Postoperative Mobilization After Flexible Intramedullary Nailing for Pediatric Femur Fracture
Yes, a 5-year-old patient who has undergone flexible intramedullary nail (IMN) surgery for a femur fracture is allowed to sit on the bed immediately postoperatively, and this should be encouraged as part of early mobilization protocols.
Immediate Postoperative Activity Guidelines
Sitting is permitted immediately after surgery and should be initiated within the first 1-2 days postoperatively. 1, 2 The flexible intramedullary nailing technique provides sufficient stability to allow early mobilization without risk of fracture displacement or hardware failure in this age group. 3, 4
Progressive Mobilization Timeline
- Day 1-2 postoperatively: Sitting in bed and transferring to chair are safe and encouraged 2
- Days 2-7: Free mobilization with protected weight bearing can begin, with most children starting ambulation within the first week 2, 5
- Week 1: Full weight bearing is typically allowed within 7 days (range 1-30 days) based on patient comfort and fracture stability 2
- Average time to full weight bearing: 10-16 days across multiple studies 3, 4
Key Clinical Considerations
The flexible nail construct provides adequate rotational and longitudinal stability for a 5-year-old child with a standard midshaft femur fracture. 1, 4 This allows for immediate sitting without external immobilization in most cases. However, if the fracture pattern was length-unstable or comminuted requiring augmentation with external fixation, sitting would still be permitted but weight bearing might be delayed. 1
Activity Restrictions to Emphasize
- No restrictions on sitting, bed mobility, or transfers 2, 5
- Avoid high-impact activities until radiographic union (typically 8-12 weeks) 1, 4
- Monitor for nail exteriorization (occurs in 9-12% of cases), which would be visible at the insertion site but does not contraindicate sitting 2, 4
Hospital Discharge Planning
Most children are discharged within 1-9 days (mean 2.6-9.1 days depending on the series), with sitting and mobilization well-established before discharge. 2, 4, 5 The short hospital stay is predicated on early mobilization being safe and effective. 5
Pain Management During Mobilization
Continue regular paracetamol throughout the perioperative period, and use opioids cautiously with reduced dosing if any renal concerns exist. 6, 7 Avoid codeine due to constipation and cognitive effects. 6, 7
Common Pitfalls to Avoid
Do not restrict sitting or bed mobility based on outdated concerns about fracture stability—the flexible nail provides adequate fixation for these activities. 3, 2 The main complication to monitor is nail exteriorization (11-12%), which presents as visible hardware at the skin but does not require activity restriction beyond avoiding the specific movement that causes irritation. 2, 4
Do not delay mobilization waiting for radiographic union—clinical union and return to full activity occur at a mean of 4.9 months, but sitting and protected ambulation begin immediately. 3