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Sugery Recovery - I brok my femur, Tibia, and Fibula.

I am 18 years old and a female 4 weeks ago March 4, 2013 I went skiing and I had a accident from losing control and running into a tree. I brok my femur, Tibia, and Fibula. That day I had surgery where they put 7 screws and two rods in my leg they did not fix the fibula because they said it is a non wieght usage bone. They did not put a brace or cast on in me or anything and said i could put wieght on it right after sugery and I use walker. The surgeon said 6 to 8 weeks recovery time but my orthopedic did not give me a recovery time. What do you think will be the time untill I can walk by myself and for it to be healed?
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replied April 3rd, 2013
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TaylorB13,

Sorry about your accident.

Luckily, nowadays, with the surgically technology, it is possible to place intramedullary nails (IM nails) in the femur and tibia, allowing the immediate mobilization of the patient.

Rather than having to place the patient in balanced skeletal traction, with pins through the bones with weights attached, in a Balkan bed frame. This was the way femur and tibia fractures were treated, up until not too long ago, and still is the treatment is some parts of the world. It is still used temporarily, if the patient cannot be taken to the OR for some reason.

So, it is very nice to be able to move the joints and get up out of bed immediately. This reduces the chances of developing a lot of post-op problems, such as bed sores, pulmonary problems, GI tract dysfunction, and many other trauma related problems.


However, the surgeon was being a bit over optimistic with his/her statement that you would be healed in about 6-8 weeks. That’s probably not going to happen.


According to the Wheeless Textbook of Orthopedics, out of Duke University Orthopedic Department, the following is given for the union of tibia fractures:

TIME TO UNION:

> Low energy fractures: 10-13 weeks;
> High energy fractures: 13-20 weeks;
> Open fractures:
… Type 1, 2, and 3A fractures: 16-26 weeks;
… Type 3B & 3C open fractures requires 30 to 50 weeks for consolidation;
> Distal tibial fractures may be more prone to non union than proximal fractures due to absence of muscular soft tissue envelope;
> In the report by Skoog A, et al., the authors studied 64 consecutive patients with a tibial shaft fracture; 12 months after the injury, 44 percent had not regained full function of the injured leg, although all but two of the patients had returned to preinjury working status;
> Reference: “One-Year Outcome After Tibial Shaft Fractures: Results of a Prospective Fracture Registry”, Skoog A, et al, J Orthop Trauma. 2001 Mar-Apr;15(3):210-5



Femur fractures usually take about 8-12 weeks for union.

And this is just for union of the bone, it does not include the rehabilitation time. Since your are being allowed to get up with a walker is a good sign. Are you allowed to bear weight on the injured limb? If so, your fractures are probably transverse in fracture pattern, which are inherently stable. By bearing weight on the healing fractures, this brings in Wolff’s Law - bone responds to the stress applied to it.


But, you did not injure just the bone. All of the soft tissues around the fractures have also been injured: the periosteum (a soft tissue covering of the bone, which carries the nerves and blood vessels to the bone) is ripped apart, the muscle attachments are torn off, and all of the fascia, nerve, blood vessels have been stretched, twisted, and torque when there was no bony support for the limb. So, all of this damage also has to heal. It can heal with a lot of scar tissue in some patients. Every patient is unique in the way he/she heals the soft tisses.

As stated, some patients form abundant scar tissue which can hinder the rehab process. Others form less scar and do well in rehab.


So, again, these times given are only for the union of the bone. It does not include the time for rehabilitation. It is not uncommon for it to take as much as a year to 18 months to fully recover from just a femur fracture or just a tibia fracture. You have both.

So, it is going to take a lot of hard work. You are going to spending a lot of time in the gym, doing weight lifting and aerobics.


Once all of your incisions are healed, you might look into getting into a pool. The warmth of the water makes the tissues more pliable and stretchable. This makes range of motion a little easier. The buoyancy of the water allows for essentially nonweight bearing (in chest deep water) or partial weight bearing in more shallow water, so you can work on gait mechanics. You can do resistance training in the water. You can do aerobic exercises in the pool. It is also safe, you cannot fall down in the water. In some pools, they have weighted vests, so that patients can “run” in the deep end of the pool. This is a common technique that elite athletes use when they have a lower extremity injury and need to stay in shape. It is something to look into.


