Fracture of the Leg (Broken Leg)

First aid for a broken leg

1. Call 911 or your local emergency number for a suspected thighbone fracture, an open fracture, or if the person cannot be moved safely.
2. Do not try to straighten the leg or push back a protruding bone.
3. Stop bleeding from any wound with firm pressure around, not on, a protruding bone, and cover it with a clean dressing.
4. Keep the leg still. Support it in the position found. If help is far away, splint it with padding and something rigid along both sides, including the joints above and below the break, or tie it gently to the other leg.
5. Apply ice wrapped in cloth to reduce swelling, and watch for shock: pale, clammy skin, fast breathing and faintness. Lay the person flat and keep them warm.
6. Give nothing to eat or drink in case surgery is needed.

Broken leg symptoms

• sudden, severe pain that worsens with movement or pressure
• a snap or grinding sound at the time of injury
• swelling and bruising, often spreading over the following days
• a leg that looks bent, shortened or turned outward
• being unable to stand or walk on it
• tenderness at one exact spot on the bone

A fibula fracture alone can be surprisingly mild: some people can still walk, because the fibula carries little body weight. A small stress fracture may cause only aching pain that builds with activity. Children's bones can bend or buckle rather than break cleanly, so a child who refuses to walk after a fall should be checked even without obvious deformity.

Types of leg fracture

By bone

By pattern

• Stable (non-displaced): the bone ends stay lined up.
• Displaced: the ends have moved apart and need realigning.
• Open (compound): the skin is broken over the fracture, with high infection risk. It needs antibiotics and surgery within hours.
• Comminuted: the bone has broken into several pieces.
• Spiral, oblique or transverse: describes the line of the break and hints at the force that caused it.
• Stress fracture: a hairline crack from repeated loading, common in runners and military recruits.

Causes and risk factors

• falls, including from ladders and on ice
• contact sports, skiing and football tackles
• motor vehicle, motorcycle and pedestrian accidents
• repeated impact from running or marching, especially with a sudden increase in training
• osteoporosis, long-term steroid use, low vitamin D and some cancers, which let bones break with little force

How a broken leg is diagnosed

A doctor checks the skin, the shape of the leg, the pulses and feeling in the foot, and whether you can move your toes. X-rays in two directions confirm and classify the fracture, including the knee and ankle joints. CT scans map fractures into a joint for surgical planning. MRI or a bone scan may detect a stress fracture that does not show on early X-rays.

Treatment

Non-surgical

Stable fractures, many fibula fractures and some children's tibia fractures are treated with:

• a splint at first, while swelling settles
• a cast or a walking boot for 6 to 12 weeks
• crutches, with limited weight-bearing as advised
• pain relief and elevation

A displaced fracture may first be pushed back into line under sedation (closed reduction) before casting.

Surgery

Most femur shaft fractures and many tibia fractures are fixed surgically, because it lets people get moving sooner and keeps the bone straight:

• intramedullary nail: a metal rod inserted down the center of the bone, the standard for femur and tibia shaft fractures
• plates and screws: for fractures near or into joints
• external fixator: a frame outside the leg, used for open fractures with damaged skin or as a temporary measure

Recovery and rehabilitation

Physical therapy begins early to restore knee and ankle movement and rebuild muscle. Return to walking without aids usually takes 3 to 4 months for tibia and femur fractures, and full return to running or contact sports 6 months or more. Smoking, diabetes and poor nutrition slow healing.

Complications

• Compartment syndrome: swelling inside the tight muscle compartments of the lower leg cuts off blood supply. It causes pain out of proportion to the injury, made worse by stretching the toes, and needs emergency surgery.
• Blood clots: deep vein thrombosis and pulmonary embolism are a real risk while mobility is reduced. Blood thinners are often prescribed after surgery or casting.
• Fat embolism: fat from the marrow travels to the lungs, usually 1 to 3 days after a femur or tibia fracture, causing breathlessness, confusion and a pinpoint rash.
• Infection, especially after open fractures or surgery.
• Delayed healing or nonunion, most common in the tibia because of its limited blood supply.
• Malunion, leg length difference and later arthritis when a fracture involves a joint.

Frequently asked questions

What are the symptoms of a broken leg?

The main broken leg symptoms are sudden severe pain, swelling, bruising, a bent or shortened appearance, and being unable to put weight on the leg. You may hear a snap. A fibula or stress fracture can be milder, with pain at one spot on the bone.

Can you walk on a broken leg?

Usually not with a femur or tibia fracture. With a fibula fracture or small stress fracture, some people can walk with pain, which is why being able to walk does not rule out a break. Get an X-ray if you cannot take 4 steps or the bone itself is tender.

How long does a broken leg take to heal?

A fibula fracture usually heals in about 6 to 12 weeks. Tibia and femur fractures take 3 to 6 months to unite, and full strength can take longer. Children heal faster, often in half the time. Smoking and diabetes slow healing.

Does a broken leg always need surgery?

No. Stable, well-aligned fractures, many fibula breaks and most stress fractures heal in a cast or boot. Displaced, unstable, open and most femur shaft fractures need surgery with a rod, plate or screws.

What is the most serious complication of a leg fracture?

In the first days, compartment syndrome, major bleeding from a femur fracture, and fat embolism are the most dangerous. Over the following weeks, blood clots in the legs and lungs are the main risk. Infection is the main concern after open fractures.