Femoral Neck Fracture Healing and Weight-Bearing Guidelines

Healing of femoral neck fractures?

Hello Dr.
Chen: I am 47 years old.
On July 4th, I suffered a displaced femoral neck fracture in my right leg, for which I underwent internal fixation with both a thick and a thin screw and a plate.
During my third follow-up appointment on September 24th, after an X-ray, the doctor said that my fracture site has healed and that I can gradually bear 100% weight and start to wean off the crutches.
I am very happy, but it has been less than three months, and considering it is a femoral neck fracture, I am a bit worried.
I fear there may be long-term complications, and I am struggling internally.
Therefore, I would like to ask you if it is really safe to wean off the crutches and bear weight now? Thank you for your response.
Thank you.

Chen Jiabao, 40~49 year old female. Ask Date: 2020/09/26

Dr. Chen Bochen reply Orthopedics

Hello, if you are concerned, you can try to increase the weight by 10% each week.
If you feel comfortable, continue to increase it up to 100% and even incorporate some light exercise.
If you experience mild discomfort, maintain your current level without further increases.
If you feel significant discomfort, return to your attending physician for evaluation.
Gradual progression is a safe and reassuring approach.
Wishing you a speedy recovery.

Reply Date: 2020/09/26

More Info

Understanding femoral neck fractures and their healing process is crucial, especially for someone like you who has recently undergone surgery. A femoral neck fracture, particularly one that is displaced, can be a serious injury, often requiring surgical intervention to stabilize the bone and promote healing. In your case, it sounds like you had a successful surgery with the placement of screws and a plate, which is a common approach for this type of fracture.

The healing process for a femoral neck fracture can vary significantly from person to person, depending on factors such as age, overall health, the severity of the fracture, and the type of surgical intervention performed. Generally, the healing time for a femoral neck fracture can take anywhere from 12 to 16 weeks, but this can be shorter or longer based on individual circumstances.

Your doctor has indicated that your fracture site has healed sufficiently to allow for 100% weight-bearing and gradual cessation of crutch use. This is a positive sign, but it is understandable that you have concerns about potential long-term complications. Some common concerns following a femoral neck fracture include:
1. Nonunion or Malunion: This occurs when the bone does not heal properly, which can lead to chronic pain and instability. Regular follow-up appointments and X-rays are essential to monitor the healing process.

2. Avascular Necrosis (AVN): This is a condition where the blood supply to the femoral head is compromised, leading to bone death. This is a risk with femoral neck fractures, particularly in older adults or those with certain medical conditions.

3. Post-Traumatic Arthritis: Damage to the cartilage during the fracture can lead to arthritis in the hip joint over time, which may cause pain and reduced mobility.

4. Range of Motion and Strength: After a fracture, it is common to experience stiffness and weakness in the affected leg. Rehabilitation exercises are crucial to restore strength and mobility.

Regarding your concerns about weight-bearing and crutch use, it is essential to follow your doctor's recommendations closely. If your doctor has cleared you for full weight-bearing, it typically means that the fracture has healed sufficiently to withstand normal activities. However, it is wise to gradually increase your activity level and listen to your body. If you experience pain or discomfort, it may be a sign that you need to slow down or modify your activities.

In terms of rehabilitation, physical therapy can play a vital role in your recovery. A physical therapist can guide you through exercises designed to improve strength, flexibility, and balance, which are crucial for regaining full function of your hip and leg. They can also help you develop a safe and effective plan for gradually increasing your activity level.

As for your diet, ensuring adequate nutrition is essential for bone healing. Focus on a balanced diet rich in calcium and vitamin D, which are vital for bone health. Foods such as dairy products, leafy greens, fish, and fortified foods can help meet these nutritional needs. Additionally, staying hydrated and maintaining a healthy weight can also support your recovery.

In summary, while it is encouraging that your doctor has cleared you for full weight-bearing, it is essential to remain vigilant about your recovery. Monitor for any signs of complications, adhere to your rehabilitation program, and maintain open communication with your healthcare team. If you have any doubts or experience unusual symptoms, do not hesitate to reach out to your doctor for further evaluation. Your proactive approach to your recovery will be beneficial in achieving the best possible outcome.

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