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Femoral Shaft Fracture - Internal Fixation

 
 

What is it?

Your thigh bone (femur....fee-mer) is broken. Fractured means broken. There is no difference in severity between a fractured bone and a broken bone.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made in your buttock over the top end of the thigh bone. A steel rod (often called a nail) is then passed down the inside of your thigh bone. It goes across the break and holds your bone in the correct position.

The surgeon may pass some screws across the rod for added stability. The wound is then closed with stitches or clips. There will probably be a fine plastic drainage tube coming out from the wound to drain any residual blood from the operation. You will be in hospital four or five days after the operation.

Any Alternatives

If you leave things as they are with your leg in a traction splint, the thigh bone would eventually heal. It might take three months of rest in bed to do so. There may be shortening of the bone and the pieces may heal out of line. A plate of metal on the outside of the bone is not strong enough. Some fractures, such as those at the lower end of the thigh bone, are not suitable for nailing.

Before the operation

You will have come to the hospital as an emergency. You need to let the doctors and nurses know about your general health, past illnesses, and drug treatment. Arrangements will be made for you to have the operation within 24 hours or so of the injury. You will have all the necessary tests to make sure that you are well prepared and that you can have the operation as safely as possible.

After - In Hospital

Your leg will no longer be in a traction splint. The wound may be painful. You will be given injections and later tablets to control this. Ask for more if the pain is getting worse. . A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time. The discomfort of the operation can make it difficult to pass urine and empty the bladder. It is important that your bladder does not seize up completely. If you cannot get the urine flowing properly after six hours, contact the nurses or your doctor. The wound will have a simple adhesive dressing on it. The nurses will usually remove the wound drain one or two days after your operation. This doesn’t hurt. Your stitches or clips will be taken out when you come to the outpatient clinic 10 to 12 days after the operation. You will be asked to start getting out of bed the day after the operation. As long as the fracture is firmly held by the nail, you should be able to walk, you will need crutches for six weeks or so. You will be shown how to keep your ankle, knee and hip joints mobile. Wash around the dressing for the first 10 days. You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you like once the stitches are out. You will be given an appointment to visit the orthopaedic outpatient department to have check-up X-rays. The nurses will advise about sick notes, certificates etc.

After - At Home

You must not drive for six weeks after you leave hospital. You will not be able to perform an emergency stop as quickly as normal before then. How soon you can return to work depends on your job. If you sit whilst at work, you will be able to return to work two or three weeks after your operation. This also depends on you being able to get to work. If your job is manual you will be unable to work for at least three months. You may swim gently as soon as the stitches have been taken out. You may play light sports 12 weeks after your operation. You may not play contact sports until you have been told that the break has soundly healed. When you start playing, you will not be able to play for as long as normal. Your leg will ache at the end of a game. Your leg will continue to improve for up to 12 months. The cross screws may need to be removed after a few weeks. This is a minor procedure. This is done as a day-case. If you are less than 40 years old, it is recommended that the metal rod is removed. This will be at least 18 months following its insertion.

Possible Complications

As with any operation under general anaesthetic there is a very small risk of complications related to your heart or your lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Wound infection sometimes happens. You will be given antibiotics to prevent this. You can develop a blood clot in one of your calf or thigh veins (deep vein thrombosis -DVT). This can be very dangerous because it can travel to your lungs which can be potentially lethal. You will be given medication (injection of blood thinners), as well as compression stockings and foot pumps to protect you and minimise the risk of DVT.

Rarely, you might have nerve or blood vessel damage after this operation and you might need another operation to fix the problem.

There is always a risk of delayed healing or even non-healing. The X-rays will show these up and you will have further treatment to allow proper healing.

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