Recovery: 9 year old has slight limp 9 weeks post femur fracture

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Hello and thanks in advance for your time.

On Sept. 28, 2011 my 9 year old son Jacob suffered a spiral midshaft fracture of his left femur when he collided with a teammate at hockey practice. Prior to the injury he was a healthy and very fit young man that played multiple sports at a very high level. It was repaired at Sick Kids hospital in Toronto on Sept. 30 using titanium elastic nailing. Had no perioperative complications other then swelling around knee and thigh, the majority of which subsided within 2- 3 weeks. I have included his last x-ray taken on Nov 8th.

His recovery has been going well. We have been doing the ROM and strength exercises program made for him by the physio at sick kids hospital since week 2. At 5 weeks he was partial weight baring using a walker and at 6 weeks was able to walk short distances independently. He is now 9 weeks post surgery and is very active, walks up and down the stairs in our home 15 times X 3 times a day to build strength, has not required assistive devices to ambulate for over 2.5 weeks, swims twice a week and walks over a 1.5 km three times a week....all without any pain or difficulty.

My concern is his limp. He still walks with a slight limp that over the course of the last two weeks has greatly improved and has become less noticeable, but it is still there HERE is a link to a video of him walking a few days ago.

On assessment he can move the affected limb with good control. Two exceptions. First is when seated in a chair and asked to extend the left leg until straight he can not straighten the leg completely and can only bring it to 165 degrees. The second is he can not bring his left foot all the way back to his bum yet and can only manage to close the angle to approx. 30 degrees or about 4 inches away.

MY QUESTIONS:

-Will it go away on it's own?
-Are there exercises we can do that can help reduce/remove the limp?
-I think his inability to straighten the knee is causing the limp. Does that sound possible and is it possible that this is caused by weak quads/hip flexors?
-What is the typical time to regain strength and range of motion?
-He has not been going to Physio as our surgeon said it was not needed...should he be?

We meet with his surgeon for what he expects to be the last time on Dec 13, 2011. Any questions I should be asking him?

Thank you SO much for your time and effort and I look forward to your response.

UPDATE:

Had Jacob seen by a highly recommended physiotherapist yesterday. He said that his limp is the result of him having "Quad Lag" and gave us some exercises to do. I can remember most of them, but could really benefit some input on form. I want to add a variety of exercises to try to keep in interesting for him and need to know that we are doing them correctly. Can anyone suggest exercises for quad lag and if possible, provide a link to video or a good description of how they are to be performed?

I know the good people here and hammered with questions all the time, but I could really use some help....please? :)

Thanks in advance for your time and effort.

Jacobs Dad Jim

dear Jim,

I understand your worries. Am a parent as well.
The best person to ask everything is the physiotherapist you have gone to.
Variety in exercising is more fun but I suggest you do the exercises you were given first.

Time is the crucial thing, bones need time to heal.
Question I would have for the surgeon is: when will the pins being removed?
Question for you; does Jacob have any pain during weightbearing? if so, the surgeon needs to know.
Pain can be a reason to limp.
The limp should go away at a certain point.

Looking at the video I had the impression that his leg might be a little shorter at this moment.
This does happen often with fractures.

The best advice I can give you is to ask your physio to answer your questions and discuss with him/her what to ask the surgeon.

I wish you both well.

Esther

Thanks for the reply.

The surgeon has said the flexible nails will not be removed.
Jacob has not had any pain since week 3 post surgery and has zero pain/discomfort of any kind when walking. He just says he is having trouble straightening his leg all the way. Physio says his leg length is very slight and would not effect his gait. The bone is now 100% healed (don't have his new x-ray available yet), but images were taken last night and they were shocked at his rate of heeling. So it looks like we just need to get work on the quad lag and he will be well on his way to a complete recovery.

We meet with his surgeon on Tuesday, Dec 13th.

Well that sounds good.

It is really hard to judge when you do not see the child and assess them yourself.
That is why the best people to ask are your physio and the surgeon.

