Learning to walk after femur surgery – orthopedics forum – ehealthforum p gasket 300tdi


When it is suggested to put 25% weight on the leg, the best way to determine that is to use your bathroom scale. Using your crutches for support, stand next to the scale. Put the foot of your bad leg on the scale. Start applying pressure on the leg, till the scales reaches the amount equal to 25% of your body weight (i.e. if you weigh 175 lbs, then you would want to put around 45 lbs on the foot.) Do this several times till you get the idea of what 25% body weight feels like. Hope that make sense.

When ambulating with a cane in the opposite hand, it has been shown through physics (vector forces through the hip joint, accounting for the pull of the gluteus medius muscles, and others also), that it reduces the force through the femoral neck, into the acetabulum, by up to 50%. If that helps any.

If you are interested at looking at the hip joint from an engineering or biomechanical standpoint, there are several texts available that go over all of the joints in the body in vector analysis. You can determine exactly how many neutons of force you are applying through the femoral neck in each phase of gait, and also when using ambulatory appliances, or if there is muscle weakness in certain muscle groups. This is actually required as part of orthopedic residency training programs. To be able to figure all of this out. It really plays into gait analysis, with cerebral palsy or stroke patients. So, the information is out there.

The key in femoral neck fractures is to get the bone to heal. The screws will only hold up for so long, before succumbing to cyclic loading stress. And they take a lot of stress in the single leg stance phase of walking. That is where the crutch or cane comes in, to decrease the amount of stress applied.

Our fancy bathroom scale responded with "error", no matter how or where I placed my foot to try your 25% weight bearing suggestion. But on Labor Day, I finally found a friend with a scale that worked. I pushed with my foot to a point that felt close to what my leg felt like when I exercised it for about the 1/4 mile crutch aided exercise walks in the neighborhood. Two attempts (79 and 84 lbs) appeared to be pretty close to that point. With my body weight of about 136 lbs, my exercise level is about 60% of my body wt.

I was scheduled for and kept my sep1 appointment for the post-op with my original surgical group from the hospital. [I "chatted" with you recently about an ortho who saw me 3 times, being a 2nd opinion, who only used the 3 sets of films he took to suggest that my bone was not healing and needed a hip replacement (for some reason, he did not want the films I broght from my surgery teams post-ops)]. At the sep1 appt, it was shown and shared with me that my fractured bone was compressed as shown on films from my july15 and sep1 appt. But because was no change from the july15 to the sep1 film, there is no reason to be alarmed yet, even with the compression difference resulted in the same length of "exposed" screws. I was told, however, that any complications resulting from this would probably mean a hip replacement.

When I showed them how I walked and inquired about my healing, they indicated that I have more of a gait than limp problem and that I have no healing issue that should preclude my ability to walk, even by now, and that I would grow away from my limp eventually.

I’m concerned about the screws now, especially as this relates to stress comment you made. They advised against contact sports or high impact activity and scheduled for a follow-up appt in 6 months. They also advised that I decrease my use of the crutch.

To make the gait more natural, the cane should be in the opposite hand, the hand away from the injured side. Thus, the cane proceeds forward as the injured leg steps forward. Weight is shifted onto the cane, so as the injured leg is in the stance phase of ambulation, part of the weight in on the injured leg and part of the weight is borne on the cane. And when it is done this way, the upper body/torso does not have to lean to one side, and the patient does not develop bad gait habits.

When the cane is used this way, up to 50% of the body weight can be borne through the cane. When the cane is used on the same side, the upper body has to lean over, and more stress is applied to the wrist/hand holding the cane. It is just an awkward way to try to ambulate, and actually takes more strength and energy to walk that way, besides being quite a bit slower.

It will take a little practice, but, after a while is becomes very natural. It is sort of like the gentleman walking down the streets of London, with his umbrella in his hand. You don’t have to add the little flair like he does as he moves the unbrella forward, but you get the idea.

As a fracture heals, in general, you will see a little area of what looks like fluffy stuff at the edges of the bone. The fracture line itself will begin to become less and less distinct. It will start to become fuzzy. This is when the bone is beginninbg to bridge the "gap" The bone on both sides of the fracture line are joining together.

As healing continues, the fracture area may look a lot whiter on the x-ray becasue it has extra bone around it. There may even be extra bone on the edges. With time, as the bone remodels the bridging bone begins to look more and more like the normal bone around it.

How much bone the body actually lays down, depends upon a lot of factors. If the fracture is fixed, usually not as much bone is laid down. Since the bone is not moving around, the body doesn’t need to lay down a whole bunch of callus to stop the motion.

So, when you look at an x-ray, you can tell how the fracture is healing, by the way the bone is appearing. It progresses in a predictable fashion. If it stops, or deviate from the progression, then the surgeon can tell that something is not quite right.