A broken femur, the long bone of the thigh, is a severe injury that requires immediate medical attention and almost always necessitates surgery. Because the femur is the longest and strongest bone in the body, a fracture results from high-energy trauma, such as a car accident or a significant fall. The time spent in the hospital is highly variable, depending on the injury’s specifics and the patient’s overall health. While a young, healthy patient may be discharged within three to six days following a straightforward surgical repair, older individuals or those with complex injuries often require a stay of 10 days or more. The acute hospital stay is dedicated to surgical stabilization, pain management, and achieving initial mobility goals before transitioning to the next phase of recovery.
Initial Medical Interventions
Upon arrival at the hospital, the immediate focus is on stabilizing the patient and the limb to reduce pain and prevent further damage to surrounding tissues, nerves, and blood vessels. This initial phase often involves the application of a temporary splint or skeletal traction, which uses a pin inserted into the bone to apply gentle pulling force. Stabilizing the fracture site is important because the powerful thigh muscles spasm and can cause the bone fragments to override each other.
For most femur fractures, definitive treatment involves surgical fixation, ideally occurring within 24 to 48 hours of admission once the patient is medically optimized. The most common procedure is intramedullary nailing, where a specialized metal rod is inserted into the bone’s central canal across the fracture site. In other cases, Open Reduction and Internal Fixation (ORIF) is performed, using plates and screws to hold the fragments in alignment. The majority of femur breaks are operatively treated to ensure proper healing and allow for earlier mobilization.
Key Factors Influencing Length of Stay
Simple, closed fractures of the femoral shaft in otherwise healthy, younger adults allow for a shorter hospital stay, sometimes averaging less than four days post-surgery. Conversely, fractures involving the proximal femur (hip fractures) in older adults are associated with a mean length of stay often exceeding a week, sometimes reaching 16 days. The presence of additional injuries, such as those sustained in multi-system trauma, significantly complicates the recovery trajectory and necessitates longer hospitalization for overall stabilization.
A patient’s pre-existing health conditions, known as comorbidities, profoundly affect the time required for medical readiness. Conditions like diabetes, heart disease, or chronic obstructive pulmonary disease increase the risk of post-operative complications, such as infection or issues with wound healing. Frailty in older patients increases the risk of an extended stay. Delays in the operating room, such as surgery occurring between 48 and 120 hours after admission, can increase the median length of stay by several days compared to earlier intervention.
Discharge Criteria and Readiness
A patient is considered ready for discharge only when specific medical and functional milestones have been achieved within the hospital setting. A primary requirement is achieving stable and acceptable pain control managed solely by oral pain medication, demonstrating the ability to wean off intravenous (IV) or epidural pain management. Medical teams must ensure the patient’s vital signs are stable and that there are no signs of immediate post-operative complications, such as a developing wound infection or deep vein thrombosis.
Functional readiness is determined by physical therapists who assess the patient’s ability to safely move. This assessment includes demonstrating proficiency in transferring from a bed to a chair and safely mobilizing a short distance using an appropriate assistive device, such as a walker or crutches. The patient and family must also receive thorough education on incision care, monitoring for complications, and managing their prescribed medication regimen.
Planning for Post-Hospital Recovery
Discharge from the acute care hospital is not the end of the recovery journey but a transition to the next, often mandatory, phase of rehabilitation. Planning for this transition begins almost immediately upon admission to ensure a smooth and timely move from the hospital setting. The primary decision revolves around the most appropriate post-acute environment to meet the patient’s functional needs and provide the necessary level of care.
Healthier patients who have adequate support at home may be discharged to their residence with home health services, including visiting nurses and physical therapists. However, a significant number of patients, particularly older adults with hip fractures or those with complex medical needs, require intensive rehabilitation at a Skilled Nursing Facility (SNF) or an acute inpatient rehabilitation unit. This dedicated setting offers daily, intensive physical and occupational therapy necessary to regain the strength and mobility required for independent living. The selection and availability of the appropriate facility can sometimes cause a temporary delay in discharge from the acute hospital.