A Strange Femur Fracture

There's a report this morning that Arnold Schwarzenegger, the Governor of California, broke his leg while skiing in Sun Valley.  I've read the report, and it doesn't make sense.

SAN FRANCISCO (AP) - California Gov. Arnold Schwarzenegger broke his leg while skiing with his family Saturday morning in Sun Valley, Idaho, a spokesman said.

Schwarzenegger, 59, was taken to a hospital for X-rays and was discharged with a fracture to his right femur, said Adam Mendelsohn, the governor's Deputy Chief of Staff for Communications.

He will have surgery to repair the bone when he returns to Los Angeles, Mendelsohn said. The governor remained at his Sun Valley home Saturday night and still planned to spend Christmas there.

What's wrong?  Well, ordinarily a femur fracture is not the kind of break you can go home with and have surgery at a more convenient time.  Almost always the patient is admitted to the hospital, or transferred to a preferred hospital directly, and surgery is performed expediently rather than on a delayed basis.  There are risks of blood loss, compartment syndrome, and thrombosis (blood clots) that would be elevated by waiting.  In addition, the surgery is more difficult when delayed by more than 24-36 hours.

Is this a femur fracture then?  Possibly, but it would be a very strange femur fracture.  The only common type of break that could be treated in this fashion would be a greater trochanter fracture, but those can often be treated without surgery.  The other possibility is that the report is wrong on the fracture site.  Perhaps it's a fibula (near the ankle) and not a femur (mid-thigh).

(Update at Sounds a Little Like a Real Femur Fracture)

Comments

[J.R. Seafood]

I would agree completely with your comments concerning femur fractures and some surprising aspects of this story. Blood loss, pain control and further injury to the surrounding large muscles of the thigh are of great concern. Its hard to imagine a patient with a femur fracture not having surgery within several hours of the injury much less being discharged home to ultimately be transported to another city for surgery a couple of days later. Furthermore the femur is the strongest long bone of the body and fractures of this structure are associated only with injuries where large energies and forces are generated. Such fractures are not common amongst recreational skiers and more are typical of skiers such as downhill racers moving at very high rates of speeds falling and striking inanimate objects such as trees or lift towers. These fractures will also occur in skiers who ski off of high cliffs or who have taken off very high jumps and land on flat rather than slopping terrain. A femur fracture occurring in an atypical skiing situation might be a sign of osteoporosis, a bone disease in which the bone is weakened and though it occurs primarily in women also occurs in men.

[Mande Ville]

Anabolic steroids have in fact been used to treat osteoporosis and have been shown to increase bone density. The long term adverse effects on bone density of these substances is unknown. Another bone disease, avascular necrosis of the femoral head ( that portion of the bone which comprises half of the hip joint ) IS associated with anabolic steroid use. This condition can result in collapse of the femoral head which might not require immediate surgery and allow Governor Schwarzenegger to return to Los Angeles. This would stand in distinction to a displaced fracture involving the shaft or neck of the femur. Surgical options for patients with avascular necrosis of the femoral head and subsequent collapse include total hip replacement. At this time, sufficient information to fully understand his injury is lacking.

[Giacomo]

Both excellent points, JRS and Mande Ville. I hadn't thought about the anabolic steroid connection (though Mr. Schwarzenegger has always insisted he never used them), although typically AVN is more associated with cortico-steroids, like prednisone, than anabolic steroids. AVN with collapse would certainly be a type of "femur" fracture that could wait, but I wouldn't have expected it to be called a "femur" fracture. Though a low-velocity femoral shaft fracture would be unusual, you could conceivably get one by falling directly on the thigh hitting a rock or hard ice.

[Mande Ville]

With all due respect to both you and the Governor, he has admitted to using anabolic steroids but has said that he did so under a a doctors supervision, whatever that means exactly.

I refer you to the following two articles and any number of others which I am sure you can find quite easily.

http://www.cbsnews.com/stories/2005/02/26/politics/main676684.shtml
http://espn.go.com/columns/farrey_tom/1655597.html

I am also not sure that he has not suffered from other adverse effects of these substances. I am sorry though that he or anyone else has suffered any injury or ill effects from any cause whatsoever.

[Giacomo]

I stand corrected on the "insisted he never used them" comment; still, corticosteroids are much more associated with osteoporosis and AVN than anabolic steroids. In fact, they have been trialed in treatment for osteoporosis.

[Coleen]

I broke my femur a few years ago and I totally agree that you don't wait around to get the surgery! I was rushed to the hospital by ambulance. Pain management is the biggest issue, and then there are other very real medical dangers (making sure your femoral artery isn't in danger, blood clots, etc.)

Something is amiss here...

[Richard Evan]

It's a PR thing.
I think they are avoiding calling it a "hip fractue" (associated w/ the elderly and/or someone w/ AVN- such as an anabolic steroid user) and calling it a fracture of the "femur" or "leg" (more assoc. w/ young, athletic, result of trauma, etc.)