Gamma Nail and Strength Training

[CeeKa]

Hey Rip,

do you think strength training (especially squatting) with a gamma nail can be dangerous? My 63 old mother has one in her right leg since she had broken her femur half a year ago. Doctors seem to have no definite view on whether to remove the nail or not.
Given that the gamma nail is an intramedullary nail, how would that effect the improvement of bone density through strength training?

I would very much appreciate your opinion on this.

[Mark Rippetoe]

That would depend on the fixation of the nail. How much load is borne by the appliance vs the bone? Outside my ability to evaluate.

[CeeKa]

Thanks for your quick reply. We are going to ask various doctors about this and some other things and evaluate based on that.

[Philbert]

Hey Rip,

do you think strength training (especially squatting) with a gamma nail can be dangerous? My 63 old mother has one in her right leg since she had broken her femur half a year ago. Doctors seem to have no definite view on whether to remove the nail or not.
Given that the gamma nail is an intramedullary nail, how would that effect the improvement of bone density through strength training?

I would very much appreciate your opinion on this.

Disclaimer: I am not an orthopedic surgeon, and if I were I would not be your mother's orthopedic surgeon.
That said, the fundamental principle of orthopedic fixation is providing just enough rigidity to keep the bone from coming apart, so that the bone experiences some stress with normal movement. If the fixation is too rigid the bone will not heal. If the bone has healed then it is bearing some weight, and like other living tissues will adapt to increased stress provided the stress/recovery cycle is appropriately timed, and the rate of adaptation demanded is not too great. The bone will become denser, and bone will be added on the outside surface.

[Mark Rippetoe]

Quite correct. How many orthopods apply this logic in the fixation of geriatric fractures?