Stiff Knee joint after Femur Fracture

[Wyx555!]

Hello,
I had a distal femur fracture a month ago, my ortho fixed it with DCS implant (Dynamic Condylar Screw (DCS) Implant). The leg was immobilised for some time using bandage and knee brace to aid fixation. 1 month now and x ray show bone union still not full that I give it 4 more weeks, however the knee joint is stiff and a bit swollen. The knee brace too was removed. What could be the cause?

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[physiobob]

Totally normal. Give it time! 6 weeks as a minimum for bone callous to form, then 2-3 months for basic strength (although the DCS implant will assist). 12-18 months for full normal function. It will be swollen until you are several weeks into a full exercise program as the knee needs to return to normal function to assist the reduction in swelling. In general think about all muscles that cross the knee - hamstrings, calf and quads. You can work on all and neural tissue to facilitate a return to normal knee function. But be guided by your surgeon as to how much and when. If you have an images on x-ray we'd love you to post them

[yelufem]

It seems you are doing well as Physiobob rightly put it.Post-immobilisation stifness of the associated joints in most of our hospitals remains unavoidable giving the facilities most commonly available in many orthopedic wards.
I would also suggest a medium grade of static exercise ( e.g.quad setting) of the surrounding muscles to prepare you for smooth and rapid recovery.This could also control your swelling.Please do not embark on exercise above without discursing it with your physio or surgeon.
You are doing well.So no cause for alarm.yelufem.

[Wyx555!]

Thanks Physiobob, will surely post the x ray films, another concern, is the DCS usually removed after healing?

[Wyx555!]

Thanks Yelufem, so does the stiffness persist even after healing? What can I do to avert this as of now I can not fully straighten or bend the knee (160-100 degree). and the swelling is in the knee joint, will the said exercise help?

[yelufem]

Hi wxy555. It seems your surgeon did not refer you for physio. You see, in most cases, reduction of the fracture of the long bones are accompanied by the stiffness of the associated joints b/c they must be kept immobile to allow smooth fracture healing.
Post immobilization rehabilitation is essential in most cases and your Dr should have prepared your mind for physio.
Nevertheless, u need a physiotherapist at this stage to mobilize your stiff knee. Your hx reveals, u might have developed extention lag of that knee.Yes the exercise i prescribed is appropriate for u but u need a physio to mobilize your knee in order to improve your knee range of motion and to prescribe case specific rehab program for u.
You may remind your Dr to consider referring u for physio.
Your fracture can be healed and still have gross limitation in joint motion.
With adequate rehab you would be out of this soon.yelufem.

[Wyx555!]

Thanks for insight, I certainly gonna request for physio sessions.

You talked of extensor lag... but my case when I cant extend/bend my knee more it hurts and I feel like something in the knee can not move any more. Could it be the knee was not aligned correctly? How can I verify this from x ray film
If I have extensor lag, are excercise enough to clear it or there is some other procedures involved?

BR

[yelufem]

Seeing a physio will surely be a great ideal. I do not have the luxury of seeing your x-ray,this could have helped in making informed judgement on while u had extention lag. You did not report that your distal femoral fracture communicated into the joint space.Besides malunion of the said fracture could also be responsible for your extention lag.So many factors could be responsible.I am sure,u would surely find solace in the hand of a competent physio.
I am looking forward to seeing u out of this soon.yelufem.