Broken Femur Recovery Time: My Day-by-Day Timeline

Thomas Prommer Hybrid Athlete & Technology Executive Follow on Strava

Published: May 13, 2026

Updated: May 25, 2026

This is the real timeline from my own recovery, drawn from a daily log I started in the hospital. Days 1 to 20 are captured below in the level of detail they happened in. Everything from Week 4 onwards is the plan, not the result — I will update this page as each milestone lands, or as the plan changes when it meets reality. Recovery from a comminuted subtrochanteric femur fracture is not on rails; it is on radiographs.

Overview at a Glance

Days 0 to 7: The Hospital Week

Day 0 (Tuesday, April 21, 2026)

Crash on the first outdoor ride with aerobars at 15:00 ICT. Right subtrochanteric femur fracture. Pre-operative imaging at the small local clinic, then escalation to BVDK Tâm Anh, Tân Bình. Surgery began the same evening. Cephalomedullary intramedullary nail, cephalic lag screw, distal interlock, end cap. On the operating table by ~23:00, eight hours door-to-door. Same-day surgery is one of the strongest single determinants of outcome for this injury. Earlier fixation reduces soft-tissue swelling and infection risk and allows earlier mobilization.

Day 1 to Day 3: bed-based

Positioning every two hours, half-lying or Fowler's, then progressively more upright with pillows. Ankle pumps 25 reps twice a day for DVT prophylaxis. Ultracet and Celecoxib for pain. Rivaroxaban 10 mg once daily for anticoagulation. Cefuroxim for infection prophylaxis. Gabapentin at night. No weight bearing, no hip flexion past 0°, no hip abduction. ROM target for this window is hip flexion 0–20°, knee flexion 0–30° by Day 5.

Day 4 to Day 6: first ROM work

Passive range-of-motion work in supine with the hospital PT. Isometric quadriceps, glute, and hamstring sets: squeeze the muscle without moving the joint. Cryotherapy on the surgical sites. Continued ankle pumps. ROM target by Day 8 is hip flexion 0–30°, hip abduction 0–15°, knee flexion 0–45°. The hospital extended the stay through Tuesday to make sure transfers and bathroom logistics were sorted before discharge. That was the right call. The first week home breaks a lot of people who go home too early.

Day 7 (Monday, April 28): Discharge Day

Discharge from BVDK Tâm Anh. NWB for 4 more weeks confirmed by BS Lưu. Discharge prescription locked in: Cefuroxim, Celecoxib, Ultracet, Esomeprazole, Rivaroxaban, Gabapentin (all on a 7-day course). An Pháp PT home visit at 18:00, the first session at home. Iron labs come back normal (ferritin 151.4). Race deferrals submitted: Da Nang 70.3 medical deferral with surgeon's letter, Challenge Roth transfer to 2027.

Days 8 to 14: First Week Home

Day 8: First home day

Day 2 of 7-day prescription. Outreach to multiple clinics for outpatient PT (FV, CMI, JIO, Raffles, SPS, Maple, AIH). The orthopaedic clinic network in HCMC is highly variable. Some clinics do not do home visits, some do not have IM-nail-femur experience, some are happy to coordinate with BVDK Tâm Anh. The shortlist process took a week and is a separate rabbit hole.

Day 9: Ice pack arrives, new home-visit PT

Reusable gel ice pack added to the post-PT routine, 15–20 minutes wrapped in cloth, never directly on skin. New home-visit PT (referral from the BVDK Tâm Anh hospital PT) started at 16:00. More aggressive than the An Pháp session: passive-assisted right-leg straight-leg raise (could not lift unassisted), side-lying hip abduction from bed-edge as homework. Crutch gait corrected to a three-point NWB pattern: crutches and right (injured) leg advance together with no load, then the healthy left leg swings through with body weight on the crutches.

Day 11: First deep-tissue session with Vinh

First night sleeping in own bed instead of the hospital-rented bed. Only about 2 hours of actual sleep, but it felt better than the hospital bed in the morning. Vinh (Nhựt Vinh, hospital-referral PT) home visit at ~17:00. Different approach: deep-tissue massage along the right leg including the surgical area, more passive-assisted SLR work, lots of standing practice. Subjective comfort gain real, with no adverse reaction the next morning. Flagged at the Day 15 visit for explicit BS Lưu sign-off on deep tissue over the IM-nail entry.

