ANATOMICAL ASPECTS OF

FEMORAL FRACTURE

SGD B01:
NI PUTU RANI APSARI DEWI (1402005001)
HANANYA DWI ANGGI MANURUNG (1402005002)
KOMANG CHANDRA SURYA DIKA (1402005003)
YOSEFANY SAMUDRA SATYA (1402005004)
JESSICA YUWONO (1402005009)
NI PUTU OMASIH KIANTIMI (1402005010)
NI NYOMAN KANTA KARMANI (1402005011)
YOSI WANDA KUSUMA (1402005016)
MAYA PARAMITA WIJAYA (1402005017)
TIFANIA MELUCHA MIGUEL LEONG (1402005254)
FLORENCE DIANA THOMAS (1402005164)
GANESHWARY GANASAN (1402005165)
THAM HONG YUAN (1402005166)

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FAKULTAS(KEDOKTERAN(
UNIVERSITAS(UDAYANA(
2014(
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 CONTENTS

Cover................................................................................................................i
Contents...........................................................................................................ii
Foreword..........................................................................................................iii
CHAPTER I......................................................................................................1
Introduction
CHAPTER II.....................................................................................................3
Review of Literature
CHAPTER III...................................................................................................20
Conclusion
Bibliography....................................................................................................21

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 Foreword
Praise the all mighty God for all of his might the author can finish this
Student Project titled "Anatomical Aspects of Femoral Fracture" in time. This
project is written for the requirements to pass the Studium Generale block,
first semester of the medical studies of faculty of medicine, Udayana
university.
In this chance, the Author will say thanks to all of the helping hand that
was given during the writing of this project, from the dosen, from all of the
friend whom cannot be mention all by name. The Author also acknowledge
that the writing of this project is still far from perfect. So that that's why
critique and advice will be most appreciated for the improvement od the
Student Project. And the Author will hope that this Student Project will be
somewhat helpful for others.

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Author! !

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 CHAPTER I.!
INTRODUCTION

Bones are one of the most important organ system in the human
body; it is used for support, movement, protection of vital organs, to act as
the reservoir of calcium ions, and blood producer1. Bones could be used
as protection because bones can withstand a lot of force, the maximum
tibiofemoral compressive force reached an average load of 3.9 times
body-weight2. Excess force to the bone could cause cracks called
fractures. Fractures is a break or rupture in the bone3, it occurs in normal
bone because of abnormal load or stress, in which the bone gives way1.
The most common fracture is the fractures that take place in femur.

Femur, or sometimes called the thigh bone, is the longest, heaviest,

and strongest bone in the body, and is essential for normal ambulation.
Although it is the strongest bone, it is the most common fractured bone,
based on the data from Sistem Informasi Rumah Sakit (SIRS) in
2010, the prevalence of bone fracture increases every year since 2007. in
2007, 22.815 incidences of bone fractures were recorded. in the following
year, 2008, the prevalence of bone fractures increased to 36.947. in 2009
became 42.280 and in 2010 there were 43.003 cases4. It consists of 3
parts (i.e., femoral shaft or diaphysis, proximal metaphysis, distal
metaphysis). The femoral shaft is tubular with a slight anterior bow,
extending from the lesser trochanter to the flare of the femoral condyles.
During weight bearing, the anterior bow produces compression forces on
the medial side and tensile forces on the lateral side. The femur is a
structure for standing and walking, and it is subject to many forces during
walking, including axial loading, bending, and torsional forces. During
contraction, the large muscles surrounding the femur account for most of
the applied forces5. Its proximal end articulates with the acetabulum of the
hip bone. Its distal end articulates with the tibia and patella1.

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 Femoral fracture patterns vary according to the direction of the
force applied and the quantity of force absorbed. A perpendicular force
results in a transverse fracture pattern, an axial force may injure the hip or
knee, and rotational forces may cause spiral or oblique fracture patterns.
The amount of comminution present increases with the amount of energy
absorbed by the femur at the time of fracture5,6.