Hope things come out for the best (which they often do with children) and please let us know how things work out.

kind regards

Esther

Hi there,
The fact that the bone is healing well (may take a few more months to heal fully), he is painfree and there is no significant leg-length discrepancy are all very positive things!
He's hip hitching - ie he's lifting his hip up, you can even see his shoulder raise on the affected side. this amy be due to weak quads he may not trust that they have teh strenght to bend his knee or they may have been a time where it was difficult to do this due to pain and it may just be a habit.
He probably doesn't even know he's doing it try having him walk in front of a mirror.
i suspect that strenghtening the quads as u are already doing will increase his ability to straighten out the leg fully which will in turn make him feel more secure about weight-bearing fully through that leg.
You sound like very caring parents!
At 9 weeks post fracture I think he's doing very well
Keep us posted on his progress and Happy Holidays!

UPDATE:

Hello Everyone,

It has been a 2 months since I last posted and since that time Jacob has made remarkable progress. Our meeting with the surgeon was good, but he ordered that Jacob should continue to physio and could return to hockey practice, but with NO contact for 3 months. It was a sad day for him and if I am being honest me too, as we had hoped he would be cleared to return when tolerated. Instead of sulking about it, Jacob (keep in miind he is 9) put the time to good use, working hard every day one his physio, riding the bike and by January the leg was so strong he returned to practice with his team. It was at this time that our physiotherapist referred us to a sports physiotherapist. We started seeing her once a week where she would give him new exercises, test his progress and he was given EMS (Electronic Muscle Stimulation) on the quad of his effected limb. As you can see in this video I took of him just now, his limp is gone when walking. When he runs and skates he has a slight hitch in his stride, but even that has become less and less as his quad/glute continue to grow in size and strength.

Jacob has now progressed to the point where she said he no longer needed to see her. He continues to do lunges, planks, balance ball and runs 2-4 km four days a week. On the ice, his speed, hands and shot have not lost a thing, but I have noticed his first three strides (where you get all your power) are not the same, but realize that like all things in the process take time.

As it stands now Jacob will meet with the surgeon on Mar 2 and is expected to clear him for full games/practices. It's unfortunate that he missed his entire AAA hockey season, but as it turns out he will return just in time for playoffs and his team are expected to win the provincials. Exciting for him and us.

I will update when I know more, but wanted to take the time to thank everyone that offered their help to us here. As a parent it's a scary thing to see your child injured and even tougher if they are asking question you don't have the knowledge to answer. That was the case for me and being able to get support here was very reassuring to both myself, my wife and my son. Thank you all.

One last thing, over this process I have learned a great deal about the recovery of hockey related femur #'s and if anyone is reading this and has question I would be more then willing to try to help you just as so many here have helped us.

Thanks Jim

Another UPDATE:

We met with Jacobs surgeon March 6th and he has been cleared to play games. He now walks/runs without a limp and is skating well, but since he plays AAA hockey is still not where he was, but is making huge progress. At this point he is just happy to be able to get back with his team and play games....and so are we.

One of the things that would have helped me when all this happened was to have some idea of what to expect. So I have put this together in hope that it may help someone else...

Day 1- September 28th midshaft fracture of left femur, admitted to hospital
Day 3- Surgery completed using flexible nails to fix fracture
Day 5 - Up in wheelchair for first time, using pain meds around the clock
Day 6- Discharged from hospital, using wheelchair
Day 17- No need for pain medication
Day 25 - returned to school in wheelchair
Day 30- Started walking short distances in house using walker
Day 40 - Full weight bearing and able to walk short distances while holding our hands. Extreme limp
Day 50- Using walker and crutches
Day 65- Started seeing sports physiotherapist
Day 90 - On skates for first time since injury
Day 100- Returned to regular practice with his hockey team. Very slow and has limp while skating
Day 125- Skating speed much better, limp less and has started to run 3 km
Day 140- No limp while walking or running or skating,
Day 150- Able to keep up with some teammates on ice, but still about 70 percent of ability
Day 155- Surgeon cleared him to play

I estimate he is about another 30-50 days away from being back to 100 percent.

Thanks for this.

This could be a help for someone.
Every case is different so it may go differently.

I am glad everything is going well for Jacob.

Thanks so much for sharing your story. My 8 yr old son, Cameron, broke his left femur (spiral fracture post/pre surgery pictures below) two days ago. He was transported to Arnold Palmer Children's Hospital in Orlando, FL. They have an amazing group of Physicians and Nurses. He had surgery in which they placed two titanium pins into his bone. He has been cleared to come home after seeing the physical therapist today. He did very well on the walker - made it all the way to the nurse station with his upper body strength and his good leg. He is small for his age, but such a tough little guy! He will have a one week post op and then we will start the long road to recovery. He is extremely active and plays on a competitive soccer team. I am very concerned about the long term affects of such an injury, but after reading about your Jacob, I am feeling much better. I hope that Cameron can get back on the pitch and keep on doing what he has come to love.