Day 13: First PT-provoked pain

First time pain has been provoked by a PT session rather than eased by one. Second PT slot cancelled rather than push through. Pacing over pushing in Week 2. Day 7 of the prescription cycle: last doses of Cefuroxim, Ultracet, Celecoxib, Esomeprazole, Rivaroxaban, plus the final 7th gabapentin night.

Day 14: The NSAID-washout pain day

Significant pain day. Pain breakthrough at 3.5 hours on paracetamol monotherapy (1 g at 01:00, 1 g at 04:30), well inside the safe re-dose window, meaning paracetamol alone is not holding the pain. Pain sits in the expected NSAID-washout window: Celecoxib half-life is roughly 11 hours, so the anti-inflammatory effect clears 24–48 hours after the last dose. Day 13/14 PT-provoked residual stacks on top of that, plus unrelieved swelling driving mechanical pain. No fever, no drainage. The bridging analgesia question becomes the top ask for the Day 15 visit.

Days 15 to 21: Sutures Out, New Rx, First Real Progress

Day 15 (Tuesday, May 6): Week 2 visit with BS Lưu

The first follow-up since discharge. Vitals at intake: 94.0 kg, 196 cm, BMI 24.5, BP 148/90, HR 103. All flagged OK.

• Suture removal: very pain-free, quick. No bandage afterwards; air-healing protocol. Distilled-water clean as needed. No topical for 48 hours (Day 18 is the silicone scar-care kickoff).
• X-ray: hardware unchanged from Day 0, fracture appearance fine. Subtle haziness on the medial cortex consistent with very early periosteal callus initiation.
• Weight-bearing: NWB for 4 more weeks from today. Week 6 imaging on June 3 will decide whether 25% partial weight-bearing begins.
• Renewal Rx (14-day course, May 6 to May 19):
  • Celecoxib 200 mg, 1 capsule AM + 1 capsule PM
  • Ultracet (paracetamol 325 + tramadol 37.5), 1 tablet three times a day
  • NextG Cal, 2 capsules AM (calcium hydroxyapatite + D3 + K1)
  • Gabapentin (Neurontin) 300 mg, 1 capsule at night
• What is not in the new Rx: Rivaroxaban (operative DVT window closed), Esomeprazole (no GI symptoms on Celecoxib), Cefuroxim (course complete).
• Massage clearance: deep tissue including the surgical area cleared verbally.
• Other instructions: rest, elevate the leg, limit activity. Avoid low chairs, stairs, squatting, kneeling, cross-legged sitting, and leg-crossing.

Day 16: The Rx works

First full pain-zero day since the crash. 7.5 hours of largely unbroken sleep, the first night since surgery that pain has not dictated the sleep window. The renewal Rx is doing exactly what it was designed to do: Celecoxib for inflammation, Ultracet for breakthrough analgesia, Gabapentin for night-time neuropathic coverage. The 04:00 wake, 20:00 bed window is now empirically validated.

First day without a PT session since Day 7. A deliberate rest day. Wound cleaned with distilled water as instructed; open-air healing continuing.

Day 17: Barber day, two bad movements

First trip out for a non-medical reason since surgery: 11:00 barber appointment, six-seater Grab cab each way. Two accidental loading moments getting in and out of the chair. The NWB discipline that holds fine inside the apartment slips outside it when attention is on a non-walking task. Useful lesson for any future out-of-routine trip: brief the helper, set the chair height, plant the crutches deliberately, treat every transition as a high-risk movement window.

Day 18 (Saturday, May 9): First shower, silicone scar-care starts

48 hours past suture removal — the standard window for water contact after suture removal. First shower since surgery: short, lukewarm, no scrubbing the incision, pat dry, 10 minutes air-dry before any topical. Silicone scar-care protocol starts (Mepiform tape, cut to incision length, 12–24 hour wear, replaced every 2–3 days).

Two PT sessions in one day, the heaviest single-day mobility load yet: Billy (US-trained PT, Phan/Martin referral) at 10:00 for the first assessment session, then Vinh in the PM for continued Phase 2 work. EMS machine applied in Billy's session as priming. No red flags from either session.

Day 20 (Monday, May 11): First unassisted SLR

The first unassisted right-leg straight-leg raise. First time the operated leg has lifted under active hip-flexor control with no manual assist from a PT. The trajectory:

• Day 9: passive-assisted only, the leg dropped under its own weight
• Day 11: still passive-assisted, many reps with Vinh, no unassisted lift
• Day 20: unassisted. Nine days from passive-assisted introduction to active execution.

