Broken Femur in Children: Symptoms, Treatment & Recovery Guide

What Are the Symptoms of a Broken Femur in Children?

The main symptoms of a broken femur in children include severe pain in the thigh that prevents movement, inability to bear weight or walk, visible swelling and deformity, and the child refusing to let anyone touch the affected leg. The leg may appear shortened or rotated compared to the uninjured side.

A femur fracture is one of the most painful injuries a child can experience. The femur (thighbone) is the longest and strongest bone in the human body, running from the hip to the knee. When this bone breaks, the symptoms are typically obvious and severe, making diagnosis relatively straightforward for medical professionals.

Children with a broken femur will almost always refuse to move the affected leg. This is a natural protective response to prevent further damage and minimize pain. The child will typically lie still and may become very distressed if anyone attempts to examine or move the leg. This behavior pattern is often one of the most reliable indicators of a significant fracture.

The severity of symptoms can vary based on the type of fracture. Complete fractures where the bone breaks entirely through typically cause more obvious deformity and pain than incomplete or "greenstick" fractures, which are more common in young children due to their softer, more flexible bones. However, all femur fractures require emergency medical attention regardless of severity.

Common Signs to Watch For

• Severe pain in the thigh area: The child will cry intensely and resist any movement
• Inability to walk or bear weight: The child cannot stand on the affected leg
• Visible deformity: The thigh may appear bent, shortened, or twisted
• Significant swelling: Rapid swelling develops around the fracture site
• Bruising: Discoloration may develop within hours of the injury
• Leg length discrepancy: The injured leg may appear shorter than the other
• External rotation: The foot and toes may point outward unnaturally

When Should You Call an Ambulance for a Broken Femur?

Call emergency services (ambulance) immediately if your child has severe pain after a fall, refuses to move their leg, or won't allow anyone to touch it. Ambulance transport is critical because paramedics can immobilize and transport the child safely, provide pain relief, and prevent further injury during transport.

Unlike many childhood injuries that can be managed with a trip to the emergency room by car, a suspected femur fracture requires emergency medical services for several important reasons. The femur is surrounded by large muscles and blood vessels, and improper movement can cause significant complications including additional tissue damage, severe pain, and in rare cases, dangerous blood loss.

Emergency medical technicians (EMTs) and paramedics are trained specifically to immobilize and transport patients with suspected long bone fractures. They have specialized equipment including traction splints that can help align the bone and reduce pain during transport. Attempting to transport a child with a femur fracture in a car without proper immobilization can worsen the injury and cause unnecessary suffering.

Additionally, children with femur fractures often require sedation or general anesthesia for proper examination and treatment. This means they should not eat or drink anything while waiting for medical care. By calling emergency services, the child enters the medical system quickly and can receive appropriate pain management while the nil per os (NPO) status is maintained.

What to Tell Emergency Services

When you call for emergency medical assistance, be prepared to provide the following information to help the dispatcher send appropriate resources:

• The child's age and approximate weight
• What happened (how the injury occurred)
• Where the pain is located
• Whether the child can move the leg at all
• Any visible deformity, swelling, or wounds
• Whether the child is alert and breathing normally

What Can Parents Do While Waiting for Help?

Keep the child still and calm, do not try to move or straighten the leg, place a soft pillow under the thigh if comfortable, do not give food or drinks, and you may give paracetamol (acetaminophen) for pain. Stay with the child and reassure them that help is coming.

While waiting for emergency services to arrive, your primary role is to keep your child as comfortable and safe as possible without causing additional harm. The most important first aid principle for a suspected femur fracture is immobilization - keeping the leg completely still. Children will naturally want to keep the injured leg motionless, so your job is to support this instinct and prevent any unnecessary movement.

Many parents feel helpless when their child is in pain and want to "do something" to help. However, with a femur fracture, doing less is often better. Attempting to splint the leg yourself, move the child, or straighten a deformed limb can cause additional damage and increase pain. Professional emergency responders have the training and equipment to safely manage these injuries.

One thing that can provide some comfort is positioning. If the child is lying down, placing a soft pillow or rolled blanket under the thigh and knee (keeping the knee slightly bent) can relieve some pressure and pain. However, only do this if it doesn't require significant movement of the leg and if the child tolerates it. Never force a position that causes more pain.

First Aid Steps

1. Stay calm: Your composure will help keep the child calmer
2. Call emergency services: Do this before attempting any first aid
3. Keep the child still: Do not allow them to try to walk or move
4. Support the leg gently: Place a pillow under the leg if tolerated
5. Nothing by mouth: Do not give food or drinks (surgery may be needed)
6. Pain relief: Paracetamol (acetaminophen) can be given orally
7. Monitor: Watch for signs of shock (pale skin, rapid breathing)
8. Cover the child: Keep them warm with a blanket

How Is a Broken Femur Diagnosed?

A broken femur is diagnosed through physical examination and X-ray imaging. The doctor will assess the leg's alignment, check blood flow and nerve function, and take X-rays to see exactly where and how the bone is broken. This information determines the best treatment approach.

