This information has been designed to give you and your family a basic understanding of what a fractured shaft of femur is and what you can expect to happen before and after the operation. This information is intended as a guideline, you may have many more questions, which the doctors, nurses, physiotherapists and occupational therapists will only be too happy to answer.

Why is the operation necessary?

The femur or thighbone is the longest bone in your body and is the main weight bearing bone. The shaft is the main part of the femur and is below the hip joint and above the knee joint. These fractures usually occur from direct force. Following a fractured shaft of femur, two treatment options are available. These are operative fixation or traction. Operative fixation involves inserting a nail into the centre of the femur, which allows early mobilisation and prevents the complications of bed rest. The purpose of this kind of surgery is to give the femur stability and increase movement, thus reducing the pain that you may be suffering following your injury.

You will be admitted to the ward from the Accident and Emergency Department. The nursing staff will meet you and explain the ward routine. They will ask you a number of questions, so that they can cater for any individual needs you may have.

The ward doctor will see you and arrange for your pre-operation tests. These are usually an examination, an x-ray, blood tests, and an ECG (heart trace).
In some cases a Thomas splint may be used to aid pain relief prior to your operation. This is a way of applying traction, and is attached to the leg with bandages. If this is required the staff will explain this fully to you at the time. Although the splint may be uncomfortable, it will reduce your pain, as it relieves muscle spasm in your thigh. The splint is usually applied in the Accident & Emergency Department.

The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have. The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent. The anaesthetist will discuss the type of anaesthetic best suited to you but usually the procedure is performed under general anaesthetic. A spinal anaesthetic is sometimes used, this means you are numbed from the waist down for the duration of the procedure, a sedative is usually also given. The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.

The physiotherapist will come and see you before the operation to teach you the exercises you need to do after the operation, to help you to recover. However, if you are admitted as an emergency this might not always be possible.

The most important preparation is for you to understand what the operation involves and for you to feel comfortable with your decision. Remember that staff are here to help you and answer any questions you may have.

You will not be able to eat or drink for a period of time before your operation. The nursing staff will advise you on admission when you should stop eating in preparation for your surgery. You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre. A member of nursing staff will escort you to theatre either on a trolley or bed. Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and who will look after you until it is time for your anaesthetic.

Once in the anaesthetic room, you will be given an injection in your hand to put you to sleep, if you are having a general anaesthetic. If the anaesthetist has advised you that you are having a spinal anaesthetic this will be explained to you fully at the time.

The first 48 hours

After a short stay in the theatre recovery area you will return to the ward.

You will usually have a ‘drip’ in your arm to ensure that you get plenty of fluids, as you are unable to take any by mouth for a short time after the operation. Once you are able to eat and drink normally this ‘drip’ will be removed. This is usually on the first day after your operation.

If necessary you may also be given a blood transfusion to replace the blood you have lost during your operation and to prevent you from becoming anaemic.
You will also have a drainage tube in your wound. This will drain into a bottle and prevent any blood collecting around your wound because this could cause painful swelling. This is normally removed 24- 48 hours after the operation. You may also have a pressure dressing around your operation site to prevent further bleeding.
You will also have stitches or clips in the wound and these are usually removed 10 -14 days after surgery.

Many patients worry about how painful thigh surgery will be and all staff understand this. It is usual to experience some discomfort and the staff will give you painkillers when you need them to help keep you comfortable. Everyone feels differently and it is important that you tell the nurses if you are in pain.

Getting up and about

You will remain in bed for approximately 1 – 2 days after your surgery, during which time an x-ray will be taken, if this has not already been taken in theatre. Your surgeon will then decide when you can begin to move about.

The physiotherapists, and nurses will help you out of bed and supervise your walking. You will start to walk using a Zimmer frame to support you and progress to using crutches when your walking improves and you feel more confident. You will be supervised until you are safe. Your surgeon will dictate as to how much weight you are able to put through your operated leg.

The physiotherapist will teach you appropriate exercises.

What problems can occur?

No operation is without the risk of complications. Your surgeon and therapist will explain any particular risks/complications of your operation before surgery.

