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Health condition · Clinically reviewed

Broken leg, from stress fractures to open femoral shaft trauma.

The lower limb takes every step you make. When a bone gives way, the right pathway - from primary survey to specialist ortho-plastic care - decides how well you walk again.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BOA/BOAST and peer-reviewed orthopaedic trauma sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK orthopaedic trauma practice including ortho-plastic care for open fractures and fracture liaison for fragility injuries.

Key facts

Lower limb fractures at a glance.

The essentials, in plain English - the sites, the surgical priorities, and the two emergencies that must not be missed.

  • What it is

    A fracture anywhere in the lower limb long bones - femur, patella, tibia or fibula. Ranges from hairline stress fractures to complex open injuries.

  • Femoral shaft

    Typically high-energy trauma in young adults or a low-energy pathological fracture in older patients. Fixed with an intramedullary nail.

  • Tibial shaft

    The most commonly fractured long bone. Often open, with a real risk of compartment syndrome and delayed union.

  • Hip fractures

    Femoral neck and intertrochanteric fractures in older patients are covered in our dedicated hip fracture guide.

  • Open fractures

    A surgical emergency - antibiotics within an hour, tetanus cover, and definitive ortho-plastic care in a specialist centre.

  • Compartment syndrome

    Pain out of proportion and pain on passive stretch - suspect it early. Urgent four-compartment fasciotomy saves the limb.

Why this guide matters

A pathway that matches the fracture.

A tibial stress fracture and an open comminuted femoral shaft are both broken legs - but almost nothing else is the same. The three points below shape everything on this page.

  • The site drives the plan

    Femoral shaft, tibial plateau, patella and stress fractures each have their own imaging, fixation and recovery pathway.

  • Two emergencies come first

    Open fractures and compartment syndrome dictate everything else - antibiotics within an hour and fasciotomy on suspicion.

  • Rehabilitation decides outcome

    Fixation is only half the answer. Structured physiotherapy, appropriate weight-bearing and bone health follow-up decide how well you walk again.

How the assessment is made

From arrival in ED to a clear surgical plan.

The steps a UK trauma team will follow in order - primary survey first, the fracture next, and the underlying bone health last.

  1. 01

    Assessing

    Primary trauma survey

    ATLS-style airway, breathing, circulation and disability check first - a broken leg from a fall can hide a life-threatening injury elsewhere.

  2. 02

    Assessing

    Focused limb examination

    Deformity, shortening, external rotation, skin integrity, and a documented neurovascular check of the peroneal, tibial, femoral and popliteal territories.

  3. 03

    Assessing

    Compartment assessment

    Serial pain scores, pain on passive stretch, and paraesthesia as the earliest sign. Compartment pressures if consciousness is impaired.

  4. 04

    Confirming

    X-ray - AP and lateral

    Full length views including the joint above and below the injury. Non-negotiable in tibial and femoral shaft fractures.

  5. 05

    Confirming

    CT for complex patterns

    Tibial plateau, pilon, distal femur and any intra-articular or comminuted pattern needs a CT for surgical planning.

  6. 06

    Confirming

    MRI for the occult picture

    Suspected stress fracture, occult hip fracture, ligamentous injury with tibial plateau fractures, or early avascular necrosis of the femoral head.

  7. 07

    Preparing

    Wider trauma workup

    Chest X-ray, spine imaging and a full secondary survey where the mechanism is high-energy. Fat embolism syndrome is a real risk after femoral shaft fractures.

Typical timeline: from ED assessment to definitive fixation within 24 to 36 hours for most closed fractures.

Presentation

What a broken leg actually looks like.

The obvious features - deformity, swelling, inability to weight-bear - and the subtler ones that determine whether a limb is at risk.

  • Severe, focal pain

    Sudden inability to bear weight, pain on the slightest movement, and tenderness right over the fracture line.

  • Deformity and shortening

    Angulation, rotation, or a shortened limb - classic for femoral shaft. External rotation and shortening point to a hip fracture.

  • Swelling and bruising

    Rapid swelling within hours, tense skin, and bruising that tracks along fascial planes over the following days.

  • Skin breach - open fracture

    Any wound overlying a fracture is an open fracture until proven otherwise - it changes the whole management pathway.

  • Neurovascular compromise

    Cold, pale, pulseless foot or new numbness and foot drop - a limb-threatening emergency needing immediate vascular and orthopaedic input.

  • Compartment syndrome - the 5 Ps

    Pain out of proportion (earliest), paraesthesia, pallor, pulselessness and poikilothermia. Pain on passive stretch is the key clinical sign.

  • Stress fracture pattern

    Insidious activity-related shin or thigh pain in runners and military recruits - worse with loading, better with rest.

  • Red flag - pathological pattern

    A low-energy fracture through an area of pre-existing pain, weight loss, or a known cancer - think metastasis, Paget’s or myeloma.

Management

How lower limb fractures are treated in the UK.

Emergency care first for open injuries and compartments - then site-specific fixation, VTE prophylaxis and structured rehabilitation.

  • Open fracture pathway

    Intravenous antibiotics within one hour, tetanus cover, photograph, saline-soaked dressing and splint. Definitive fixation within 24 hours in an ortho-plastic centre.

  • Fasciotomy for compartments

    Suspected compartment syndrome is a surgical emergency - urgent four-compartment fasciotomy of the leg, not a wait-and-see call.

  • Intramedullary nail - femur

    The gold standard for femoral shaft fractures - a long metal nail down the medullary canal, locked at each end. Early weight-bearing and return to function.

  • ORIF for the distal femur

    Plate fixation or a retrograde nail for supracondylar and intercondylar patterns. Revision knee replacement if the fracture is around an existing arthroplasty.

