As seasoned personal injury attorneys in Atlanta, over the years we have represented numerous people with serious hand fracture injuries. Our hands are the tool of tools, distinguishing humans from apes. If you work with your hands, your brain, and your heart, you are an artist, whether as a construction worker or a surgeon. The loving touch of a hand by a parent or a lover is essential for nonverbal communication.  Loss of full use of a hand can have devastating effects on productivity and quality of life.

Hand fractures are common injuries that can significantly impact one’s daily life and functionality. Whether it’s due to an auto or truck crash, a fall on dangerous premises, a defective product, a workplace accident, or a sports injury, hand fractures require prompt attention and appropriate treatment to ensure proper healing and restore optimal hand function.

Hand fractures can occur as a result of various causes. Some of the most common causes include:

1. Direct impacts: Falls and car and truck accidents often lead to hand fractures. Direct blows or forceful impacts on the hand can cause bones to break. We have seen many variations of this type of hand injury. Repeatedly over the years, we have represented people whose hands were broken through a variety of impacts in car and truck crashes.

•  Crush Injuries: Heavy objects falling onto the hand or getting caught in machinery can result in fractures. Crushing forces can cause bone fractures and damage surrounding tissues.

We have represented workers whose hands were crushed due to defects in the design or manufacture of machinery on which they were assigned to work. In one case, a carpet mill worker’s hand was drawn into a machine and crushed. We discovered that the manufacturer of carpet laminating equipment had disregarded instructions from the manufacturer of an emergency stop component.  The equipment manufacturer omitted the emergency cutoff from that side of machines and the e-stop on the other side was never connected. By the time a co-worker was able to turn off the machine, our client’s hand and arms had been crushed between rollers.

 3. Repetitive Stress: Certain repetitive motions or activities, such as those involved in certain types of work, can lead to stress fractures over time. These fractures typically occur due to overuse and inadequate rest periods.

Symptoms of Hand Fracture Injuries: Identifying the symptoms of hand fractures is crucial for early detection and appropriate medical intervention. Common signs and symptoms of hand fractures include:

1. Pain and Swelling: Fractures are typically accompanied by localized pain and swelling. The affected area may become tender and sensitive to touch.

2. Deformity: Hand fractures can cause visible deformity, such as misalignment or angulation of fingers or hand bones. The affected area may appear crooked or visibly out of place.

3. Limited Range of Motion: Fractures can restrict the normal range of motion of the hand and fingers. Inability to move fingers or hand joints, or experiencing pain while attempting to do so, may indicate a fracture.

Treatment Options for Hand Fracture Injuries: The treatment of hand fractures depends on various factors, including the type and location of the fracture, as well as the severity of the injury. Common treatment options for hand fractures include:

1. Immobilization: In cases of stable fractures or minor injuries, immobilization may be sufficient for healing. This involves applying a splint, cast, or brace to immobilize the hand and promote proper bone alignment.

2. Hand surgery aims to restore proper alignment, stability, and function to the fractured bones and surrounding structures.

1. Open Reduction: During surgery, an open reduction is performed to realign the broken bones. The surgeon makes an incision near the fracture site to access the bones directly. They manipulate the bones back into their proper position, ensuring alignment and stability.
2.  Internal Fixation: Once the bones are aligned, internal fixation techniques are used to hold the fracture in place while it heals. This may involve the use of screws, plates, wires, or pins, depending on the location and complexity of the fracture. These devices provide stability and support to facilitate proper healing.
3.  External Fixation: In certain cases, external fixation may be employed. This involves the use of pins or wires inserted into the bone above and below the fracture, which are then connected to an external frame. The frame holds the bones in alignment during the healing process.

1.  Bone Grafting: If there is significant bone loss or a gap between the fractured bone ends, bone grafting may be necessary. In this procedure, bone tissue is taken from another part of the body (autograft) or sourced from a donor (allograft) to fill the gap and promote bone regeneration.
2.  Soft Tissue Repair: Hand fractures often involve damage to the surrounding soft tissues, such as ligaments, tendons, or nerves. During surgery, the surgeon may repair these structures to ensure proper healing and restore hand function.

