Broken leg

A broken leg (leg fracture) will be severely painful, swollen or bruised and you usually won’t be able to walk on it. If it’s a severe fracture, the leg may be a funny shape and the bone may even be poking out of the skin.

There may have been a "crack" sound when the leg was broken and the shock and pain of breaking your leg may cause you to feel faint, dizzy or sick.

If you think you or someone you’re with has broken their leg, go immediately to your nearest hospital’s accident and emergency (A&E) department. Call 999 for an ambulance if it’s not possible to walk.

Types of leg fracture

Some broken legs are more serious than others – it depends on the location of the fracture, how the bone has broken and whether there is any damage to the surrounding tissue. The most common types of fracture are described below.

• Stress fractures – tiny cracks in the bone caused by overuse of the leg; common in athletes.
• Undisplaced or hairline fracture – a fracture through the bone with little damage to the surrounding tissue.
• Displaced fracture – the two parts of the broken bone have moved apart (misaligned).
• Comminuted fracture – the bone has broken (shattered) into several pieces.
• Open or compound fracture – a complicated break where the bone has broken through the skin, or the initial injury has exposed the broken bone.

How a broken leg is treated

Immobilisation

First, a doctor will give you painkillers and then may fix a splint to your leg to secure it in position and prevent further damage. For severe pain you may be given gas and air or stronger painkillers through a drip. An X-ray is often necessary to assess the fracture.

A stress, undisplaced or hairline fracture (where the bone remains aligned) can usually be treated by applying a plaster cast. This holds the bone in place so it can heal. The cast may not be applied immediately if there is a lot of swelling but a splint will usually be left on.

You may be provided with painkillers to take home and information on how to look after your cast. Read information about how to look after your plaster cast.

Reduction

If the bones are misaligned (displaced) then a non-surgical technique called "closed reduction" may be used to pull them back into place.

Sedatives are sometimes provided before the procedure and local or regional anaesthetic is used to numb the leg. In some cases a general anaesthetic is needed (which means you’ll be asleep during the procedure).

Once the bones are in the correct position, a plaster cast can be applied (see above).

Surgery

Most severe fractures are best treated with surgery to realign and fix the broken bones. Surgeons can fix bones with wires, plates, screws or rods, using a procedure known as open reduction and internal fixation. Any metalwork is usually not removed unless it becomes a problem.

In rare cases, an external frame (external fixator) is attached to the broken bones with metal pins to help keep them in place. This is removed once the fracture has healed.

After surgery, a plaster cast is applied to protect the repair (see above).

Follow-up appointments

An appointment will be made for you to attend a fracture clinic so specialist orthopaedic doctors can monitor the care of your fracture. This is usually booked for a week or two after your treatment.

Severe fractures will usually heal within three to six months, but may require follow-up appointments every few months for a year or more afterwards. Further X-rays are often necessary to monitor your progress.

Recovery

You will be given advice by your doctor on how much you should move your leg, and when you can put weight on it.

It takes around six to eight weeks for a minor fracture to heal, and you will probably need to use crutches or a wheelchair during this time, until it is possible to put weight on the leg again. The hospital will show you how to safely use any mobility equipment they provide.

More severe fractures can take between three and six months to fully heal. Some fractures can take even longer, especially open or comminuted fractures.

The hospital may book regular physiotherapy appointments to help you maintain or regain muscle strength, movement and flexibility. This will include specific exercises to do before and after the cast is removed. It is important to follow the physiotherapist's advice to avoid delaying your recovery.

The pain of the injury usually stops before the bone is fully healed so aim to gradually introduce regular activities, especially sports or manual labour.

You should not drive while in a cast. Seek advice from your doctor about when you can drive again.

Complications

There is a risk of complications developing before, during or after surgery for a broken leg. These include:

• Damaged muscle, nerves or blood vessels around the fracture – this can occur during the initial injury (often caused by a sharp piece of broken bone) or during surgery. This may lead to loss of movement or feeling, or may affect the blood supply to the limb.
• Bone infection – the risk is increased if surgery is performed, or if it is an open fracture. This can significantly delay the healing process. Antibiotics can help to treat the infection but further surgery may also be needed.
• Acute compartment syndrome – this is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles (a muscle "compartment"). This can occur soon after a fracture, after the plaster cast has been applied or after surgery. Emergency treatment is needed using a surgical procedure called an emergency fasciotomy.

In rare cases, the bone may not heal properly, which means a further operation may be needed.

This could be caused by the bone not being aligned properly during surgery, trying to put too much weight on the bone before it has healed, the nature of the injury or from smoking.