Broken leg

Overview

A broken leg, also called a leg fracture, is a break or crack in one of the bones in the leg. Common causes include falls, motor vehicle accidents and sports injuries.

How a broken leg is treated depends on the location of the injury. And it depends on how serious the break is. A serious fracture, where the bone is badly damaged, may require metal plates, rods or screws to hold the fragments together. Milder breaks may need only a cast or splint to keep the bone in place while it heals.

If you think you may have a broken leg, seek medical care right away. Timely treatment is needed for proper healing and a full recovery.

Symptoms

The thigh bone, also called the femur, is the strongest bone in the body. Breaking it typically requires a great deal of force. So it's often very clear when the thigh bone is broken due to the nature of the injury. But a break in the shinbone or in the bone that runs alongside the shinbone may be less obvious, especially if the injury isn't that bad or the bones stay in place. The shinbone also is called the tibia. The bone that runs alongside the shinbone is called the fibula.

Symptoms of a broken leg may include:

• Serious pain, especially when moving the leg.
• Swelling around the injured area.
• Tenderness to the touch.
• Bruising.
• A bent or twisted leg or a shorter-looking leg than before the injury.
• Not being able to walk or put weight on the leg.

Toddlers or young children who break a leg may start limping or simply stop walking even if they can't explain why.

When to see a doctor

If you or your child shows any symptoms of a broken leg, get medical care right away. Without the right treatment, healing can take longer and may lead to long-term problems that affect your comfort, mobility and quality of life.

Get emergency medical help right away if the leg injury happened during a high-impact accident, such as a car or motorcycle crash. And get emergency care right away if you suspect a thighbone fracture. A broken thighbone is a serious and potentially life-threatening injury. It needs emergency medical care.

Causes

A broken leg can happen in many ways. Here are some of the most common causes:

• Falls. A simple fall can break one or both of the lower leg bones. A stronger impact typically is needed to break the thighbone.
• Car or motorcycle accidents. A crash can break all three leg bones. This can happen if your knees hit the dashboard or if your legs are directly injured during the accident.
• Sports injuries. Contact sports can lead to broken legs from falls, sudden twists or a direct hit, such as from a hockey stick or another player.
• Child abuse. In children, a broken leg may be a sign of child abuse, especially when the injury happens before the child can walk.
• Overuse. Repeating the same movement over and over, such as long-distance running, can cause stress fractures. Stress fractures are tiny cracks in the weight-bearing bones of the body, including the shinbone. These are more likely to happen if the bone is already weakened by a condition such as osteoporosis.

Risk factors

Stress fractures typically result from doing the same movement over and over. This type of injury is more likely with activities such as:

• Running.
• Gymnastics.
• Ballet dancing.
• Basketball.
• Marching.

Contact sports, such as hockey and football, increase the risk of leg fractures due to direct hits or falls.

People who do not play sports still can get stress fractures, especially if they have certain health conditions that weaken the bones, such as:

• Decreased bone density, as in osteoporosis.
• Diabetes.
• Rheumatoid arthritis.

Complications

While most broken legs heal well with proper care, some injuries can lead to complications, especially if the fracture is serious or not treated quickly.

• Pain in the knee or ankle. A broken leg may cause pain in nearby joints even if they weren't directly injured.
• Bone infection, also called osteomyelitis. If a broken bone breaks through the skin and causes a wound, it is called an open fracture. If you have an open fracture, the bone can be exposed to germs that may cause infection.
• Delayed or poor healing. Serious fractures, especially open fractures of the shinbone, may heal slowly or not fully heal. This typically happens due to lower blood flow to the shinbone.
• Nerve or blood vessel damage. A break can damage nearby nerves or blood vessels, leading to numbness, a change in skin color or poor circulation. Get medical help right away if you have any of these symptoms.
• Compartment syndrome. This rare but serious condition causes pain and swelling in the muscles around the broken bone. It's more common after high-impact injuries, such as car or motorcycle crashes. Compartment syndrome may require surgery.
• Arthritis. If a fracture affects a joint or heals out of alignment, it can lead to osteoarthritis years later. Osteoarthritis is a common form of arthritis that typically affects joints. If you feel new joint pain long after a break, see your healthcare professional.
• Uneven leg length in children. In children, a break that goes through a growth plate can lead to one leg becoming shorter or longer than the other over time. A growth plate is the area near the ends of a child's bones where bones grow.

