Broken Leg

A broken leg or leg fracture is a break or crack in one of the bones of your leg – the femur, the patella, the tibia, or the fibula.

A broken leg may appear swollen with bruises and severe pain that causes difficulty walking.

Sometimes, a cracking sound may be heard when a bone breaks, and the shock and pain of breaking your leg may make you feel faint, dizzy or sick.

Types of fractures

If the fracture is severe, the leg attains an odd shape with the broken bone that has been exposed through the skin, and it is called an open or compound fracture.

If there is only a tiny crack in the bone, often a result of overuse, it is called a stress fracture.

If the bone gets shattered into many pieces, it is called a comminuted fracture. A fracture is said to be displaced if the two fragments of the broken bone are misaligned.

A broken leg may be caused due to trauma during a fall, a motor vehicle accident and sports injuries.

The treatment of a broken leg varies based on its location and severity.

A severe leg fracture may require surgical treatment in which devices are implanted into the broken bone to maintain correct alignment during healing.

Other injuries may be treated with the placement of a cast or a splint.

In all cases of broken leg, prompt diagnosis and treatment is crucial for complete healing to take place.

The major signs and symptoms of a broken leg may include:

• Severe pain, which worsens with movement
• Swelling
• Tenderness
• Bruising
• Inability to walk 

A broken thighbone (femur) is more obvious as it takes a large amount of force to break, being the strongest bone in your body.

The fractures of your shinbone (tibia) and the bone that runs alongside your tibia below your knee (fibula) may be comparatively subtle.

Signs of deformity of the leg include:

• Shortening of the affected leg
• Twisting of the leg below the break
• Bending of the leg at the site of the fracture rather than at the joint

Toddlers and young children who have a broken leg may simply avoid walking.

Unexplained crying may also be a symptom of a toddler who has a broken bone.
Seek emergency medical care if you or your child has any signs or symptoms of a broken leg.

Prompt diagnosis and treatment of broken leg can prevent complications such as poor healing.

Thighbone fractures are severe, potentially life-threatening, and require emergency medical services to protect the area from further damage and to transfer you safely to your local hospital.

There are several causes for your leg to break, including:

• Falls: A fall from a significant height may break one or both of your lower leg bones. However, the thighbone is less likely to break during a fall as it needs a large forceful injury to fracture.
• Motor vehicle accidents: All the three leg bones may fracture during trauma from a motor vehicle accident. Fractures may occur when your knees are forced against the dashboard during a collision.
• Sports injuries: Hyper-extension of your leg during sports activities can cause a broken leg. Additionally, a direct blow from a hockey stick or an opponent's body may cause a fracture of the leg.
• Child abuse: In children, a broken leg can indicate a case of child abuse, particularly if such an injury occurs before the child starts walking.
• Repetitive overuse: Stress fractures are tiny cracks that can occur in the weight-bearing bones of your leg such as your shinbone. These fractures typically occur due to repetitive force or overuse, such as movements of the leg during long distance running. It can also occur with normal use of a bone when it has been weakened by a condition such as osteoporosis.

A bone breaks when it is subjected to an excessive amount of force that it cannot withstand.

It usually requires a lot of force for the leg bones to give way, however, the bones that have been weakened by disease such as cancer, bone cysts, or osteoporosis can break more easily.

Making a diagnosis of broken leg is done by several tests.

After assessing the severity of your leg fracture, your family doctor or an emergency care physician will refer you to an orthopedic surgeon for further evaluation and treatment.

You may prepare a list that includes the following information:

• A detailed description of your symptoms and the event that lead to the fracture
• Information regarding past medical problems
• All the regular medications and dietary supplements you or your child take

For a broken leg, some basic questions you may ask your doctor include:

• What type of diagnostic tests will be needed?
• What is the best treatment available?
• Is surgery necessary for my condition?
• Are there any alternatives to the primary approach that you have suggested?
• What are the restrictions that I need to follow?
• What pain relievers do you recommend?

Your doctor is likely to ask you certain questions, including:

• What caused your bone to break?
• How severe are your symptoms?
• Is there anything that seems to improve/worsen your symptoms?

During the physical examination, your doctor will inspect the affected leg and check for signs of tenderness, swelling, deformity or an open wound.

X-rays will be ordered to find out the exact location of the break and to determine whether the injury extends to any adjacent joints.

In some cases, your doctor may also recommend more-detailed imaging studies such as computerized tomography (CT) or magnetic resonance imaging (MRI).

The treatment for a broken leg varies and is decided based on the type and location of the fracture:

• Stress fractures, in many cases need only rest and immobilization of the leg.
• Open (compound) fracture: This is a serious condition, and requires prompt, aggressive treatment to decrease your risk of an infection.
• Displaced fracture: A displaced fracture may require surgery in order to realign the bones properly.