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 CHAPTER II
REVIEW OF THE LITERATURE

II.1 Definition
A fractured femur is a breakage in the thigh bone (femur), the longest,
strongest and heaviest bone in the human body. The strength and size of
the femur means that under typical circumstances, a large force or
extensive trauma is needed in order to result in a fracture. The femur is
the largest and strongest bone and has a good blood supply9. Because of
this and its protective surrounding muscle, the shaft requires a large
amount of force to fracture. Once a fracture does occur, this same
protective musculature usually is the cause of displacement, which
commonly occurs with femoral shaft fractures. A thigh bone (femur)
fracture is a break in the upper bone of the leg. 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)7,8 .
Generally Femur Fracture can be classified into three types :

II.1.1Proximal Femur Fracture

Proximal Femur Fracture, or Hip Fracture, is a fracture which

takes place above the lesser trochanter. But the specific types of
proximal femoral fracture discussed are intertrochanteric, femoral
neck, subtrochanteric, and greater trochanteric fractures. This
proximal femur fracture can lead to substantial morbidity and
mortality. The picture bellow depicts an anteroposterior

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 radiograph showing an unstable proximal femoral fracture of the
right hip in a man who fell outside.

II.1.2 Femoral Shaft Fracture

If the femur is broken between the proximal and distal

(where it meets knee) ends, then it is referred to as a femoral
shaft fracture. The spectrum of femoral shaft fracture is wide and
ranges from nondisplaced femoral stress fracture
to fractures associated with severe comminution and significant
soft-tissue injury. Isolated injuries can occur with repetitive stress
and may occur in the presence metabolic bone diseases,
metastatic disease or primary bone tumors. This is a serious
injury , generally associated with severe trauma, and in most
cases necessitating surgery. The picture is an example of an
isolated, short, oblique midshaft femoral fracture, which is very
amenable to intramedullary nailing. Although not seen in this x-
ray film, radiographic visualization of both the proximal and distal
joints should be performed for all diaphyseal fractures

II.1.3 Supracondylar Femur Fracture

Supracondylar femur fracture can be classified as a rare

injury, supracondylar femur fracture is a breakage of the
thighbone immediately over the knee joint. As such, this injury

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 generally harms the knee’s cartilage. A patient who sustaints
significant cartilage damage will very likely develop arthritis as
he/she ages. Supracondylar femur fractures require anatomically
stable internal fixation for best results, which usually necessitates
surgical treatment. These fractures usually occur in elderly
patients with multiple comorbidities and osteoporotic bone ;thus,
a high rate of complications exists. Supracondylar femur fracture
treated in traction. Traction allows nonoperative restoration of
length and alignment while the patient is stabilized for surgery,
but it is associated with the major complications of prolonged
bedrest when used as definitive treatment.

II.2 Etiology

A femur fracture is generally the result of an intense blow. A relatively

strong force is required to break this sturdy bone in otherwise healthy
individuals, so motor vehicle accidents and high impact falls are among
the most common causes. The fracture can occur anywhere along the
bone. Most ‘hip fractures’ are actually fractures of the neck of the femur.
Certain conditions, such as osteoporosis or cancer that has invaded the
bone marrow, can make involved bones more susceptible to breakage.
Traumatic injuries are rarely an isolated event and often occur with other
injuries – external or internal.If the femur is compromised for some reason,
such a fracture can be caused by milder injuries.

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 A number of factors increase the risk of a fractured femur. Not all
people with risk factors will get fractured femur. Risk factors for fractured
femur include:
• Age over 65

• Deconditioning (loss of muscle mass, muscle weakness)

• Driving while intoxicated or under the influence of drugs

• Frailty (general weakness, fatigue, loss of muscle mass and strength)

• Metabolic bone disease

• Metastatic (widespread) cancer

• Not wearing seat belts while driving or riding in a car

• Osteoporosis

• Participating in extreme or contact sports

• Severe kidney disease

• Tendency to fall

II.3 Internal Factor

Age and Diet Factor
Everyone in every age range has a risk in bone fracture because it
depends on the bone mass and strength of the people, their activity,
lifestyle and so on. From 20 to 25 years old, the bone forming process
from calcium can repair the broken or weaken bones. The peak time for
bone development is reached from 25 to 40 years old, after that the bones
mass start to decrease.
Age-related incidence of femur fracture is associated body with the
increase of osteoporosis and the increase of the frequency of falls with
advancing in age. Femur fracture most often occurs in individuals younger
than 25 years or older than 65 years. The teenagers who are younger than