Prevention

A broken leg can't always be prevented. But these basic tips may reduce your risk:

• Build bone strength. Eat calcium-rich foods, such as milk, yogurt and cheese, to build strong bones. A calcium or vitamin D supplement also may improve bone strength. Ask your healthcare professional if these supplements are right for you.
• Wear proper athletic shoes. Choose the right shoes for your sports or activities. Replace your athletic shoes regularly, especially if the tread or heal is worn out or if they wear unevenly.
• Cross-train. Alternate activities to prevent stress fractures. For example, mix running with swimming or biking. If you run on a sloped track indoors, alternate the direction of your running to even out the stress on your bones.

Diagnosis

During the physical exam, a healthcare professional checks the injured area for pain, swelling, an unusual shape or an open wound.

X-rays typically show where a bone is broken and whether nearby joints are injured. Sometimes, more-detailed images are needed, such as from a computerized tomography scan or magnetic resonance imaging. These imaging tests are called CT and MRI for short. For example, if your healthcare professional thinks you may have a stress fracture, you may need a CT scan or MRI. Stress fractures typically don't show up clearly on X-rays.

Treatment

Treatment for a broken leg depends on the type and location of the fracture. Stress fractures typically heal with rest and immobilization. But other types of fractures may need surgery for best healing. Fractures are identified as one or more of the following:

• Open fracture. The bone pierces through the skin. This is serious and needs immediate treatment to prevent infection.
• Closed fracture. The broken bone does not pierce the skin, leaving the skin intact.
• Incomplete fracture. The bone is cracked but not fully broken into separate pieces.
• Complete fracture. The bone is fully broken into two or more separate pieces.
• Displaced fracture. The bone fragments are not properly aligned. Surgery may be needed to realign them.
• Greenstick fracture. The bone is cracked but not completely broken, like bending a fresh, green stick. This type of fracture typically happens in children because their bones are softer and more flexible.

Setting the leg

Treatment for a broken leg typically begins in an emergency room or urgent care clinic. Healthcare professionals examine the injury and use a splint to keep the leg still and supported. If the bone is out of place, called a displaced fracture, the care team may need to gently move the pieces back into the correct position before applying a splint or cast. This process is called reduction. In many cases, a splint is used first to allow swelling to go down. Once swelling improves, a cast is placed to hold the leg in position while it heals.

Immobilization

For a broken bone to heal properly, it needs to stay still. A splint or cast typically is used to keep the bone from moving. This is called immobilization. You may need to use crutches or a cane to keep weight off your injured leg for at least six weeks.

Medications

A pain reliever you can buy without a prescription, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), or a combination of the pain relievers, can reduce pain and inflammation. If you're experiencing serious pain, your healthcare professional may prescribe stronger pain medicines.

Therapies

After your cast or splint is removed, you'll likely need physical therapy or exercises to help lessen stiffness and get your leg moving again. Since you haven't been using your leg for a while, even the muscles in uninjured areas may feel weak or tight. Rehab can help with this, but full recovery from a serious injury may take several months or longer.

Surgery and other procedures

Most broken bones heal with a cast or splint to keep them still. But in some cases, surgery is needed to hold the bones in the right position using metal plates, rods or screws. Surgery is more likely if you have:

• More than one fracture.
• A fracture that is unstable or out of alignment.
• Loose bone pieces that could enter a joint.
• Damage to nearby ligaments.
• A fracture that goes into a joint.
• A fracture caused by a crushing injury.

Some injuries are treated with a metal frame outside the leg, attached to the bone with pins, to keep it stable while it heals. This is called external fixation. The frame typically is removed after about 6 to 8 weeks. There's a small risk of infection around the surgical pins.

Preparing for an appointment

Depending on how serious the break is, your healthcare professional may refer you to an orthopedic surgeon for further evaluation and treatment.

What you can do

Make a list that includes:

• Details about the symptoms and the incident that caused them.
• Information about past medical conditions.
• All the medicines and dietary supplements you take.
• Questions to ask your healthcare professional.

For a broken leg, some basic questions to ask include:

• What tests are needed?
• What is the best course of action?
• Is surgery necessary?
• What are the alternatives to the primary treatment you're suggesting?
• What restrictions need to be followed?
• Should I see a specialist?
• What pain medicines do you recommend?

Don't hesitate to ask any other questions you have.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, including:

• How and when did your injury occur?
• Were there any other injuries or areas of pain?
• Have you had broken bones in the past or a history of osteoporosis?
• Do you have any numbness, tingling or loss of sensation to the injured area?
• Were you able to get up and stand or walk, bearing weight on your leg, after your injury?
• How serious is the pain from your injury?
• What, if anything, seems to improve the pain?
• What, if anything, appears to worsen the pain?

For injuries to children, the evaluation often includes routine questions to rule out concerns for intentional injury or child abuse.