Setting the leg

• Initial treatment for a broken leg begins in an emergency room or urgent care clinic, where the doctors evaluate your injury and immobilize your leg using a splint. If there is a displaced fracture, your doctor may need to realign the bone fragments back into their appropriate positions before applying a splint. This process is called reduction. The splints will be applied for a day or two so that the swelling subsides before they are put into a cast.
• Immobilization: It is very important to restrict the movement of the affected leg for proper healing to occur. For this, you may need a splint or a cast and you may need to walk with the use of crutches or a cane to avoid putting weight on the affected leg for about 6-8 weeks.
• Medications: To manage the pain and inflammation, your doctor may recommend taking over-the-counter pain relieving medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a combination of both. If the pain is very severe, your doctor may prescribe stronger painkillers.
• Therapy: After your cast or splint has been removed, you will need rehabilitation exercises or physical therapy to get rid of the stiffness and restore movement in your injured leg. Rehabilitation is useful, but it may require several months — or even longer — to achieve complete healing of the severe injuries.
• Surgery and other procedures

Most cases of a broken leg heal with immobilization.

However, surgery may be required to insert internal fixation devices, such as plates, rods or screws, to hold the bone fragments in proper position during healing.

These internal fixation devices may be required if you have the following type of injuries:

• Multiple fractures
• An unstable or displaced fracture
• Loose bone fragments that can get inside a joint
• Damage to the surrounding ligaments
• Fractures that involve a joint
• A fracture that occurs due to a crushing accident
• A fracture in your thighbone

In few cases, your doctor may recommend an external fixation device, which is a frame on the outside your leg but is attached to the bone using pins.

This device keeps the bone stable during the healing process and is usually removed after about 6-8 weeks.

There is a risk of infection that might occur around the surgical pins, which are connected to the external fixation device.

A broken leg cannot always be prevented but you can follow certain precautions to decrease your risk of injury such as:

• Build strong bones: Intake of calcium-rich foods such as milk, yogurt and cheese can help improve your bone strength. A calcium or vitamin D supplement may also be taken to keep your bones strong. Ask your doctor whether these supplements are appropriate for you.
• Wear proper athletic shoes: Choose a suitable shoe for your favorite sports activity and replace your athletic shoes regularly. Replace your sneakers as soon as the heel wears out or if the shoes are wearing out unevenly.
• Cross-training: Alternate your activities to prevent stress fractures. Rotate running with activities such as swimming or biking. If you run on a sloped track indoors, alternate the direction of your running to even out the stress placed on your skeleton.
• Wear a seat belt to decrease your risk of injury from a motor vehicle accident. Keep children restrained in an appropriate safety seat while traveling.
• If you are at an increased risk of falls or have an unsteady gait, use assistance from a cane or walker.
• Discuss with your doctor whether you need a screening test to detect diseases that may weaken your bones.

There are several complications associated with broken leg.

Stress fractures are often a result of repetitive stress on your leg bones from physical activities, such as:

• Running
• Ballet dancing
• Basketball
• Marching
• Playing contact sports such as hockey and football may pose a risk of direct blows to the leg that can result in a fracture.

Apart from these situations, stress fractures are more common in people who have:

• Decreased bone density (osteoporosis)
• Diabetes
• Rheumatoid arthritis

In most cases, a broken leg will heal completely within a few months without any further problems.

However, complications may occur sometimes, and these include:

• Knee or ankle pain
• Poor or delayed healing: A severe leg fracture may not heal fast or may heal incompletely. This is common in an open tibial fracture because of decreased blood flow to this bone.
• Bone infection (osteomyelitis): This may occur if a surgery has been performed or if a broken bone is exposed to fungi and bacteria that can cause infection. It can cause delay in healing and is often treated with antibiotics and/or surgery.
• Nerve, muscle or blood vessel damage: This can occur during the fracture of the leg or during surgery. It may cause loss of sensation or movements and affect the blood supply to the limb. Seek immediate medical treatment if you note any numbness or problems with blood circulation.
• Compartment syndrome: This is a very painful and a serious neuromuscular condition which results from bleeding or swelling within a muscle near the broken bone. This is a rare complication, but is more common in high-impact injuries such as a car or motor vehicle accident. This complication may occur as soon as there is a fracture, after the plaster cast has been applied or after surgery. To relieve the pressure build-up in your leg, emergency surgery will be performed.
• Arthritis: Fractures that involve the joint and result in poor bone alignment may lead to osteoarthritis after some years.
• Unequal leg length: Long bones grow at their ends, a softer area called the growth plates. If a fracture line goes through this growth plate, the affected limb may eventually become shorter than the opposite limb.