Driving After a Broken Bone or Surgery: When? (Law+ PT tips)

Why question when is the right time to drive again?

After a fracture or surgery involving the lower or upper limbs or the spine:

• You may find certain movements more difficult to perform
• Whether you have a brace, cast, or corset or not, your doctor, surgeon, or physiotherapist may have advised against certain movements or positions
• You may experience pain while performing certain movements or staying in one position
• Alternatively, you may not feel particularly hindered to move or drive, but a healthcare professional or someone close to you has “prohibited” or “advised against” driving a car (or another vehicle).

For one or more of these reasons, my patients wonder when and how to drive again after breaking a bone or undergoing surgery. And if you’ve come across this article, it’s probably because you’re also in this situation!

Let’s first see what the law, the French regulations, says about this.

What law determines whether you can drive or not after a fracture or surgery?

The answer to this question will depend on the country in which you live. I have already written a comprehensive article for France.

Here, I will focus on the regulations in the United States, as the majority of my English-speaking readers come from there. Feel free to let me know in the comments if you would like me to cover other countries as well!

In US, there is no specific federal law that governs whether a person can drive after a fracture or surgery. Driving regulations are primarily governed by individual state laws, although most of the rules of the road are similar.

Each state has its own Department of Motor Vehicles (DMV) or equivalent agency that sets the rules and regulations (see link at end of article to find yours).

However, the responsibility for assessing a person’s fitness to drive often falls on the individual driver. And not on the healthcare provider.

What does the law say in general?

In general, the traffic laws in different states of the United States do not have specific rules regarding driving with a fracture. They state general guidelines, such as:

Every vehicle driver must constantly be in a condition and position to easily and promptly perform all the maneuvers required of them.

In essence: it is up to you to determine whether you are fit to drive or not.

Driving & Insurance Concerns After an Injury or Surgery?

These texts are quite vague, which leaves room for interpretation by insurance companies in case of an accident.

You will have to prove that you were fit to drive. There is a whole body of case law on this subject.If these insurance matters concern you, you can:

• Check what is written in your motor liability insurance contract.
• Contact your insurer to learn more.

Can you legally drive with a cast or splint?

The US Traffic Code does not specifically mention whether it is allowed or not to drive with a cast.

• With a cast on your arm, it is highly likely that it can be assumed that you may not be able to properly handle the steering wheel in case of a problem.

• The same goes for a cast or walking boot on your lower limbs, especially if you don’t have an automatic car.
• As for the splint, by definition, it is removable. If you wear it solely for pain relief, to alleviate your pain from time to time, driving might still be possible.

In general, states do not strictly forbid driving with a splint, brace, or cast. However, the Traffic Code states that the driver must ensure that they are constantly able to perform all maneuvers.

What is the risk of driving too soon after a fracture or surgery?

Here are the risks of returning to driving too soon after a fracture, replacement, or other operation on the limbs or arm:

• The main risk of resuming driving too early is not being physically fit enough for your safety and the safety of others you encounter on the road.
• You could also have issues with your insurance in case of an accident.
• You may experience pain, either in the short or medium term.

However, there are also advantages to resuming driving a car!

You can get back to your normal life more quickly for both professional and personal activities. You are potentially more active if you use the car to do things that require movement. You can focus on something other than the problem you had. That’s why there is a delicate balance to be found between too much and too little precaution in deciding when to drive again!

A research team sought to find out what was the most significant factor hindering people from resuming driving after surgery on the lower limbs.

Here is the order of importance that patients placed on different factors before driving again:

• The risk of increasing pain (62%),
• The risk of damaging the hip replacement, knee replacement or surgical material (17%),
• The time frame for resuming driving recommended by their healthcare professionals (13%),
• The safety of the braking system (8%).

Source: DeLeon 2022

How long to wait before driving again after a fracture, replacement or surgery?

A research team from the United States and Italy has observed significant variations in practices among surgeons regarding when to allow patients to resume driving after orthopedic surgery on the lower or upper limbs.

The team compiled all the academic literature on this subject and summarized the findings based on the most frequently asked questions from patients and healthcare professionals.

