fracture line that encircles the bone
• Comminuted fracture: A severe type of fracture where the bone breaks into three or more pieces
• Segmental fracture: The bone is broken in multiple places creating separate segments

Fractures are also classified by whether the skin is broken^[5]:

• Open (compound) fracture: This causes serious damage to the surrounding soft tissue as the bone fragments stick out through the skin to the external air, exposing the fracture site. This is a serious condition that requires immediate treatment to decrease the chance of infection^[10]
• Closed (simple) fracture: The broken bone has not pierced the skin and the surrounding skin remains intact

Other types include^[5]:

• Stress fracture: Also called a hairline fracture, this appears as small thin cracks in the bone and occurs due to overuse or wear and tear
• Greenstick fracture: An incomplete fracture where the bone cracks but does not break all the way through, like when you try to break a green stick

Diagnosis

If you or your child has any signs or symptoms of a broken leg, you should seek medical care right away^[2]. Delays in diagnosis and treatment can result in problems later, including poor healing^[2].

A healthcare provider will diagnose a broken leg by first conducting a physical examination^[13]. During the physical exam, the provider will inspect the affected area for tenderness, swelling, deformity, or an open wound^[10]. They will look for signs of swelling, bruises, rupture of the skin, or any other bone deformities^[5].

X-rays can usually pinpoint the location of the break and determine the extent of injury to any nearby joints^[10]. An X-ray should include views from different angles and include the knee and ankle joints^[7]. The X-ray will show if the bone is broken, where the bone is broken, and how severe the injury is^[5].

Sometimes, more detailed images are needed. A CT scan (computed tomography scan) or MRI (magnetic resonance imaging) may be needed for more complex fractures or to assess damage to soft tissues, tendons, and ligaments^[10][5]. For suspected stress fractures, a CT scan or MRI is often needed since X-rays often fail to show this type of injury^[10].

Treatment options

Treatment of a broken leg varies depending on the type and location of the break^[2][10]. The treatment approach depends upon the type and severity of the fracture and involves both non-surgical and surgical methods^[5].

Non-surgical treatment options include^[5][10]:

• Rest: For stress fractures, you will need to avoid the activity that caused the fracture and take the weight off it by using crutches or wearing a padded boot
• Casting and splinting: A cast or splint is used to hold the fractured bone fragments in proper position until the bone heals. Casts and splints are typically made of plastic, fiber, or similar materials that hold your limb still while it heals
• Traction: This method involves placing the limb in a weight and counterweight system to pull the bone back into place and ensure the bones are properly aligned. This is often used to treat small children with a broken thigh bone
• Closed reduction: For severe angled fractures where the bones have not broken through the skin, your doctor will gently move and realign the bone fragments to their normal position

Surgical treatment may be needed for serious breaks. Surgery options include^[2][9]:

• Internal fixation: This is the most common method for treating a broken femur. A metal rod is inserted into the center of the femur and then down the fracture to keep it in place. Sometimes metal plates and screws are attached to the bone and secured together to repair the fracture
• External fixation: The physician will apply an external surgical piece that acts as a stabilizing frame and holds the bones in place
• Open reduction and internal fixation (ORIF): The fracture site is exposed through surgery and the fracture is reduced (put back together). Internal fixation is done with devices such as wires, plates and screws, and metal rods

A severely broken leg may require metal pins and plates to hold the fragments together^[2]. Less severe breaks may be treated with a cast or splint^[2].

Recovery and healing

A broken leg usually takes 6 to 12 weeks to heal, but it can sometimes take longer^[8][13]. Broken bones take around 4 to 8 weeks to heal, depending on the age and health of the person and the type of break^[16].

You will usually have follow-up appointments to check your leg is healing properly^[8]. Your provider will take X-rays during the healing process to make sure that the bone is healing properly^[22].

After the cast is removed, you may need physical therapy for several months to reduce any stiffness in your leg and help strengthen it^[8]. Physical therapy is a crucial component for recovery after a fracture. It not only helps you to regain strength and function, but it can also decrease any pain after the fracture^[22]. You will rebuild strength and eventually get back to using your limbs again^[22].

Your recovery will go better if you follow your doctor’s orders and stay as active as possible^[17]. Exercise improves blood flow to the fracture site, rebuilds the muscles around it, and can help speed up the healing process^[22].

During recovery, it is important to^[18]:

• Rest and raise your leg whenever possible
• Take pain medication as directed by your doctor to ease pain
• Gently move your toes while wearing a cast to ease stiff muscles
• Prop up your leg on pillows when you sit or lie down, keeping your leg higher than the level of your heart to help reduce swelling
• Put ice or a cold pack on your lower leg for 10 to 20 minutes at a time, but put a thin cloth between the ice and your cast or splint

You heal best when you take good care of yourself. Eat a variety of healthy foods, and don’t smoke^[18].

Living with a fracture

When you are nursing a broken bone, your life will change for a while as you recover^[17]. You may find it more difficult to do some of your daily routines, depending on which bone you broke^[22].

Make your home safer

Your home is most likely not designed for someone with limited mobility^[22]. Ask your family or friends to help make your home safer while you heal^[17]. Important steps include^[17]:

• Rearrange the furniture to clear a wide path through each room. If needed, move your bed to the first floor until you can climb the stairs again
• Clear out clutter such as stacks of clothes, books, or magazines
• Secure large area rugs with double-stick tape around all edges. Remove small throw rugs
• Add lighting to make sure all entries and hallways are brightly lit. Put nightlights everywhere you walk after dark
• Install handrails on both sides of stairs and grab bars in the shower
• Keep a phone nearby, especially if you live alone

Make daily tasks easier

You may need to do things differently for a while^[17]. Tips for daily activities include^[17]:

• For cooking: Sit on a high stool with a back while fixing meals. Move pots and dishes onto the countertop within easy reach. Slide pots and dishes along the counter instead of lifting. Stock up on healthy, frozen meals you can heat in the microwave. Buy pre-washed, pre-cut vegetables and fruit
• For bathing: Use a long-handled sponge to scrub your feet, lower legs, and back. Put a non-slip rubber mat in the bathtub or shower. If recovering from a broken hip or spine, add a raised toilet seat and use a bath chair with a hand-held sprayer so you can sit to bathe
• For dressing: Pull on clothes with a dressing stick that has hooks or pinchers. Choose loose clothes to fit over a cast or brace. Put on your shoes with a long-handled shoehorn instead of bending over. Switch to elastic shoelaces to slip into lace-up shoes easily. Wear low-heeled, sturdy shoes to help prevent falls

Get help and be patient

One of the best things you can do while your bone is healing is to ask for help from family and friends^[19]. This includes tasks like grocery shopping or getting a ride to your follow-up appointment^[19]. If you normally have to prepare meals for yourself or others, you will likely need help after a bone fracture^[17].

It is hard to wait around and put your life on hold as your bone heals. While it can be tempting to push the limits, try your best to be patient while you heal^[19]. Pushing yourself too hard instead of asking for help can delay your recovery^[19].

Do not put weight on your leg unless your doctor tells you to. Use crutches to walk^[18]. You should avoid moving your leg or putting weight on it, and avoid raising your leg^[20].

Although it is hard to wait around while your bone heals, know that it will not take forever^[19]. Your life is going to change for a few months, but when your bone heals, you should be able to get back to most of your normal activities^[19]. When your cast is removed and you complete physical therapy, your provider will let you know when you can return to contact sports or other activities that put a lot of strain on your leg^[8].