Are you looking after someone who has had a femur fracture? or have you already had one and you are wondering if you can recover from it.
This article will take you through common questions patients normally ask after a femur fracture and rehabilitation tips.
Based on my experience as a diagnostic radiographer and my research in international scientific studies specifically on this topic.
Happy reading!😀and feel free to ask questions in the comments or share your own experience.🙏Last updated: May, 2026. Written by Juliet Semakula, a diagnostic radiographer.
▶️What are some of the types of femur fracture?
Femur fractures are severe breaks in the thighbone classified by location.
Here are some of the types I see in x-ray.
♦️Proximal Femur Fracture (Hip Fracture): Breaks at the top of the femur near the hip joint, common in older adults.
♦️Femoral Shaft Fracture: Occurs in the middle, long, straight part of the bone.
♦️Supracondylar/Distal Femur Fracture: A break just above the knee joint, which can affect knee stability.
Image source: https://www.sfh-tr.nhs.uk/
▶️Why do older people break their femurs more easily?
I have seen so many older people break their femurs more easily primarily due to even a simple fall from their own height.
Here are some of the common reasons:
🟣Weakened bones (osteoporosis): Aging causes reduced bone density, structural deterioration, and increased porosity, making the femur less able to withstand normal impact.
🟣 Increased fall risks: While younger people require high-impact trauma (like car crashes) to break a femur, older adults can fracture it simply from falling from a standing position.
This is due to reduced muscle mass (sarcopenia) which means less padding and support to absorb the impact of a fall.
🟣 Micro-architectural Weakness: As people age, the femur’s structure, particularly in the neck area, changes, making it more brittle and prone to shattering under stress.
🟣And for adults, the biggest cause is motor vehicle accidents.
🟣 In children, abuse is often the main cause.
Reynolds, 2013
▶️How serious is a fractured femur?
Usually a fractured femur (broken thighbone) is an extremely serious, potentially life-threatening injury that requires immediate emergency medical attention.
When patients come to x-ray from the emergency dept. Patients are in pain and shock.
▶️Here are some of the reasons why a femur is treated as an emergency.
The femur being the body’s strongest bone, a break indicates high-energy trauma particularly in the elderly.
⚪The thigh has major blood vessels so a break can cause massive internal bleeding that can lead to shock.
⚪High Mortality Risk especially in older adults, a broken femur carries a high mortality rate if not treated quickly.
⚪Severe Complications such as potential blood clots (deep vein thrombosis), pneumonia, or fat embolism.
⚪Severe infection if the bone breaks through the skin.
⚪Long Recovery for months is normally seen with femur fracture with extensive physical therapy requirement.
▶️Femur fracture treatment options.
Treatment for a fractured femur almost always involves surgery to realign and stabilize the bone.
In all my years of practice as a radiographer, I have never seen a femur fracture in elderly patients treated without surgery.
However, in some patients when surgery is not possible due to medical reasons especially in children.
Non-Surgical & Supportive Care is applied
⚫In some cases when surgery is not possible, normally a traction is used to temporarily align the bone, followed by a bracing.
⚫Non-displaced femur fractures in children or the elderly, Splinting/Casting can be used for initial support and immobilization.
For example: Age-Based Treatments:
♦️Under 6 months: Typically managed with a Pavlik harness or splint.
♦️6 months to 5 years: Often treated with a Hip Spica cast or traction.
♦️School-age (5–11 years): Usually requires surgical fixation.
♦️Adolescents (11+ years): Often treated with rigid nails or metal plates.
♦️Pain Management medications such as NSAIDs, muscle relaxants, or opioids may be used.
Femur fracture surgery.
The two types of surgery procedures I normally see in theatre are:
1️⃣ Intramedullary Nailing where a metal rod is inserted down the deep centre marrow canal of the femur, secured with screws at the hip and knee, offering strong, stable fixation.
2️⃣Open Reduction and Internal Fixation (ORIF), here plates and screws are used for unstable, severe, or displaced femur fractures, allowing for accurate realignment and stable fixation.
3️⃣External Fixation is when pins inserted into the bone above and below the fracture are connected to a bar outside the skin, often used as a temporary measure.
Source: Williams,2024
▶️What is the purpose of rehabilitation after a femur fracture in the elderly?
In many elderly patients, the hip femur fracture seriously affected their physical and mental functioning and exerted a severe impact on their health status.
Rehabilitation after a femur fracture in the elderly aims to:
♦️Restore pre-fracture mobility.
♦️Managing the pain and discomfort associated with the fracture or surgery. It’s common to experience pain in the buttock, leg, or back after a femur fracture.
♦️Restore independence: Many fit and active elderly individuals after a femur hip fracture lose their independent mobility (Alexiou,2018)
♦️Physical function
The aim is to prevent dangerous complications such as deep vein thrombosis, pressure ulcers, and muscle atrophy.
