Delayed Healing of Femoral Fracture: When Can I Consider Bone Grafting?

Comminuted displaced femoral fracture, non-union for nearly 6 months?

Hello Doctor, I would like to ask about my situation.
I was in a car accident on March 10 of this year and underwent internal fixation surgery on March 12.
I sustained fractures to my tibia and tibial plateau (both comminuted) as well as a displaced femur.
During my follow-up last month, the tibia showed more significant signs of healing, but there is hardly any noticeable healing in the femur.
I would like to know if I must wait until nine months to undergo bone grafting, or is it possible to do it a bit earlier? My attending physician advised me not to put weight on my leg, but I have been lightly bearing weight and walking (without crutches) for nearly six months now.
It has been quite frustrating to rely on others for mobility.
My knee joint has regained a flexion angle of 130 degrees through rehabilitation, but there has been little progress this month.
If I continue with rehabilitation, will I be able to regain the ability to squat as I used to? Thank you for your response, Doctor.

Xiao Ru, 30~39 year old female. Ask Date: 2018/09/04

Dr. Shi Guozheng reply Orthopedics

Femoral fractures typically heal within six to twelve months.
If healing has not occurred after one year, then bone grafting may be necessary.
Your attending physician's advice is correct; it is prudent to wait at least nine months before making a decision.
Achieving a flexion of 130 degrees after knee joint surgery is already a very good outcome.
If further improvement is desired, a more diligent rehabilitation program will be required.

Reply Date: 2018/09/04

More Info

Delayed healing of femoral fractures can be a challenging situation, especially after significant trauma such as a car accident. In your case, it seems that you have experienced a complex injury involving both the tibia and femur, which can complicate the healing process.
First, let's address the question of bone grafting. Bone grafting is typically considered when there is a nonunion or delayed union of a fracture. A nonunion is defined as a fracture that has not healed after an adequate period, usually around 6-9 months, while a delayed union is when the healing process is slower than expected. In your case, since you mentioned that the femur shows little to no signs of healing after six months, it may be appropriate to consider bone grafting sooner rather than later, depending on the specific circumstances of your injury and the recommendations of your orthopedic surgeon.

The timing for bone grafting can vary based on several factors, including the type of fracture, the patient's overall health, and the presence of any complications such as infection or poor blood supply to the area. While your surgeon may suggest waiting until the nine-month mark, if there are clear signs of delayed healing, it may be worth discussing the possibility of an earlier intervention. Bone grafting can help stimulate healing by providing a scaffold for new bone growth and can be performed using either autograft (bone taken from another site in your body) or allograft (donor bone).

Regarding your concerns about weight-bearing and mobility, it is crucial to follow your surgeon's advice regarding weight-bearing restrictions. While it may be tempting to put weight on your leg, doing so prematurely can jeopardize the healing process and lead to further complications. It is understandable to feel frustrated with the limitations imposed by your injury, but adhering to your doctor's recommendations is essential for a successful recovery.

As for your knee rehabilitation, achieving a full range of motion and regaining strength is a gradual process. The fact that you have regained 130 degrees of flexion is a positive sign, but progress can sometimes plateau. Continuing with physical therapy is vital, as a skilled therapist can provide targeted exercises to improve strength and flexibility. It is also important to communicate with your therapist about your goals, such as being able to squat again, so they can tailor your rehabilitation program accordingly.

In summary, while it is common to wait several months before considering bone grafting, if your femur shows little healing after six months, it may be worth discussing the option of earlier intervention with your orthopedic surgeon. Adhering to weight-bearing restrictions is crucial for healing, and continuing physical therapy will help you regain function in your knee. Remember, recovery from complex fractures can take time, and patience is key. Always consult with your healthcare provider before making any changes to your treatment plan.

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