Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Fracture, Femur


Related Terms

  • Broken Leg
  • Broken Thigh Bone
  • Fracture of Thigh Bone
  • Thighbone Fracture

Differential Diagnosis

  • Hip dislocation
  • Hip fracture
  • Previously undiagnosed hairline fracture

Specialists

  • Emergency Medicine Physician
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Vascular Surgeon

Comorbid Conditions

Factors Influencing Duration

Any complications or associated injuries may lengthen disability.

Medical Codes

ICD-9-CM:
821.00 - Closed Fracture of Unspecified Part of Femur
821.01 - Closed Fracture of Shaft of Femur
821.10 - Open Fracture of Unspecified Part of Femur
821.11 - Open Fracture of Shaft of Femur
821.20 - Closed Fracture of Unspecified Part of Lower End of Femur
821.21 - Closed Fracture of Femoral Condyle
821.22 - Epiphysis, Lower (Separation)
821.23 - Closed Supracondylar Fracture of Femur
821.29 - Other; Multiple Fractures of Lower End
821.30 - Open Fracture of Unspecified Part of Lower End of Femur
821.31 - Open Fracture of Femoral Condyle
821.32 - Open Fracture of Lower Epiphysis of Femur
821.33 - Open Supracondylar Fracture of Femur
821.39 - Open Fracture of Lower End of Femur, Other

Overview

A thigh bone (femur) fracture is a break in the upper bone of the leg. Because the femur is the longest, strongest bone in the body, unless the bone is diseased, it takes great force to break it. Femur fracture most commonly occurs after a motor vehicle accident, a collision playing a sport, a fall from a high place, or as the result of a gunshot wound and underlying tumor (neoplasm). Nevertheless, elderly individuals or others who have weakened bones as a result of osteoporosis or other bone disease may experience a femur fracture from a simple fall in the home. Fractures of the femur near the hip are generally termed "hip fractures," with the term "femur fracture" used for fractures that occur in the shaft of the femur or near the knee.

Femur fractures are classified on the basis of the fracture line, whether the bone fragment breaks through the skin, and the location in which the break occurs. Fractures are classified by types, including simple, comminuted, closed, open, pathological, and stress. Simple fractures consist of a break in only one place in the bone. In a comminuted fracture, the bone is broken in more than two places. In a closed fracture, the skin is not broken by the fracture, while in an open fracture, the skin is broken and the bone fragments are exposed. A pathological fracture occurs after the bone has been weakened by disease, and a stress fracture consists of a gradually occurring break that is so slight that it may not even appear on x-ray. Femur fractures are further classified according to degree, shape, and type of soft-tissue injury.

Incidence and Prevalence: Femur fractures occur at a rate of 3 in 10,000 individuals per year for individuals younger than 25 years and older than 65 years; the rate for individuals outside of those age ranges is 1 in 10,000 individuals per year (Aukerman).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who engage in high-risk activities, such as skiing, rock climbing, snowmobiling, and horseback riding are most likely to experience a fractured femur. Individuals who have a poor diet low in calcium and vitamin D or who have osteoporotic bone disease or another type of disease that weakens the bones are also at higher risk.

Femur fracture most often occurs in individuals younger than 25 years or older than 65 years.

Source: Medical Disability Advisor



Diagnosis

History: Because the origin of a fractured femur is almost always traumatic, it is usually apparent that the individual sustained an injury. If the individual is conscious, he or she will likely describe an accident that produced traumatic force on the femur and complain of severe pain in the thigh. The individual cannot bear weight on the leg and may indicate that he or she can feel the bone fragments sliding in the thigh. If a large amount of blood is lost, the individual may complain of numbness, coolness, and tingling in the lower leg as well as feeling faint. Often the individual has other significant injuries in addition to a fractured femur.

Physical exam: Swelling, bruising, and deformity at the fracture site will be evident.

