Intertrochanteric Femur Fractures: Healing Time and Surgical Considerations

Intertrochanteric femoral fracture

I fell on December 19, 2004, and sustained an intertrochanteric fracture of the left femur (it was just a crack).
I underwent surgery to have a steel nail inserted, and it has been nearly two months since then.
The doctor told me that it would take two months for the bone to heal and four months before I could move freely.
Is this true? Additionally, will the steel nail need to be removed surgically after a year? If it is not removed, what are the potential complications? I appreciate your patience in answering my questions! Thank you very much!

Robin, 30~39 year old female. Ask Date: 2005/02/11

Dr. Xu Zhaoren reply Orthopedics

Intertrochanteric fractures typically occur in the elderly, while younger individuals usually sustain them due to significant trauma.
In younger patients, the associated soft tissue injuries (muscle, periosteum) tend to be more severe.
Healing generally takes about 4 to 6 months.
The inserted hardware, such as nails and plates, is considered a foreign body; in elderly patients, it is usually left in place, whereas in younger patients, it is preferable to remove the hardware.

Reply Date: 2005/02/11

More Info

Intertrochanteric femur fractures, which occur in the region between the greater and lesser trochanters of the femur, are common injuries, especially among older adults due to falls. Your situation, where you sustained a fracture from a fall and underwent surgical intervention with the placement of a nail, is a typical approach to managing this type of fracture.

Regarding your healing timeline, it is generally accurate that bone healing can take approximately 6 to 12 weeks, depending on various factors such as the patient's age, overall health, the severity of the fracture, and the surgical technique used. In your case, your doctor indicated that it would take about two months for the bone to heal, which aligns with standard expectations for intertrochanteric fractures. However, achieving full functional recovery, where you can move freely and without pain, may indeed take longer, often around four to six months. This timeline allows for not just the healing of the bone but also for rehabilitation to regain strength and mobility.

As for the surgical hardware, such as the steel nail you mentioned, it is not uncommon for orthopedic surgeons to recommend leaving the hardware in place unless it causes discomfort or complications. Many patients live with these implants without any issues. If the hardware is left in, potential long-term effects can include discomfort or irritation in the area where the hardware is located, especially during physical activities. In some cases, the hardware may become a source of pain if it becomes prominent under the skin or if the surrounding bone does not heal properly.

If your surgeon recommends removing the hardware after a year, it is typically due to concerns about the potential for irritation or complications. However, if the hardware is stable and not causing any problems, many surgeons will opt to leave it in place. The decision to remove it should be made in consultation with your orthopedic surgeon, who can assess your specific situation and provide personalized advice.

In terms of rehabilitation, physical therapy is crucial after the initial healing phase. Engaging in a structured rehabilitation program can help restore strength, flexibility, and function to the affected leg. Your physical therapist will likely focus on exercises that promote range of motion, strength training, and balance to help you regain your pre-injury level of activity.

In summary, your understanding of the healing process is generally correct. Expect a healing period of about two months, with full functional recovery potentially taking four months or longer. The decision regarding the removal of the steel nail should be made based on your comfort and the advice of your orthopedic surgeon. Regular follow-ups and communication with your healthcare provider will be essential in ensuring a successful recovery. If you have any concerns or experience unusual symptoms, do not hesitate to reach out to your doctor for further evaluation.

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