Also, you are going to have a lot of ups and downs during your recovery period. It is not uncommon for patients to become depressed. Unfortunately, depression can actually affect the recovery of the patient. So, if you start to notice that you have developed depression, get some treatment for it. Depression is not a weakness or being crazy. It is a medical disorder, that needs treatment. So, again, depression can really slow down recovery. If you develop it, get treatment.


So, again, the surgeon was just giving you the “usual” time frame that most bones will unite in. But he/she did not think about the overall recovery period, and healing of all of the soft tissues.


You should speak with your orthopedic surgeon. Find out what your weight bearing status is. Follow your orthopedic surgeon’s instructions. Get started on knee range of motion as soon as you can. And get your mind and soul ready for a long and hard recovery.

Recovery does not “just happen”, it has to be worked on. The harder you work in rehab, the sooner you will recover. The more you put into it, the more you will get out of it.

We usually tell the athletes, that for every day they are out of practice, it takes two to get back to the starting lineup. If they get back earlier than that, they are happy. But, if it takes that long, at least they were forewarned.

And, not only strength and range of motion have to be worked upon. You will also have to get balance and agility back. This is something that is often overlooked, but it really needs regular attention. Also, if you play any type of sports, you will have to relearn the specific skills for that athletic competition.


However, you have youth on your side, so you should heal up pretty well. There really is not any way to speed up the healing process, but you can slow it down.
> Do not smoke or use smokeless tobacco. Nicotine is probably the single most detrimental thing there is to the healing the process in fractures. It is a vasoconstrictor, so it causes the new tiny blood vessels growing into the fracture to clamp down, causing no blood to get to the fracture callus. If no blood is getting in, no oxygen is either. So, this can be very bad for fracture healing.

> Eat a proper diet. You need extra protein. Protein provides the building blocks for the body to heal the fracture. You also need extra calcium, vitamin D, and magnesium. These are the vitamins and minerals that are needed for proper bone growth and healing. The best place to get vitamin D is from the sun. Sun shining on the face and arms for 10-30 minutes a day will provide the needed vitamin D. Food is actually a poor source of vitamin D. But, many foods are fortified with it. So, you will see milk and bread that is vitamin D fortified. For the others, you might want to take a daily calcium tablet and a multivitamin (One-a-Day Vitamins).

> Weight bear according to the surgeon’s instructions. Weight bearing will stimulate the body to heal the bone faster. This is Wolff’s Law - bone will respond to the stress applied to it. This is why weight lifters and heavy manual laborers have very strong and stout bones. While the reverse is also true. Patients who do not place any stress on the bones will develop osteoporosis (age, injury, space flight).

> Work had on regaining knee motion. It is not uncommon for patients with femur fractures to have difficulty flexing the knee (bending the knee). Because of the soft tissue injury around the fracture site, there can be a lot of scar formation, which can tether down the quads. When the femur breaks, the sharp edges of the bone can actually cut the muscle. Which has to heal. Scar in the quad muscle does not stretch and contract like “normal” muscle tisse.

> Work hard and diligently on regaining strength and muscle mass. The muscles atrophy pretty quickly after a significant injury. So, it takes a lot of work in the gym, doing resistance training to rebuild the muscles. So, when the surgeon says it is okay to start working, go for it. Recovery does not “just happen”.

> Work on balance and agility. It actually takes special exercises to regain balance and agility, and they have to be worked on specifically. Work on specific sports skills, if you play any particular athletic event.

> Treat depression if it occurs. If you develop clinical depression during your recovery period, get it treated. Depression is a medical illness (just like diabetes or high blood pressure). It is not a sign of weakness. It has adversely affect the recovery from an injury. So, seek professional help for it. Get it treated.



Hope that you have an uneventful recovery. Work hard. Hang in there.

Wishing you the best. Good luck.
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