Thigh Strains And Fractures
A muscle strain, also called a pull or tear, is a common injury, particularly among people who participate in sports. The thigh has three sets of strong muscles: the hamstring muscles in the back, the quadriceps muscles in the front, and the adductor muscles on the inside. The quadriceps and hamstring muscle sets work together to straighten (extend) and bend (flex) the leg. The adductor muscles pull the legs together. The hamstring and quadriceps muscle sets are particularly at risk for muscle strains because they cross both the hip and knee joints. They are also used for high-speed activities such as track and field events (running, hurdles, long jump), football, basketball, and soccer.
Signs and symptoms
Muscle strains usually happen when a muscle is stretched beyond its limit, tearing the muscle fibers. They frequently occur near the point where the muscle joins the tough, fibrous connective tissue of the tendon. A similar injury occurs if there is a direct blow to the muscle. Muscle strains in the thigh can be quite painful, and may involve some bruising if blood vessels are also broken. Once a muscle strain occurs, the muscle is vulnerable to reinjury, so it's important to let the muscle heal properly and to follow preventive protocols. A person who experiences a muscle strain in the thigh will frequently describe a popping or snapping sensation as the muscle tears. Pain is sudden and may be severe. The area around the injury may be tender to the touch, with visible bruising.
Diagnosis and treatment
Your physician will ask about the injury and examine the thigh for tenderness or bruising. You may be asked to bend or straighten your knee and/or hip so the doctor can confirm the diagnosis. An X-ray may be needed if there is a possible fracture or other injury to the bone. Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily, while a grade 3 strain is a severe tear of the muscle that may take months to heal. Most muscle strains can be treated with the RICE protocol. RICE stands for Rest, Ice, Compression, and Elevation.
- Rest: Take a break from the activity that caused the strain. Your physician may recommend that you use crutches to avoid putting weight on the leg.
- Ice: Do not apply ice directly to the skin, but you can use cold packs for 20 minutes at a time, several times a day.
- Compression: To prevent additional swelling and blood loss, wear an elastic compression bandage.
- Elevation: To minimize swelling, keep your leg up higher than your heart.
Preventing muscle strains
Several factors can predispose you to muscle strains. These include:
- Muscle tightness. Tight muscles are vulnerable to strain, so athletes should follow a year-round program of daily stretching exercises.
- Muscle imbalance. Because the quadriceps and hamstring muscles work together, if one is stronger than the other, the weaker muscle can become strained.
- Poor conditioning. If your muscles are weak, they are less able to cope with the stress of exercise and more likely to be injured.
- Muscle fatigue. Fatigue reduces the energy-absorbing capabilities of muscle, making them more susceptible to injury.
- Insufficient warm-up. A proper warm-up is protective because it increases range of motion and reduces stiffness. You can take the following precautions to help prevent muscle strain:
- Warm up before any exercise session or sports participation, including practice. This will help increase your speed and endurance.
- Stretch slowly and gradually, holding each stretch to give the muscle time to respond and lengthen. You can find examples of stretching exercises on this site or ask your physician or coach for help in developing a routine.
- Condition your muscles with a regular program of exercises. You can ask your physician about exercises programs for people of your age and activity level.
- If you are injured, take the time needed to let the muscle heal before you return to sports. Wait until your muscle strength and flexibility return to pre-injury levels, a process that can take 10 days to 3 weeks for a mild strain, and up to 6 months for a severe strain.
The thighbone (femur) is the longest and the strongest bone in the body. To break the thighbone across its length (shaft) takes a great deal of force, as might occur in a motor vehicle accident or a fall from a high place. Because of this, a broken thighbone is often associated with potentially life-threatening injuries to other body systems. In children younger than 3 years of age, a thighbone fracture is often an indicator of abuse.
Diagnosis
A broken thighbone is usually obvious, even if the bone does not break through the skin. Severe pain, inability to move the leg, deformity and swelling are characteristic. The injured thigh may be shorter than the uninjured one because the strong thigh muscles may force the broken edges of bone out of alignment (displacement). The injury may disrupt the rich blood supply to the muscles of the thigh, resulting in extensive bruising and loss of blood. If the fracture resulted from high-energy trauma such as a motor vehicle accident, the patient might not be conscious and may have other injuries. It is important that emergency medical personnel tend to the injury and transport the individual to a hospital. The physician will examine the injury and evaluate the circulatory and nervous systems, as well as the fracture. Several X-rays may be required, including the leg, knee, hip and pelvis, to determine the extent of injury to the adjacent joints.
Treatment
As with all broken bones, a broken thighbone will need to be "reduced" or returned to alignment and immobilized until it heals. There are several methods that can be used, depending on the patient's degree of skeletal maturity, the amount of displacement, the type of break and the presence of associated injuries. If you are the parent of a child with a broken thighbone, ask your orthopaedic surgeon which option he or she recommends and why.
- Traction. Traction is the traditional method of treating thighbone fractures. The leg is placed in a cast and sticky tape (skin traction) or a metal pin (skeletal traction) is used to attach a series of strings that connect to weights. X-rays are used to monitor the position of the bone so that the traction can be adjusted. Although traction is effective, it requires a lengthy hospital stay. Because research has confirmed the importance of early mobility in reducing complications and promoting successful healing, other methods of fixation are now more popular than traction.
- Casting. Very young children (under 8 years of age, depending on their size and weight) with an isolated fracture to the shaft of the thighbone can be treated with casting. A spica cast, which goes up over the hips and includes the other leg, may be used. A child with a spica cast can be cared for at home.
- Plating. In some cases, the surgeon may apply a metal plate to the side of the thighbone across the break. The plate is held in place with screws. The plate helps bear weight and makes early mobilization possible. However, the plate may also shield the bone from stress, which is not necessarily a good thing. Because some stress on the bone is necessary to strengthen it as it heals, this stress-shielding may leave the bone with a residual weakness. This generally disappears as the patient resumes normal activities. However, one concern is that when the plate is removed, the still-weakened bone may break again, but this is an infrequent occurrence. Plate-and-screw fixation can be an ideal choice for a patient with open growth plates or a nerve injury.
- External fixation. Although less frequently used for thighbone fractures, external fixation is an option if there are severe soft-tissue injuries along with the fracture. A frame around the leg is attached to the bone with pins. This has the advantage of allowing early mobilization, but caring for the pin insertions is difficult and infections are common. Nevertheless, external fixation may be appropriate for children with open growth plates and for patients with contaminated wounds.
- Internal intramedullary fixation. Internal intramedullary fixation (placing a rod inside the bone) is usually recommended for people who have attained skeletal maturity. The thighbone is like a tube, with a soft center surrounded by hard (cortical) bone. During a surgical procedure, a special rod (intramedullary nail) is inserted into the thighbone. The insertion may be near the hip or just above the knee. The rod extends into the middle of the bone and across the fracture site. It is locked in place with screws that pass through the bone and across the rod. This enables early movement and good stabilization of the fracture. After the fracture heals, the nail is removed.
Credit: National Institute of Health.