When your child arrives at the hospital, the medical team will first ensure they are stable and provide appropriate pain management. For a young child in severe pain, this often means giving pain medication through an injection, as oral medications may not be sufficient and the child should not eat or drink before potential surgery.

The physical examination serves multiple purposes beyond confirming the fracture. Doctors carefully assess the neurovascular status of the leg - checking that blood is flowing properly to the foot and that the nerves are functioning. They look for pulses at the ankle and foot, check the color and temperature of the toes, and ask older children if they can feel touch. This assessment is critical because femur fractures can sometimes damage blood vessels or nerves that run alongside the bone.

X-rays are the definitive diagnostic tool for femur fractures. The imaging will show exactly where the break occurred (upper, middle, or lower third of the bone), the type of fracture pattern (transverse, spiral, oblique, or comminuted), and whether the bone ends are displaced or aligned. The X-ray typically includes views of the hip and knee joints to ensure there are no additional injuries. As a parent, you may stay with your child during the X-ray but will need to wear a protective lead apron or step out briefly when images are taken.

Types of Femur Fractures in Children

How Is a Broken Femur Treated in Children?

Treatment depends primarily on the child's age and size. Children under 2 years may receive a hip spica cast. Children aged 2-6 years are often treated with traction (skin or skeletal). Children over 6 years typically undergo surgery with flexible intramedullary nails. All treatments aim to align the bone and keep it stable while healing occurs.

The treatment of pediatric femur fractures has evolved significantly over the past decades, with the goal of achieving good bone alignment while minimizing hospital stay and allowing children to return to normal activities as quickly as safely possible. The treating orthopedic surgeon will explain which treatment is recommended for your child's specific situation and answer your questions.

Unlike adult femur fractures, which almost always require surgery, children have more treatment options because their bones heal remarkably well and have significant capacity for remodeling. This means that even if the bone heals with some angulation, the body can gradually straighten it over time as the child grows. This remodeling capacity is greatest in younger children and decreases as children approach skeletal maturity.

The choice of treatment considers several factors: the child's age and weight, the location and type of fracture, the degree of displacement, associated injuries, and family circumstances. Each treatment approach has advantages and disadvantages that will be discussed with you before proceeding.

Treatment by Age Group

Children Under 2 Years: Hip Spica Cast

For infants and young toddlers, a hip spica cast is often the preferred treatment. This is a large cast that extends from the chest down to the ankles, immobilizing the hip and knee to keep the femur stable. The cast is applied under sedation or general anesthesia, and the child typically goes home within a day or two.

While caring for a child in a spica cast can be challenging for families, this approach avoids surgery and its associated risks. The cast remains in place for approximately 3-4 weeks, depending on the child's age and how the fracture is healing. Younger infants heal faster than older toddlers. During this time, families learn special techniques for diapering, positioning, and caring for the child at home.

Children 2-3 Years: Skin Traction (Bryant's Traction)

For children in this age group, skin traction may be recommended. The child lies on their back in a hospital bed with both legs suspended vertically using adhesive straps attached to the legs. Weights provide gentle traction that keeps the fracture aligned while healing occurs.

This treatment requires the child to remain in the hospital for approximately 3-4 weeks, though some hospitals can arrange for home traction after the initial week. While hospitalization is challenging for families, this approach provides excellent fracture alignment and avoids surgery. Modern pediatric wards have child life specialists, play therapists, and entertainment options to help children cope with the extended stay.

Children 3-6 Years: Skeletal Traction

Older preschool and early school-age children may be treated with skeletal traction. A small metal pin is surgically placed through the bone near the knee, and this pin is connected to a traction apparatus that maintains alignment while the bone heals. This provides more controlled traction than skin traction and is appropriate for larger children.

The child remains in traction for approximately 4-6 weeks, though the exact duration depends on healing progress monitored through regular X-rays. The traction pin is removed in the hospital using local anesthesia when healing is sufficient. After traction is discontinued, the child typically transitions to crutches or a wheelchair for a few weeks before returning to full weight-bearing.

Children Over 6 Years: Surgical Fixation

For school-age children and adolescents, surgery with flexible intramedullary nails is typically the preferred treatment. During this procedure, the surgeon inserts two or more flexible titanium or stainless steel rods into the femur through small incisions near the knee. These rods stabilize the fracture internally, allowing earlier mobility.

The advantages of surgical fixation include shorter hospital stays (typically 2-3 days), earlier mobilization, and faster return to school and activities. Children can often return to school within 2-3 weeks after surgery, using crutches for support. The nails are typically removed in a second procedure 6-12 months later, once the bone has fully healed and remodeled.

How Long Does Recovery Take After a Broken Femur?

Recovery time depends on the child's age and treatment type. Younger children heal faster, typically 3-4 weeks for infants and 6-8 weeks for older children. Most children do not need formal physical therapy and return to full activities within a few months. There is a 4-6 week period after treatment ends when contact sports should be avoided.

One of the remarkable aspects of pediatric bone healing is how much faster it occurs compared to adults. A fracture that might take 3-6 months to heal in an adult can heal in just weeks in a young child. This rapid healing is due to children's robust blood supply, active bone growth, and the presence of the periosteum (the bone's outer covering), which is thicker and more active in children.