 Rehabilitation: Once a hand fracture is stabilized, rehabilitation plays a vital role in restoring hand function. Physical therapy exercises, which are often quite painful on the path to healing, help improve range of motion, strength, and flexibility. Hand therapy may also include techniques to reduce swelling and manage pain. In injury litigation, we have found the testimony of a good hand physical therapist is often essential for explaining clearly what the patient endured. Physical therapy for hand fractures generally includes:

1. Range of Motion Exercises: After a hand fracture, the affected hand may experience stiffness and limited range of motion. Physical therapists design specific exercises to gradually increase the flexibility and mobility of the injured hand. These exercises may include gentle stretching, finger movements, and wrist rotations to improve joint mobility.

2. Strengthening Exercises: Hand fractures can lead to muscle weakness due to immobilization and reduced use. Physical therapists prescribe strengthening exercises to rebuild muscle strength in the hand and fingers. These exercises may involve squeezing a stress ball, using therapy putty, or performing resistance exercises with therapeutic bands.

3. Functional Activities: Physical therapy focuses on improving hand function for daily activities. Therapists guide patients through activities that simulate real-life tasks, such as buttoning shirts, gripping objects, or writing. These functional exercises help patients regain dexterity and coordination.

4. Scar Management: Hand fractures often result in surgical incisions or scars. Physical therapists employ techniques to minimize scar tissue formation and improve scar mobility. This may include scar massage, gentle stretching, and the application of specialized creams or ointments.

5. Edema Control: Swelling, or edema, is a common issue following hand fractures. Physical therapists employ various techniques to reduce swelling, such as elevation, compression bandages, and lymphatic drainage techniques. By minimizing edema, therapy can enhance range of motion and facilitate healing.

6. Pain Management: Hand fractures can be accompanied by pain and discomfort. Physical therapists utilize modalities like heat or cold therapy, ultrasound, or electrical stimulation to alleviate pain and promote tissue healing.

7. Patient Education: Physical therapists educate patients on proper hand and finger ergonomics, joint protection techniques, and strategies to prevent re-injury. They provide guidance on activity modifications and recommend assistive devices, if necessary, to support hand function during the recovery process. It is important to note that physical therapy interventions are tailored to the individual’s specific needs and the severity of their hand fracture. Working closely with a skilled physical therapist ensures that the rehabilitation process is safe, effective, and personalized. In conclusion, physical therapy plays a critical role in the recovery and rehabilitation of hand fractures. Through a combination of range of motion exercises, strengthening techniques, functional activities, scar management, edema control, pain management, and patient education, physical therapists help individuals regain optimal hand function and return to their daily activities with confidence. If you have experienced a hand fracture, consult with a qualified physical therapist to develop a comprehensive rehabilitation plan tailored to your unique needs.

If you or a loved one have suffered a fractured hand injury, submit our inquiry form or call us now at 404-253-7862.

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Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949. The founders of the firm were also among the founders of the Georgia Trial Lawyers Association. Current partners include former presidents of the State Bar of Georgia and the Atlanta Bar Association.

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Ken Shigley, senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was the lead author of eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School, and completed certificate courses in trial practice, negotiation and mediation at Harvard Law School.

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A broken ankle is a painful, often complex, and potentially disabling injury. It is essential to obtain expert medical care and if there is a potential legal claim for the injury, legal counsel familiar with the injury.

Ankle fractures can be caused in many ways, through impact, twisting, and crush injuries.  We often see ankle fractures incurred through Impact in car and truck accidents or falls from a considerable height. Ankle crush injuries may occur when a heavy object rolls or falls over the ankle.  Impact injuries also may result from a pedestrian being struck by a vehicle.

Ankle fractures comprise about nine percent of all fractures. They are the most common lower limb fractures in the United States, and are the most frequent fracture injuries seen in hospital emergency departments.

Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. Complications may include a high ankle sprain, compartment syndrome, stiffness, disunion, and post-traumatic arthritis. A relatively simple non-displaced fracture may be treated with “RICE” (rest, ice, compression, and elevation).  However, more complex ankle fractures are likely to require surgery.

There are many varieties of ankle fractures. Some involve hairline fractures that are overlooked as people assume it’s merely a sprain and do not get a proper medical examination with x-rays for a long time. This can lead to unfortunate complications.

The ankle joint includes three bones – the talus (top of foot), the tibia (shin bone) and the fibula (thin calf bone connecting to the outside of the ankle joint).

Trimalleolar fractures

are the least common and most severe ankle injuries, as there are three breaks in the fibula and tibia. These usually result from a high-impact accident, but may occur in less dramatic occurrences. Trying to walk with a trimalleolar fracture would be very painful and might damage your ankle ligaments and tendons. The prognosis is often poor. Treatment of a trimalleolar fracture almost always involves surgery called “ORIF” (open reduction – internal fixation) with the insertion of rods, screws, and bone grafts. After surgery, there is extensive physical therapy. It often involves permanent impairment with a substantial effect on the quality of life.

For example, we represented a woman who was airline passenger walking through an airport concourse when she was struck by a passenger cart running silently and too fast. We obtained a video of the entire incident which showed her foot flopping from one side to the other as both her fibula and tibia were snapped in two and separated from the talus. It was touch-and-go whether she would require a rare ankle joint replacement surgery. While she was able to return to work, she had a permanent injury and had to give up her beloved activities of running with her dog and equestrian competitions.

Bimalleolar fractures

occur when there are breaks in the bony bumps on both sides of the ankle, the lower parts of both the tibia and fibula, the lateral malleolus and the medial malleolus. These bones connect with the talus to form the ankle joint. The ankle is supported by ligaments on both sides that stabilize the foot under the leg and lock the fibula and tibia together. Bimalleolar fractures can affect these ligaments. Because this is an unstable fracture, ORIF surgery is usually required.

The more complex an ankle fracture, the more difficult the treatment and recovery. If bones are shattered into many pieces the surgical reconstruction can be especially tricky involving several screws and plates at peculiar angles. The worst ankle fractures may be comminuted (broken in more than one place), intra-articular (fracture extends into the joint), open (bone fracture breaks the skin), or some combination of those factors.

Sometimes a subtle ankle fracture may be misdiagnosed as a mere sprain. Proper diagnosis of ankle fractures may include musculoskeletal ultrasound, MRI, CT scans, and weight-bearing CT scan.

A serious, complex ankle fracture, or one in which treatment is inadequate, may cause a permanent limp, limitation of activities, and a degree of permanent impairment.

If you or a loved one have experienced a serious ankle fracture due to the negligence of someone else, call us at (404)253-7862 or complete the inquiry form on this website.

Johnson & Ward, established in 1949, soon was recognized as the first and best personal injury law firm in Georgia.  The partners who started the firm were among the founders of the Georgia Trial Lawyers Association. Firm alumni served as judges of Fulton County Superior Court and the Georgia Court of Appeals and were authors of leading books on Georgia law. Current partners include past presidents of the Atlanta Bar Association and the State Bar of Georgia.

Ken Shigley, a partner at Johnson & Ward, is a former president of the State Bar of Georgia. In 2019, he received the “Tradition of Excellence Award” for lifetime achievement in the legal profession. Mr. Shigley was lead author of eleven annual editions of a book about Georgia’s civil trial practice. He was the first Georgia lawyer to earn three national board certifications from the National Board of Trial Advocacy in trial practice and truck accident law. He graduated from Furman University and Emory University Law School. He also completed certificate programs in mediation and negotiation at Harvard Law School. A widower, he has two adult offspring. His son is a golf fitness trainer  and his daughter works in hospice with terminally ill patients. 