This is on schedule for a comminuted intertrochanteric / subtrochanteric pattern with calcar involvement and lesser-trochanter avulsion plus PFN fixation. The generic Week 2 target in the PT protocol assumes a stable A1 pattern or diaphyseal shaft fracture, which this is not. Literature for unstable 31A3-pattern fractures fixed with a PFN puts unassisted SLR commonly at Week 3–4 post-op. On schedule is the correct frame.

Two clinically meaningful sub-signals: the lesser-trochanter avulsion is not producing persistent iliopsoas dysfunction (active hip flexion against gravity would not be possible if iliopsoas were non-functional), and the hardware is stable enough to tolerate the shear load of unassisted hip flexion at Day 20.

Weeks 3 to 6: The Long Wait

This is the segment of recovery I am living in as this article goes live. The work is unglamorous: maintain the prescription cycle, hit PT four times a week, keep the supplement stack consistent, sleep eight hours, walk on crutches without loading the operated leg, accumulate strength on the contralateral side. The mood drop predicted by Week 2 to Week 4 is in the post. I will update the daily log honestly when it arrives.

• Week 3 ROM targets: hip flexion 0–70°, hip abduction 0–35°, knee flexion 0–90°. Add active hip abduction in side-lying.
• Week 4 ROM targets: hip flexion 0–90°, hip abduction 0–45°, knee flexion 0–110°. Standing-balance preparation on crutches, no weight bearing yet.
• Week 6 imaging (June 3, 2026): the decision-gating X-ray. Bridging callus on the medial cortex is the criterion for 25% partial weight-bearing.

Weeks 6 to 12: Progressive Weight Bearing

Conditional on the June 3 X-ray showing bridging callus. If yes:

• Week 6 to Week 7: 25% partial weight-bearing on the operated leg. Gait re-education on two crutches with consciously loaded steps. Pool work cleared if wounds are fully sealed.
• Week 7 to Week 8: 50% partial weight-bearing. Pool work continues, stationary cycling with low resistance begins. Single-leg dumbbell work on the operated side becomes possible at very light loads.
• Week 9 to Week 10: 75% partial weight-bearing. Functional ROM near full. Step-ups onto a low box with the operated leg start as a strength reintroduction movement.
• Week 10 to Week 12: 100% weight-bearing on two crutches, transition to single crutch, gait normalization. Stationary cycling moves to moderate resistance. Walk-jog intervals not yet. Bone first.

If the Week 6 X-ray does not show bridging callus, the protocol holds. NWB continues for another 2–4 weeks pending the next imaging, and the rest of the timeline shifts by the same amount. The X-ray decides, not the calendar.

Weeks 12 to 24: Return to Walking, Then Running

• Week 12 to Week 16: crutch-free walking. Normal gait, no limp, hip flexor and glute strength on the operated leg restored to within 15% of the contralateral side.
• Week 16 to Week 20: walk-jog intervals. Short jogging bouts (30 seconds to a minute) on soft surface, with walking recoveries. The operated leg must absorb the impact load without pain, swelling, or compensation in the gait.
• Week 20 to Week 24: continuous easy running. Time on feet, not pace. Easy aerobic running 20–40 minutes, three to four times a week. Single-leg strength benchmarks at 80%+ of the contralateral side before any structured running.

Month 6 to Month 14: The Ironman Build

The full periodization plan to Challenge Roth 2027 lives in the Road to Roth 2027 article. The short shape:

• Month 6 to Month 8: aerobic base rebuild across the three disciplines. Swim engine first (already largely recovered by this point), bike second, run third. Volume over intensity.
• Month 8 to Month 11: threshold work. Tempo runs, sweet-spot bike intervals, threshold swim sets. Build run mileage to 60–70% of pre-crash peak.
• Month 11 to Month 13: Ironman-specific build. Long brick sessions, race-pace bike volume, marathon-pace tempo runs. A B-race for confidence (likely a half-Ironman in late Q1 2027).
• Month 13 to Month 14: taper and race. Challenge Roth 2027, Sunday July 4, 2027.

Athletic Metrics Through the Recovery

A separate read of the same timeline, this time through the lens of fitness rather than orthopaedic milestones. These are the numbers I will be tracking as benchmarks of the comeback, not just whether the bone heals.