The younger the child, the faster the healing. An infant may have clinical union (bone stable enough for gentle activity) within 3-4 weeks, while a teenager may require 8-12 weeks for the same degree of healing. Your child's orthopedic surgeon will monitor healing progress through periodic X-rays and will advise when it's safe to progress to more activity.

After the formal treatment period ends (whether cast removal, discontinuation of traction, or surgical healing), there is typically a gradual return to normal activities. Children will initially favor the affected leg and may walk with a limp. This is normal and typically resolves over the following weeks as the muscles regain strength and the child gains confidence in the healed bone.

Dealing with Prolonged Bed Rest

For children treated with traction, spending several weeks in bed can be emotionally challenging. Children are naturally active, and confinement to a hospital bed goes against their instincts. However, most children adapt surprisingly well after the first few days. Modern pediatric hospitals provide entertainment, education support, and socialization opportunities to help children cope.

Activities that can help include: tablet or computer games, movies and television, art projects that can be done lying down, schoolwork brought by teachers or tutors, video calls with friends and family, visits from siblings and classmates (when hospital policies allow), and reading or audiobooks. Many children report that the time passed faster than they expected.

Physical Therapy and Rehabilitation

Unlike adults who typically require formal physical therapy after a femur fracture, most children do not need structured rehabilitation. Children naturally return to activity as they feel able, and this self-directed activity is usually sufficient to restore strength and range of motion. The orthopedic team may provide simple exercises for home, but formal physical therapy is rarely prescribed.

Parents should allow children to set their own pace in returning to activities. Pushing too hard can cause pain and frustration, while being overly cautious can delay recovery. Trust that your child's body knows what it can handle. Walking, running, and playing will gradually return to normal over the weeks following treatment.

How Can Parents Prevent Femur Fractures in Children?

Prevention focuses on age-appropriate supervision, proper safety equipment, and teaching children about risk awareness. Use car seats correctly, ensure playground equipment is safe and age-appropriate, require helmets and protective gear for sports, and supervise young children during physical activities.

Femur fractures in children typically result from significant trauma - the forces required to break the body's strongest bone are substantial. Common causes include motor vehicle accidents, falls from height, sports injuries, and in young children, sometimes seemingly minor falls. While it's impossible to prevent all accidents, there are steps parents can take to reduce risk.

Proper car seat use is one of the most important protective measures. Children should remain in rear-facing car seats as long as possible (until they exceed the seat's height or weight limits), then transition to forward-facing seats with harnesses, then booster seats, and finally seat belts when they fit properly. The rear seat is safest for all children under 13 years.

For children engaged in sports and recreational activities, appropriate protective equipment and proper training are essential. Helmets reduce head injury but don't prevent leg fractures - proper technique, adequate supervision, and age-appropriate activities are key. Teaching children to assess risks and make safe choices is an important part of injury prevention as they grow.

What Happens in the Body When a Child Breaks Their Femur?

When a femur breaks, the body immediately begins the healing process. A blood clot forms at the fracture site, then soft callus (new bone tissue) develops around the break over 2-3 weeks. This hardens into bone over the following weeks. Children's bones heal faster than adults' and can remodel (straighten) over time as the child grows.

The femur is the longest bone in the human body, extending from the hip joint to the knee joint. It's designed to bear tremendous forces - during normal walking, the femur experiences forces of 2-3 times body weight, and during running or jumping, these forces can exceed 5 times body weight. This remarkable strength means that significant force is required to cause a fracture.

In children, bones have several unique characteristics that affect both how they break and how they heal. Children's bones have a thicker periosteum (the fibrous covering of bone) and contain a higher proportion of cartilage compared to adult bones. This makes them more flexible and less likely to shatter into multiple pieces. Instead, children often have "greenstick" fractures where the bone bends and cracks without completely breaking through.

The healing process begins immediately after injury. Blood from torn blood vessels forms a clot at the fracture site, and inflammatory cells arrive to clean up damaged tissue and recruit healing cells. Within days, specialized cells begin producing fibrous tissue and cartilage to bridge the gap between bone ends. This soft callus gradually mineralizes and hardens into bone over the following weeks.

Bone Healing and Remodeling

During healing, a visible bump often develops around the fracture site. This is the callus - the new bone forming to repair the break. In children, this callus may initially be quite prominent but will gradually remodel and become smoother over the following months to years. In young children, even significant angular deformities can completely remodel as the child grows.

The remodeling process is more active in younger children and decreases as they approach skeletal maturity (around age 14-16 for girls and 16-18 for boys). This is why treatment strategies differ by age - younger children can tolerate more residual angulation because it will correct itself, while older children and adolescents need more precise alignment since they have less remodeling capacity.

Complete healing occurs in stages. Clinical union (when the bone is stable enough for protected activity) occurs first, followed by radiographic union (when X-rays show the fracture line is filled with bone), and finally complete remodeling (when the bone returns to its normal shape). The time for each stage depends on the child's age, the fracture type, and individual healing factors.