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Femural Shaft Fracture - Im Rod Removal???? (Page 1)

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Hi, new to the forum!

Can anyone offer advise for this...

When I was 18 I was involved in a car accident in which I suffered a femural shaft fracture (femur fracture). In the following operation I had surgery which involved the insertion of a Intramedullary Rod ('IM rod') into the femur supported by screws. This was stitched and the bone has since fully healed.

I am now 21, 3 years later and still have the rod/nail in place. The only visible sign of my fracture is scar tissue on the outside. I still get discomfort when sitting down for long periods of time and cannot play football/soccer as well as I used to.

I have read several articles that mention the removal of the IM rod - and one reccommending that this is removed if I am under the age of 40! I cannot remember my consultant/surgeon mentioning a removal yet I am now concerned.

Is this something I should have removed at my age?
Is there a risk of keeping it in place?
If I did have it removed, would there be a reduction in discomfort?
How long does treatment take for removal and how long would I be off work for considering my job is physically intensive?

Many thanks!!

Dave
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First Helper cabeachgirl
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replied November 29th, 2007
Rod Removal
Hi, I too have a rod in my femur following a spiral fracture. I had the pins removed from the knee area with-in 6 months of their placement because of the discomfort they caused. How nice to have them gone. No interuption in my activities. My Dr told me that if I ever had to have knee replacement the rod would have to come our first. I am 55. I didn't have the time for a long recovery from rod removal. A good friend of mine has a daughter who at age 15 broke her femure and had a rod inserted but a year later they took it out. Her recovery wasn't too bad but it is all relative. In young people they take them out because life has more options. You need to talk to your orthopedic guy and see what they have to say about YOU
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replied July 20th, 2011
Vel,

I had femur fracture on jun 08,Now i am 40. and thinking of to remove the rod now though i don't have severe pain of problems. however i do have little pain if i walk for long time or some discomfort.

After reading all this reply i understand the removal of rod is neither advisable nor suggested. It is all based on fracture type, problems and age.

Even after removal of rod, we should be careful at least for three months.

But I Still wonder, it is possible for the doctor judge by seeing .
Any suggestions please.
Vel
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replied July 20th, 2011
Especially eHealthy
Vellikhita,

The first requirement is that the femur is solidly healed. Then, there has to be a good reason for removing the rod. Usually, if the patient complains of pain, that is enough for most surgeons.

However, the incidence of pain being eliminated after rod removal is very low, unless there is a plainly seen problem (like the rod is broken, it is proud, it is impinging on the muscles, etc).

To take out the rod, is a major undertaking. The same incision through which the rod was placed is used again. Any interlocking screws are removed. Dissection is taken down to the end of the rod, at the hip region. Any bone that has grown over the end is removed, so that the removal instrument can be screwed into the end of the rod. Then the rod is hammered out of the bone. You do need to be careful until the screw holes fill in and you regain your strength.

The biggest risk is a refracture of the femur when taking the rod out. If that happens, then a new rod is placed and you start at square zero. And, of course, the risks that go along with any operation still apply.


Again, elimination of pain is not guaranteed. Some patients get great results from removal of the rod. Others, have worse pain. Most are somewhere in the middle.

This is something that you need to discuss with your surgeon. Good luck.
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replied July 20th, 2011
Gaelic,
Thanks, My fracture operation type ORIF with interlocking nails. (2 Screws in both sides of thigh bone)

I agree all your points. I have booked appointment with orthopaedics, and let me put all these questions and see what the doctor suggests.

My only concern is, If I did not remove now, then later it may complicate and create more problems. after fixing the rod, doctor told me that, i can remove the rod after 2 years.
Thx
Vel
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replied July 20th, 2011
Especially eHealthy
Vellikhita,

Rods (metal in general) can be left in forever, as long as they are not causing any problems. There is no evidence that leaving the metal in, is going to cause problems down the road.

However, if the rod is causing problems, then it can be taken out (as long as the bone is completely healed). You just have to be sure that it is the rod that is causing the problem. If not, you will go through the surgery and not be any better off than before.


In the past, all rods were taken out after two years in young men. It was felt that if they participated in high risk activities (motorcycle racing, skydiving, etc) and broke the bone with the rod in place, they would not be able to remove the rod. However, currently the tools have changed, so that is no longer any concern. So now, the only reason to remove a rod, is if it is causing problems.

