pain is felt in the knee or groin. The leg
tends to turn outwards and hip move-
ments are restricted.
Surgery is needed to fix the epiphysis
into its correct position and is usually
completely successful. In some cases, the
other hip may also need to be stabilized.
femoral herniaA type of herniathat
occurs in the groin area, where the
femoral arteryand femoral vein pass
from the lower abdomen to the thigh.
femoral nerveOne of the main nerves
of the leg. The nerve fibres making up
the femoral nerve emerge from the low-
er spine and run down into the thigh,
where they branch to supply the skin
and quadriceps muscles.
Damage to the femoral nerve (which
impairs the ability to straighten the
knee) is usually caused by a slipped
disc in the lumbar region of the spine
(see disc prolapse). Damage may also
result from a backward dislocation of
the hip or a neuropathy.
femurThe medical name for the thigh-
bone, the longest bone in the body. The
lower end hinges with the tibia (shin) to
form the knee joint. The upper end is
rounded into a ball (head of the femur)
that fits into a socket in the pelvis to
form the hip joint. The head of the
femur is joined to the bone shaft by a
narrow piece of bone called the neck of
the femur, which is a common fracture
site (see femur, fracture of).
At the lower end, the bone is enlarged
to form 2 lumps (the condyles) that dis-
tribute the weight-bearing load through
the knee joint. On the outer side of the
upper femur is a protuberance called
the greater trochanter. The shaft of the
femur is surrounded by muscles which
move the hip and knee joints.
femur, fracture ofThe symptoms, treat-
ment, and possible complications of a
fracture of the femur (thigh-bone) dep-
end on whether the bone has broken
across its neck (the short section
between the top of the shaft and the hip
joint) or across the shaft.
Fracture of the neck of the femur, often
called a broken hip, is very common in
elderly people, especially in women
with osteoporosis, and is usually associ-
ated with a fall. In a fracture of the neck
of the femur, the broken bone ends are
often considerably displaced; in such
cases there is usually severe pain in the
hip and groin, making standing impos-
sible. Occasionally, the broken ends
become impacted. In this case, there is
less pain and walking may be possible.
Diagnosis is confirmed by X-ray. If the
bone ends are displaced, an operation
under general anaesthesia is necessary,
either to realign the bone ends and to
fasten them together, or to replace the
entire head and neck of the femur with
an artificial substitute (see hip replace-
ment). If the bone ends are impacted
the fracture may heal naturally, but
surgery may still be recommended to
avoid the need for bed rest.
Complications include damage to the
blood supply to the head of the femur,
causing it to disintegrate. Osteoarthritis
may develop in the hip joint after frac-
ture of the femur neck itself. However,
immobility and the need for surgery in
the elderly may result in complications,
such as pneumonia, that are not dir-
ectly related to the fracture site.
Fracture of the bone shaft usually
occurs when the femur is subjected
to extreme force, such as that which
occurs in a traffic accident. In most
cases, the bone ends are considerably
displaced, causing severe pain, tender-
ness, and swelling.
Diagnosis is confirmed by X-ray. With
a fractured femoral shaft there is often
substantial blood loss from the bone. In
most cases, the fracture is repaired by
surgery in which the ends of the bone
are realigned and fastened together
with a metal pin. Sometimes the bone
ends can be realigned by manipulation,
and surgery is not necessary. After
realignment, the leg is supported with a
splintand put in tractionto hold the
bone together while it heals.
Complications include failure of the
bone ends to unite or fusion of the bro-
ken ends at the wrong angle, infection
of the bone, or damage to a nerve or
artery. A fracture of the lower shaft can
cause permanent stiffness of the knee.
fenbufenA nonsteroidal anti-inflamma-
tory drug(NSAID) used to relieve pain
and stiffness caused, for example, byFEMORAL HERNIA FENBUFEN
F