Postoperative care of femoral and supracondylar fx

1. PostoperativeCare
Dr. Mohammad Mahdi Shater
Orthopedic Surgery Resident

2. Plate Fixation
for Femoral
Shaft
Fractures
 External supports such as casts or cast braces are unnecessary
 Early active range-of-motion exercises should be encouraged as soon
as wound healing allows.
 Weight bearing should be limited to the weight of the leg until there is
radiographic evidence of healing and resolution of fracture site
discomfort.
 Radiographic evaluations at 6-week intervals are usually adequate for
following the progression of healing.
 If direct reduction and compression plating are used, primary bone
healing is predicted. As a result, radiographic evidence of healing and,
thus, weight bearing are frequently delayed for 4 to 5 months.
 If bridge plating and indirect reduction techniques are used, healing
should progress similar to intramedullary nailing with callus formation
evident on radiographs. As a result, weight bearing can usually begin
earlier.
 Plate removal should be limited to symptomatic patients and should
be delayed for a minimum of 18 to 24 months because of the risk of
refracture

3. Intramedullary
Nailing
for Femoral
Shaft
Fractures
 Operative stabilization of femoral shaft fractures allows early
patient mobilization, decreases pain, facilitates nursing care,
minimizes joint stiffness, and allows early functional
rehabilitation.
 Early mobilization avoids many of the complications associated
with prolonged recumbency such as pulmonary compromise,
pressure sores, and muscle deconditioning.
 Patients usually experience significantly diminished pain after
femoral stabilization. As a result, they should be encouraged to sit
up and get out of bed immediately after fixation.
 Quadriceps and hamstrings exercises can proceed according to
the patient’s comfort.
 Unrestricted active and passive range-of-motion exercises of the
knee and hip can similarly be instituted immediately after surgery

4. Intramedullary
Nailing
for Femoral
Shaft
Fractures
 Restoration of motor strength is dependent on the traumatic
injury to the muscles, any associated injuries,and the patient’s
motivation.
 In patients with isolated femoral shaft fractures, supervised
outpatient physical therapy may not be absolutely necessary.
 However, a specific rehabilitation protocol that focuses on the
known impairments associated with femoral intramedullary
nailing has been shown to be effective and can predictably restore
function.
 These targeted impairments include abduction weakness, knee
extensor weakness, anterior knee pain, and gait abnormalities.

5. Intramedullary
Nailing
for Femoral
Shaft
Fractures
 Weight bearing on the extremity is guided by a number of factors
including the patient’s associated injuries, the soft tissue injury,
and the location of the fracture.
 For fractures treated with the currently manufactured
intramedullary nails, immediate weight bearing is safe from a
mechanical standpoiny.
 early weight bearing after reamed statically locked antegrade
intramedullary nailing is safe. Early weight bearing may encourage
callus formation and should be encouraged in applicable patterns.
 Fractures with proximal or distal extension and associated
ipsilateral femoral fractures require individual modification to the
weight-bearing progression

6. Intramedullary
Nailing
for Femoral
Shaft
Fractures
 If weight bearing is limited during the first 6 to 12 weeks, an ankle
dorsiflexion splint or orthosis should be used to avoid an equinus
contracture.
 Radiographic evaluations are usually obtained at 6 weeks, 12
weeks, and 6 months and should include two views of the entire
femur to include the proximal and distal interlocking screws as
well as the hip and knee joints
 . Groin pain in a patient who has sustained a femoral shaft fracture
should be evaluated at any point in the postoperative course given
the possibility of an associated clandestine or iatrogenic femoral
neck fracture. However, clandestine femoral neck fracture has
been observed in asymptomatic patients as well.
 This review emphasizes the need for dedicated hip radiographs
postoperatively and at any time a patient becomes symptomatic.

7. Supracondylar
Fractures of
the Distal
Humerus
 acetaminophen , ketorolac (a nonsteroidal anti-inflammatory)
 Patients with minimal swelling felt to be at little risk for
compartment syndrome may be discharged to home with
appropriate postoperative instructions, but otherwise children are
generally admitted overnight for elevation and observation.
 We recommend the elbow is elevated over the heart for at least 48
hours postoperatively.
 The patient customarily returns 5 to 7 days postoperatively at
which time AP and lateral radiographs are obtained
 The cast is generally removed 3 weeks postoperatively
 The pins are removed in the outpatient setting at this time.
 Range-of-motion exercises
 The child returns 6 weeks postoperatively for a range of motion
check, with no radiographs at that time.