So, if it is causing problems, have it taken out.

Good luck.
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replied July 21st, 2011
Thanks Gaelic, I get some amount of pain near the screws, when i walk for long distance or also even while sitting for long time.

Suppose if the pains getting severe down the road, will it be possible to remove the rod later stage. considering that i feel removing early may put a stop for this.
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replied July 21st, 2011
Especially eHealthy
Velikhita,

Also, if it is the interlocking screws that are bothering you, which is actually quite common, they can be removed, and the rod left in place.

It is usually very easy to remove the interlocking screws. Sometimes they can be proud, especially around the knee region, and the muscles can move over them, causing pain. In this case, it is usually an easy solution to just take out the offending screw.

Again, hope you do well. If you want the nail out, have it taken out. Just be realistic in your expectations. Good luck.
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replied July 22nd, 2011
Thanks for all your immediate suggestions.
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replied August 4th, 2012
Rod in femur removal
Vellikhita I would like to share my experience with you as far as not removing the rod, removal of just screws ect..I was involved in a sereous motorcycle accident over twenty years ago and would like to educate you on my experiences my rod was to be removed 3 years after and chose to ignore the proceedure due to the fact it was not bothering me a couple years later I did have the large bolt removed in my hip due to the scar tissue that was causing the bolt to get stuck in front of the tissue it was rather large but got releif after that well 20 years later ive been feeling so much odd pain some normal due to weather changes and some awkward so made many trips to er orthopedics which all they would do is give me something to mask the pain. I kept feeling sharp poking in my kneecap thinking the rod was just pushing away cause it was no longer needed. Still no results or anything that seemed to make sence to me to cause this pain. Literally making me mental and at sometimes wishing I would have lost my leg, until i heard of ghost pains which again made me thankful for having two legs finally I was sufferering some severe back pain and sure enough another xray was taken nothing found so finally from being in tears with pain the doctor ordered up an mri which later explained what was going on with my leg and the pain. you see in order to live we must work which most of my jobs required lifting or standing on my leg all day with the pokey pain in knee....found out my femur was coming out of socket which would explain that im walking with the rod poking into my knee cap. He has now refered me to a chiropractor to help put back in place not sure since a rod is involved why not an orthopedic im still yet to make the appointment due to lack of funds but I do have relief that im NOT crazy anymore not sure where to take this but i feel wronged by doctors and wish they would listen more carefully to a patient and not be so quick to think that we are just wanting to be drug addicts anyhow listen to your body and if I would have to of done it differently I would have had the rod removed I hope my experience helps you and anyone else who reads this.
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replied August 4th, 2012
Rod in femur removal
Vellikhita I would like to share my experience with you as far as not removing the rod, removal of just screws ect..I was involved in a sereous motorcycle accident over twenty years ago and would like to educate you on my experiences my rod was to be removed 3 years after and chose to ignore the proceedure due to the fact it was not bothering me a couple years later I did have the large bolt removed in my hip due to the scar tissue that was causing the bolt to get stuck in front of the tissue it was rather large but got releif after that well 20 years later ive been feeling so much odd pain some normal due to weather changes and some awkward so made many trips to er orthopedics which all they would do is give me something to mask the pain. I kept feeling sharp poking in my kneecap thinking the rod was just pushing away cause it was no longer needed. Still no results or anything that seemed to make sence to me to cause this pain. Literally making me mental and at sometimes wishing I would have lost my leg, until i heard of ghost pains which again made me thankful for having two legs finally I was sufferering some severe back pain and sure enough another xray was taken nothing found so finally from being in tears with pain the doctor ordered up an mri which later explained what was going on with my leg and the pain. you see in order to live we must work which most of my jobs required lifting or standing on my leg all day with the pokey pain in knee....found out my femur was coming out of socket which would explain that im walking with the rod poking into my knee cap. He has now refered me to a chiropractor to help put back in place not sure since a rod is involved why not an orthopedic im still yet to make the appointment due to lack of funds but I do have relief that im NOT crazy anymore not sure where to take this but i feel wronged by doctors and wish they would listen more carefully to a patient and not be so quick to think that we are just wanting to be drug addicts anyhow listen to your body and if I would have to of done it differently I would have had the rod removed I hope my experience helps you and anyone else who reads this.
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replied August 14th, 2012
I had broke my femur 385 days ago recovery was long it was a spiral fracture just above the knee
6 months after the surgery one of the screws started to extract out so went to the surgeon and he took it out left just one in at the knee
Recovery was going well
Then 2months ago I started to get pain in my hip area where the top of the pin and around where the screws are
It is very painful can't sit to long walking is painful I would like to get the whole thing taken out
The fracture has completely healed so can I get screws and pin removed?
Has anyone else had similar problems to this ?
I am seeing a surgeon in 6 days I hope he can help me with this huge pain I have