Is the operation always successful?

The surgeon’s expectations of your operation will be discussed before surgery (usually when seen in Outpatients) so that you understand the likely result, and the risks/benefits of the proposed operation. This information must be taken into account when you make the decision to undergo surgery.

Your Discharge

Once you are moving around safely on your own, you will be discharged home as soon as suitable arrangements can be made. You may however require a longer period of rehabilitation depending on your individual circumstances.
Planning for going home begins as soon as you arrive in hospital, if you have any fears or concerns regarding discharge please discuss these with your named nurse.

Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and cooking.

If your named nurse feels you and your carer will require extra support she will discuss this with you and with your permission will arrange for you to talk with the hospital social worker and Occupational Therapist/Orthopaedic Discharge Team.

If you live in the Newcastle area then you will be assessed by the Orthopaedic Discharge Team (ODT) who will assess your suitability for their service, which provides a two week supported discharge with nurse, physiotherapist and Occupational Therapy involvement.

Transport home

Please discuss your transport arrangements home with your named nurse before your day of discharge. It is possible in some instances to organise hospital transport, if required.

The day of discharge

On the day of your discharge your named nurse will give you some things to take home, these will include:

• A letter for your GP (in some instances this will be posted) This should be handed in to your GP by either a relative or friend on the next working day following your discharge.
• Medication Any medication you have bought into hospital will be returned to you. You will also be given 28-day supply of any new medications. The nurse will advise you on how and when to take these.
• Dressings You will receive a 7-day supply of any dressing you need and a letter for your district nurse.
• Outpatient Clinic Appointment You will be given an appointment to be reviewed in clinic. If transport is required this can be arranged by contacting your GP providing a weeks notice where possible. If for any reason you are unable to attend your appointment please contact the outpatient department to rearrange the appointment.
• Stockings If you have been given anti-embolic stockings to wear during your stay, you will receive an additional pair. These should be worn until your doctor advises otherwise (usually around 6 weeks).
• Care Plan If you have a care package arranged you will receive a copy of the care plan from the social Worker before your discharge home. This is for your own information.
• Discharge Record This provides details about your stay and is for your own information.
• Mobility aids It is important that you have your walking aids and any other equipment that you require.
• Patient information Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.

General advice after discharge

You should anticipate at least a 6 - 12 week period of convalescence at home before you are able to resume your normal activities.

• Walking You will need to use a walking aid for a period of time specified by your Consultant. Check the rubber ends on your walking aids regularly. If they are wearing smooth consult the Physiotherapy Department at the hospital in which you stayed.
• Stairs Before you go home, you will practice climbing up and down the stairs with the physiotherapist. Always use your crutches on the stairs as shown by the physiotherapist, and remember when going upstairs lead with your good leg (unoperated leg), and when going down stairs lead with your bad leg (operated leg).
• Transfers When getting on and off a chair, bed or toilet, always use the armrest if available and stick your operated leg out in front of you.
• Cars and Driving It is inadvisable to drive while wearing a cast, splint or restrictive bandage. Always check with your insurance company before starting to drive again. It is not the responsibility of your consultant to make this decision. He will advise when he feels driving will cause you no harm.
• Bathing You must not get your wound wet until the stitches have been removed, once these have been removed you can bath or shower as you feel able.
• Exercise Walk about at regular intervals throughout the day. Check with your consultant before commencing any activities.
• Work How soon you are able to return to work will depend on the type of job you do and you should discuss this with your consultant or GP.
• Pain Take your painkillers as prescribed. Do not take more than the stated dose. Contact your doctor if you have any pain or swelling in your calf or if you have any chest pain.

Follow up

You will receive a follow up appointment to be seen in the outpatient department (Fracture Clinic). Once at home if you have any concerns or are worried please contact your GP or your ward.

Return of equipment

Please return all of your walking aids to the Physiotherapy Department at the hospital where you stayed when they are no longer required. All other equipment should be returned to the loan equipment store it came from, ring them and they will collect it (the numbers are outlined overleaf).