Baseline before the crash (December 2025)

• Body composition: 94.0 kg, 196 cm, ~11% body fat, 83 kg lean mass.
• Cycling FTP: 261 W, 2.77 W/kg. Targeting 280 W (3.0 W/kg) by Roth 2026.
• Run thresholds: LT1 at 7:05/km @ 140 bpm, LT2 at 5:10/km @ 166 bpm. Max HR 190.
• Marathon prediction: 3:49 (Garmin), targeting 3:45–3:50 in real conditions.
• Resting HR: 59–63 bpm, the lowest end of an active 46-year-old male range.

Detraining curves I expect

• VO2max: 5–10% loss per month of complete inactivity, gradually slowing. Realistic floor at Month 3 is roughly 80% of pre-crash. Lower-body strength loss is steeper than aerobic loss.
• Cycling FTP: typically 5–10% per month, but cycling has the best contralateral and aerobic carry-over of the three disciplines. With swim engine running and contralateral leg work loaded heavily, expect FTP at Month 3 to be 220–240 W rather than the textbook 200 W.
• Run economy: the slowest to come back. Specific running fitness needs running, and running is gated on bone healing. Realistic LT2 pace at first run-clearance (Month 4–5) is somewhere around 5:30–5:40/km at the same heart rate, with weeks of progression needed to approach pre-crash thresholds.
• Swim CSS: swim-specific fitness is the most preservable. With pool work starting Week 4–6 and full sessions by Month 2, expect CSS to be within 5% of pre-crash by Month 4 and back to baseline before the run engine is even cleared.
• Lean mass: the surprising one. Even with aggressive contralateral loading and high protein intake, 4–6 kg of estimated lean mass loss across the first 3 months is realistic. The GLP-1 cluster on this site documents the same pattern from a different cause; the principle is the same — protein, resistance, and high training volume can slow muscle loss but rarely prevent it during a forced rest.

Re-entry milestones — what gets logged

• First pool session: aiming for Week 4 to Week 6. Pull-only, float between knees. The first 1,000 m back in the water gets a real entry in the daily log.
• First stationary bike session: conditional on Week 6 X-ray. 20 minutes, low resistance, just spinning. Heart rate, RPE, any pain — all recorded.
• First outdoor walk over 1 km: after full weight-bearing clearance (Week 10–12). Treated as a real session, not a chore.
• First easy jog: Month 4 to Month 5. 30 seconds, on a treadmill or track. This is the milestone I am writing toward.
• First continuous 5 km run: Month 5 to Month 6. The marker that says the run engine is rebuilding, not just starting up.
• First long ride over 60 km: Month 5 to Month 6. The Ironman bike volume rebuild begins here.
• First brick session: Month 8 to Month 9. Bike followed by a short run, the discipline-stack test that the Ironman build is actually possible.
• First half-Ironman: Q1–Q2 2027. The tune-up race ahead of Roth 2027. A fitness check, not a result.
• Challenge Roth 2027: Sunday, July 4, 2027. The line.

What the daily log captures that a clinical chart does not

• Mood through forced rest. Athletes lose identity faster than they lose fitness. The Week 2 to Week 4 mood drop is real and predictable. Three consecutive days under 5/10 is a coach call, not a "wait and see."
• Sleep quality independent of total hours. Seven hours of broken sleep is not seven hours of sleep. The Day-16 night that broke through pain (7.5 hours largely unbroken) was a different kind of recovery from the Day-14 night of pain breakthrough on paracetamol monotherapy.
• Subjective fitness perception. Athletes are unreliable narrators on their own recovery early on. Recording perceived fitness next to objective milestones forces honesty about the gap.

What Would Change This Plan

Three things could move the entire timeline:

• Delayed union or non-union at the Week 6 or Week 12 X-ray. If callus is not bridging on schedule, the weight-bearing progression slows and the running window pushes out. Worst case, a revision operation. This is the largest single risk in months 1 to 4.
• Hardware-related complications. Lag-screw migration, varus collapse, peri-implant fracture. Any of these resets the protocol.
• A re-injury during the rebuild. Stress reaction in the operated leg during the return-to-running phase, or a soft-tissue injury during the contralateral-loading work. Catching it early (the daily log exists for this) keeps it from becoming a season-ender.

None of these are likely if the protocol holds. All of them are possible if it does not.

Update Cadence

This page is updated as milestones land: Week 6 X-ray, first weight-bearing step, first shower, first pool session, first run. Last updated 2026-05-13. If you are reading this several months after that date and the page looks identical, the likely answer is that the next milestone slipped and the pillar page will have the explanation.