  • Patella - tension band or ORIF

    Tension band wiring for transverse fractures with a disrupted extensor mechanism. Partial patellectomy is reserved for severely comminuted poles.

  • Tibial plateau fixation

    ORIF with a buttress plate for Schatzker I to VI patterns, often staged with an external fixator first when soft tissues are poor.

  • Tibial shaft - IM nail

    Intramedullary nailing is the workhorse. External fixation is chosen for grossly contaminated open fractures until definitive cover is achievable.

  • Conservative and stress care

    Stable fibular fractures, some paediatric patterns and stress fractures are managed with rest, protected weight-bearing and treatment of the underlying cause.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your orthopaedic surgeon knows your imaging, soft tissues and bone quality and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Fractures (complex): assessment and management (NG37).

  • NICE. Fractures (non-complex): assessment and management (NG38).

  • British Orthopaedic Association Standards for Trauma (BOAST) - Open fractures.

  • British Orthopaedic Association Standards for Trauma (BOAST) - Diagnosis and management of compartment syndrome of the limbs.

  • Royal College of Physicians. National Hip Fracture Database and Fracture Liaison Service standards.

Red flags

When a broken leg needs urgent attention.

Most fractures follow a predictable pathway. These are the situations that don’t - and where minutes matter more than hours.

  • Open fracture

    Any wound over a fracture site - even a small puncture. Needs IV antibiotics within an hour and an ortho-plastic centre pathway.

  • Compartment syndrome

    Pain out of proportion, pain on passive stretch and progressive paraesthesia. Do not wait for pulselessness - fasciotomy first, imaging later.

  • Neurovascular compromise

    A cold, pulseless or insensate limb after fracture or dislocation - a time-critical vascular and orthopaedic emergency.

  • Fat embolism syndrome

    Confusion, hypoxia and a petechial rash 24 to 72 hours after a femoral shaft fracture - supportive care and early fixation reduce risk.

  • Pulmonary embolism and DVT

    New breathlessness, chest pain or a swollen calf after any major lower limb fracture - assess urgently. Prophylaxis is standard from admission.

  • Suspected pathological fracture

    A fracture through an area of prior bony pain, in an older patient, or with unexplained weight loss - needs staging imaging and MDT input.

  • Fragility fracture

    Any low-energy fracture over 50 - always refer to the Fracture Liaison Service for DEXA and bone protection.

  • Deep infection after fixation

    New warmth, wound discharge or systemic upset weeks after surgery - assume infection until proven otherwise and refer back to the operating team.

  • Non-union and malunion

    Persistent pain, movement at the fracture site or angular deformity months on - warrants specialist review and revision surgery.

Recovery

A treatable injury, with a clear pathway back.

Four things that make the biggest difference to how well you walk again - structured rehabilitation, disciplined weight-bearing, bone health follow-up and a realistic timeline.

A quiet reminder

Union is not the same as recovery.

Bone often unites long before the muscles, joints and confidence catch up. Patience with rehabilitation pays off for years.

  1. 01 Recovery

    Rehabilitation is the treatment

    Fixation is the start, not the end. Structured physiotherapy - range of motion, strength and gait - is what returns you to function.

  2. 02 Loading

    Weight-bear as instructed

    Follow the surgical team’s weight-bearing regime exactly. Getting it wrong risks fixation failure, malunion or a fresh fracture.

  3. 03 Bone

    Protect the whole skeleton

    Fragility fractures deserve a DEXA scan and bone protection. Athletes need a RED-S screen after a stress fracture.

  4. 04 Return

    A realistic timeline

    Most straightforward long bone fractures return to full sport in 3 to 6 months. Open, comminuted or intra-articular fractures take considerably longer.

Frequently asked

Everything we get asked about broken legs.

Quick answers on fracture sites, open injuries, compartment syndrome, fixation and recovery timelines.

  • What counts as a broken leg?

    Any fracture involving the femur (thigh bone), patella (knee cap), tibia (shin bone) or fibula (calf bone). It ranges from a hairline stress fracture in a runner to a life-threatening open femoral shaft fracture after a road traffic collision.

  • Why is compartment syndrome such an emergency?

    Pressure inside the muscle compartments cuts off blood flow to nerves and muscle within hours. The earliest sign is paraesthesia and pain out of proportion, especially on passive stretch. A four-compartment fasciotomy done within a few hours saves the limb - a delay leads to muscle death and permanent disability.

  • How are open fractures managed?

    They are a surgical emergency. Intravenous antibiotics go up within an hour, tetanus cover is checked, the wound is photographed and covered with a saline-soaked dressing, and the limb is splinted. Definitive fixation and any plastic surgery cover happens within 24 hours at a specialist ortho-plastic centre.

  • What is the treatment of choice for a femoral shaft fracture?

    A locked intramedullary nail passed down the medullary canal. It allows early weight-bearing, has a very high union rate and returns most patients to normal function. Plate fixation and external fixation are reserved for specific patterns.

  • How long does a broken leg take to heal?

    Bone typically unites in 12 to 16 weeks, but soft tissues, muscle strength and gait take longer. Straightforward long bone fractures return to full sport in 3 to 6 months. Open, comminuted or intra-articular fractures - and any fracture complicated by infection - can take considerably longer.

  • What is a pathological fracture?

    A fracture through bone weakened by an underlying disease - most commonly osteoporosis, but also metastatic cancer, primary bone tumours, Paget’s disease or myeloma. Any low-energy fracture in someone over 50, or a fracture at the site of prior pain, needs staging imaging and a multidisciplinary review.

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