Femoral Shaft Fracture Treated With Intramedullary Fixation Phase 1 to 6 weeks Phase 2—cont’é 6 weeks to 3 months cont'd Phase 3 306 months + If the fracture has bone to-bone contact and a stable construct with a nail diam- eter of 12. mm or more, allow weight bearing to tolerance, with progression to full weight bearing as tolerated, usu- ally by 6 to 12 weeks. For patients with unstable fractures or fractures stabilized ‘with small-diameter nails, begin with 25 kg (= 50 Ibs) weight bearing with ‘crutches or walker as other injuries per- rit # Rogin quadriceps sets, ghiteal sets, hamstring sets, ankle pamps. + Perform straight leg raising in all planes, supine and standing. + Perform knee active ROM exercises @lexion and extension) + Use stationary bicyele for ROM and strengthening ROM during this phase. With smaller diameter ails (10 to 11 mil, achieve- full weight bearing incrementally wsing the scale technique for progression, Perform isokinetic exercises Perform closed-chain exercises (p. 152) Most patients have progressed to full weight bearing and from crutches to a cane. If the patient is not fall weight bearing and radiographic studies reveal lack of healing, consider either dy- namization or bone augmentation one grafiing, electrical stimulation). Continue closed-chain exercises until the patient obtains full knee and hip ROM, can perform a full squat, and can climb and descend stairs full weight bearing without an assistive device. Phase 2 B weeks to 3 months Phase 4 > months Instruct and obseive cruteh walking technique. *+ Begin open- and closed-chain exercises as tolerated, If full weight bearing is not possible, tase scale technique. The patient places the injared extremity on a scale to mea- sure the amount of weight bearing that is comfortable. Insinict the patient to progress weight bearing in to 10-Kg increments each week until full weight bearing is possible. Continue the crutches until the patient caf bear full ‘weight in the one-limb stance. Use a cane if necessary until gait is corrected with no lurch or Trendelenburg, gait Most patients regain 80% to 90% of Full ‘Thigh circumference should be almost equal to the uninjured side before dis- continuing rehabilitation. ‘Most patients have returned to athletic activities other than contact sports, ‘which must be judged on an individual basis. Ifa plateau is reached with no im- provement in the amount of weight bearing or evidence of nail loosening or screw breakage, and there are signs of radiographic nonunion, exchange nail- ing or auiologous bone grafting may be considered, caution: If delayed healing is suspected, the patient should be evaluated to rule ‘out occult infection, vascular insuffi ciency, or metabolic etiology for the nonunion. Resume full work and recreational ac- tivities as tolerated. NOWWANIEVHat O1G3vdOH.NO 40 YOORGNYH FOF qyusoapeg 40mo7 ous Jo soumoesg YMC UIldVHOFemoral Shaft Fracture Treated With Plate-and-Screw Fixation Rehabilitation is the same as that following intramedul- lay nailing, with the exception that the patient is kept non-weight bearing with crutches for 8 to 12 weeks Weight bearing is not progressed until evidence of con- solidation of the fracture is visible on two radiographic views, usually at 3 to 6 months. Phase 1 * Begin isometries and upper extremity con- ditioning while in traction (preop). Phase 2 + Apply cast brace or hinged, commercial re- habilitation brace. + Ambulate with 20 kg weight bearing until evidence of bridging callus on two radio- graphic views, Phase 3 + Begin open: and closed-chain exercises (p. 18. * Perform ROM exercises for knee in cast brace, + Remove brace. + Ambulaie with crutches until achieving full ‘weight bearing in single leg stance, + Progress open- and closed-chain exercises (p. 152). + Stress active ROM anid active-assisted ROM of the knee after cast removal.