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Among the worst injuries a person may suffer is a “broken neck,” a fracture in the cervical vertebra. It may result in irreversible paralysis or death.

The C1 and C2 vertebrae are the top two of seven vertebrae in the cervical spine. Depending upon their severity, these types of spinal cord injury are categorized as complete or incomplete.  Injuries at this top level of the spine can block nerve impulses to the rest of the body below that point, often leading to death or complete paralysis.

The C1 vertebra is also called the Atlas vertebra, named after the mythical ancient Greek hero who bore the weight of the world. The C2 vertebra is also called the Axis because it provides the ability for the head to rotate. The fracture of the C2 vertebra is often called a “Hangman’s fracture.”  The combination of C1 and C2 supports the skull, protects the spinal cords, and enables the head to rotate and swivel.

Injuries at the C1-C2 level are less common than at lower levels of the cervical spine. The most frequent causes of fractures at the C1 and C2 levels are diving, motor vehicle collisions, and falls that impact the head.

Symptoms of fractures at C1-C2 include:

• Loss of ability to breathe without help from a ventilator
• Loss of ability to speak
• Loss of feeling or sensation below the level of injury
• Paralysis of arms, hands, torso, and legs
• Limited neck and head movement

That is why a , a C1-C2 fracture spinal cord injury is among the worst injuries a person can have. Fortunately, near our office is one of the top spinal cord injury rehabilitation facilities in the United States, the Shepherd Center. Over the years, families of Shepherd Center patients have often asked us to meet with them at the hospital. Prospects for the degree of recovery from such injuries include considerations of:

The outlook of a person’s recovery from a cervical vertebra injury depends on a variety of factors, including:

• Health and fitness at the time of injury.
• Speed of response in getting appropriate treatment and stabilizing the injury, initially with a hard collar and then typically with external fixation devices.
• The completeness or incompleteness of  injury.
• Prompt use of anti-inflammatory and steroid medications to relieve swelling and pressure on the spinal cord.
• Prompt access to therapies and treatments at a specialized spinal cord rehabilitation facility such as the Shepherd Center.
• Ability of the patient, family, friends, and caregivers to adhere to a consistent care plan.

Therefore, a C1-C2 fracture spinal cord injury is among the worst injuries a person can have.

Legal representation of a person with such an injury due to someone else’s negligence generally involves identification of all at-fault parties and insurance coverages,  coordination with the medical team and development of the life care plan, understanding of the many medical and rehabilitation issues, empathy is working with a family in severe crisis, and settlement planning to coordinate insurance and governmental benefits through a special need trust.

If you or a loved one has a cervical fracture and spinal cord injury caused by another’s negligence, call us at 404-253-7862.

Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

Foot drop injury is a common complication of nerve injuries in the back, hip or legs. Also called “drop foot,” it is a result of weakness or paralysis of the muscles involved in lifting the front part of the foot.

Foot drop injury can be a frightening development for a person who is accustomed to being very active. It makes it hard to lift the front part of the foot, so it might drag on the floor when in walking. To compensate, one raises the thigh when walking as though climbing stairs (steppage gait), to help the foot clear the floor. This exaggerated gait might cause you to slap your foot down onto the floor with each step. Imagine trying to run, participate in sports, or do one’s normal work and other life activities in this condition.

I developed foot drop at age 39 due to a herniated disc at L5-S1 in the low back after a side   impact T-bone collision in an intersection.  It was frightening to find myself unable to walk normally. For weeks I had experienced increasingly severe sciatic pain, but I was unwilling to take off time from work to deal with it. Then I woke up morning to find that my leg no longer worked.  Fortunately, one of the top neurosurgeons in Atlanta was able to fit me into his schedule that week. He fixed it so that I was able to run marathons afterward. Most people are not that lucky.

The most common cause of foot drop is compression of the peroneal nerve that controls the muscles involved in lifting the foot. Traumatic injuries leading to foot drop can include fracture to tibial plateau, Patellar dislocations, ankle inversion injury, sciatic neuropathy resulting from either a traumatic injury of the hip or secondary to surgery and lumbosacral injuries.

