Taylor Fedun, pre-femur fracture.

Few injuries can compete with concussions in terms of rehab time, the uncertainty of a full recovery, and absolute brutality. A femur fracture is one of those few injuries.

When Edmonton defenceman Taylor Fedun slid feet-first into the boards on September 30th he shattered his right femur. He didn’t crack it, he didn’t just break it, he shattered it. Into pieces. He had surgery that night in Minnesota, returned to Edmonton within the week, and is now able to get around on crutches. In three months time Fedun’s bone should be healed, but it could be at least a year before he’s likely to play again.

 

 

The femur (thigh bone) is the longest, strongest bone in your body, and it takes an unbelievable amount of force to break it. Being the strongest bone means the femur is surrounded by some of the strongest muscles, which is the reason treatment of these fractures is so complicated. This isn’t something you can just slap a cast on and stump around with crutches for a few weeks. Femur fractures are generally a surgical fix, and complications from this injury can range from sort of annoying to life-threatening. The Ducks’ Kurtis Foster figured both of these out first-hand when he broke his left femur in 2008. Not only did he lose dangerous amounts of blood during his surgery, he missed the start of this season because a wire used in the repair managed to work its way out of his femur. He has been with the AHL’s Syracuse Crunch on a conditioning stint, but hopes to rejoin the Ducks as soon as Friday.

There are several different flavours of femur fracture, ranging from stress fractures (which are fairly common in athletes) to simple breaks (broken in one place), to complex fractures (like Fedun) where the bone is broken in more than one place. While stress fractures can be treated with rest, full-on femoral breaks are almost always going to earn you a trip to the OR and some fancy bone hardware.

 

See if you can spot the problem here.

 

The thigh carries a lot of important things – the nerves to your feet, some massive blood vessels, lots of very strong muscles, and half your body weight. When you break your femur, those unopposed muscles tend to cause fracture displacement, meaning the ends of the broken bone will slip past one another.  Now you have one leg shorter than the other, and the potential for a lot of really important structures to get shredded. Blood loss and nerve damage are real concerns with a femur fracture, and it’s not hard to lose 20% of your blood volume into your thigh with this injury. It’s also not hard to end up with an open fracture, as the broken ends of the bone are sharp as crap and will punch through muscle and skin with great enthusiasm.

Treatment

Doctors love acronyms, and femur fractures have a lot of them. They’re most often treated with ORIF using an IM nail. (Excuse me?) Open reduction and internal fixation (cut it open and hold it in place) using an intramedullary nail (a rod that runs the length of the bone). The orthopedist makes an incision over the top end of the femur, reams out the bone, and stuffs a titanium rod in there. The rod gets screwed into the bone at either end, and voilà – you’re Wolverine. Now, obviously it’s not as simple as that – the surgeon has to make sure both legs are the same length, that the broken leg isn’t rotated in a weird direction, and there may be a need to clean out bone fragments from the fracture site. The procedure is done under fluoroscopy, which is like a live-action x-ray. This allows the surgical team to literally see what they’re doing inside your leg as the surgery progresses. As awful as it sounds, this is a surgery with lots of positives – it’s more stable than screwing a plate to the outside of the bone, and it allows the patient to be up on their feet sooner than you’d expect.

 

Femoral intramedullary nails. The pretty colours are a bonus (that you probably don't care about if it's your femur that's broken)..

 

The Aftermath

Within a few days you’re up and around on crutches. Physical therapy starts shortly after with simple knee range of motion exercises. In six weeks (assuming healing is progressing well) you can start full weight-bearing on the broken leg. In six months you can start non-contact sports. After a year you’ll be back to playing hockey. Maybe. Femur fractures are complicated, and the treatment is complicated. Complicated things have complications, like infection, non-union (the bone ends don’t heal together), malrotation (the bottom part of the leg isn’t facing exactly where it should), and intraoperative bleeding. This doesn’t even take into account any additional damage the injury might have caused to blood vessels (hello, vascular surgeon), nerves (hello, neurosurgeon), or skin (hello, plastic surgeon).

Kurtis Foster was back with the Wild within eleven months of his injury in 2008. With luck (and hard work), it’s possible Fedun could do the same. The fact remains, however, that he’s going to miss all of this season, and with an injury this significant there’s always a chance he may not be able to play ever again. The good news is Fedun has already been very vocal about his intent to play again, and he has youth (and all the benefits of being a pro athlete) on his side. Here’s hoping we see him back at full strength for 2012-13 with a little bit more Wolverine in his stride.

 

Comments (31)

  1. TYPO: Foster returned in the 2008-09 season with the Minnesota Wild, not the Anaheim Ducks

  2. OH MY GOD. My deepest apologies for this egregious error. I have shamed myself.

    Aaaaaand I’m over it.

  3. Thank you for taking the time to do these articles. They’re super interesting, very relevant and I love all things hockey + medical so it’s just perfect in my opinion! In the cases where the femur is shattered into a bunch of pieces what do they do? Can they reattach all the little pieces or do they have to do some sort of replacement?

  4. Love your articles, followed you on Puck That Hurts and it’s great to see you write on this blog. Looking forward to your next post.

  5. Great article :)

    I’m a Radiographer (X-Ray Tech) here in the UK.

    As Jo has stated in the article, it takes an incredible amount of force to shatter the femur. I’ve seen quite a few and they have all been as the result of a car crash which illustrates the speed and energy that NHL-calibre players are playing with these days.

  6. Ow. That’s gotta sting a little.

  7. Good question about severely comminuted fractures (i.e. shattered). There’s a few options, and a lot of it depends on the patient (an osteoporotic older lady versus a hockey player, for example). The lady won’t be much good at building new bone, so she’s likely to end up with a whole lot of bone cement or bone graft, a plate on the bone, and no weightbearing for a while. Someone like a hockey player would most likely still get an IM nail. Even if there’s a big bone gap you’ll still get good results the majority of the time as bone “telescopes” up/down the nail (grows around it to fill the void). It’s not unheard of in these cases to get poor healing, so sometimes re-operation is needed for bone grafting, hardware tweaks, etc.

  8. I broke my femur all the way through nearly 5 years ago now. Had the stated surgery, still have the rod, and all the screws in my leg. The doctors had me walking the day after surgery and was off crutches in 3 weeks.

    The injured leg is stronger than ever, and I was back on the ice roughly 4-5 months after the break. This injury is not fun, but thankfully was repaired quickly with a great turnaround time. Medical advances are unreal these days as well as the people performing.

  9. I’ve nothing to add other than this is an excellent article. Going to go hunt down some of your other writings now, Jo!

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