Good day i just want to ask about my leg. I had an injury 2 months ago and had a surgery 2 weeks after the accident my thigh bobe or femur had fracture in the distal 3rd portion and treated with intramedullary nail with locked screws inserted by retrograde aproach. Its been a month and a half now. The muscle strenght is back about 80% but the rom of the knee is 90 degree. And theres a pain when im moving my knee.. And my doctor instruct me to 25% weight bearing and i think i can do more than 25% cause im walking only with a cane.. I just want to ask if its ok that ill walk with a full weight bearing??? Thanks in advance and please instruct some exercise for my leg and knee thanks p.s. Whats the time for yhe femur to heal and able to walk and bear full weight
It usually takes about 13 to 20 weeks for a femur fracture to unite. But, this can be less or more, depending upon the age and overall health of the patient. The usual way to know for sure when a femur fracture has united, is to x-ray it.
If the surgeon has allowed you to go to a cane, that actually means that you are putting 50% weight across the fracture (that's the max amount of weight reduction that a cane can provide). But, if the surgeon has told you only 25% and thinks that you are still on crutches (ie you went to the cane yourself), then you need to be very careful.
In the fixing of fractures, it is always a race between getting the bone to heal before the hardware fails. There is no hardware made that can withstand continued stressing. Unless the bone heals, all hardware will eventually break. Sort of like a paperclip being bent over and over, it will final snap.
Even though you do not have pain at the fracture site, that does not mean the fracture has healed. It is a good sign, but the IM nail and the early callus may be holding the fracture fragments together. But, this is not stout enough to take full weight bearing.
I understand you want to get going and get over this injury. But, try to follow your surgeon's instructions. He/she knows how strong the fixation is and how healed the bone is. Some weight bearing is good, because is does stimulate the body to lay down more callus. Bone will respond to the stresses applied to it, called Wolff's Law. That is why bone will become stouter and stronger when you lift weights, and why it becomes osteoporotic with disuse (age, injury, space flight).
Unfortunately, knee pain is extremely common after retrograde IM nailing. Anytime the knee joint is violated, there is a possibility of inflammation and scarring within the joint cavity.
Being only 8 weeks out from surgery, you are still very much in the healing phase. Before going to full weight bearing, be sure the bone is strong enough to withstand the stress. Or you can break the nail, putting you back to square one.
continue to work on active knee flexion. It is very common for patients to lose knee flexion after a femur fracture, because of the damage to the quad muscles. The quads can scar down, thus limiting knee flexion.
Good luck. It sounds like you are doing very well, but don't push it too far.
It sounds like you are healing on schedule. It is the usual course to gradually increase the amount of stress across the fracture, by increasing the weight bearing. If the surgeon was worried that the bone was not on course, he/she would have kept you toe touch weight bearing.
Walking a little around the house (ie to the bathroom at night) with a cane is probably okay, just don't push too much by trying to go outside the house with just the cane.
The signs of hardware failure is usually pain. If just one of the interlocking screws would break, you may not even notice. If the nail broke, it would be catastrophic. You would know immediately, as the femur would probably collapse at the same time, and you would be like you were right after the initial injury.
It sounds like you are doing very well in your recovery. Now is the dangerous period for many patients, as they are feeling much better, but the bone is just not quite healed enough to be able to withstand the full stresses be applied to it.
So, try to have a little patience. Continue to work on ROM and strengthening. You will probably be allowed to go to full weight bearing, as tolerated, at your next visit.
Unfortunately, it is always difficult to tell a patient how long they are going to take to heal and recover. Every fracture and patient is unique.
Usually, femur fractures take somewhere around 10-13 weeks to unite. But, again, everyone is different.
You should eat a proper diet, with extra protein, calcium, vitamin D, and magnesium. Do not smoke, smoking is the single most detrimental thing there is to fracture healing.
As soon as the surgeon clears you to begin weight bearing, you need to do so. Placing stress across a fracture can help speed its healing, this is known as Wolff's Law - bone will respond to the stresses applied to it.
You need to begin knee range of motion exercises as soon as possible. It is very common for the quad muscles to get scarred down around the fracture site, which can make it difficult to regain knee flexion.
Also, with an intra-articular fracture it is important to do range of motion to help smooth and polish the cartilage surfaces. Unfortunately, patients with intra-articular fractures have a higher risk of developing traumatic arthritis down the road. This is due to the damage to the articular surfaces. Surgery is done to try to reduce the risk of developing arthritis, by putting the articular surface back together as smoothly as possible.
So, you have a lot of work ahead of you, in getting this fracture to heal and then doing rehab exercises to fully recover. It is not uncommon for it to take as much as a year to 18 months for a patient with a femur fracture to fully recover from it.