Femur Fracture Fixation with Intramedullary Rod

An intramedullary rod is simply a metal rod inserted through the canal of the femur along the femoral shaft. The purpose of this rod is to stabilize and align the femoral shaft after a fracture or break. The exact presentation of the fracture will largely determine the scope of the repair, however the intramedullary rod is useful for most femur shaft fractures including:

• A transverse fracture where the femur shaft is simply broken in two, horizontally
• An oblique fracture, where the femoral shaft is broken at an angle
• A spiral fracture where, the break creates a spiral of broken bone down a portion of the femoral shaft, usually as a result of a twisting injury
• A comminuted fracture where the femur has broken into three or more pieces

The Surgical Process

Ideally, the femur fracture is repaired within a day or two of the injury. However, this may be delayed due to other life-threatening injuries that sometimes accompany the femur fracture. Because of the force required to fracture the femur, it is often associated with other significant injuries. If the fracture cannot be permanently fixed right away, external fixation may be required as a temporary solution. Pins and screws are placed into the bone both above and below the fracture – a bar is attached on the outside of the skin. This creates a sort of exoskeleton to hold the bones in place.

Once the patient is stable enough for internal fixation, an intramedullary rod is inserted into the femur along its entire length. This creates a very strong foundation for the repair. Screws are inserted through the femur both above and below the fracture to ensure that the rod stays in place and the bone is in alignment.

Recovery From Surgery

Recovery from a femoral shaft fracture requires up to six months, but may require more time if the fracture is particularly severe or if the patient has impediments to healing, including general health issues, diabetes or tobacco use. During this time, patients will also undergo a full course of physical therapy to strengthen surrounding muscles and speed recovery. Depending on the nature of the fracture and repair, patients may or may not be able to put weight on the leg.

Complications & Considerations

Complications and considerations of a femoral shaft fracture include damage to surrounding soft tissue structures such as ligaments and damage or irritation to nerves and blood vessels. While this is rare, it is important to remember that whatever caused the fracture required significant force, increasing the likelihood of surrounding injury. Open fractures – where the bone penetrates the skin, or the wound reaches the bones – may become infected. Acute compartment syndrome may also occur, where excessive pressure within the muscles decreases blood flow and may compromise the muscle.

Surgical complications can be mitigated by an experienced orthopedic surgeon such as Dr. Manning, but can include infection, injury to surrounding blood vessels and nerves, blood clots, malalignment of the bones, nonunion – where the fracture does not heal, and reaction to the hardware implants.