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Originally Posted by Libby321

Thanks so much for sharing your story. My 8 yr old son, Cameron, broke his left femur (spiral fracture post/pre surgery pictures below) two days ago. He was transported to Arnold Palmer Children's Hospital in Orlando, FL. They have an amazing group of Physicians and Nurses. He had surgery in which they placed two titanium pins into his bone. He has been cleared to come home after seeing the physical therapist today. He did very well on the walker - made it all the way to the nurse station with his upper body strength and his good leg. He is small for his age, but such a tough little guy! He will have a one week post op and then we will start the long road to recovery. He is extremely active and plays on a competitive soccer team. I am very concerned about the long term affects of such an injury, but after reading about your Jacob, I am feeling much better. I hope that Cameron can get back on the pitch and keep on doing what he has come to love.

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Hello,

First off, I am sorry to hear about Cameron's injury, but so glad that posting Jacobs story was of help.

From the x-rays it appears that your son also had Titanium flexible nailing to fix his fracture and since we have just been through it all with our athletic son I hope we can be of further help should you have ANY questions or concerns.

One of the toughest things for Jacob once his pain was managed was finding things for him to do. It wasn't until his injury that we realized how much of his life revolves around sports and being physically active. Since that wasn't possible during his recovery, we encouraged him to read, we play board games, some video games and attended many sporting events. We also continued to go to all his teams games and the coaches of his AAA hockey team were very good to include him in everything they could. This helped him still feel apart of things, as missing his teammates was as big a loss to him as being unable to play.

Some things we wished we had done differently and things you may want to consider:

1)Sports Physiotherapy- As soon as possible to avoid muscle atrophy. We waited too long and the time it took for him to regain his muscle was longer then it took for the bone to heal.
2)Electronic Muscle Stimulation EMS - Our sports physio told us we had we gone to see her week 3 post fracture, the EMS would have GREATLY reduced the muscle atrophy and it turn shave 6-10 weeks off the recover time.
3)Realistic expectations - We made the mistake of thinking he would be back playing hockey sooner then was realistic and it was tough on Jacob. This is a major injury and even in the best scenario you can expece a 6 month recovery time.

0-10 weeks - Initial fracture recovery, where the more new bone is created over the fracture site to act as a temporary splint of sorts
10-20 weeks - Remodeling phase of bone recovery, where the bone regains it's density and strength. Physio should be underway as well, so muscle building also taking place.
20-40 weeks - Normal activities are resumed during early stages of this phase. The body makes changes to correct slight differences in leg length, bone becomes even more dense.

Any way we can help please don't hesitate to ask. Send me a private message if you like and I will give you me email. Best of luck to your family.

Hello Everyone,

Just thought it might be time to add another update on Jacobs progress and ask a question.

First off, Jacob is doing fantastic! He was back in time to play in the AAA championships in March and did pretty well. Strength, power and confidence that his leg wasn't going to break again were all things we noticed he needed to work on. The hockey team he plays for is very good and a team that over 100 kids tryout for. Under normal circumstances he is a lock, but he was nervous knowing that he was not where he was and really wanted to make the team. He continued to train hard on and off the ice for the next month. He is very proud that not only did he make the team, but will be one of the team captains again and received a leadership award from the executives of his hockey club.

For the month of May he played in two hockey tournaments with what is called "spring hockey". He played with most of the best players in the province and looked shaky at first, but with each game gained more and more confidence. By the end of the second tournament he was starting to look like himself again for the first time since his injury and his leg looked much stronger as did his confidence in it.

As of now Jacob will continue to train on the ice once a week for the summer and will be playing with his soccer team all summer. The soccer is great for his endurance and muscle building....and he loves it almost as much as hockey.

QUESTIONS:

Jacob's fractured leg is about 9 mm shorter then his other leg. During the remodeling phase of his recovery will the body even that out?

Also, after he participates in multiple games (hockey or soccer) at a tournament by the last day we have noticed that he has a very slight limp and when asked says his muscles are sore. Is this just part of his body continuing to rebuild the muscle he lost or should we be concerned?

Thanks again for your time

Jim