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25 years old has a risk to experience femur fracture because it is the best
time to do so much activity , sports and the others. Individuals older than
65 years has a decreased bone mass and lower bone mineral density
when it is started from 40 years old so they have a risk to experience the
femur fracture.
The bone strength is closely related to the bone mass with a
correlation coefficient of 0.6 to 0.8 between the bone mineral density and
the force required to induce fracture. The mechanical strength of proximal
femur depends on the size of the bone and the distribution of mass within
the bone. The WHO has identified several risk factors of fracture
occurence. These are : glucocorticoid use, cigarette smoking, excessice
alcohol consumption and low body weight. The combined use of these risk
factors together with age and bone mineral density (BMD) allows the 10-
year probability of fractures to be predicted.
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 has a higher risk to experience a fractured femur.
Calcium has a big role in bones development, it is also necessary
for the other process such as heart beat, muscle strength. If the calcium in
our body is not enough for that process then the calcium in our bones will
be taken for the other process in body which is more urgent and important.
That’s why we need to consume calcium while we are still young because
calcium absorption is very good in young and mature age. The sun rays or
vitamin D is also needed for well calcium absorption in intestine.
Based on the new England journal of medicine about Vitamin D
Dose Requirement for Fracture Prevention, it concludes high-dose vitamin
D supplementation was somewhat favorable in the prevention of hip
fracture and any nonvertebral fracture in persons 65 years of age or
older1.
Vitamin C has a function in bone forming that can help calcium
absorption by maintaining the form of calcium in solution and also help
osteoblast growth. Vitamin C is also important in some hidrolysis which is

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needed to produce colagent, karnitin and serotin. Colagent is a protein
compound that influence the cell structure integrity in all connective tissue.
Smoking can increase a bone fracture risk because it can decrease
: the bones mass density, body mass index, estrogen hormones in
woman. It can decrease the body ability to absorp calcium, destroying new
bone cells. Alcohol has a role in bones weakening because it solutes the
magnesium, calcium and other minerals in bones.

Hormonal Factor
Fractures can also be caused due to hormonal factor. Reduced
estrogen after menopause can increase the chances of developing
Osteoporosis. Osteoporosis is a disease characterized by reduced bone
mass and microarchitecture abnormalities, which result in increased bone
fragility . Typically , people begin to experience bone loss at the age of 30-
40 years. At age 40, bone mass will begin to decrease , causing fragile
bones.
Reduced bone mass affect Osteoblasts process . Osteoblasts are
cells that play a role in bone formation . 98 % of calcium is stored in bone
osteoblasts plays an important role in the process. Calcium is the role that
calcium ions are influenced by the three hormones, such as parathyroid
hormone, 1,25-dihydroxy vitamin D, and calcitonin. Parathyroid hormone
plays a role in the process of bone resorption by activating osteoclasts and
will lead to increased levels of calcium in the blood . 1,25 -dihydroxy
vitamin D will stimulate osteoblasts then stimulates osteoclasts . While
calcitonin act as a deterrent osteoclasts . Of research is also known that
estrogen plays a role in the suppression of bone resorption process10.
People who suffer from osteoporosis will be more prone to
spontaneous fractures . Spontaneous fracture is a broken bone that is
caused by the things that light itself could even fracture . Approximately 80
% of people with osteoporosis are women, especially during the cessation
of the menstrual cycle (menopause). At the time of menopause hormone
estrogen that is produced will be reduced . The hormone estrogen helps

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keep the calcium needed for bone. So, on the menopause in the calcium
content of the bones is reduced, causing osteoporosis . Therefore , we
must regulate calcium nutrients that enter the body enough to keep our
bones to be strong.

Pathogenic Factor

The pathogens that infect the body can also play a major roll in the
weakened structure of the femoral bone. Diseases like AIDS is one of the
example. In a study of 5826 patient with HIV, 233 patients had fractures.
This means that the Age-adjusted fracture rates among HIV-Infected
Persons in the HIV Outpatient Study patients were higher than rates in the
general US population during the period 2000–200620.

II.4 External Factor

• Impact of Femur
When we do activities , then our femur collided with something hard
which has a great force can lead to fractures . This great force can
causes a fractures of femur .
• Pressed of Femur
Is the result of the power that drives a bone against another bone or
power presses against the bone length . Often occurs in older
women that bones become fragile due to Osteoporosis.

