The femur refers to the thigh bone, which extends from the hip to the knee. Impairment refers to any loss or abnormal change related to structure or function. In this case, a fracture is the impairment. Descriptions of several types of fractures are as follows:

• Transverse: The fracture line forms a right angle with the bone axis.

• Oblique: The fracture line crosses the bone at approximately a 45° degree angle to the bone's axis.

• Comminuted: The bone is broken in several pieces.

• Spiral: The fracture line encircles the bone, creating a spiral pattern.

• Longitudinal: The fracture extends in a longitudinal direction along the bone axis.

Nonunion of a fracture is a condition in which the bone fails to unite. Malunion of a fracture represents faulty positioning of the bony fragments.

Fractures are usually caused by trauma, disease, or repeated bone stress. Nonunion of fractures may be caused by lack of adequate stabilization and inadequate blood supply. Infected fracture sites may contribute to nonunion.

Signs of a fracture include: pain with tenderness over the fracture site; bruising; deformity; abnormal mobility; crepitus and possible limb shortening. In nonunion of a fracture, there will be excessive mobility of the joint or bone. Malunion of a fracture will display deformity.

Tests used include: x-ray; bone scan; electromyography (EMG); computed tomography (CT) scan; and magnetic resonance imaging (MRI).

Fracture treatment will depend on the type of fracture. Possible treatments include: a closed reduction with a cast or brace; open reduction with internal fixation; external fixation; arthroplasty; or bone graft. Nonunion treatment methods may vary. They include: compression plating; intramedullary rod placement; use of electrical fields to stimulate bone production; cancellous bone graft; surgery to scrape the avascular bone ends; and use of autogenous bone graft. Malunion of a fracture in the lower extremity is not well tolerated if one limb is more than one inch shorter than the other. An osteotomy and bone graft may be performed.

Physical therapy and rehabilitation are often needed for the deconditioning that results from fractures and surgery.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• To properly rate disability, accurate measurement of range of motion of thigh abduction, adduction, and rotation is required and must be reported in degrees. The use of a goniometer in the measurement of range of thigh abduction, adduction, and rotation is indispensable. 38 CFR 4.46 [Accurate measurement]

• Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.