Tests: Anteroposterior and lateral x-ray views of the femur are obtained to confirm the fracture, along with x-rays of the lower leg, the hip joint, and the knee joint to detect any associated injuries. Because a fractured femur is typically associated with other traumatic injuries, a general physical examination is conducted. Arteriography may be done in cases where blood supply to the thigh and lower leg shows signs of compromise. Neurologic function may be assessed below the fracture (distal), in the thigh and lower leg. Significant swelling may lead to a compartment syndrome and compartment pressures may be measured.

In cases of suspected stress fracture, radionucleotide scanning may be used to detect fractures 3 weeks before they appear on plain x-ray. MRI may be used to detect bone marrow signal even earlier. Bone mineral density testing may be used to rule out or diagnosis osteoporosis or the related condition osteopenia.

Routine laboratory blood and urine tests will be needed before surgery, including complete blood count (CBC), chemical profile, blood clotting profile, and electrolytes. Chest x-ray and electrocardiogram (ECG) are usually done to assess the risk of receiving anesthesia.

Source: Medical Disability Advisor



Treatment

If other injuries are life threatening, stabilizing the individual’s condition may take precedence over treating a fractured femur. The individual is given pain medication, the femur is immobilized, and the area of the fracture may be cleansed with an iodine solution. With open fractures, wounds are carefully cleaned, a tetanus vaccination is given, and antibiotics are administered.

The type of treatment depends on the location, the number of breaks, and any associated injuries, but normally the break needs to be surgically repaired under anesthesia. The pieces of bone are re-aligned into in their anatomically normal position. Steel screws, plates, and/or rods are then used to reattach the broken bones and fix them in place so healing can occur (open reduction, internal fixation [ORIF]). Plates are usually screwed in crosswise against the bones; rods are typically inserted lengthwise through the bone fragments. Casts and traction are now only rarely used for this type of fracture in adults unless other injuries require the use of a body cast, because a good outcome relies on early mobility. Occasionally, if the individual has an infected wound associated with the break, external fixation may be used. A frame is placed around the leg and attached to the bones with pins. The individual usually must remain hospitalized for at least several days. Individuals with a femur fracture may lose up to 2 to 3 units of blood by bleeding into the soft tissues of the thigh, and 50% will require a blood transfusion as a result (Mirza).

Source: Medical Disability Advisor



Prognosis

The prognosis depends on the type and location of femur fracture, age and health status of the individual, and concomitant injuries. Recovery is generally expected; however, individuals over age 60 with closed femur fracture have a mortality rate of 17% (Keany). Nonunion rate is about 1% (Aukerman). Permanent problems with gait may occur, and disability may result from other injuries sustained at the time of the fracture.

Source: Medical Disability Advisor



Rehabilitation

The goal of rehabilitation after a femur fracture is to restore function. The rehabilitation protocol depends on the type, location, and severity of the fracture, as well as the physician's protocol for treatment. Consideration must be given to the method for stabilizing the fracture (operative, nonoperative) and on the stability of the fractured bone. The individual's general condition prior to the fracture and the individual's weight-bearing status may influence the rehabilitation process.

Of primary importance during the early phase of recovery is ambulation, with weight bearing as advised, and assistive devices as needed. Depending on the procedure, partial weight bearing may be delayed until there is evidence of bony union, and full weight bearing may be restricted for an additional month (Whittle). The physical therapist should teach ankle exercises to promote circulation through the lower extremities and should advise individuals to perform these intermittently throughout the day.

As the individual increases his or her mobility, an occupational therapy evaluation may be beneficial to maximize independence with activities of daily living and to supply adaptive equipment, such as a raised commode or tub seat, to promote independence.

Once the fracture is stable, gentle range of motion and strengthening exercises can be started and progressed as indicated. The therapist should make sure that adjacent joints are exercised to prevent loss of motion and strength (Whittle). Both to complement supervised physical therapy and to be continued independently after the completion of rehabilitation, a home exercise program should be taught during this period.

