Evaluating Recovery Options for Femoral Fractures: Seeking Third Opinion

Recovery from femoral fracture?

Hello Dr.
Chen, I suffered a comminuted femoral fracture in September 2017.
It has been over two years since the surgery, and I am currently under the care of two physicians (hereafter referred to as A and B).
However, their opinions on my condition differ, and I would like to seek a third-party opinion.

Dr.
A believes that the bone has healed about 80% and will continue to heal if it is going to, and if it is not, it will not.
Therefore, he suggests that I do not need to return for follow-up appointments (the bone is healing, but at a slower rate).
He advises that I can engage in normal activities as long as I do not experience pain.

On the other hand, Dr.
B thinks that although it has been over two years since the fracture, the bone is still not very solid.
He recommends surgery to clean up the fracture site and replace it with a stronger and thicker intramedullary nail to promote more solid healing.

Current situation:
1.
My leg is not very painful anymore, but I do experience slight stabbing pain after walking for a long time, which is very mild and resolves quickly with rest.
2.
I engage in brisk walking 3 to 5 times a week, covering 5 to 6 kilometers (about 1 hour) each time.
3.
I perform 100 squats daily.
Here is my X-ray: https://drive.google.com/file/d/1w3F25gpgCRrmaHkAKX4zC7YBDEpt2iiF/view?usp=sharing
I would like to ask the doctor if surgery is necessary, or should I continue to wait?

Xiao Cheng, 40~49 year old female. Ask Date: 2020/01/06

Dr. Chen Yongxue reply Orthopedics

Hello, based on your X-ray, the bone callus has developed quite well.
Additionally, as you described, movement is not an issue.
I personally believe it will continue to improve, so don't worry.

Reply Date: 2020/01/06

More Info

When evaluating recovery options for femoral fractures, especially in the context of a complex case like yours, it is essential to consider multiple factors, including the nature of the fracture, the healing process, and the opinions of different medical professionals. In your case, you have received differing opinions from two orthopedic surgeons regarding the status of your recovery and the necessity of further surgical intervention.

Understanding the Healing Process
Femoral fractures, particularly comminuted fractures, can present significant challenges in terms of healing. The healing process involves several stages, including inflammation, repair, and remodeling. During the repair phase, new bone tissue forms, and during remodeling, the bone becomes stronger and more organized. It is not uncommon for the healing process to take longer than expected, especially in cases of comminuted fractures where the bone is shattered into multiple pieces.

Opinions from Your Doctors
1. Doctor A's Perspective: This doctor believes that your bone has healed approximately 80% and that as long as you are not experiencing significant pain, you can engage in normal activities. This perspective emphasizes the body's natural healing ability and suggests that further monitoring may not be necessary.

2. Doctor B's Perspective: This doctor is more cautious, suggesting that the bone has not healed sufficiently and recommending surgical intervention to remove any non-union or poorly healed bone fragments and replace the internal fixation device with a stronger one. This approach is more aggressive and aims to ensure that the bone heals properly.

Factors to Consider
- Pain Levels: You mentioned that your leg is not very painful, but you do experience slight discomfort after prolonged walking. This is an important indicator of your recovery status. If the pain is manageable and does not worsen with activity, it may suggest that your bone is healing, albeit slowly.

- Activity Levels: Your current activity level, including regular walking and deep squats, is a positive sign. Engaging in physical activity is crucial for bone health and can promote healing. However, it is essential to listen to your body and avoid overexertion.

- Imaging Results: The X-ray images you provided can give valuable insights into the healing status of your femur. If there are signs of bone bridging or callus formation, this may indicate that healing is progressing. Conversely, if there are gaps or signs of non-union, this may support Doctor B's recommendation for surgery.

Recommendations for Moving Forward
1. Seek a Third Opinion: Given the differing opinions from Doctors A and B, it may be beneficial to consult a third orthopedic surgeon. This can provide you with additional insights and help you make a more informed decision regarding your treatment options.

2. Consider Imaging Studies: If you have not had recent imaging studies, it may be worthwhile to obtain updated X-rays or even a CT scan to assess the current state of your fracture healing. This can provide objective data to guide your treatment decisions.

3. Monitor Symptoms: Keep a close eye on your symptoms. If you notice increased pain, swelling, or any changes in your ability to walk or perform daily activities, it may indicate that further intervention is necessary.

4. Physical Therapy: Engaging in a structured physical therapy program can help improve strength and mobility in your leg. A physical therapist can also provide guidance on safe exercises to promote healing without risking further injury.

5. Discuss Surgical Options: If you decide to pursue surgery based on the recommendations of your doctors, ensure that you fully understand the procedure, the risks involved, and the expected outcomes. Discussing these factors with your surgeon can help alleviate any concerns you may have.

Conclusion
In summary, the decision to undergo further surgery for your femoral fracture should be based on a comprehensive evaluation of your healing progress, pain levels, and activity tolerance. Seeking a third opinion and obtaining updated imaging studies can provide valuable information to guide your decision-making process. Remember that recovery from a complex fracture can take time, and patience, along with appropriate medical guidance, is key to achieving the best possible outcome.

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