Broken Femur Questions


26 replies to this topic
  • motopsycho650

Posted January 17, 2006 - 03:00 PM

#1

Back in March of '05, I shattered my left femur when I found a hole in the middle of a field at 60mph. The doctor called it a "butterfly break" because the middle 3 inches of the bone crushed on impact.

So far, I have had 2 surgeries. The first was the initial nail. Then, six months later they replaced the nail and did a bone graph at the same time. It's been almost 4 months since the second surgery, and though it feels much better, I still cannot run, jump, or do much else with that leg because of pain in my knee.

I want to know what kinds of things I can do to help the healing process? What kinds of things can I do to re-train my leg to work equally? I try to use my left leg, but unless I am thining about it, I do everything with my right leg.

  • DrMark

Posted January 17, 2006 - 03:08 PM

#2

You need to have your knee looked at. 30% of femoral fractures are associated with various internal derangements of the knee such as mensical tears, ligament tears, and articular surface injuries.

Assuming that you just have the stiff knee that comes from a fractured femur, twice operated on, start yourself on the stationary bike, one hour per day everyday, for the rest of your life. That should fix it up.

BTW, has your femoral fracture healed yet?

  • dirtflea

Posted January 17, 2006 - 03:12 PM

#3

Get into physical therapy as soon as possible. I not going to lie, its going to hurt, the muscles,tendons, and such have been immobile for some time. Stay away from the pain killers the best you can, and exercise that leg. Some Shiatsu therapy will help with muscle pain, good luck!

  • motopsycho650

Posted January 17, 2006 - 03:28 PM

#4

No, it is not completely healed yet. The doctor who did the surgery said that it looks good, but not great. As of right now, I am waiting for another 3 months for another x-ray (and possibly a CT scan).

The knee joint it's self, doesn't hurt. Nor is my knee very stiff anymore. I have almost full flexation (my heal will not make the last inch to touch my butt). The pain is just above the knee where the screw is, and also in the center of my thigh where the break is.

Another puzzling thing is, the doctor has told me not to do any physical theropy yet, although he says I have no activity restrictions. Does that make sence?

  • DrMark

Posted January 17, 2006 - 03:50 PM

#5

He may be concerned that some therapist, trained in Nazi Germany, may decide to do his/her own manipulation. This may be the reason behind your doc's reluctance to perscribe PT.

Riding the stationary bike will get you exactly where you want to be without ruffeling anyone's feathers.

If the knee pain is because of irritation from the distal locking screw, then you will have to live with it until the fracture is healded.

Post a copy of your X-rays. I am concerned that there is pain about the fracture site. I do not think its healing.

  • motopsycho650

Posted January 17, 2006 - 06:37 PM

#6

It looks like it's making progress consitering how bad the break was. Unfortunatly, the most recent X-Rays I got are small, and the text is in the way in one. It's not pretty, but it's better than it was.

The first 3 pics are the original x-rays from april '05. The last one is from last week, (3 months after the bone graph).

Posted Image Posted Image Posted Image Posted Image

I'm looking for anything I can do to get this thing in gear. I really don't want plates in my leg (No more sugeries, PLEASE!!)

Thanks for backing up his PT decision, my doctor seems to give me a lot of generalized answers, and I'm not sure what he's thinking sometimes. He was a very good surgeon though.

  • DrMark

Posted January 17, 2006 - 07:06 PM

#7

It isn't anywhere near healed.

Tell me again when did they switch out the rod?

How are you walking? Normally, crutches, wheelchair?

What is the range of motion of your knee?

Was this a compound fracture? (bone came through the skin?)

Do you have incisions on the thigh or just near the butt and the knee??

What pain medications are you taking if any?

What kind of work do you do? Are you working now?

Have you considered electric stimulation?

  • motopsycho650

Posted January 17, 2006 - 07:46 PM

#8

I know it's not anywhere close to healed yet, but it feels pretty good. This is the first bone I've ever broke. On every other injury I've had, I've been a very quick healer.

