A broken femur is one of the most serious lower-limb injuries you can have. Whether you had an intramedullary nail or a plate fixation, the rehab is long, structured, and rewards patience over heroics. We've seen patients race back at three months and end up worse than the ones who took six. Here's what to actually expect.
What's actually been fixed
The femur is the thigh bone, the longest and strongest bone in your body. Breaking it takes serious force. We see three main causes at the clinic: high-energy trauma like car accidents and falls from height, low-energy falls in older adults with more fragile bone, and athletic injuries in younger patients.
The fixation type changes everything. An intramedullary (IM) nail is a metal rod inserted down the centre of the bone, used for most shaft fractures and often allowing earlier weight-bearing. A plate and screws is typically used for fractures near the knee or hip, and usually keeps you off the leg for longer. An external fixator is a temporary frame, often for complex or open fractures. Know which one you had before you start rehab.
The most important number: your weight-bearing protocol
Before you leave hospital, your surgeon gives you a weight-bearing protocol. Get it in writing. Take a photo of the discharge note. This single instruction shapes the first three months of your rehab.
IM nail for a femoral shaft fracture often allows partial weight-bearing immediately, progressing to full weight-bearing at six to twelve weeks. Plate fixation near the knee often requires non-weight-bearing or toe-touch only for six to twelve weeks. Complex or open fractures usually need longer protected weight-bearing. Loading the bone too early risks hardware failure. Loading too little for too long causes the deconditioning we then spend three months reversing. Both delay recovery.
What the timeline looks like
- Week 1 to 2: Out of bed, ankle pumps hourly, gentle knee bend to 60–90 degrees. Quad sets to wake the muscle up. The quad shuts down after femur surgery and has to be taught to work again.
- Week 3 to 6: Knee bend past 90 degrees, glute activation, sit-to-stand work, walking with crutches or a frame to your prescribed weight-bearing level.
- Week 6 to 12: Surgeon review with X-ray and usually a progression of weight-bearing. Strength building begins. Gait retraining starts in earnest, because the limp becomes a habit fast.
- Month 3 to 6: Strength is the focus. Squats, deadlifts, lunges, step-ups, single-leg work. The injured leg will be 30–50% weaker than the other side. Closing the gap takes months.
- Month 6 to 12: Return to running, sport, plyometrics. Bone is usually fully healed on X-ray by month six to nine. Soft tissue and confidence take longer.
The knee will stiffen. Plan for it
Femur fractures love to stiffen the knee. The swelling, the immobilisation and the proximity of the surgical site all work against knee mobility. A stiff knee at twelve weeks is one of the hardest things to recover, and it stays a problem for years if you let it.
Knee bend work has to be daily, not weekly. Most patients can get to 110–120 degrees by week twelve with consistent effort. The patients we see fall short of that are almost always the ones who skipped a week or two early on because they were sore.
Bone heals on a schedule. Strength doesn't. Plan to be in the gym at month three, and plan to still be there at month nine.
Common mistakes
Four patterns we see at the Liverpool clinic. First, pushing through pain too early. The bone may be fixed but it's not healed. Pain in the first three months is a signal. Listen to it. Second, neglecting the knee. The hip and knee both stiffen after femur surgery and the knee is the harder of the two to recover. Third, stopping rehab at three months because the patient feels fine. Feeling fine and being fine are different. The strength gap doesn't close until six to twelve months. Fourth, ignoring the unaffected leg. It's been overloaded for months and is the next thing to flare up if you don't load both sides.
How we structure femur fracture rehab
We typically see femur fracture patients twice a week for the first six weeks, then weekly through month three, then every two to three weeks through month six. We work directly with your orthopaedic surgeon's rooms to confirm your weight-bearing protocol and milestones if you give us permission. Book a 60-minute initial within the first two weeks of leaving hospital if you can. The earlier the rehab structure is in place, the better the long-term outcome.