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Dad fell last month and had surgery to put a long nail into his thigh bone and some plates and screws to hold everything together. I saw the X-rays today at the surgeon's office. For all the metal they have in and around the knee, I'm wondering why they didn't just give him a knee replacement.

Fractures just above or even through the knee joint are called distal femoral fractures. The femur is the long thigh bone. This type of fractures can be very complicated to treat. Since your father had surgery, we can assume it was more than a simple fracture. Stable, nondisplaced (separated) femoral fractures can be treated with a knee brace. Comminuted fractures (bone is broken into many tiny pieces) or bones with multiple fracture lines require surgical management. A long nail down through the bone is referred to as intramedullary nailing. Intramedullary nailing makes it possible to stabilize the fracture without disturbing the surrounding soft tissue and outer covering of the bone called the periosteum. Screws are used to hold the pin in place. On X-ray, it can look like a lot of hardware. But the very act of reaming out the core of the thigh bone in order to insert the long nail has a stimulating effect on the bone and generates a healing response. The nail provides a strong, stable bone that allows load and compression through the joint. This type of management makes it possible to preserve the bone. That's always the top goal whenever possible. Joint replacement may be needed later if the fracture went through the joint and doesn't heal. But repair rather than replace is always the first choice.

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