The peroneal nerve is a branch of the sciatic nerve that wraps from the back of the knee to the front of the shin. Because it sits very close to the surface, it may be damaged easily. A pinched sciatic nerve resulting from a low back injury can cause drop foot.

Injuries to the leg or low back from car and truck accidents are a frequent cause of drop foot. That was what happened to me. Other causes include brain and spinal cord disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, diabetes,  stroke, and muscle or nerve disorders such as muscular dystrophy, polio or Charcot-Marie-Tooth disease.  Risk factors other than traumatic injury can include activities that compress the peroneal nerve such as habitually crossing legs, prolonged kneeling or squatting, and wearing a leg cast. The peroneal nerve can also be injured during hip or knee replacement surgery, which may cause foot drop. Foot drop may also occur as a complication of abdominal or pelvic surgery or radiation treatments.

Treatments for foot drop can include:

• Surgery to relieve the underlying nerve compression. That worked beautifully for me at 39. Unfortunately, it is not effective for everyone.
• Physical therapy to strengthen or stretch the muscles in the leg and foot
• Braces, splints or shoe inserts to help hold the foot in position
• An electrical nerve stimulation implant to help the nerves work

If foot drop persists, it may qualify for a permanent impairment rating under the  American Medical Association Guides to Evaluation of Permanent Impairment, 6th Edition.

If you or a loved one has a foot drop injury caused by another’s negligence, call us at 404-253-7862.

Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

A fracture of a vertebra in the low back (lumbar) region causes back pain, often severe, that is aggravated by movement. When low back fracture injuries involve teh spinal cord or nerves, there may also be bowel/bladder dysfunction, numbness, tingling, or weakness in the limbs.

When low back fractrue injuries are caused by high-energy trauma, the patient may also have a brain injury and lose consciousness. There may also be other injuries—called distracting injuries—that cause pain that overwhelms the back pain. In these cases, a vertebral fracture is likely.

These can take many forms including vertebral fractures, ruptured or bulging discs, and damage to nerves, ligaments, tendons, and muscles. A single injury can have aspects of any or all of these components.

There are several varieties of low back vertebral fractures:

Compression fractures

Compression fractures are small breaks in the vertebrae that reduce the height of the vertebra. The people most vulnerable to compression fractures of spinal vertebra are post-menopausal women with reduced bone density associated with osteoporosis. With tiny cracks in soft bone, one is more vulnerable to trauma causing collapse of the vertebra. Smokers are somewhat more at risk than non-smokers. Although this can happen without a major incident, an accident such as being rear-ended by another vehicle can suddenly change the condition from merely vulnerable to acutely painful and debilitating. A common form of compression fracture involves the collapse of the front side of the vertebra. That is called a wedge fracture.   Such compression fractures can lead to chronic pain, height loss, disfigurement, impaired activities of daily living, increased risk of pressure sores, and the depression and psychological distress that commonly accompany chronic pain and loss of quality of life.

Burst low back fracture injuries

A more severe form of compression fracture is the burst fracture, which occurs when a vertebral body spread out in all directions. The increased severity is due to a couple of factors. First, bony fragments spread out in all directions bruising the spinal cord, potentially causing paralysis or other neurologic injuries. Second, when the entire margin of the vertebral body is crushed the spine is much less stable than in a wedge-type compression fracture. Burst fractures, especially in older people with brittle bones in whom it is difficult to attach plates and screws to bone, are often treated with vertebroplasty. That involves injection of bone cement into the damaged vertebra for stability and support of the spine. We have seen this most often in older women rear-ended by large trucks.

