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learning to walk after femur surgery

Is it difficult to walk after 3 months on crutches from surgery for a fractured femur?
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replied August 23rd, 2011
I got no response to my query. But while waiting to visit a new ortho on the 1st of September, I have several ponderings about this "walking" thing.
(1)Some have mentioned utilizing 25% body wt when walking .... with a crutch, I presume. It's not clear to me what this means.
(2)Some mention it is partly psychological. Since it cannot, in my mind, be determined how much wt your leg is supporting when you can actually walk without a limp, this is certainly plausible.
(3)Gaelic suggested walking between PT type parallel bars while preparing your leg for walking.

Something a little strange happened to me yesterday while I was using 1 crutch and carrying a load of clothes to the bedroom with my free hand. When I set the clothes down along with my crutch, I made maybe 6 or 7 steps without any limp what-so-ever. But when I realized it, I made about 2 more steps then I limped and quit. This gave me the thought of carrying a 5 to 10 lb barbell set in my free hand when doing my walking practice. More wt can be added as the leg is capable.

Don't know what any of you think about this, but I thought I would submit this to see. I have an engineering background so what I stumbled on makes for a measurable means, to me, for assessing a person's capability for walking.
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replied August 23rd, 2011
I should add that my fractured bone is pointing upward, but at an angle to the horizontal located between the hip and the femur head. The femur of my thigh and lower leg, being vertical, was not damaged in my bicycle accident.
So in my own estimation, my surgically repaired bone being "secured" by 3 screws may not be capable of supporting more weight than the femur of the thigh or lower leg during the healing process. Conceivably, it may have this capability after it is completely healed.
And by the way, the clothing I was able to carry, as noted in my previous comment section weighed 14.8 pounds according to my bathroom scale.

If anyone has any comments to offer, they will be appreciated.
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replied August 24th, 2011
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ftay46,

When you posted your new query, I did not answer, thinking you wanted someone else to answer. Anyways.

When it is suggested to put 25% weight on the leg, the best way to determine that is to use your bathroom scale. Using your crutches for support, stand next to the scale. Put the foot of your bad leg on the scale. Start applying pressure on the leg, till the scales reaches the amount equal to 25% of your body weight (i.e. if you weigh 175 lbs, then you would want to put around 45 lbs on the foot.) Do this several times till you get the idea of what 25% body weight feels like. Hope that make sense.

When ambulating with a cane in the opposite hand, it has been shown through physics (vector forces through the hip joint, accounting for the pull of the gluteus medius muscles, and others also), that it reduces the force through the femoral neck, into the acetabulum, by up to 50%. If that helps any.

Walking between parallel bars is the same as walking with two crutches, but with a more stable construct. With each, you can apply as much or as little weight across the hip joint as you desire.

If you are interested at looking at the hip joint from an engineering or biomechanical standpoint, there are several texts available that go over all of the joints in the body in vector analysis. You can determine exactly how many neutons of force you are applying through the femoral neck in each phase of gait, and also when using ambulatory appliances, or if there is muscle weakness in certain muscle groups. This is actually required as part of orthopedic residency training programs. To be able to figure all of this out. It really plays into gait analysis, with cerebral palsy or stroke patients. So, the information is out there.


Your program in the pool sounds like it is working in terms of building up strength and confidence.

The key in femoral neck fractures is to get the bone to heal. The screws will only hold up for so long, before succumbing to cyclic loading stress. And they take a lot of stress in the single leg stance phase of walking. That is where the crutch or cane comes in, to decrease the amount of stress applied.


Good luck.
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replied September 8th, 2011
I did want to see if others had personal experience comments to offer. There were many "views" but no comments offered. But, as usual, your comments are certainly very appreciative and most helpful. Thanks.

Our fancy bathroom scale responded with "error", no matter how or where I placed my foot to try your 25% weight bearing suggestion. But on Labor Day, I finally found a friend with a scale that worked. I pushed with my foot to a point that felt close to what my leg felt like when I exercised it for about the 1/4 mile crutch aided exercise walks in the neighborhood. Two attempts (79 and 84 lbs) appeared to be pretty close to that point. With my body weight of about 136 lbs, my exercise level is about 60% of my body wt.

I was scheduled for and kept my sep1 appointment for the post-op with my original surgical group from the hospital. [I "chatted" with you recently about an ortho who saw me 3 times, being a 2nd opinion, who only used the 3 sets of films he took to suggest that my bone was not healing and needed a hip replacement (for some reason, he did not want the films I broght from my surgery teams post-ops)]. At the sep1 appt, it was shown and shared with me that my fractured bone was compressed as shown on films from my july15 and sep1 appt. But because was no change from the july15 to the sep1 film, there is no reason to be alarmed yet, even with the compression difference resulted in the same length of "exposed" screws. I was told, however, that any complications resulting from this would probably mean a hip replacement.
When I showed them how I walked and inquired about my healing, they indicated that I have more of a gait than limp problem and that I have no healing issue that should preclude my ability to walk, even by now, and that I would grow away from my limp eventually.
I also inquired about my flexibility that limits my ability to tie my shoe. The response was to schedule rehab to help with both the walking and flexibility.