Bone healing may occur within 6 to 12 weeks; however, the bone strength and the ability of the bone to sustain a heavy load may take up to several years (Chapman). Once healing has occurred, the individual may resume full activities of daily living. It is important to instruct the individual not to overload the fracture site until the bone has regained its full strength. The resumption of heavy work and sports should be guided by the treating physician.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistFracture, Femur
Physical or Occupational TherapistUp to 24 visits within 10 weeks
Surgical
SpecialistFracture, Femur
Physical or Occupational TherapistUp to 12 visits within 6-12 weeks
Note on Nonsurgical Guidelines: Rehabilitation may not begin until tissue healing, about 6 to 8 weeks after the fracture.
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Significant bleeding can result if the rich blood supply to the femur and surrounding muscle is disrupted after fracture. Shock, secondary anemia, and injury to the sciatic nerve or the superficial femoral artery or other veins may occur. Infection sometimes occurs in individuals who sustain a compound, or open fracture. Gait problems, muscle weakness, and stiffness of the hip or knee sometimes persist, and if the plates and screws are left in place indefinitely, the bone can begin to wear away around these areas. In some rare cases, a screw may break off inside the leg. Malunion or nonunion of the fracture may also occur when the fracture either heals in an imperfect position or when underlying bone disease or other medical conditions prevent or delay healing.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual is typically hospitalized for at least 2 to 3 days after surgery. Most individuals require additional time off from work, and those who live alone or who have associated injuries may require a stay in a rehabilitation center. The average school or work time lost after femoral fracture is 30 days and the average length of activity restrictions is 107 days (Aukerman). During the healing period, the individual cannot bear any weight on the injured femur and needs to use crutches, usually for at least 8 to 12 weeks. During this time, the individual is unable to do any job that requires more walking than a few steps on crutches or walking up and down stairs.

Pain medications may affect some individual's vision, balance, concentration, and coordination. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function. Individuals in jobs that involve heavy lifting require temporary reassignment to a sedentary job. Use of a tall, high-backed chair rather than a soft one may be helpful.

The individual will require time off to attend medical and physical therapy appointments while the leg is healing. Recovery takes about 3 to 9 months, depending on job requirements. After the fracture has healed on x-ray and after at least a year has elapsed from the time of injury, any rods, plates, or screws that are causing local symptoms may be removed. Other internal fixation hardware may remain in place indefinitely. Recovery of pre-injury strength and range of motion may take up to a year. Return to work should be guided by the physician and physical therapist.

Stress fractures are less likely to occur or recur when proper footwear is worn and training techniques for athletic or work activity are followed.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual have other traumatic injuries associated with the femur fracture?
  • Was an x-ray done to determine the extent and location of the fracture?

Regarding treatment:

  • In the case of an open fracture, did infection or other complications develop? Were complications treated?
  • Was ORIF performed to fix the bones in place for healing?
  • Did treatment for other injuries slow treatment for femur fracture?
  • Was physical therapy prescribed?

Regarding prognosis:

  • Is individual receiving physical therapy? Is individual active and compliant with prescribed therapy?
  • Does individual have underlying injuries or disease that may affect femur fracture healing?
  • Has individual refrained from heavy lifting or excessive activities following surgery?
  • Does individual abuse alcohol or smoke?
  • Does individual have adequate daily intake of calcium and vitamin D?
  • Is employer able to accommodate individual’s work restrictions?

Source: Medical Disability Advisor



References

Cited

Aukerman, Douglas F., et al. "Femur Injuries and Fractures." eMedicine. Eds. Gerard A. Malanga, et al. 30 Oct. 2008. Medscape. 13 Feb. 2009 <http://emedicine.medscape.com/article/90779-overview>.

Chapman, Michael W. Chapman's Orthopaedic Surgery. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2001.

Keany, James E. "Fractures, Femur." eMedicine. Eds. Francis Counselman, et al. 21 Aug. 2007. Medscape. 13 Feb. 2009 <http://emedicine.medscape.com/article/824856-overview>.>.

Mirza, Amer, and Thomas Ellis. "Initial Management of Pelvic and Femoral Fractures in the Multiply Injured Patients." Critical Care Clinics 20 1 (2004): 159-170. National Center for Biotechnology Information. National Library of Medicine. 13 Feb. 2009 <PMID: 149793>.

Whittle, Paige A. "Fractures of the Lower Extremity." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Source: Medical Disability Advisor






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