Our 15-year-old daughter just had surgery to repair a broken femur. Guess they had to stick a long nail down inside the bone to hold all the pieces together while it heals. What kind of problems and recovery can we expect with something like this?

When it comes to holding a broken femur together, there are four different ways to surgically fix (hold in place) the broken bones. The four methods of fixation include: 1) elastic stable intramedullary nail fixation, 2) external fixation, 3) rigid intramedullary nail fixation, and 4) plate fixation.

Intramedullary nails such as you describe are often used when there is a femoral fracture that has been displaced (ends of the bone shift). The nail is designed to hold the bone steady as healing takes place.

With any type of fixation method for broken bones, there are some standard types of complications that can occur. For example, infection, refracture, delayed union, malunion, shortening or lengthening of the bone, and loss of reduction are the most common complications. Loss of reduction means that the bones shifted apart after the fractured edges were brought back together and held in place with hardware.

All four types of fixation methods mentioned here give equally satisfactory results. External fixation is the one method that seems to have the highest number of complications. With external fixation, there are pins through the skin and muscle into the bone. Pins are placed above and below the fracture site with a rigid bar outside the body holding the bone in place.

Fractures treated with external fixation take much longer to heal. That finding doesn’t necessarily mean surgeons shouldn’t use external fixation in adolescents with femoral fractures.

This particular complication could be the result of the treatment method, but it could also reflect the fact that this type of fixation is used for the more severe (open) fractures. And we know that open fractures (bone broken and protruding through the muscle and skin) take longer to heal than closed fractures (bone broken but not displaced through the skin).

Hopefully, your daughter won’t experience any complications. But should you notice anything suspicious, don’t hesitate to contact your surgeon’s office and let them know your concerns. The earlier any complications can be addressed, the better the outcomes.