II.5 EXAMINATION
Diagnose of fracture is depends on the history and the examination
of fracture. Diagnostic accuracy of history means that there’s an interview
between patient and doctor to get information about the patient’s history of
fracture. When a patient has a trauma about fracture before, then doctor
has to check correctly where and when the fracture happened11. Doctor
also has to know about kind of fracture that the patient had before and

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examine another part of body such as thorax, abdomen, head, pelvis and
etc, in this case the doctor will examine a femoral fracture. There are three
types of fracture’s examination12,
1. General Examination
In general examination, doctor is looking for opportunity of general
complication. For the example shock of fracture pelvis, open
fracture and signs of infection that happened on open fracture.
2. Physical Examination
A physical examination is an evaluation of the body and its
functions using inspection, palpation (feeling with the hands),
percussion (tapping with the fingers), and auscultation (listening).
Physical examinations of fracture are:
• Inspection
In inspection the examiner or the doctor
will observe the patient's a-ppearance. So, the doctor will check
if there’s an edema and deform-ities.
• Palpation, Percussion & Auscultation
Is a method of feeling using one’s hand or finger when body is
examine. In fracture, the examiner will press the part of body
where fracture happened and the patient will tell about what
they feel to the doctor. The doctor can easily know which one
part of join or bone where the pain, effusion and crepitation
happened.
3. Supporting Examination
The important of supporting examination that has to be done
is Rontgen using X-Ray to get the three dimensions picture or
image of the position and the condition of the bone where the
fracture happened. So, supporting examination needs to use
minimal two projections anterior and posterior. In a special
condition, sometimes supporting examination needs more than two
projections. The function is to show the pathology that the doctor
looking for, because of superposition. For the new fracture, X-Ray

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 has function to see the type and position of fracture and it needs to
show the both sides of bone. The another supporting examination is
bones scanning to identify about the position of fracture and the
condition of soft tissues13.

II.6 CLINICAL MANIFESTATIONS

Clinical manifestations are the evident symptoms of a disease that

make it easy for a physician to diagnose. These manifestations are
deemed to be subjective if they are perceived by the patient. The clinical
manifestations the fracture of femur is pain, loss of function, deformity,
shortening of the extremity, crepitus, swelling local, and color changes are
described in detail as follows:

1. Ongoing pain and increasing severity until the bone fragments

immobilized. Muscle spasm accompanying fracture is a form of
natural splint designed to minimize movement between the bone
fragments.
2. Deformity can be caused by a shift in the fracture fragments and
extremity. Deformity can be in the know to compare with the normal
limb. Extremity can not function properly due to normal muscle
function depends on the integrity of the bone drug
3. Shortening of the bone, due to contraction of muscles attached
above and below the fracture.
4. Krepitasi extremities when checked by hand, palpable bone rattle.
Palpable crepitation due to friction between fragments with one
another.
5. Local swelling and discoloration of the skin caused by bleeding
following trauma and fractures. This sign only after a few hours or a
few days after the injury.

Not all these signs and symptoms present in each fracture. Most
just do not exist in linear fracture, fissure and fracture impaction (fracture

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surface pushed each other to each other). Diagnosis of fracture depends
on symptoms, physical signs, and rays - x patient. Usually patients
complained of an injury in that area.

II.7 Medicamentosa on Femur Bone Fracture

II.7.1 Non surgical treatment

This nonsurgical treatment rarely used for femoral shaft fracture,
because most femoral shaft fracture requires surgery to heal. The doctor
may be able to manipulate the broken bones back into place without
operation this nonsurgical treatment only works on very young children.
Spica casting is one of the nonsurgical treatments for femur bone
fractures, this spica casting can only works for children between 7 months
and 5 years old, this cast applied to keep the fracture pieces in the correct
position until the bone is completely healed. In general spica cast applied
from the chest and then extend down to the fracture femur. Because
children’s bone grows quickly so while in the cast the bones will grow and
heal back into the normal shape.

II.7.2 Surgical treatment

In cases of femoral fractures, the surgeon will give the patients
multisystem stabilization and clearance for surgical intervention. Also
consultations with specialists must be arranged for specific purpose.
Traction may be necessary for initial stabilization to maintain leg length
before impending surgery.