They swiched the rod and did a bone graph on 10/03/05.

I am walking normally with a slight limp. I have done really well with bending my knee & ankle to keep my foot straight.

My knee bends ok. I cannot touch my heal to my butt (I have less than 1 inch to go). I think that is improving (slowly).

It was not a compound fracture. I never saw the x-ray or CT scan from before the surgery.

I do have an incision on my thigh. He went in durring the first surgery to try to push some of the pieces back into place. He re-opened the same incision for the bone graph.

I take Tylenol or advil once in awhile for pain, but most days I don't take anything.

I was working as an auto mechanic. I actually feel like I could return to work, but the corp. office won't let me yet.

I have a ultra-sound stimulator that I have been using since July, '05. I havn't been getting in everyday lately, but I have been using it at least 5 days a week.

Mainly, any pain I feel is mostly just above the knee, where the screw is. (I expect that). and the muscle gets sore around the break. I tried jumping up & down today, landing on both feet together, and it felt ok. I think the x-rays look worse than it feels. I've actually been out riding a week ago. I can't stand on the pegs though.

  • DrMark

Posted January 18, 2006 - 12:00 AM

#9

From what you have told me, I think you need to sit tight and expect that it will heal between six months and one year after the last surgery. continue the bone stimulator and ride a stationary bike one hour per day, everyday.

  • motopsycho650

Posted January 18, 2006 - 06:37 AM

#10

Thank you for your suggestions. I have been riding my bicycle, but I can see how a stationary bike would be better. I need to work the left leg by-it's self for awhile to get it stronger, and more even with my other leg. I figured it would take a long while to completely heal.

The doctor I have wants the bone to heal so he can eventually take out the screws. He says they will eventually break.

On an average person, (I know I'm not average), how long could the screws stay in? I'm afraid of breaking a screw, or the bone around a screw.

Anyways, Thank you

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  • DrMark

Posted January 18, 2006 - 07:38 AM

#11

There is no magic number for how long it will take for the screw to break. It depends on how fast the bone heals.

Either way, there is little choice in this matter now. You just have to sit tight.

  • motopsycho650

Posted January 18, 2006 - 07:58 AM

#12

I'm tired of waiting. But, I know that's what has to happen. I'm gonna hit the excercise bike, and hope for the best. Thank you for your suggestions, I needed someone else to back up my doctor's opinion, just for my own piece of mind.

One last quick question. With the original rod, he put 2 screws above my knee. When they replaced the rod, he olny used one. Just wondering why he did that if it still wasn't healed?

Thanks for your help.
Justin

  • KTMPT

Posted January 18, 2006 - 03:54 PM

#13

Dr. Mark,

First of all, I respect your opinions very much as you seem to be a good surgeon. Although I cannot understand why you think that I am a Nazi or PT in this case. If this patient with a broken femur showed up in my clinic the last thing on my mind is to "manipulate", so to generalize that PT's will do this is not appropriate. Fractures are a well known contraindication to manipulation and shouldn't be performed. This patient could benefit from a skilled PT to return to work and Mxing upon healing of the fracture. How is a patient going to understand when you tell them to perform closed chained exercises. Maybe one of your "trainers" could enlighten me since you generalize me as not having enough skill to help this person out.
I have been riding since 5 and racing since 11 so I know what is required and how to rehab a patient appropriately(just coming off of my own injuries) and I cannot stress enough on how disrespected I felt with the Nazi comment. I have come across some less than skilled ortho surgeons in my day but do you see me comparing them to you. NO.

The the person with the wonderful fracture. Great x-rays. I would concur that with your reported range of motion that therapy would not be warranted at this time. Upon healing, even 1-2 visits with a skilled PT would help guide you with the proper exercises to increase balance, range of motion, endurance and strength.

  • DrMark

Posted January 18, 2006 - 06:35 PM

#14

I did not say that you or anyone was figuratively or literally a Nazi.
The rider was asking why his doc would not refer him to PT.
I was surmizing, and of course I could be wrong in my assumption, that that rider's orthopaedic surgeon may have been afraid that someone would perform "manipulation" on a very, very tenously internally fixed femur fracture.

