Poor Healing in Femoral Fractures: Key Questions Answered

Q: Poor Healing in Femoral Fractures: Key Questions Answered

Hello： In response to your question. <br>You are truly filial, and with your devotion, your mother’s condition will surely improve! From a medical perspective, your mother has a femoral fracture that has been stabilized with intramedullary nailing. <br>After a year and a half, it

Poor healing of femoral fractures?

Hello Doctor, my mother is 61 years old.
She had a femoral fracture due to a car accident a year and a half ago.
The fracture was caused by impact and is a non-comminuted fracture.
She underwent surgical fixation with a plate and two screws at both ends of the femur.
Follow-up X-rays have shown no signs of healing at the fracture site to date.
I have the following questions:
1.
Should the ends of the fracture be completely and tightly joined for proper healing, or is it acceptable to maintain a certain gap to allow for bone regeneration? Would a gap of approximately 2.5 mm affect the healing process?
2.
If the 2.5 mm gap is considered normal, can shockwave therapy help promote bone growth and healing?
3.
Are patients with high blood sugar or diabetes suitable candidates for shockwave therapy?
4.
What are the precautions and risks associated with shockwave therapy?
Thank you, Doctor!

webdoff, 30~39 year old female. Ask Date: 2007/10/15

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question.
You are truly filial, and with your devotion, your mother’s condition will surely improve! From a medical perspective, your mother has a femoral fracture that has been stabilized with intramedullary nailing.
After a year and a half, it has still not fully healed.
Clinically, fractures can present in various forms; some are transverse, while others are oblique, and during reduction, it may not achieve perfect apposition.
A gap of 2.5 mm is generally acceptable.
Typically, if a fracture has not healed after nine months, it is considered nonunion.
There are several treatment options for nonunion.
If intramedullary nails are used, the most common approach is to remove the transverse screws either from the top or bottom, allowing for weight-bearing to promote the ends of the fracture to unite.
Shockwave therapy is also an option, but it is not covered by health insurance and would need to be paid out of pocket.
Regarding the applicability of shockwave therapy for diabetic patients or any associated risks, I personally recommend that you find a hospital that offers shockwave therapy and have a responsible physician evaluate the situation.
It would be best to discuss it face-to-face with that physician.
Shockwave therapy is generally considered a safe treatment method (similar to extracorporeal shock wave lithotripsy), but I am not a shockwave expert and cannot provide further advice on that.
Lastly, I wish your mother a speedy recovery!

Reply Date: 2007/10/15

More Info

Understanding poor healing in femoral fractures can be a complex issue, especially in older patients or those with underlying health conditions. Your mother’s case, involving a non-displaced femoral fracture that has not shown signs of healing after a year and a half, raises several important questions regarding the healing process and potential treatment options.

1. Bone Healing and Gap Management: In general, for optimal bone healing, the fracture ends should be in close proximity to each other, ideally with minimal or no gap. A gap of about 2.5 mm can hinder the healing process, as it may not provide the necessary mechanical stability for the bone to regenerate properly. The body typically requires direct contact between the bone ends for effective healing, especially in cases of non-displaced fractures where the alignment is crucial. If the gap is too large, it may lead to delayed union or non-union, where the bone fails to heal completely.

2. Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) has been studied for its potential to enhance bone healing, particularly in cases of delayed union or non-union. This treatment can stimulate bone regeneration by promoting blood flow and cellular activity at the fracture site. However, the effectiveness of shockwave therapy can vary based on the individual case. If the gap of 2.5 mm is deemed significant, shockwave therapy may help, but it is essential to consult with an orthopedic specialist to evaluate whether this treatment is appropriate for your mother’s specific situation.

3. Diabetes and Shockwave Therapy: Patients with diabetes, particularly those with poorly controlled blood sugar levels, may face challenges in bone healing. High blood sugar can impair the healing process and increase the risk of complications. While shockwave therapy can be beneficial, it is crucial to manage blood sugar levels effectively before considering this treatment. A thorough discussion with the treating physician about the potential risks and benefits of shockwave therapy in the context of diabetes is essential.

4. Considerations and Risks of Shockwave Therapy: Shockwave therapy is generally considered safe, but there are some risks and considerations. Patients may experience discomfort during the procedure, and there is a potential for bruising or swelling at the treatment site. Additionally, it is not suitable for everyone; for instance, individuals with certain conditions, such as infections or tumors in the area of treatment, should avoid this therapy. It is also important to have realistic expectations, as while shockwave therapy can promote healing, it may not guarantee complete recovery.

In summary, your mother’s situation requires careful evaluation by an orthopedic specialist. They can assess the fracture site through imaging studies and determine the best course of action, which may include surgical intervention, additional imaging, or alternative therapies like shockwave treatment. It is crucial to address any underlying health issues, such as diabetes, to optimize healing outcomes. Regular follow-ups and open communication with her healthcare team will be vital in navigating her recovery process.

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