Baylie
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replied August 14th, 2012
Especially eHealthy
Baylie,

Sure, you can have the IM nail and interlocking screws removed, as long as you are willing to go through a major orthopedic surgery, and are willing to accept the possible associated risks/complications.

You have to make sure that it is the IM protion of the construct that is causing your problems though. If it is just the interlocking screw that is causing the problem (due to the formation of a bursa over the head, snapping of tendons over the screw head, backing out of the screw, etc), then as you know, it is much easier to take just the problematic screw out.


If it cannot be proven that the IM (intramedullary) portion of the system is actually causing problems, then the removal of the nail may not do anything for your problems. But, if you are willing to go through the procedure, then you can usually have it done (as long as the fracture is completely healed).


This is something that you need to discuss with your surgeon.

Good luck.
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replied August 14th, 2012
Baylie
Thank your taking the time to reply my leg just seems to get worse everyday
It's a big decision having another surgery
One orthopedic surgeon says it has fully healed
But I am freaked out to have the surgery but I cannot take the pain
I am on morphine until I see the surgeon
Thanks again
Baylie
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replied August 15th, 2012
I never had or have had pain where the actual break is just above my knee that seems strange to me the pain has always been where the screws are
Weird?
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replied April 12th, 2010
re: I had the IM Nail removal
Hello there,
I just had my IM Nail removed last week after a 2 yr old injury. I was having a lot of pain, especially with long walks and squatting. Was unable to still put on my sock with ease but had good mobility and no longer had a limp. Couldn''t sleep at night comfortably and approached my surgeon and expressed my emotional side of things as it was affecting my daily life activities ever so much. All though the pain is there as the scars are trying to heal, I already feel a relief and don''t feel like my leg is heavy and tight, so we will see.
The recovery period for me is 2 weeks non-weight bearing on crutches (can toe touch for balance, but no pressure to be put on the femur- risk of fracturing areas where screws / top of rod was)
then to ambulate with a cane for 4wks. Took 2.5 weeks off of work as i stand alot. Will have to do more physio/exercises, pretty much the same ones given after the initial surgery to strengthen the muscle loss once again, only shouldn''t be as intensive.
Hope this helps, and so far I highly recommend it.
My doctor really didn''t want to do it, but when I ended up in tears and he saw that i really was suffering then he arranged it. best wishes on your ventures,
Sue, Ontario Canada.
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replied June 27th, 2010
IM Rod
I had a IM rod inserted when i was 20 and removed when i was 21.
I am now 54 and i am just starting to get arthritis in the knee.
Is this common?
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replied April 13th, 2011
Yes! Very common. Even for 54 year olds without past femur fractures, but more so with them. I suffered an open compound femur fracture (IM rod inserted with 3 IM Nails, top one removed a couple weeks ago) a commuted patella fracture, internally fixated with wires and pins and an open compound tib-fib fracture on the opposite leg that's fixed with a 6x2 inch plate and pins. Docs say I'll probably have the arthritis. :-/ This all thanks to the drunk driver that hit me.
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replied July 23rd, 2010
Hardware Removal
I had my femur break right apart in the neck of it in the hip area. That was Jul 22/09. I just had the rod and screws removed Jun 16/10 and I'm still having difficulties. The pain from the hardware in my leg was so unbearable that I ended up on long term disability. Since it's been removed I feel a whole lot better because now I can sit for longer than 20 minutes and am more mobile. It took three weeks after the last surgeory to feel that way but I am still on crutches because my surgeon says that I have significant bone loss in my femur. I think I'll have quite a few more months until I can put full weight on my left leg but it seems to be coming along. I was 38 when this happened. I've been told by my Dr. that if I was over 60 to 65 that they won't take hardware out but I was still young enough. It really is immobolizing with that stuff in you. If you can do it, get it removed. Best of luck to all.
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replied November 29th, 2010
femur break and rod/pin removal after recovery
I broke my femur skiing in February 2009 and just had my rod and pins removed 3 days ago - November 2010. I had found that my hip was having discomfort when I would run or walk for long periods of time and my surgeon said it is common for the upper screw to rub on tendons and ligaments the wrong way, and the removal would in fact take away any discomfort I may have been having. I am still using the crutches three days after surgery, but if you are young when you break your femur I recommend having the pin and screws taken out so that you can go back to a normal life. The hardware inside of you can be a little limiting at times.
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Users who thank fynnsta for this post: KSenning 

