Femur Fracture Fixation
Are you suffering from a femur fracture? At MD West ONE our specialists are trained to perform femur fracture fixations. Open reduction and internal fixation (ORIF) is surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken thighbone (femur).
The femur is the large bone in the upper part of your leg. Different kinds of trauma can damage this bone, causing it to fracture into 2 or more pieces. This might happen to the part of the femur near your knee, near the middle of the femur, or in the part of the femur that forms part of your hip joint. In certain types of femur fractures, your femur has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the trauma moves the bone fragments out of alignment.
If you fracture your femur, you usually need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces during surgery, so that they are back in their proper alignment. This contrasts with a closed reduction, in which a healthcare provider physically moves your bones back into place without surgically exposing your bone.
Internal fixation refers to the method of physically reconnecting your bones. This might involve special screws, plates, rods, wires, or nails that your surgeon places inside your bones to fix them in the correct place. This prevents your bones from healing abnormally. For a fracture in the long, middle part of your femur, your surgeon may insert a long metal rod through the middle of your bone. The entire operation usually takes place while you are asleep under general anesthesia.
Why is my surgeon recommending a femur fracture fixation?
Certain medical conditions may make fracturing your femur more likely. For example, if you are an older adult, osteoporosis increases your risk for fracturing your femur. Your femur might also be more likely to break if you have bone cancer. Motor vehicle accidents, sports-related injuries, gunshot injuries, and falls are common sources of trauma that can lead to a femur fracture. A direct blow to your hip may break the part of the femur associated with your hip joint.
Most people with a fractured femur need some sort of surgery, usually ORIF. Without the surgery, your broken femur may not heal properly. ORIF can place your bones back into their proper configuration. This significantly increases the chance that your bone will heal properly. Your healthcare provider might recommend nonsurgical treatment for a very young child, or for people with other medical conditions that make surgery more dangerous.
You might need ORIF for a fracture that occurs anywhere along your femur, including the portion that forms part of your hip joint. In a “broken hip,” it is actually part of your femur that breaks, and not part of the hipbone itself.
Procedure
Your healthcare provider can help explain the details of your particular surgery. These details will depend on the location and severity of your injury. An orthopedic surgeon and a team of specialized healthcare professionals will do the surgery. The whole operation may take a few hours. In general, you can expect the following:
- You will receive general anesthesia to make you sleep through the operation, so that you will not feel any pain or discomfort during the procedure. (Or, you may receive local anesthesia and a medicine to help you relax.)
- A healthcare provider will carefully monitor your vital signs, like your heart rate and blood pressure, during the operation. You may have a breathing tube inserted down your throat during the operation to help you breathe.
- After cleaning the affected area, your surgeon will make an incision through your skin and muscle of your thigh.
- Your surgeon will bring the pieces of your femur back into alignment (reduction).
- Next, your surgeon will secure the pieces of your femur to each other (fixation). To do this, he or she may use screws, metal plates, wires, or pins. For a fracture in the middle part of your femur, surgeons often use a specially designed long metal rod that passes through the middle of the bone. It screws into the bone at both ends. (Ask what your surgeon will use in your case.)
- Your healthcare provider may make other repairs, if necessary.
- After the team has secured your bone, the layers of skin and muscle around your thigh will be surgically closed.
Possible Complications from a Femur Fracture Fixation
Most people do very well after ORIF for their femur fracture. However, rare complications can sometimes occur. Possible complications include:
- Infection
- Bleeding
- Nerve damage
- Blood clots
- Fat embolism
- Healing of the fractured bone in an abnormal alignment
- Irritation of the overlying tissue from the hardware
- Complications from anesthesia
There is also a risk that the fracture will not heal properly and that you will need repeat surgery.
Your risk for complications may vary according to your age, the anatomy of your femur fracture, and other medical conditions. For example, people with low bone mass or diabetes may be at greater risk for some complications. Smokers may also have an increased risk. Ask your healthcare provider about the risks that most apply to you.
After Surgery
Talk to your healthcare provider about what you can expect after your surgery. You may have significant pain after your procedure, but pain medicine may help ease your pain. You should be able to resume your normal diet fairly quickly. You will probably have imaging procedure done, like an X-ray, make sure your surgery was successful. Depending on the extent of your injury and your other medical conditions, you might be able to go home within the next couple of days.
Talk with your healthcare provider about how you can move your leg and whether it is OK to put weight on it. This will depend on the type of injury you have. You may need to protect your leg from water. Follow all your healthcare provider’s instructions carefully. You might need to take a medicine to prevent blood clots (a blood thinner) for a little while after your surgery. Your healthcare provider might not want you to take certain over-the-counter medicines for pain. Some of these can interfere with bone healing. Your healthcare provider may advise you to eat a diet high in calcium and vitamin D as your bone heals.
You might have some fluid draining from your incision. This is normal. Let your healthcare provider know right away if you see an increase in redness, swelling, or draining from your incision, a high fever, chills, or severe pain. Also, let him or her know about any loss of feeling in your leg.
Make sure to keep all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery.
At some point, you may need physical therapy to restore strength and flexibility to your muscles. Doing your exercises as prescribed can improve your chances for a full recovery. Most femoral fractures take about 4 to 6 months to heal completely, but you should be able to resume many activities before this time.
Important At Home Notes After Surgery
A femur fracture fixation is major surgery and it will impact your day-to-day movement and activities for several months after the operation. It is important to ensure your home is set up to accommodate your limited movement and creates a safe environment for you as you heal and recover. Some things to do around your home before surgery include:
- Have a bed low enough so that your feet touch the floor when you sit on the edge of it.
- Keep tripping hazards out of your home.
- Learn how to prevent falls. Remove loose wires or cords from areas you walk through to get from one room to another. Remove loose throw rugs. Fix any uneven flooring in doorways and have good lighting.
- Make your bathroom safe by putting hand rails in the bathtub or shower and next to the toilet. Place a slip-proof mat in the bathtub or shower.
- Do not carry anything when you are walking around. You may need your hands to help you balance.
- Put things where they are easy to reach.
- Set up your home so that you do not have to climb steps. Some tips are:
- Set up a bed or use a bedroom on the first floor.
- Have a bathroom or a portable commode on the same floor where you spend most of your day.
If you do not have someone to help you at home for the first 1 to 2 weeks, ask your provider about having a trained caregiver come to your home to help you.
Rehabilitation
Immediately after surgery, the leg is put in a cast or set in a brace which should be worn for about 8 weeks. Wearing the cast or brace will require crutches so you do not put weight on the leg in the first 6 to 12 weeks. It's important to use the crutches safely, so it is typically recommended to work with a physical therapist to ensure you are doing so.
A full recovery from femur fixation surgery most often takes 4 to 6 months. The length of your recovery will depend on how severe your fracture is, whether you have skin wounds, and how severe they are. Recovery also depends on whether your nerves and blood vessels were injured, and what treatment you had.
Your care provider will be able to create a treatment plan following surgery to help you get back to full mobility and heal in a safe and proper way.
When should you contact your healthcare provider or go to an emergency room?
You will have regularly scheduled follow-up visits with your provider throughout the healing process to ensure everything is on track for a full recovery. However, outside of those visits, if you are experiencing any of the following symptoms, call your provider or go to an emergency room right away:
- Shortness of breath or chest pain when you breathe
- Frequent urination or burning when you urinate
- Redness or increasing pain around your incision
- Drainage from your incision
- Swelling in one of your legs
- Pain in your calf
- Fever higher than 101°F
- Pain that is not controlled by your pain medicines
- Nosebleeds or blood in your urine or stools, if you are taking blood thinners