 Chance fractures / flexion-extension seat belt fractures

Named after the British radiologist who first defined it in 1948, a Chance fracture is an unstable spine fracture, usually at T10-L2, the thoracolumbar junction. About half of all spinal injuries outside of the cervical spine are this part of the spine. It is a type of flexion-extension fracture because the upper body is thrown forward, typically in a head-on collision,  while the pelvis is stabilized only  by a lap seat belt.  It is also called a  “seatbelt fracture” because it often occurs when, upon sudden deceleration, the spine forcefully bends over the lap seat belt which serves as a fulcrum, resulting in the separation of the middle and posterior elements of the spine. This was seen more often before shoulder harnesses became common.

CT and MRI scans are essential in the diagnosis and are called for when there is seatbelt bruising after a motor vehicle crash. This is a horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. A Chance fracture is an unstable horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. However, in about half of Chance fractures there are also concurrent intraabdominal injuries, especially spleen, bowel and bladder ruptures. Early recognition of this injury is critical as a delay in diagnosis significantly impacts clinical outcomes, but unfortunately, emergency physicians can easily overlook Chance fractures on clinical exam because patients may present without initial neurological deficits. Treatment often involves stabilization with a brace or cast, though more severe cases with neurological symptoms may are stabilized surgically.

Rotation low back fracture injuries

This less common fracture results from rotation of the low back  or extreme sideways (lateral) bending. With rotation fracture-dislocation, both bone and soft tissue around a vertebra are injured, often resulting in spinal cord compression. Treatment involves surgery to stabilize the spine, generally with places, screws, rods or cages.

Permanent Impairments after Low Back Fracture Injuries

Most lumbar spine fracture injuries involve an impairment rating under the American Medical Association Guides to Evaluation of Permanent Impairment.   Physical impairment as rated under this system is not the same thing as occupational disability. A person with a relatively low impairment rating may be completely disabled from a physically demanding occupation. But a person with the same physical impairment rating may be fully capable of doing an office job. We may also consider evaluation by a vocational rehabilitation expert to evaluate real-world disability.

If you or a loved one have suffer ed a low back fracture injury, call us at 404-253-7862.

Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of  eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

The femur (thigh bone), extending from the hip to the knee, is the strongest and longest
bone in the human body. Because it is so strong, in relatively young people it usually requires a great deal of kinetic force to break the femur shaft. That often happens in truck, car and motorcycle crashes. In older people with weaker bones, however, a fall may be sufficient to fracture of the femur, especially the neck of the femur where it joins the pelvis.

In our decades of representing badly injured Georgians, we have handled numerous femur fracture cases. In one such case arising from a truck wreck, the jury in a conservative rural county surprised everyone with a verdict of $2,345,940.17. This was three times the highest previous verdict in the history of the county up until then and nearly a million dollars more than the $1.3 million we had requested in closing argument.  It reminded people of the 1982 movie, “The Verdict.”  This verdict was broken down as follows: compensatory damages: $1,742,845.70, attorney fees due to the defendant trucking company’s bad faith in violating mandatory safety rules, $580,948.57, expenses of litigation due to bad faith, $22,145.90. Medical expenses were $112,228. The highest offers from defendant’s insurance company were $100,000 the week before trial and $400,000 on third day of trial. It came from meticulously presenting the details of the injury without appearing to overreach and giving the jury a method to reach their own conclusion.

Femur fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture).

Femur fractures are classified depending on:

• The location of the fracture (the femoral shaft is divided into thirds: distal, middle, proximal
• The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle)
• Whether the skin and muscle over the bone is torn by the injury

The most common types of femoral shaft fractures include:

• Transverse. In this type of fracture, the break is a straight horizontal line going across the femoral shaft.
• Oblique. This type of fracture has an angled line across the shaft.
• Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture.
• Comminuted. In this type of fracture, the bone has broken into three or more pieces. The number of bone fragments corresponds with the amount of force needed to break the bone.
• Open. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications—especially infections—and take a longer time to heal.
• Any or all of these diagnostic criteria may be combined in a single injury.

Femur Fracture Diagnosis

Physical examination, combined with imaging by X-ray, CT and MRI, is used to diagnose a femur fracture and determine the exact location and pattern of fracture.