Before the final surgery of a femoral shaft fracture, the patient

should be hemodynamically stable and fully resuscitated. The time to
definitive surgical stabilization is 24 hours. However, if the patient is
hemodynamically unstable and has not been adequately resuscitated,
femoral fixation should be delayed and temporized with an external fixator.
Surgical treatment for femur bone fracture:

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 • External Fixation
This is one of the operations for the femur bone fracture, this
operation using metal pins or screws which placed into the bone
above and below the fracture sites, the device is attached to a bar
outside the skin. The function of this device is to stabilizing the
bones in a proper position so that the bone can heal. External
fixation is a good treatment for temporary femur fracture until the
patient is ready for the final surgical, but in some cases the external
fixation left until the femur is fully healed, but this isn’t common
case.

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 • Hip Pinning
Hair pinning is a surgical procedure for femoral neck
fracture. This procedure is done by placing several screws across
the fractured bones, this screws will keep the bone together in a
proper place until the bone is healed. When a hip pinning is
performed, the patient usually under go general or spinal
anesthesia, then the doctor made a small incision on the outside of
the thigh to put the screws into the broken bones.

• Hip Hemiathroplasty
Hip hemiarthroplasty is half of a hip replacement. This
procedure is use to replace the fractured head of femur. In this
procedure, the ball of the ball-and-socket joint is removed, and a
metal prosthesis is implanted into the joint. A hip hemiarthroplasty
is performed under general anesthesia or spinal anesthesia. An
incision is made over the outside of the hip. The fractured femoral
head is removed, and replaced with a metal implant.

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 Hip hemiarthroplasty on femoral head fracture

• Intramedullary nailing
Intramedullary nailing is currently the method that most
surgeons use for treating femoral shaft fractures. This method
requires a special designed rod which will inserted to the marrow
canal of femur. This rod will passed through the femur fracture, to
keep the bone in their proper position. This intramedullary nail
inserted into the canal either from the hip or the knee through a
small incision. The intramedullary nailing will be screwed to the both
ends of the femur bone, this will keep the intramedullary nail and
the bone in the proper position until the bone is fully healed.

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 • Plates and screws

In this operation, the bone fragments are first repositioned

(reduced) into their normal alignment. They are held together with
special screws and metal plates attached to the outer surface of
the bone. Plates and screws are used when intramedullary nailing
may not be possible, such as for fractures that extend into either
the hip or knee joints14.

II.8 Non Medicamentosa of Femur Fracture

Non-Medicamentosa is methods that use to heal some diseases,

illnesses and injuries without any operations but it uses some techniques,
methods and treatments which are able to make parts of the body do their
own recovery.
The things that the physiotherapists able to do in order to heal fracture
with non-medikamentosa methods are return and recovery the abilities
and functions of the bone using physiotherapy exercises. Physiotherapy
exercises are healing treatments which are using passive locomotors and
active locomotors15. There are some techniques that physiotherapists use
in physiotherapy activity:
1. Posisioning.
2. Static Contraction.

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 3. Passive Exercise.
4. Active Exercise.
5. Walking Exercise.
6. Installation of Gypsum.

Physiotherapy exercises have some benefits, for example it helps to

reduce pain due to injury, it reduces swelling around the fracture area, it
helps to maintain and increase the movement of the femur therefore the
patients able to do their activites again.
1. Posisioning.
Posisioning is changes positions of our femur. This treatment can
decrease the swelling on our femur. The physiotheraphist will
instruct the patients to bend their femur with pillow below their
femur. The dosage of this therapy is 1 hour for bending the femur
and 1 hour to relax the femur to normal position.

2. Static Contraction.
Static contraction is theraphy exercise that needs muscle
contraction without changes muscles length or the movements of
joints (Kisner, 1996). The purpose of this treatment is to improve
blood circulation , helps to decrease pain and swelling and also this
treatment makes the patients’ muscle to be stronger moreover
avoids antrophy to be happened.

