Is There a Standard Rehabilitation Protocol After Femoral Intramedullary Nailing?

Abstract

The purpose of this article was to describe the impairments and functional deficits associated with femoral shaft fractures treated with an intramedullary (IM) nail and to illustrate an evaluation-based rehabilitation program designed to target these functional deficits. The current literature describing management of diaphyseal femur fractures is replete with evidence regarding surgical management and optimal bone healing. However, a dearth exists with respect to postoperative rehabilitation recommendations, targeting the impairments that often limit return to activity. Current literature suggests that residual impairments after IM rod fixation of a femoral shaft fracture include hip abduction weakness, knee extensor weakness, anterior knee pain, and gait abnormalities. Any combination of these impairments can potentially limit the ability of a patient to return to prior levels of function. A rehabilitation program designed to target these impairments provides the best opportunity for a favorable outcome. REHABILITATION PROTOCOL: An evaluation-based rehabilitation protocol designed to target known impairments after a femoral shaft fracture is presented. Progression through the program is dependent on successful attainment of baseline goals. These goals address weight bearing (WB) status, knee effusion, quadriceps control, and hip abduction strength. The program is a dynamic incorporation of interventions designed to target these known impairments. An evaluation-based rehabilitation protocol for femur fractures treated with an IM nail can facilitate restoration of function in a predictable manner and should be considered as a standard for patients with these injuries.