If feasible, tell the doctor should be informed how the injury occurred. The physician will look for:

• Bony pieces that may be pushing on or through the skin
• Deformity of the thigh/leg, such as an unusual angle, twisting, or shortening of the leg.
• Breaks in the skin
• Bruises

After inspecting the leg visually, the doctor will feel the thigh, leg, and searching for abnormalities and tightness of the muscles and skin of the thigh, and checking pulses. If the patient is awake, the physicians tests for sensation and movement in the leg and foot.

Treatment of a Femur Fracture

Treatment for femur fracture may vary based on the type and location of the break and may often include:

Setting the leg

A displaced fracture may require the broken bones to be realigned, prior to splinting of casting of the leg. Depending on the degree of displacement, surgical or nonsurgical methods may be used to manipulate the bones back into position.

Severe or multiple fractures may require external fixation, which uses an outer metal rod and pins to hold the bone or bones in place until they heal.

• Open Reduction and Internal Fixation (“ORIF”) involves surgery and use of fixation devices, including an intramedullary rod or “nail” through the center of the bone, secured with various types of metal plates and screws, is used often to stabilize the broken femur during healing. This hardware is usually left in the leg permanently though sometimes it may be removed or replaced. Advantages of intramedullary nailing include quicker return to weight bearing, enhanced rehabilitation, and a high bone union and fusion rate compared with external fixation. But there are also potential disadvantages including increased risk of fat embolism, increased rates of infection and blood loss, and potential impediment to obtaining correct alignment. We have handled injury cases in which intramedullary fixation failed. In one case involving a femur shattered into several pieces, a small town hospital did not have the exact length of intramedullary rod immediately available. It was necessary to repeat the surgery a year later, and the patient had a permanent limp and a degree of permanent impairment in his occupation.
• Immobilization through a splint or cast. Whether or not there is surgical fixation of the fracture, femur fracture treatment usually involves use of splints or casts. A college friend had a femur fracture in football. He spent his senior year in a full leg cast. While his dreams of going to the NFL were as shattered as his leg, but he chose graduate school and ultimately returned as president of the college.
• Pain medication. Femur fractures are extremely painful. Physicians and patients must be aware of the delicate balance between pain control and risk of narcotic dependency or addiction. We know one severely injured person who was sent home with a huge quantity of hydrocodone but within a few days weaned himself off potentially addictive drugs because he needed to resume brain work, switched to over-the-counter Tylenol, and “sucked it up” for several months of recovery.
• Physical therapy. Most patients recovering from femur fractures are prescribed months of physical therapy (“PT”) to restore normal muscle strength, range of motion, and flexibility. Patients often jokingly refer to physical therapists as “physical terrorists” because the process can be quite painful, but it’s a good pain that helps recover function.
• Maximum medical improvement after a femur fracture usually takes about 4 to 6 months but sometimes can take a year or two.

 Permanent Impairments after Femur Fracture

In preparing for settlement or trial of femur injury cases, we typically obtain from the physician an impairment rating under the American Medical Association Guides to Evaluation of Permanent Impairment.   Physical impairment as rated under this system is not the same thing as occupational disability. A person with a relatively low impairment rating may be completely disabled from a physically demanding occupation. But a person with the same physical impairment rating may be fully capable of doing an office job. In the context of femur injuries, the determination of physical impairment involves complex tables and formulas that rate factors such as limb length discrepancy, gait derangement, muscle strength and atrophy, range of motion, arthritis, nerve injury, complex regional pain syndrome, and reduction of blood circulation. When appropriate, we also consider evaluation by a vocational rehabilitation expert to evaluate real-world disability.

 Wilderness First Aid for Femur Fractures

Most of the femur fracture injuries we see are the result of motor vehicle collisions on streets and highways.  These initially addressed by emergency medical personnel who can quickly stabilize the fracture and transport the patient by ambulance to a hospital. But if a femur fracture occurs in a remote wilderness setting beyond the reach of immediate emergency medical services, it is important to have someone in the group trained in wilderness first aid. One of our lawyers was trained years ago on how to set a displaced femur fracture in the wilderness using sticks tied off with bandanas, jackets, or t-shirts. We pray that it never becomes necessary to utilize that training.

