Broken femur and the prospect of running again.

James,

Just a couple a questions. From the description of the internal fixation, it sounds like you had a midshaft femur fracture, rather than a femoral neck fracture. Also, it is more likely to be a midshaft since the surgeon is allowing early weight bearing.

The reason for the differentiation is that usually, midshaft femur fractures heal and the person goes on with life, after they have rehabilitated. Whereas, femoral neck fractures are a different animal. These are usually referred to as "hip fractures" in the elderly. They can have significant complications, like AVN (avasular necrosis) of the femoral head (the ball), which could lead to traumatic arthritis of the hip.


So, hopefully, it was a midshaft femur fracture.



The other question, has the surgeon determined why you broke the femur. Was it due to a stress fracture? Usually, athletes have strong stout bones, and as a result, they do not just break with a wrong step.

However, runners, especially fanatical runners (are you one?), who will run though some aches and pains, are set ups for stress fractures. Usually, these occur in the metatarsals of the feet, the femoral neck, the pelvis, but can be seen around the knee, the shin, and of course, the femur.

If it is just due to the usual stress fracture, then the bone should heal fine.


But, you really need to know, why did a healthy adult male, physically fit, just snap the femur, the largest bone in the body?



But, back to healing of a femur fracture. Since the surgeon is allowing early weight bearing, you probably have a transverse fracture pattern, which is inherently stable. So, the intramedullary (IM) nail is just acting as an internal splint, and your bone is actually taking most of the stress.

This is good, because the body will lay down callus to help unite the bone.

But, it can take many weeks (10-20) for a femur to unite. And, that is only for union of the bone, that does not include the time for rehabilitation.


If is not uncommon for it to take as much as a year to 18 months for a patient to fully recover from this injury. That is not to say that you will be laid up for that long, but that it make take that long till you know the final result.

And of course, this will not just happen. You will have to make it happen, through hard work in therapy.


You will need to regain full knee and hip motion. Then you will have to rebuild the muscle strength you have lost. Then, finally, comes the balance, agility, and proprioception. So, it is going to take some time.



There is one thing you may look into. Some pools have a way for runners to be able to run in the water. With the use of a weighted vest, the patient is placed in the deep end of the pool, and allowed to run, just as if running on land. This is commonly used for elite runners, who are injured and cannot weight bear.

Exercise in the pool is great for lower extremity injured patients. The warmth of the water makes the tissues more pliable. The buoyancy takes the stress off of the lower extremities. You can work on range of motion, strength, agility, balance, etc.


But, you also need to do weight bearing activities, to rebuild the bone mass.


You may want to have a DEXA scan done, to determine your bone density. If you are osteoporotic, you may need medications. But, it is rare for running athletes to have osteoporosis, except for patients with metabolic disorders. (There is the problem in female runners, known as the female triad, where they can develop osteoporosis, but that is due to their low calorie intake, loss of menstrual cycles, and heavy activities, which can lead to stress fractures. But, that is not your problem. lol)

But, again, why did you break your largest bone? A rhetorical question, but a valid one.


Once you have healed and done your rehabilitation, there is no reason why you should not be able to return to running. There are many, many patients out there who have had femur fractures that have returned to sports, motorcycle racing, parachuting, bull riding, military special ops, etc, etc, etc.


Good luck.

Keep working on your rehab.

Today I posed the question "what type of fracture do I have" to physical therapist and after some effort she indicated that the fracture was located near the end of femur and described the fracture as "communated" (sp?) At first, she described the fracture as a "shatter" with bone fragments scattered. Pardon my ignorance, but Is this the femoral neck area?

I hope this additional information gives a better understanding of fracture and the healing prognosis.

And thanks again for the information about "water running" with buoyant. When tapering for the 100th Boston marathon I engaged in that activity to keep fit prior to the run.

Best regards

James

James,

A comminuted fracture means that the bone has more than one fracture line, more than just two pieces. So, a broken bone that has three, four, or more pieces, is a comminuted fracture.


The femur is basically divided into four parts: the shaft, the distal condyles, and the intertrochateric section, and the neck/head.

The shaft part is pretty obvious, it is the straight part in the middle.

The distal condyles are the flares, which are at the end which match up with the tibia, to make the knee joint.


The trochanters are the two knobs at the proximal end of the femur. There is the greater trochanter, which you can palpate on the outside of the thigh. The lesser trochanter is of course smaller and is located on the medial side of the proximal femur, in the groin region. The psoas tendon attaches to the lesser troch.

So, the intertroch region in the section of the femur that contains the trochanters.


The neck is the angled portion that goes up into the hip joint. The head is the ball portion of the bone.


So, if you get a picture of the femur, this will all make sense. As they say, a picture is worth a thousand words.



The reason it is important, is that a femoral neck fracture does not heal as well as a shaft fracture or an intertroch fracture.

The blood supply to the head of the femur goes up long the neck. So, a fracture in the neck region can disrupt this blood supply and the head can die, called avascular necrosis. This can lead to the head collapsing, becoming out of round. This of course would lead to arthritis due to the incongruity of the joint surfaces.


Unfortunately, runners are very prone to stress fractures of the femoral neck.


But, it sounds like yours is in the distal shaft, or just above the condyles. These usually heal fairly well.

One problem that they have is scarring of the thigh muscles. You have to understand that you do not injure just the bone. But, all of the soft tissues around the break are also damaged. The periosteum is ripped apart. The muscles are torn off their attachments. The fascia, nerves, blood vessels, are all stretched and twisted when the thigh is not supported with an intact femur.

All of this soft tissues damage, as well as the bone, bleeds like stink. You develop a hematoma around the area of the break. The body will resorb this and heal the soft tissues, but it does it by laying down collagen (scar).

Some patients will actually form a scar ball and tether their quads down to the bone. This makes getting your knee flexion back quite difficult. This is why knee motion is stressed very early. The physical therapist will usually really push you do get your knee motion going very early on. Stretching of the scar tissue while it is forming will help it form in an elongated manner. So, your knee motion won’t be restricted.



So, hopefully, you will go on to an uneventful recovery. Since you are familiar with the running in water, hopefully you will be able to make use of that. It has been found to be very helpful in patients recovering from femur fractures.

Again, good luck. Wishing you the best.