I'm concerned about the screws now, especially as this relates to stress comment you made. They advised against contact sports or high impact activity and scheduled for a follow-up appt in 6 months. They also advised that I decrease my use of the crutch.
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replied September 8th, 2011
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ftay46,

Compression, at least a little compression, is actually a good thing, because the bone tends to heal better when compressed.

When you say "exposed" screws, do you mean at the "head" end of the screw at the lateral aspect of the greater trochanter? It is not uncommon for the heads to be a little uncovered, when the fracture compresses some. Of course, if they are a lot uncovered, then they more be prominent, and cause discomfort when you lay on that side.

The other end of the screws, the "thread" side, should always be totally within the bone of the femoral head. It is not good, if they "cut out" on that side, as then, the metal from the screws is actually scraping around on the inside of the joint. When that happens, it is a surgical emergency, to get them out of the joint. And the patient always knows when this happens, they can feel the cartilage being gouged out of the joint. I am just mentioning this to be thorough, as this rarely happens, but when it does, the patient knows.


So, if the x-rays haven't changed, that could be good, in that the bone is healing and the hardware is intact. The stress you are applying is not causing any damage as far as can be determined.


If the surgeon wants you to decrease the crutch use, go to a cane in the opposite hand for awhile. You can actually decrease the weight going through the hip by about 50% that way. And, is allows for a more normal gait pattern.


Good luck. Hope everything continues to go well.
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replied September 8th, 2011
The head end of the screw plus some distance of the thread area was exposed. I guess I did not look too carefully because it seems as if I could not see completely to see completely to the end of the threaded side without the head. That said, I can't judge the thread portion in vs out of the compressed area. Actually, I could recognize the head area because of the shape, but I have no idea if the "thread" section began right after the head or if there was a non-thread section before the threads began.

I feel a little less worried, but I will be considerate of any problem that remotely appears to be related to the screws and that area.

And when you say use the cane on the opposite side, I presume you mean on the same side as the "bad" leg. Is that correct?

Question. Is healing represented by a break between the fractured ends that would be less seen while a completely closed break, represents a complete heal?
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replied September 9th, 2011
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No, the cane is in the hand on the uninjured side. (If you watch the TV show "House", he does it the wrong way.)

Watch someone walk normally for several strides. When the right foot goes forward, so does the left hand. Then, with the next step, as the left foot proceeds forward, the right hand goes with it.

So, in normal gait, the opposite hand and foot are in conjunction with each other.

To make the gait more natural, the cane should be in the opposite hand, the hand away from the injured side. Thus, the cane proceeds forward as the injured leg steps forward. Weight is shifted onto the cane, so as the injured leg is in the stance phase of ambulation, part of the weight in on the injured leg and part of the weight is borne on the cane. And when it is done this way, the upper body/torso does not have to lean to one side, and the patient does not develop bad gait habits.

When the cane is used this way, up to 50% of the body weight can be borne through the cane. When the cane is used on the same side, the upper body has to lean over, and more stress is applied to the wrist/hand holding the cane. It is just an awkward way to try to ambulate, and actually takes more strength and energy to walk that way, besides being quite a bit slower.

It will take a little practice, but, after a while is becomes very natural. It is sort of like the gentleman walking down the streets of London, with his umbrella in his hand. You don't have to add the little flair like he does as he moves the unbrella forward, but you get the idea.


As a fracture heals, in general, you will see a little area of what looks like fluffy stuff at the edges of the bone. The fracture line itself will begin to become less and less distinct. It will start to become fuzzy. This is when the bone is beginninbg to bridge the "gap" The bone on both sides of the fracture line are joining together.

As healing continues, the fracture area may look a lot whiter on the x-ray becasue it has extra bone around it. There may even be extra bone on the edges. With time, as the bone remodels the bridging bone begins to look more and more like the normal bone around it.

It adults, it is usually possbile to tell that a bone has been fractured sometime during adulthood. Adults just don't remodel bone as much as kids do. But, it really doesn't matter.

How much bone the body actually lays down, depends upon a lot of factors. If the fracture is fixed, usually not as much bone is laid down. Since the bone is not moving around, the body doesn't need to lay down a whole bunch of callus to stop the motion.

In these cases the fracture is healed with primary bone healing. The bone bridges the gap with new bone, but does not have to put down a whole lot extra bone. The marrow cavity is reconstitued quicker this way also.


So, when you look at an x-ray, you can tell how the fracture is healing, by the way the bone is appearing. It progresses in a predictable fashion. If it stops, or deviate from the progression, then the surgeon can tell that something is not quite right.


Hope you are progressing in your therapy. Keep up the work. Practice the cane ambultation, before long it will be second nature.
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replied September 10th, 2011
Got it. Thanks a bunch!
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