Source: Lieberman,2002
Physiotherapy sessions or a stay in follow-up and rehabilitation care are very often prescribed here in the United Kingdom.
From the very first session, your physiotherapist will conduct an assessment that will allow them to define personalized goals with you. These goals will be based on your fracture, but also on your lifestyle, priorities, desires, etc.
▶️What are the different options for rehabilitation?
Depending on your health and lifestyle, rehabilitation can take place in different settings.
1️⃣ Inpatient Rehabilitation/Subacute Rehab: If you are not safe to go directly home, you may be transferred to a community hospital or skilled nursing facility to practice daily activities (transfers, stairs) with therapists before returning home.
2️⃣Home-Based Physical Therapy: A therapist visits your home to assist with initial recovery, focusing on safety, mobility, and early exercises.
3️⃣Outpatient Physical Therapy: Once mobile enough to leave the house, this is the most common option, focusing on intensive strengthening, balance, and gait training.
4️⃣Hydrotherapy (Aquatic Therapy): A specialized, low-impact option that uses water buoyancy to allow movement and muscle activation against resistance with reduced joint stress, often used early in the rehabilitation process.
Other professionals can also help. Occupational therapists, for example, can help you adapt your home.
▶️When should rehabilitation begin?
Rehabilitation for a femur fracture normally begins immediately, often within 24 to 48 hours after surgery. Reason being, it helps to prevent complications.
Making an appointment with a physiotherapist in the days following your fracture will allow you to assess what can be done at this stage.
This does not necessarily mean that you are going to start intensive rehabilitation!
Initial Activities: Early rehab focuses on gentle bed exercises (like ankle pumps), sitting on the edge of the bed, and standing with a walker or frame to prevent complications like blood clots or chest infections.
In-Hospital Phase: You will typically work with a physiotherapist daily while in the hospital to practice safe transfers and basic walking
▶️Research done by Alexiou et al 2018, noted that:
Patients who were rehabilitated using geriatric care after a femur/hip fracture showed a better improvement.
Geriatric care means a specialized medical approach focused on the unique health needs, quality of life, and independence of older adults, rather than treating isolated care.
Patients treated with comprehensive geriatric care during hospitalization had improved physical behaviour and independent living as compared to those treated with orthopaedic care.
Mid-Stage Rehabilitation normally start at:
♈Weeks 2–6: Focus is on maintaining range of motion and performing non-weight-bearing or toe-touch exercises. You will likely use crutches or a walker during this time.
♈ Weeks 6–12: As the bone begins to form a “hard callus,” therapists usually progress to partial weight-bearing and more active strengthening of the quadriceps and glutes.
♈6-Week Milestone: Many patients receive permission to drive around this time, provided they have regained sufficient control and are no longer on certain pain medications
Typically, rehabilitation can last for 3 to 6 months, though full recovery can take up to a year.
The study group that included 127 elderly patients 85 years of age who were hospitalized for rehabilitation following surgery for proximal femur fracture (Lieberman,2002)
54% patients had a significant lack of independence in ADLs at discharge from rehabilitation.
42% with no significant functional improvement after rehabilitation.
From the functional point of view, rehabilitation after surgery for femur fracture was less successful in the 85+ group than in a group of 75-to-84-year-olds but is no different in terms of duration or the rate of most complications or mortality during the process.
Source: Lieberman,2002
▶️How long can you start walking with a fractured femur after treatment?
Depending on various reasons, you may be restricted with how much weight you can bear after your surgery.
This is at your operating surgeon’s discretion and may be to aid healing or protect the metalwork.
Key Recovery Milestones & Timelines:
♈Days 1–2 (Post-Op): Early mobilization begins, often sitting on the edge of the bed or standing with physical therapy.
♈Weeks 1–6: Walking is generally restricted to partial weight-bearing or non-weight-bearing using aids.
♈Weeks 6–12: Progression to full weight-bearing often allowed.
In general, it’s a good idea to stop physio sessions once you’ve regained an autonomy close to that which you had before the fracture and you are walking without pain or discomfort.
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We have come to the end of this article, hope I have answered some of your questions, wishing you a quick recovery!🙋
📚Source:
Williams JA, Khawar H, Middleton R. = Br J Hosp Med (Lond). 2024 Feb 2;85(2):1-9. doi: 10.12968/hmed.2023.0378. Epub 2024 Feb 27. PMID: 38416520.
Lieberman D, Lieberman D. Rehabilitation after proximal femur fracture surgery in the oldest old. Arch Phys Med Rehabil. 2002 Oct;83(10):1360-3. doi: 10.1053/apmr.2002.35113. PMID: 12370868.
Reynolds A. The fractured femur. Radiol Technol. 2013 Jan-Feb;84(3):273-91; quiz p.292-4. PMID: 23322864.
Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging. 2018 Jan 24;13:143-150. doi: 10.2147/CIA.S150067. PMID: 29416322; PMCID: PMC5790076.