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Femur Shaft Fracture and bone grafting

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I had a bike accident on 12-12-12 and broke my femur shaft. Ihad a surgery the same night and had IM rod inserted. After three months the bone still didn't join and I always had a doubt wheneva I saw the side view of the extra by bone was not aligned straight it was tilted from the fracture area to wards back of my thigh. I travelled back to my home country india and showed the doctor there. He said he will have to realign and do a bone grafting. I agreed to it they did an operation and did the bone grafting but when I saw the xray from the side view it was still tilted and I asked the doctor he said the if he would have straightnd my leg would have half inch short and he didn't want that and he said its fine the way it is there wont be any problem. Like its a slight tilt. I had my bone grafting done on 17-03-13. Its been around 8 weeks now. Since I am here I hvnt done an xray till now and I am still on both cruthes. I can do the knee movement and all but I don't know if I should try walking with one stick now?.. and if I do which hand should I hold that one crutch? I have the fracture on my right leg. and ya one more thing I am smoker.. I know I have read everywhr that it doesn't heal fast and stuff but they do heal right?? I am not a heavy smoker..
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replied May 7th, 2013
Especially eHealthy

Sorry about your injury.

First, about the smoking, that is the single most detrimental thing there is to fracture healing. Every time you smoke, you decrease the blood flow to the healing bone. Nicotine is a vasoconstrictor, it makes the blood vessels clamp down. Without the blood flow, there is no oxygen getting to the newly formed tissue, which is very sensitive to hypoxia. Thus, every time you smoke, you actually kill off some of the newly formed cells. It is sort of like taking two steps forward and sliding one step back. As long as your tissues can form enough new bone to stay ahead of the amount you kill, you will eventually heal the fracture.

As to advancing your weight bearing status, that is up to your surgeon. Be sure to ask if it is okay for you to put weight on the fracture. In most cases, the fracture pattern is what dictates if early weight bearing is allowed (before there is significant callus formation). If you have a transverse fracture (straight across), these are inheriently stable, and can be walked on immediately after IM nailing. But, in oblique and spiral fractures, there is no stability, so there has to be healing of the fracture before significant weight can be placed across the fracture.

The IM nail will usually support the stress of weight bearing for a little while, but it will not hold up forever. It is basically just an internal splint until the bone is healed. Thus, it is a race: will the bone heal before the hardware fails?

If your surgeon allows you to advance your weight bearing, it is usually best to use a cane rather than just one crutch. You would place the cane in the hand opposite the injury. This is to maintain the proper gait mechanics (remember, when you walk, the upper extremities move opposite of the lower extremities. In other words, the right foot and left hand move forward, then the left foot and right hand move forward.) Hope that made sense. You can use one crutch in the same way. But, it is very awkward to use just one crutch (unless it is the forearm type of crutch - the Lofstrand type).

It is desirable to advance weight bearing as soon as possible. The stress of weight bearing can actually help to heal a fracture. This is Wolff's Law - bone will respond to the stresses applied to it. But, it is a fine line. You do not want to weight bear if the stress will displace the fracture.

The slight angulation in the sagital plane (looking from the side), it not a problem. As long as the bone heals solidly.

So, if you can, you might want to give up smoking until the bone is healed. But, also, be sure to eat a proper diet, with extra protein (needed for the "building blocks" for new tissue formation), calcium, vitamin D, and magnesium. And, if it appears that the bone is still not healing, you might look into a bone stimulator.

Good luck. Hope your femur heals quickly.
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replied July 22nd, 2013
Hi Doctor,

My husband broke his proximal femur 6 weeks back and he had intramedullary rodding procedure done on the next day. During the 6 week appointment, doctor found a problem on x-rays and told us that a bone fragment was being pulled by the muscle and it is not aligned to the main bone.

He gave us the option to
1. leave it as it is if not bothersome
2. do the surgery to cut the bone fragment off (simple surgery)
3. try to fix the problem by aligning the bone with the main bone. (complex surgery)

We checked with my friend's uncle who is also orthopedic surgeon and found that we can cut the fragment off and do the bone grafting as an option, can you let please advise?
PS: I have the x rays but do not know how to attach them.

Thank you for looking into this,
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