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Thread: broken femur

  1. #1

    broken femur

    What are some complications or precautions to take when a T/5 para has a clean break of the femur? The plan is to put a pin in but personal care issues come to mind; particularly B&B. Also, what about spasms? Any information would be greatly appreciated particularly from the nurses or Dr. Wise.

    Thanks

    [This message was edited by Linda on 04-15-04 at 04:59 PM.]

  2. #2
    Where is the break? Near the hip or knee or halfway?

  3. #3
    Linda, without much personal experience with this issue, I can only say that you are asking the right questions. In theory, however, once the pin is placed and the fracture is stabilized, there should be minimal pain and therefore there should not be AD or increased spasms. Unless they are immobilizing the fracture site with a cast that includes the hip and knees, I don't think that this will have much effect on your bowel and bladder. Were you doing standing and other exercises before the fracture? You should anticipate that the immobilization and stopping any exercise will result in some bone and muscle atrophy.

    Wise.

  4. #4
    Thank you, the injury is right above the knee. My friend just had the pins put in today and I do not know if there will be a cast.

  5. #5
    i have read replies from the nurses in the past that a cast should never be used on someone who is sci'd, i'm guessing bcuz of lack of feeling and circulation.
    about 10yrs ago a friend of mine had a cast put on a femur fracture and developed an absolutely huge pressure sore, deep and wide, which took longer to heal than a broken bone.

    if you have a pin put in, can you move around the way you normally would?
    i'm thinking about moving legs around manually...picking them up, transferring, getting comfortable in bed, etc.

  6. #6
    I broke my femur 3 weeks ago 2" above the left knee. The doctor placed my whole leg in a hard splint, which caused 3 pressure sores in just a few days. I now have a knee immobilizer brace on that is more comfortable, but because of my spasms the break isn't healing well at all. The doctor said he doesn't want to do surgery because my bones are weak, so I don't see an end to this leg misery at all. I'm hoping the doctor will change his mind about placing pins in my leg.

  7. #7
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    Femur

    My left femur sustained a spiral fracture from top to bottom. Surgeon placed a rod and screws. That was two years ago; I was about four months post. No problems with transfers, etc., and am able to get up in my standing frame.

  8. #8
    Fractures of the distal (right above the knee) femur are the most commonly seen fracture in people with SCI.

    Surgery is generally not recommended or attempted unless the person actively walks or stands a lot. There is a big risk of hardware failure due to screws and pins pulling out of the osteoporotic bone (essentially striping themselves).

    Soft splints that can be removed for skin care and inspection are recommended generally. I have seen some truely horrendeous pressure ulcers when hard casts were used, even when frequently changed or put on with "extra padding".

    Once the area in immobilized, there is usually no limit on moving the hip, but weight bearing is usually not allowed for up to 3 months or longer. This may effect transfers and ADLs to some extent. Leg elevation is usually required for the first month or so (no knee bending).

    AD and increased spasticity can be helped somewhat by the use of appropriate pain medications, and if necessary, drugs for management of AD symptoms or temporarily increased spasticity meds.

    Many people will need more personal assistance when healing a fracture, and some require hospitalization or nursing home placement if they cannot get sufficient help at home.

    (KLD)

  9. #9
    Senior Member ChesBay's Avatar
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    I had a distal femur break approx. 2 1/2 years ago. My ortho repaired with IM- Nail procedure (rod) IM-Nail

    Healing was slow and I think age and post injury time were factors ( 25 years post injury, T2/T3)

    I had immobilizer ( soft/with leg extended) on my leg for approx. six months.

    For the first two months or so there was little to no signs of bone growth in X-Rays. My Ortho suggested "Electronic Bone Growth Stimulator", it made a big difference and got the healing process ( bone mending) going. It was a dicipline to wear ten hours a day but well worth it in the end.
    Bone Growth Stimulaor: http://www.ebimedical.com/patient_faq.html#healing

    Hope the healing process is fast but thought I would mention in the event your friend runs in to similar situation.

    I am a bit more cautious and try not to put to much torque on that leg, transfers, etc ( as SCI nurse mentions, I don't want floating hardware). During healing process I avoided weight bearing transfers and used transfer board and first few weeks some personal assistance until I got routines down.

    All in all things have gone well and I am glad surgeon & I went that route.

    Hope all goes well,
    Paul

  10. #10
    I'm C6/7 15 years post sci. I just broke my distal femur last January when I fell out of my chair on the pavement. The bone was a clean break, but totally out of place causing my leg to be 2in shorter and wouldln't straighten out. The orthopedic surgeon put me in a soft brace and we waited 3 weeks before we did surgery. I decided to have the plate and 15 screws put in because I love to stand in my frame and I would never be able to without surgery. He used bone cement and bone grafting material. I went through horrible sweating due to pain (that I never felt) but I'm now waiting for the word when I can stand in my standing frame again.
    My concern now is that my leg has increased spasms and when I lie down it takes forever to straighten and it still doesn't completely straighten. My leg is now bigger an I can feel the plate near my knee through the skin EEEEWWWW!!!!
    My doctor never would right out tell me what shape my bones are in. How do I go about getting a bone density test?
    Thanks Shannon

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