replied January 18th, 2011
i broke my femur 6 months ago and had the rod, 1 screw in my hip and 2 in my knee. after three months the bones weren't healing as the gap was too big between the bones so they took out the screws in my knee 2 months ago. this was more painful than the original operation and i have been having a lot of pain and am still on crutches, (after first operation i had no pain after 2 weeks, just a lot of stifness and was off crutches after 6 weeks!). i went to my physio last week and she said she thinks the bones in my leg are twisted cause my foot sticks out when i weight bear on my leg, i am going to have x-rays etc tomorrow to find out whats going on. has anyone had/heard/seen of anything like this before? i was also told that they would leave the rod in my leg and only remove it if i had any problems caused by it which was very unlikely.
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replied March 12th, 2011
rod
I broke my femur 5 years ago and in a motorcycle accident. I was thinking about having the rod removed. When I sit on a chair or bar stool where my foot cannot rest on the ground, I experience severe pain in my leg. I was wondering if the pain was because the rod or just because of the break.
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replied March 12th, 2011
Especially eHealthy
eric2684,
When you say your leg, I assume you mean the thigh, where the fracture occurred (just some anatomical terminology). You have to remember that the bone is not the only tissue damaged when a bone breaks, especially in high energy trauma like a motorcycle accident. The periosteum (the sheath right next to the bone) is ripped apart. The muscles that attach to the bone at the fracture site are torn off and the other muscles of the thigh are stretched, twisted, and pulled. So, even though we focus on the bone, fixing it (IM rod, external fixator, traction, cast/brace - depending upon the circumstances), then watch it carefully with x-rays as it heals, the soft tissue injuries are also healing - but, all tissue (except bone) heals with scar tissue.
There are several things that can cause pain at the fracture site. A nonunion (where the bone is not healed completely) allows motion at the fracture site, causing pain. An indolent infection, not enough to cause systemic symptoms, can also be a cause. The injury to the soft tissues can produce chronic pain symptoms. It is very rare that the hardware itself causes pain, but it's not unheard of.
In some countries (Germany especially) they feel that hardware should be removed after the bone has healed in almost all cases. However, in the US, there is no routine reason to remove hardware. If it is buried under soft tissue or is IM, and not causing problems, it's usually left in. There are some stories about people who feel that such a large piece of metal should not be left in, but, they forgot about the millions of people who have total joints, and that argument fell flat. In the past, some surgeons felt IM rods should be removed in young, active adults, especially those that engage in high risk activities like parachuting, BASE jumping, motorcycle riding, military special operations, etc. But, even the military is waiving the removal.
It is easy to blame the hardware, as it's a big piece of metal, easily seen on x-rays. If all the other causes of pain have been ruled out, and you are willing to undergo another major surgery, you can have the rod taken out. It's not quite as bad as when it was first put in (the bone's not broken now), but the surgeon still has to go back through the previous incision, dissect the muscles down to the entry point, affix the slap hammer to extract the nail, etc, etc. And there is always the risk that the nail will break and it can't all be removed or, heaven forbid, the femur breaks. Then you'd have to have another nail put in and start the whole process over again. Yes, this is not common, but it does happen.
So, you have somethings to discuss with your surgeon. He/she has examined you and seen your studies. So, you really need to sit down and ask all the questions you need to, so you can make an informed decision. Good Luck.
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replied July 20th, 2011
Military Viewpoint
I just was reading through your reply and saw something that I thought should be corrected. I am currently active duty military, and both the civilian surgeon and my doctor here on base agree that the rod needs to come out as soon as possible if I wish to remain active duty, and I was told that that is the norm if it is possible. Since the bone has no way to break without shattering if something else happens. Its a lot harder to fix that, and I was told that if that happened, my leg could possibly need to be removed if I rebroke it with my rod in place. Otherwise I wouldn't want to have the second surgery to have it removed.
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replied July 3rd, 2011
Femur facture healing
Do ever femur factured person is able to sit crossed legs or sit down..?? please let me know...
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replied July 3rd, 2011
Especially eHealthy
vara,