3. Passive Exercise
Passive exercise is movements that come from external power and
this is a kind of unrealizing muscle movements. The external power
comes from gravity,machines, or a body part of an individual
(Kisner, 1996). This treatment divides into 2 kinds of movements :
a. Relaxed Passive Exercise: In this treatment, the physiotherapist
will give some movements to the patients but the
physiotherapist do not allow the patients to do movements (all

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 that the patients need to do is stay at the right position and
receive the movement from the therapist). The purposes of this
treatment are to treat the muscle using passively and
automatically the muscle will be relax and it avoids the decreas
of muscle elasticity.
b. Force Passive Exercise: In this treatment, the physiotherapist
will give some movements and at the end of each movements,
the physiotherapist give pressure to the fracture femur. The
purposes of this treatment is to avoid stickiness of each tissues.
4. Active Exercise
Active exercise is a treatment which is using inside power (power
from the patients’ bodies,patients’ muscles and patients’ energies)
without helps. This treatment will make movements and
contractions that against gravity (Basmajian, 1978). The purposes
of this treatment are to maintain and increase the strength of
muscles, decrease swelling on the fracture, and also it helps
patients to get their motoric abilities again therefore they can do
their activities well.

5. Walking Exercise
Walking exercise is the most important aspect of all treatments.
This treatment will help the patients to be healed as soon as
possible. The physiotherapist will do this treatment step by step, it
starts by doing some movements on the bed with sprawl position
and start to make the femur move, and then the second step is high
sitting and the last exercise is trying to stand up and walking.

6. Installation of Gypsum
The doctor will give gypsum to the patient’s femur to avoid the
femur moves again to the wrong position.

Other methods that has risen is the use of the Mummy treatment.

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mummy is a traditional drug used from ancient times to improve fracture
healing. In a study of 138 patients, which were randomly selected, the
improvement rate is significantly higher than those who didn't use the
mummy treatment19.

II.9 Complication Of Fracture Femur Bone.

Complications of fractured Femur can be varies depending in the location
and severity of the break. Complication that can be occur include:

1. Infection: in case the femur fracture can be infection when the bone
breaking in the skin. The infection can be decreased when has
prevention with the antibiotic.
2. Nerve Damage: it can be happened but sometimes. The Nerve
damage can be lead persistent numbness weakness in the part of
lower leg.
3. Bone Healing Problems: if the bones cannot stable with each other,
it can be have an irritation to the bone that has infection, so that the
healing process can be stopped and required further surgery.
4. Surgical Complications: it can be happen an irritation and pain that
cause by the failure of the hardware that use to stabilized the bone
or prominence of a piece of hardware. Nerve damage has
possibility to surgery complication.

II.10 Prognosis
Patients who survive the initial trauma associated with the injury typically
heal well. Early mobilization following intramedullary nailing greatly
reduces complications associated with prolonged immobilization. Age
affects the speed and quality of recovery. Fractures may be caused by
underlying medical conditions such as osteoporosis or cancer metastasis;
these conditions may complicate recovery further16. Patients older than 60
years with closed fractures of femur have a mortality rate of 17% and a
complication rate of 54%17.

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 CHAPTER III
CONCLUSIONS

Femoral Fracture is the fracture that take place in the our body's
strongest, longest, and heaviest bone in the human body; the Femur.
Femoral fracture, depended on the place of fracture, can be divided into
three types: Proximal Femoral, Femoral Shaft, Supracondylar Femur
fracture. Because of its toughness, the femur must be given a strong force
to be fractured, usually comes from motorcycle accidents, but can also be
weaken by other thing like cancer. Other internal factor include age, diet
and hormonal; all of the internal factor is subsequently lead to
osteoporosis, which is the weakening of the bone cause by the reduced
mass of the bone. External factor include the quantity of impact and
pressing to the femur. To examine femoral fracture, it needs to be done
with three types of examination: General, which is looking for a sign of
infection; Physical, examining with physical touch; and supporting, which
is the use of tools like x-ray. Femoral fracture could manifest into an
ongoing pain, deformity, shortening of the bone, kreptasi, and local
swelling. The methods to which the femoral fracture is treated is divided
into two treatment, the medicalmentosa and non-medicalmentosa. The
medicalmentosa is the use of medical technique to treat patients.
Medicalmentosa for the femoral fracture is divided into the surgical way
and the nonsurgical way; the nonsurgical way is by the use of casting to
correct the position of the bone, but this is rarely done; and there is the
surgical way, which is the use of implants to correct the position of the
bone. Nonmedicalmentosa uses therapy in their action, like
physiotherapy. But if there is complication for the patient of femoral
fracture, like infection, nerve damage, bone healing problems and surgicla
complication.

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