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Femur fracture distal 3rd treated with IM nail retrograde

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 Smile thanks p.s. Whats the time for yhe femur to heal and able to walk and bear full weight
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First Helper User Profile Gaelic
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replied November 21st, 2011
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Kurtosis,

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.
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replied August 16th, 2013
HI Gaelic,
I SUSTAINED A FRACTURE , OPEN ONE FROM A GUN SHORT AT A CLOSE RANGE. IT IS 6 WEEKS NOW, THE DOCTOR FIX EXTERNAL FIXATOR FOR 5WEEK DURING WHEN THE WOUND ARE BEEN TREATED AND AFTER THAT HE FIX ME IN A CAST NOW. (NO INTERNAL FIXATION )
PLEASE THIS LINK IS THE XRAY DONE YESTERDAY FOR THE FRACTURE. I CANNOT SEEE ANY HEALING AND THE GAP IS TOO MUCH, DOCTOR SAID IT WILL FORM A BONE CEMENT. PLEASE CAN ANYONE LOOK AT IT AND TELL ME WHAT NEED TO BE DONE. THIS IS VERY WORRISOME. I HAVE BEEN LYING IN THE BED FOR 6 WEEKS NOW. IT IS NOT EASY AT ALL.

E:\HENRY^EHIUIGWE-20130814-5E639F3C126846D 9B41A4139BD63F4F0.bmp
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replied November 22nd, 2011
Thanks a lot. You really helped me. Now i need to be carefull... Wink) thanks
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replied November 22nd, 2011
One thing . I just want to know whats the signs of hardware failure?? Smile
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replied November 22nd, 2011
And instructing a 25% weight bearing by my surgeon it means that he found the fracture healing right???
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replied November 22nd, 2011
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Kurtosis,

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.

Good luck.
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replied November 23rd, 2011
Gaelic

Thanks again. You really help me a lot. This info is vey helpful.
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replied November 24th, 2011
Gaelic

i more question... is it ok for me to swimm in a swimming pool about 6 feet... cause i heard that if i go to pool im not caring my weight that much and its a good muscle exercise>>
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replied November 25th, 2011
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Kurtosis,

Swimming and water aerobics are excellent activities. The warm water makes the tissues more pliant and stretchable. The buoyancy takes the weight off the lower extremities.

In some pools you can actually put on a weighted vest and run in the water. It is very good exercise.

You might want to avoid swim fins, as they can put a little too much stress on the fracture site. You can try them, just be careful.

So, if you have access to a pool, go for it.

Keep on working hard in therapy. Good luck.
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replied December 1st, 2011
Thanks for the info... This site really helped me... Thanks a lot
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replied February 11th, 2013
distal femur fructure
dear dr, i broke my distal femur intra-articular plztell me what is the time required to heal ,i operated with liss plating.
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replied February 11th, 2013
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armn,

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.

Good luck.
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replied August 16th, 2013
HI Gaelic,
I SUSTAINED A FRACTURE , OPEN ONE FROM A GUN SHORT AT A CLOSE RANGE. IT IS 6 WEEKS NOW, THE DOCTOR FIX EXTERNAL FIXATOR FOR 5WEEK DURING WHEN THE WOUND ARE BEEN TREATED AND AFTER THAT HE FIX ME IN A CAST NOW. (NO INTERNAL FIXATION )
PLEASE THIS LINK IS THE XRAY DONE YESTERDAY FOR THE FRACTURE. I CANNOT SEEE ANY HEALING AND THE GAP IS TOO MUCH, DOCTOR SAID IT WILL FORM A BONE CEMENT. PLEASE CAN ANYONE LOOK AT IT AND TELL ME WHAT NEED TO BE DONE. THIS IS VERY WORRISOME. I HAVE BEEN LYING IN THE BED FOR 6 WEEKS NOW. IT IS NOT EASY AT ALL.

E:\HENRY^EHIUIGWE-20130814-5E639F3C126846D 9B41A4139BD63F4F0.bmp
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replied August 13th, 2013
hi thre I just got a accident 11 moth back my right fumer is broken so I hade my fist surgery and my doctor put peltes and in ten moth its have been broken and I have to go my next surgery put nailing and now I am recover agen how much time it will take
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