Knee > Fractured Thighbone > Treatments

    Open Reduction and Internal Fixation

Surgery Procedure

In an open reduction-internal fixation surgery, an incision is made and the broken bones are realigned by the surgeon.

   General anesthesia is typically used for surgery, though in some cases, a spinal or epidural anesthetic is used. The anesthesiologist administers the anesthesia to put you to sleep in the operating room.

   The procedure usually lasts less than two hours. One incision is generally made to expose the area of the fracture. The fractured pieces are held together and secured by metal wires or screws, which remain unless they cause discomfort or pain.

   After the bone is set, the incision is sewn up, an immobilizer or cast is placed on the leg to restrict movement, and the patient is taken to the recovery room.

After surgery to repair your fractured thighbone, you usually will stay in the recovery room for at least two hours while the anesthetic wears off. You will be given pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return and a prescription for pain medicine. When you wake up, your leg will be immobilized and bandaged. You may experience significant pain early on and you should take pain medicine as directed. Because it is easier to keep pain suppressed than it is to treat pain once it present, take pain medication as directed, and do not delay your doses. You should try to move your feet while you are in the recovery room to improve circulation. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay.

After open reduction and internal fixation to repair a fractured thighbone, most patients remain in the hospital for at least 24 hours. There will likely be pain, and you can expect to be given pain medication as needed. Be sure to ask for medication as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. Your physician will monitor your pain medication both in and out of the hospital. Ice also helps control pain and swelling. Since you will not be able to drive, make sure to arrange for someone to drive you home.

Home Recovery

After a thighbone fracture, it is important for you to monitor your condition and take specific precautions to protect the leg and speed recovery. If you require surgery to treat your fracture, things to watch for include:

   If the swelling decreases dramatically, especially during the first 48 hours after surgery, your brace may become too loose. If swelling increases, your brace may become too tight, and circulation can be dangerously cut off. In both cases, you should contact your physician immediately.

   Stitches from the incision are typically removed after about two weeks. During this time, it is important to keep the incision clean and dry to prevent infection and speed healing. Your physician or nurse will instruct you on how to care for your incision.

   A rash or irritation around your brace may indicate poor fit or sensitivity to the materials. If you develop a skin irritation around your brace, contact your physician immediately.

   You will probably experience pain for the first few days after surgery. This pain can generally be adequately controlled with the pain medication prescribed by your physician. If the pain does not gradually decrease within a few days, contact your physician.

Patients with open thighbone fractures typically wear a braces for four to six weeks. Because your mobility will be limited during this time, it is important that you take special precautions. Elevating your injured leg above heart allows gravity to help reduce swelling and fluid accumulation. Place a stack of pillows under your ankle while you are lying on your back. Moving the toes of the injured leg improves circulation throughout the leg. Straight leg raises are one way to strengthen the thigh muscles, and are usually recommended one or two days after surgery.

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Once the pain and swelling associated with a fractured thighbone have subsided, your physician may recommend physical therapy to help strengthen the muscles around your knee and improve your knee's range of motion. Though everyone's rehabilitation program is slightly different, physical therapy for a fractured thighbone follows a general pattern. Range of motion is extremely important. Movement may be painful at first, but it is important to not allow the knee to stiffen. Rehabilitation typically includes resistive exercises - those involving weights - to keep the muscles around your knee strong. You should eventually be able to resume functional activities like stair climbing, single leg support, swimming, and driving. You will be able to begin more vigorous activities as your fracture heals and your leg gets stronger.

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Prevention

Once your fractured thighbone has healed, building muscle strength around your knee can help you avoid further injury. Contact sports and activities increase your chances of re-injuring your knee. Many of the exercises and activities that are popular for fitness put stress on your knees. To prevent further knee injuries it is important to learn knee-sparing exercise techniques by dividing your activities into three components:

   Daily Living - the average person takes between 12,000 and 15,000 steps a day, exerting a force between two and five times your body weight on your knees. After a knee injury, take it easy on your knees during the day whenever possible to save them for activities and exercise. Avoid stairs when there is an elevator, take the shortest path when walking, and consider wearing athletic shoes designed to absorb shock.

   Muscle Strengthening/Conditioning - activities themselves are not a substitute for conditioning. Adhere to the muscle strengthening program you learned during your rehabilitation program. The best strengthening programs are low-impact and non-weight-bearing, like stationary bikes and certain weightlifting programs, because they do not force the knees to absorb excessive shock and take stress off the knees.

   Recreation - your sport or activity of choice helps maintain mental and physical well-being, but it is not a conditioning program. Sports that require twisting and quick direction changes put great strain on your knee, increasing your chances of reinjury.

A discussion with your physician or physical therapist can help determine the appropriate exercise program and activity level for you.

PAIN

A small amount of pain is normal during physical activity, but if you feel so much pain in your knee to warrant taking pain medication before an activity, you should consider cutting back or stopping. Pain can also indicate reinjury. Do not play through the pain after a fractured thighbone - it may be a sign that your activity is putting too much stress on your knee. If you are unsure of the safety of an activity, discuss it with your physician.