You give very little information, but the answer, in general, is yes. The functional return after a fractured femur depends greatly upon how badly the femur was fractured, any coexisting injuries, how it was treated, the age of the patient, and the health of the patient.

Some patients return to all the activities they were doing before being injured, including contact sports and military endeavors. However, there are also some patients who are able to ambulate, but never really get back to full activities. It is a full spectrum, because the injury is so varied.

In general, the majority of patients can do almost anything they want to do, once the fracture is healed and the patient has completely rehabilitated. However, no two femur fractures are exactly alike.

Good luck.
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replied July 4th, 2011
Hi Gaelic.... Thank you so much for your immediate reply... My cousin met with an car accident recently ie in May 2011. Her Femur bone broken [single piece] and her age is 26 years and healthy too. Concerned part is she got engaged and her wedding will be in the month of December.Even though she is quite confident that she will recover, but still worried about being able to sit down as most of the wedding customs done with crossed leg sittings...As u will be aware Doctors would never let the confidence to go down.

I was browsing Google and got this forum. This really helped me.

Thanks a lot Again...
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replied July 4th, 2011
My query remians.. Does it takes more than 6 months..?? or will be alright by December [ in most of facture cases again ]
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replied July 4th, 2011
Especially eHealthy
vara,

I sort of need to understand exactly what you mean by cross legged. There is the polite ankle crossing and the one leg over the other at the knee, both while seated in a chair. Then there is the sitting on the floor with the legs drawn up towards the body, in the US called Indian style (after Native Americans). Then there is the full cross legged position with the feet pulled all the way up onto each other, yoga style (which a lot of people can't get into at any time).

The first two would be no problem. The style sitting on the floor, with the feet drawn up to the body, will take some emphasis during rehab on getting the most flexibility at the knee and hip as possible. But, the minimum range of motion required would be: hip flexion of about 100 degrees, hip external rotation of at least 80-90 degrees, and knee flexion of at least 100 degrees.


Again, everyone heals at different rates. But, barring any complications, at six months the femur bone will be solidly healed. The soft tissues will have healed, and if the patient has done the proper rehabilitation, they should be strong and flexible enough for almost all "normal" activities. Heavy impact athletic type events, long distance running, gymnastics, sky diving, motorcross, etc may still require a few more months.

If your cousin emphasizes flexibility of the hip and knee during rehab, then she should have no problems at her wedding. She should speak with her surgeon and physical therapist, explaining what type of activity she needs to accomplish, so that they can tailor a rehabilitation program to her needs.


Wishing you and her the best for the future.
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replied July 4th, 2011
Thanks a ton Gaelic... and i was referring to Indian Style sitting...

Thank you once Again.. i wish her Gud Luck!!!



Regards
Vara.
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replied July 20th, 2011
Femur fracture rod removal
Vel,

I had femur fracture on jun 08,Now i am 40. and thinking of to remove the rod now though i don't have severe pain of problems. however i do have little pain if i walk for long time or some discomfort.

After reading all this reply i understand the removal of rod is neither advisable nor suggested. It is all based on fracture type, problems and age.

Even after removal of rod, we should be careful at least for three months.

But I Still wonder, it is possible for the doctor judge by seeing
Vel
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replied August 30th, 2012
I think CostieQuen123 just need reread the top & rephrase co
First thnx to you hard works on replying back to these redundant Questions, this was one of the first few websites i've ran into...

But going back to the subject because Gaelic you mentioned the indications already at the top (if there's any relating problems), she may have missed it and just blabbered off. Her passing judgement of ur answers was so ignorant per say. And after reading ur first reasons of why we should remove I've thought having a higher risk activity is one of those problems.

I've done me a research my self just now for few days for my assignment (X-ray student) and as well as for my own leg.

