Broken Leg

Picture of the bones of the leg

Picture of the bones of the hip

• The lower extremity, or the leg, contains four bones (the femur, the patella, the tibia, and the fibula) and bends at the hip, the knee, and the ankle. These bones may break (fracture) into two or more pieces.
• If a broken bone has been exposed to the outside, either by a cut over the fracture or by bone sticking out through the skin, it is called an open fracture. An open fracture is also referred to as a compound fracture.
• A break in the leg may involve any of these bones:
  • Femur: The femur is the bone in the thigh. It is the longest and strongest bone in the body. 
    • The upper part of the femur fits into the pelvis to form the hip joint. At this joint, it can move frontward, backward, sideways, and rotate in and out. When people refer to a "broken hip," it is this upper part of the femur that is broken.
    • The lower end of the femur rests on top of the tibia, forming the knee joint. At the knee, the leg can swing frontward, backward, and rotate slightly.
  • Kneecap: The kneecap (patella) glides back and forth in front of the knee joint. The kneecap suspends the ligaments from the thigh muscle and helps to add leverage for straightening out the leg.
  • Tibia: The tibia is the shinbone and supports the body's weight. The fibula runs alongside the tibia below the knee. It is on the outside part of the leg and is smaller than the tibia.
  • Ankle: The ankle is composed of the bottom ends of the tibia and fibula, the connecting foot bones, and the ligaments and tendons. Severe twisting injuries to the ankle can result in fractures of the tibia or fibula near or within the ankle joint.

The major symptoms of a broken leg are pain, swelling, and deformity. A broken leg can be obvious but may require an X-ray to diagnose. Even when very obvious, an X-ray usually is required to evaluate the severity of the fracture and exact alignment of bone fragments.

Pain caused by a broken bone is typically severe. Holding the bone still will decrease pain. Movement of the broken bone will increase pain.

Swelling and bruising over the area of a break are common.

• Deformity of the leg can occur in these ways:
  • Shortening: The broken leg appears shorter than the unaffected leg.
  • Rotation: The leg below the break is twisted.
  • Angulation: The leg bends at the break instead of at the joint.

Some parts of the leg may be broken and still feel like a severe strain or sprain. This can often be the case of injuries around the ankle, or sometimes with the fibula (the little bone next to the shinbone).

Call your doctor if these conditions describe the condition:

• The person is not able to walk without a great amount of pain.
• It hurts when the bony parts of the leg are pressed on.
• There is concern that the person may have a broken leg (even if you are unsure).

If you think you or someone else has a broken leg, go to an emergency department for further evaluation. If the person cannot walk, call 911 for an ambulance.

If the affected individual has had surgery or had a splint or cast placed on the injury previously, return to the hospital immediately if these problems develop:

• Loss of muscle strength or numbness in the leg or foot. A certain amount of strength loss is common because of the pain of the fracture, but if there is a rapid development of numbness or worsening of strength, or a significant increase in pain unrelieved by your pain medication, these may be signs of a "compartment syndrome." Compartment syndrome occurs when swelling gets so severe within the leg that it cuts off blood flow to the leg. This can cause damage to muscles and nerves of the leg.
• Redness, fever, increased swelling or pain, or drainage of pus from a surgical incision are all signs of possible wound infection.

The doctor will examine the patient's leg for evidence of a break (fracture).

• If the doctor suspects that a bone has been broken, X-rays will be ordered.
• The doctor also will look for signs that an artery or nerve was damaged or injured. To do this, the doctor will feel for pulses and test the strength and sense of touch below the injury.
• If the doctor suspects some other medical condition has caused the weakening of the bone leading to the fracture, other lab tests may be ordered.

Diagnosis of stress fractures is often difficult, and special tests beyond X-rays may be needed.

If an injury occurs and a fracture is suspected, remember the following:

• Immobilize the leg as much as possible until help arrives.
• Rest and avoid aggravating the injury.
• Apply an ice pack wrapped in a pillowcase or towel to decrease swelling.
• If possible, keep the leg elevated with pillows or cushions to decrease swelling.
• Often with a broken leg, surgery is necessary. For this reason, do not let someone with a broken leg eat or drink anything until seen by the doctor.

The type and location of a break in a leg bone will determine what treatment is needed.

• If the bones have become displaced or out of alignment, they will need to be put back into alignment. This procedure is called "reduction." In order to do this, the patient will be given medications for pain prior to the procedure.
• An emergency doctor will be able to treat many types of fractures with a temporary plaster splint and will instruct the patient to follow up with an orthopedic doctor (bone specialist). However, fractures of the thighbone or the shinbone typically will need further care by an orthopedist as soon as possible. This may mean a cast or even an operation.
• Bones are immobilized for healing by several methods.
  • A plaster splint or cast usually is often used.
  • Surgery: When an operation is needed, pins, screws, and metal plates or wires are often used to hold together the broken ends of a bone. Surgery for fractures in the middle part of the thighbone (femur) or the shinbone (tibia), a metal rod sometimes is placed down through the center of the bone. 

The doctor will also provide the patient with medicine for the pain.

From the emergency department, the patient usually will need to follow up with an orthopedic doctor in about a week. This bone specialist will guide the patient in further follow-up appointments and rehabilitation as necessary.

If treated promptly and properly, a broken leg usually will regain normal function.

• Because the major bones of the leg support body weight, at least 6-8 weeks is usually required before the bone is healed.
• The severity of the injury and the patient's age may cause complications. For instance, an elderly person with a hip fracture may have difficulty regaining strength and mobility.
• Someone with an open fracture (where the bone sticks through the skin), may be at increased risk for infection of the bone. If infection occurs, this may delay significantly the healing process.

• To decrease the risk of injury from a car accident, use a seat belt. For children, use a safety seat appropriate for the child's age and weight.
• If participating in sports in which high speeds or heights are present, participate in the activity at your experience level and make use of proper protective gear.
• If a person is at risk for falling or has an unsteady gait (walk), use a walker or cane for assistance.
• Talk to a doctor about screening for diseases that may weaken bones.