If you or a loved one has suffered a femur fracture in a truck, car or motorcycle crash, contact us online or call us at 404-253-7862.

Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of  eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

Femur fracture injuries are serious, painful, and often cause some degree of permanent impairment. Your femur (thigh bone)  is the longest, thickest, and biggest bone in your body. It takes a lot of force to break the femur. A femur fracture may involve a break, crack, or crush injury of the bone. Auto and truck collisions are the most common cause of femur fractures.

The long, straight part of the femur is called the femoral shaft.  Femur fracture injuries anywhere along this length of bone is called a femoral shaft fracture. Fractures that break completely through the bone, or cause the bone to be displaced or crushed, require immediate surgery.  These are classified in several ways:

• Stable fracture: fragments of the broken bone line up correctly.
• Displaced fracture: broken bone fragments are out of alignment and must be put back in line.
• Closed fracture: the skin around the fracture remains be intact
• Open fracture: the broken bone has punctured the skin.
• Location of fracture:
  • Distal: near the knee
  • Middle: the long middle stretch of the femur
  • Proximal: in the femoral head or neck where the femur joins to the hip. This is a major cause of disability and the decline of older people.
• Pattern of fracture
  • Transverse fracture: a break is a straight horizontal line across the femoral shaft.
  • Oblique fracture: a break is an angled line across the shaft.
  • Spiral fracture: Twisting force causes a fracture line that spirals around the shaft like stripes on a barber pole or candy cane.
  • Comminuted fracture: bone has broken into three or more pieces.
  • Open or compound fracture: bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. This involves increased damage to the surrounding muscles, tendons, and ligaments, and higher risk for complications—especially infections—and take longer to heal.

Femoral fractures often require complex surgery. When a surgeon opens up the thigh to put bone fragments back in proper alignment that is call “open reduction.” That contrasts with “closed reduction” in which a surgeon is able to align bones fragments without cutting. When the surgeon uses rods (also called nails), screws and other hardware to secure the fragments together, that is called “internal fixation.” The entire procedure is “open reduction – internal fixation,” abbreviated as “ORIF.”   Rods (nails) inserted in the middle of the femoral shaft and secured with screws, plates, and wires. This internal hardware is usually left in the body long-term.

Some also required external fixation devices temporarily on the outside of the thigh. Complications may arise if these devices are misaligned in any way, or with infection, nerve damage, blood clots, and bones setting in incorrect positions. Sometimes more than one operation is required.

We have handled many cases involving complex femur fractures, working closely with treating orthopedic surgeons to accurately communicate the full reality of such injuries, including impairment ratings, disability factors, and custom medical illustrations.

In one femur fracture case arising from a truck wreck in a conservative,  rural Georgia county, Ken Shigley obtained a jury verdict of $2,345,940.17, roughly $1.2 million more than we asked for. That was the result of providing the jury a method of determining value in such a manner that the jurors decided to award more than the amount that we asked for in closing arguments.

If you or a loved one has suffered a femur fracture due to a truck crash or other traumatic injury, call us at 404-253-7862.

Johnson & Ward has been a leading personal injury specialty law firm in Atlanta since 1949.
Ken Shigley is a former president of the State Bar of Georgia (2011-12), triple board certified by the National Board of Trial Advocacy, recipient of the Traditions of Excellence Award for lifetime achievement, and was lead author of Georgia Law of Torts: Trial Preparation and Practice (2010-21). He graduated from Furman University and Emory University Law School.
John Adkins specializes in personal injury and wrongful death litigation. He is an honor graduate of Kennesaw State University and Thomas Jefferson School of Law in San Diego.
Ed Stone specializes in personal injury and wrongful death litigation. He is a graduate of Kennesaw State University and John Marshall Law School in Atlanta.