I found a NCBI website (more statistical):
http://www.ncbi.nlm.nih.gov/pmc/articles/P MC2384239/

And a very quick informational site:
trumbore.com/leg/remove.html

Any how Thnx for ur hard work in answering these guys...nice dude....think ur maybe a health care provider urself or something,,, correct me if i'm wrong
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replied August 30th, 2012
Especially eHealthy
barefeet80,

Very nice article. Yes, that is a big problem with hardware and it has a large effect on outcomes.

You will realize how big of an impact the litigious nature of our society has on medical care and its cost, as you progress further in your studies.


As to removal of hardware in the military, even though some members have their own opinions, the regulations state that hardware does not have to be removed, even in the special forces. It is also an older opinion that hardware HAS to be removed, before the patient can participate in high impact activities. That opinion changed many years ago, and anyone who still puts that forth is either out of date or has a pecuniary interest.

Good luck with your future studies and I hope that you enjoy your chosen profession.
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replied July 20th, 2011
Get it out asap
I also have a rod recently placed in my femur, and I am active duty Coast Guard. Mine broke as I was running. I took a step and it snapped. I have spoken with my doctor here on base, as well as the surgeon, and the rod should definitely come out if you plan on doing high-risk activities such as sports. I was told that it is not advisable that I remain active duty and keep the rod in place, since the bone can no longer break normally, like it should.If you rebreak your bone, it will shatter, and thats almost impossible to fix, often leads to amputation, which is why the Coast Guard is having me take it out as soon as possible, despite the extremely high cost to the government on my behalf. Also, the bone will not fully heal with the rod in place. So get that thing out of there, and let the bone heal all the way.
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replied July 20th, 2011
Especially eHealthy
You are passing on incorrect information. Intramedullary rods/nails can be left in place for the life of the patient, without any problems. IM nails have been in use since WWII. The femur will heal very nicely with an IM nail in place. It is because of the IM nail that you did not have to spend 3 to 4 months flat on your back in a orthopedic traction unit. Which is how femur fractures used to be treated, and still are in some parts of the world.

Sure, they can have problems, just like any operation. But, overall, they are very highly successful. Sometimes, if the nail is statically fixed both proximally and distally, it will cause stress shielding. In this case, the distal interlocking screws are removed to allow load sharing. The stress across the fracture site will help the bone heal faster (Wolff's Law).

Also, it used to be taught that any person who was going to remain very active, should probably have the nail removed. Thus, all high risk soldiers had their nails removed. That is no longer the case. With the new instrumentation available, the nail can be removed if the bone breaks and the nail doesn't. We still tell the patients, that if they are going to be doing very high risk activities, such as motorcycle racing or skydiving, and they want the nail out, we will take it out. But, in regular sports, such as football, rugby, soccer, wrestling, running, etc it is not really necessary to have it removed, unless the patient wants it out.

But, I have personally written waivers for Army Rangers who had IM nails in place and did not want to go through surgery again to take the nail out. They were allowed to stay active as a Ranger, with the nail in place. They are at no higher risk of significant injury than their fellow Rangers.

But, if you want the nail out, and the bone is healed, then it can be taken out. But, to say it has to be taken out and that it will not let the bone heal properly is incorrect.
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replied June 9th, 2012
are you sure about this? can you cite any studies which compare the incidences of severe femur fractures between individuals who have a Intramedullary nail and those who don't? also could you please cite any studies which show that Intramedullary nails do not cause discomfort?
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replied September 30th, 2011
Screw removal of femur fracture
i had a femur fracture three months back and had an IM rod placed with 1 screw at the knee and two near my hip i feel discomfort while locomotion the calcus formation has just started around the fractured area i want to know if removing of the screws can give me relief from the discomfort and what is the normal time period for doing so
NILESH
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replied September 30th, 2011
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duded,

The interlocking screws cannot be removed until the fracture is healed enough that the bone can carry the full weight placed on it. If there is callus formation, then rotation of the fracture is of little worry. But, depending upon the fracture pattern, the healing construct has to be stout enough not to collapse when weight is placed across the fracture site.

When the interlocking screws are removed, the IM nail goes from being a stress shielding construct to a load sharing construct. When the screws are not there, the forces will then go through the bone, rather than the nail.