Source: MacKenzie 2019

I have summarized the main findings of this publication in the form of a table, focusing on the pathologies most commonly treated in physical therapy, which we are most familiar with. At the end of the article, you will find the link to the publication (in English, freely accessible) if you wish to further explore the topic.

Reason for Surgery	Recommendations found for time frame before driving again after surgery
Total knee replacement	Left knee replacement: 0 to 3 months.
	Right knee replacement: 2 weeks to 8 weeks.
Unicompartmental knee replacement	Left knee: no delay.
	Right knee: 6 weeks.
Total hip replacement	Left hip replacement: 6 days to 8 weeks. One study reports 84% resumed at 6 weeks.
	Right hip replacement: 6 days to 8 weeks.
Anterior cruciate ligament (ACL) reconstruction of the knee	Left knee: mostly no delay.
	Right knee: 3 to 6 weeks.
Partial meniscectomy of the knee	Left knee: mostly no delay.
	Right knee: 1 day to 3 weeks.
Ankle fracture with or without surgery, right	6 to 9 weeks or 8 days after removing the cast.
Operated tibial plateau fracture, calcaneus fracture, tibial pilon fracture, or acetabulum fracture, right	18 weeks (6 weeks after full weight-bearing authorization).
Intramedullary nail in the femur or tibia, right	12 weeks (6 weeks after full weight-bearing authorization).
Arthroscopic rotator cuff repair	12 weeks (1 day to 4 months).
Carpal tunnel release	9 days.
Total or partial shoulder replacement, reverse or anatomical	6-12 weeks.
Distal radius fracture (wrist) surgery	3 weeks.
Outpatient hand soft tissue surgery (ligament, tendon)	50% drove immediately within the week following, the rest within the first week following.

How to know if you can resume driving or not?

At the beginning, you will probably feel that you are not ready at all to drive. Then after a few days or weeks, you may feel like you might be able to.

In this case, sit in the driver’s seat, while the car is stationary. Perform all the common maneuvers while stationary:

• Press the brake, clutch, and accelerator pedals with different intensities.
• Shift through all the gears, including reverse.
• Turn your head as if doing a maneuver.
• Press the buttons on the dashboard.
• Turn the steering wheel fully and at different speeds.

Stay seated for a few minutes as well.

If everything is okay, then you can consider driving on a short trip, about ten minutes. Then gradually increase the time spent driving.

Also, check how you feel after driving: in the hours and night that follows, are your pains more or less similar to normal?

If yes, then it is probably appropriate for you to resume driving!

These tips are also valid if you are resuming driving after a long break, regardless of the reason.

Can you ride as a passenger after a fracture, replacement or surgery?

From a regulatory standpoint, it is not prohibited to be a passenger in a car with a prosthesis or another medical condition, as long as you comply with general regulations regarding the use of seat belts, etc.

However, it can sometimes be challenging to get into a car after a surgery or fracture, especially when the hip or knee joints have been affected, following:

• Hip replacement surgery: Some people may fear dislocating their hip replacement while getting into a car. Rest assured, the risk is very low, and it mostly occurs during a fall, especially in individuals with cognitive impairments.
• Knee replacement surgery.
• Fracture of the kneecap or the tibial plateau.
• Fracture of the femur.

Individuals whose sitting position is contraindicated due to vertebral compression fractures, pelvic fractures, or herniated disc surgery may also be limited in their ability to travel by car.

If sitting is not strictly contraindicated for you, you can test it out. In this case, it is better to test if:

• You can get into the car comfortably.
• The sitting position is sufficiently comfortable while the car is stationary before considering a longer trip. In any case, start with a short journey.

Consider the following:

• Sit in the front seat, on the passenger side.
• Adjust the seat to its maximum backward position to have more legroom.
• Change your position regularly, as much as the available space allows.

The vibrations from the car are not dangerous for the replacement or the healing of a fracture. However, remaining seated for a long time without moving is not ideal for recovery. Therefore, it is advisable to limit car trips, even as a passenger, to essential ones after a fracture or surgery.

If you are unable to travel in your car, even as a passenger, you can sometimes obtain a transportation voucher to go to a physiotherapist or other medical appointments.

***