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When it comes to broken bones, one of the worst ones that you can break unfortunately would be your femur. This is considered to be one of the strongest bones in our body due to the fact that it is responsible for most of the weight-bearing stress put on our joints as we walk. A fallacy of age is that this once strong bone is one of the most susceptible to osteoporosis and as a result, elderly patients are predisposed to fractures of this bone. This can be quite problematic in this subgroup of the population because they already have difficulty with mobility. Patients that are forced to stay in bed while they recover have a possible risk of having life-threatening conditions like blood clots travel from their legs to their lungs and cause instant death. Blood does not do this naturally as we walk because it is moving too fast for it to start to clump together. 

When we are bedridden though, unless we are constantly doing exercises or taking some type of anticoagulant for a medication, clots are a likely outcome. 

The most important thing to do when you suffer from a femoral fracture is to heal to begin walking again. Healing is something that most patients would want, but unfortunately, as we age, the recoverability for these types of injuries takes much longer. One of the many perks of childhood is that these patients have some of the most active bones around. Bones continuously go through daily cycles of destruction and growth. The primary cells responsible for this would be osteoblasts and osteoclasts. As we walk throughout the day, osteoblasts are destroying our bones naturally because of the stress we put on bones from walking, but at night as we sleep, osteoclasts are more active and help rebuild and solidify the bones to make them stronger. Until about the age of 18, osteoclasts are the predominately active cell in our bones, and they are the main reason why we grow. 

Once growing stops, growth hormones are no longer secreted to keep osteoclasts busy, and as a result, our bones begin to stop having the same rejuvenating capabilities they once had. What this means for patients is that the older they get, the longer they will have to wait for bones to be able to recover from fractures. 

What this means in recovery time is very subjective on the status of each patient: 

  • For children, a broken femur means that they will have to wear a leg cast for at least 8 to 12 weeks followed by another month of using crutches to let the muscles in their leg recover strength with little to no rehabilitation necessary. 
  • As we age, the recovery time is painfully long. Adults will need about 4 to 6 months for the bones to heal correctly and the more complicated the fracture, the more time this will take. Patients will then have to undergo recovery but overall, will return to near normal levels. In the elderly, the most important thing is the time until treatment begins. Studies show that the longer patients wait until the bone is addressed, the higher the mortality. There is already a significantly higher risk of death if the surgery to fix the bone is delayed for more than two days. With other medical complications, it may be hard for surgeons to perform surgeries so this window can pass in many cases. 

If surgery can be performed to stabilize the bone, most patients will have a healed bone by six months after their injury, and this does not end their road to recovery, however, and most will require up to 3 months of rehabilitation exercises to regain function of their leg. It is a painfully, frustrating process for these elderly patents and most are unable to recover the same range of motion that they had before their break. During this time, patients will also have to take anticoagulant medication and risk complications from their other medications they may already be taking. This blood-thinner can also have side effects of their own and if a patient already having trouble walking accidentally bumps his limb on a hard surface or has an accidentally fall, it will be much harder to get the bleeding to stop in these patients. [1]

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