Also, many times the pain around the fracture site is coming from the soft tissues that have been damaged in the injury. In these injuries, not just the bone is broken. The muscles are torn off their attachments, the periosteum is ripped apart, the tendons, nerves, blood vessels, fascia are all stretched and twisted when the bone breaks.

All of this damage to the soft tissues has to heal. It heals with scar tissue, which does not stretch very well. It takes longer for the soft tissues to heal and be rehabilitated than for the bone to unite. So, some of that discomfort in the thigh, around where the fracture is, could be coming from the soft tissues. Removing the screws will not help, if it is the soft tissues causing the problems.


Sometimes, the screw at the distal aspect of the nail are removed to dynamize the nail. This, again, will allow for more stress and force to go through the fracture site. This is done if the fracture is slow in healing. The extra stress across the fracture may stimulate the body to lay down more callus and heal the fracture faster. This is known as Wolff's Law.


So, first, you need to determine where the pain in your thigh is coming from. Once that is known, then a plan can be formulated to address the problem. Discuss your problems with your surgeon, and see if you can come up with a treatment plan.

Good luck.
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replied October 1st, 2011
Gaelic
thank you for your valuable response i forgot to mention that i am 24 years of age and the screw near the knee has protruded out a bit i also took a x ray to see it my surgeon says that if the lower screw is removed the fracture will have a rotating movement which is not desirable i can feel the swelling in that area its painful when while sleeping unknowingly i shift on that side. is there any other solution to this problem or do i have to operate it again and put it back in place? please help me out. my fracture is 3 month old now doing what will give me relief and bring me back to my normal lifestyle. please give me some solution so that i can speak with my surgeon regarding this.
thank you once again you are proving of a great help to patients i must say.
duded
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replied October 1st, 2011
Especially eHealthy
duded,

It is not uncommon of femoral shaft fractures to take up to 24 to 26 weeks to achieve union. It takes a lot of energy to break the largest bone in the body, so these are very significant injuries.

It sounds like your fracture is healing okay, but is still in the stage of laying down the callus to "glue" the fracture fragments back together. And, as the surgeon stated, if you take out the interlocking screw at this stage, the lower fragment can rotate around the nail, resulting in a rotational deformity.

Again, the pain you are feeling in the thigh, is not all coming from just the broken bone. The soft tissues of the thigh, especially the muscles, have been severely injured. These muscles heal with an abundant amount of scar tissue in the early stages. After the early scar tissue has formed, it is almost like a big ball of rubber. Then, gradually, the scar tissue starts to mature and soften. The collagen fibers, which were laid down hap-hazardly at first, are now more organized. So, the scar tissue will start to stretch out and become more pliabe. But, this can sometimes take up to a year or more to do this completely.

Getting the bone to unite is just the first step in recovering from this significant injury. Once the bone is united, then the hard part comes, rehabilitation. Getting the muscles back into shape will take a lot of hard work and effort. We usually tell patients that for every day that they are out of activity, it takes two to get back into shape.

So, you are still very early in the rehabilitation of this injury.


However, you do need to speak with your surgeon. You need to make sure that there is nothing else going on at the fracture site. Sometimes patients will form heterotopic bone around the injury site (this can be seen on x-ray). Rarely, an indolent infection may be present. Both of these would need to be treated.

Be sure to tell the surgeon of your pain. If you don't say anything, the surgeon will assume that you are doing okay. The surgeon should do a thorough exam, new x-rays, possibly a bone scan, labs, or other studies, to determine what is going on. Do not let the doctor just dismiss the pain, it should be evaluated.

After the evaluation, if something abnormal is found, then that can be addressed. But, if it is just the usually stages of healing, then you are looking at some hard work in physical therapy. You may need some deep tissue massage to break up the scar tissue and ultrasound can sometimes be used to help this also. But, mostly it will be a lot of stretching and strengthening, and a tincture of time.

Good luck.
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replied October 1st, 2011
thank you i will discuss with my surgeon and let you know the scenario thank you once again
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replied October 27th, 2011
ISKD nail removal femur
ISKD nail/rod removal.My daughter had her femur lengthened. The surgery occurred last Thanksgiving and the lengthening completed a month later. She is scheduled to have the rod removed on Nov 21. What should we expect? She is 15. Thanks Guy
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