Post-Surgery Concerns: Intramedullary Nails and Bone Plates

Regarding intramedullary nailing of the femur and plate fixation of the metacarpals postoperatively?

Dear Doctor, I have a few questions regarding my recovery one month after my femur fracture surgery, and I would like to seek your expertise:
1.
When I fully extend my knee, I can feel the metal rod protruding (see images 1, 2, and 3), which causes a sensation of tightness and discomfort each time I straighten my leg.
Is this normal? Will this improve over time, or will I need to wait until the rod is removed for the discomfort to go away?
2.
Currently, if I bend my knee less than 90 degrees, I experience extreme soreness in the front of my thigh, which makes it difficult to bend my knee.
Could this be what is commonly referred to as muscle adhesion? Should I wait until three months post-surgery to assess this further?
3.
Regarding the removal of the metal plate in my hand (see image 4), is it also recommended to wait a year for that, or since it involves a smaller bone, can it be removed earlier than the femur?
Thank you in advance for your guidance.

Mr. Lin, 30~39 year old female. Ask Date: 2022/09/04

Dr. Zhan Xian reply Orthopedics

Hello Mr.
Lin, the X-ray you provided cannot be opened, and I am unable to give feedback on the images.
Since it has been about a month post-fracture surgery and the fracture has not yet healed, you can discuss your concerns with the surgeon during your follow-up appointment.

Reply Date: 2022/09/04

More Info

Post-surgery concerns, especially after a significant procedure like femoral fracture repair, are quite common and understandable. It's essential to address these concerns with accurate information and guidance. Let's break down your questions one by one.

1. Protruding Intramedullary Nail: It's not uncommon for patients to feel discomfort or a sensation of "catching" when the knee is fully extended if the intramedullary nail is protruding. This sensation can be due to the nail's position relative to the surrounding soft tissues and the knee joint. While some patients may experience this discomfort temporarily, it often improves as the surrounding tissues heal and adapt. However, if the protrusion is significant and causing persistent pain or functional limitations, it may be necessary to discuss with your orthopedic surgeon the possibility of nail removal or adjustment. In many cases, the discomfort may resolve over time, but it’s crucial to monitor the situation and communicate any ongoing issues with your healthcare provider.

2. Knee Flexion and Muscle Pain: The inability to bend your knee beyond 90 degrees and the associated pain could indeed be related to muscle tightness or adhesions, commonly referred to as "muscle adhesion" or "scar tissue formation." After surgery, especially with significant trauma like a fracture, the surrounding muscles and tissues can become stiff and may not move as freely as before. This can lead to discomfort when trying to bend the knee. Physical therapy is often recommended to help regain range of motion and reduce pain. Engaging in a structured rehabilitation program can be beneficial, and it’s advisable to start gentle stretching and strengthening exercises as guided by your physical therapist. If the pain persists or worsens, further evaluation may be necessary to rule out complications.

3. Removal of the Plate: The timing for the removal of hardware, such as plates or screws, can vary based on several factors, including the type of bone involved, the healing process, and the surgeon's preference. For smaller bones, such as those in the hand, removal may be considered sooner than for larger bones like the femur. Typically, plates are left in place for at least a year unless there are complications or significant discomfort. Your surgeon will assess the healing progress through follow-up appointments and imaging studies to determine the appropriate time for hardware removal. It's essential to follow your surgeon's recommendations regarding this matter.

In summary, your concerns are valid and reflect common experiences after orthopedic surgery. It's crucial to maintain open communication with your healthcare team, attend follow-up appointments, and engage in rehabilitation to optimize your recovery. If you experience any new or worsening symptoms, do not hesitate to reach out to your surgeon for further evaluation. Remember that recovery can take time, and patience is key as your body heals.

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