While the folks who do rehab in my clinic are trainers, I refer the vast majority of my out of town patients to Registered Physical Therapists and have much respect for their ability.

  • Raven1911

Posted January 19, 2006 - 05:34 AM

#15

Dr. Mark,

First of all, I respect your opinions very much as you seem to be a good surgeon. Although I cannot understand why you think that I am a Nazi or PT in this case. If this patient with a broken femur showed up in my clinic the last thing on my mind is to "manipulate", so to generalize that PT's will do this is not appropriate. Fractures are a well known contraindication to manipulation and shouldn't be performed. This patient could benefit from a skilled PT to return to work and Mxing upon healing of the fracture. How is a patient going to understand when you tell them to perform closed chained exercises. Maybe one of your "trainers" could enlighten me since you generalize me as not having enough skill to help this person out.
I have been riding since 5 and racing since 11 so I know what is required and how to rehab a patient appropriately(just coming off of my own injuries) and I cannot stress enough on how disrespected I felt with the Nazi comment. I have come across some less than skilled ortho surgeons in my day but do you see me comparing them to you. NO.

The the person with the wonderful fracture. Great x-rays. I would concur that with your reported range of motion that therapy would not be warranted at this time. Upon healing, even 1-2 visits with a skilled PT would help guide you with the proper exercises to increase balance, range of motion, endurance and strength.


Calm down KTMPT, I am a PT also and Dr. Mark is a very good guy and doctor. He has much respect for us. Both you and I know that there are good and bad PT's out there. Dr. Mark was merely saying that if a surgeon had a bad experience with a PT or was scared that they might be too aggressive in their rehab then it can affect the healing rate. It was not a shot at your PT skill in particular. I have been a PT for 10 years now and have seen some real quack PT's out there that should not have a license. Tell me I'm wrong. It was nothing personal, but what he said was valid.

Dr. Mark, no offense taken here. Thank you for your advice.
:thumbsup:

  • motopsycho650

Posted January 19, 2006 - 08:18 AM

#16

yeah, I think Dr. Mark was just trying to use a term that a non-medical person like me could relate to. Reading that actually gave me a smile because my dad went to a somewhat crazy PT. I know that there are a lot of quality PT people out there, are I hope when I get there, I find a good one.

I do really want to build balance & strength on that leg. But, that can't have presidence over it healing. I am a bit impatient, but I understand it's going to take awhile.

Just for fun, have you ever seen a break that bad? I did a full flip when I came off the bike, and hit the ground feet first like an arrow. I had never broken a bone before, and I guess carma wanted to teach me a lesson.

  • DrMark

Posted January 19, 2006 - 11:37 AM

#17

Yep, I have seen them worse. You just need patience. Ride the bike, a controled amount of stress aids healing.

  • KTMPT

Posted January 19, 2006 - 02:18 PM

#18

I have not seen one in my clinic that bad, but for obvious reasons in that it needs to heal. I have seen other x-rays from orthopedic surgeons I know that show so serious fubar.
You have some healing to go by the looks of them, however, I am the rehab guy not the bone collector.

"I maybe used, but I ain't used up!"

  • motopsycho650

Posted January 23, 2006 - 08:41 AM

#19

I more question for DR. Mark. I know you're busy, but I have a problem.

The doctor I've seen so far has a policy at his office where they will not make work determinations. My employer, requires a statement that says I am able to return to work, but because of the doctors policy, he will not give me such a statement.

I'm not asking you for that statement, I am just wondering if your office has such a policy, and how common policies like this are becoming?

it's really turned into and endless loop. I know I can work, but my employer wiil not except a generic statement that says "no activity restrictions." And the doctor will not write a statement that involves "I can, or cannot return to work."

  • DrMark

Posted January 23, 2006 - 09:59 AM

#20

I have a full time girl who just deals with that stuff. What is that guy's problem?





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