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Isn't hypertrophic union only a temporary process? What is the meaning when you say the bone still grows out after the union and result in lengthening?

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Orthopaedic Surgeon
Practicing since : 2000
Answered : 170 Questions
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Dear Dr. WANKHEDE,

I really appreciate your answer last time. However, there are just a few more things I really want to find out about. Thank you in advance.

Last time you mentioned that after the fracture -
"There onwards the bone neither shrinks nor grows. If there are signs of hypertrophic union where in even after union the bone continues to grow out, it might result in lengthening (especially the part where you have show on your image). The soft bone that develops at fracture site is called 'callus'. It later converts into hard bone XXXXXXX

I just found out that hypertrophic union is only a temporary process. So I'm kind of confused with what you said in your last reply. What do you mean the bone still grows out after the union and result in lengthening? After that process, isn't the bone ALWAYS prone to shrink and NEVER increase (0.0mm) like you have mentioned several times? I'm confused because you suddenly introduced me to a completely new concept.

Thank you so much Dr.
Posted Sun, 15 Jul 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Atul Wankhede 4 hours later
Dear XXXXXXX
Good to see you back.

I introduced you to the concept of hypertrophic union to give you an idea of a possibility where even after fracture union the body keeps producing soft callus to give extra protection. This abnormal phenomenon occurs only side-wise (and not along the length of the bone) in a bone that fractures and never creates lengthening. But the site where you mentioned, a linear fracture at the base of calcaneum can have possibility of lengthening only if there is hypertrophy. If in case it does happen it will be a very rare phenomenon, none that I've seen in my practice.

Please do not get confused, what I opined was just a possibility. That apart there is no other possibility for bone lengthening post fracture.

Allow me to further assist you if you have more queries, I'm available for follow up.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Isn't hypertrophic union only a temporary process? What is the meaning when you say the bone still grows out after the union and result in lengthening? 1 hour later
Dear Dr. Wankhede,

Thanks a lot for your answer.
So in the part where you said: "But the site where you mentioned, a linear fracture at the base of calcaneum can have possibility of lengthening only if there is hypertrophy"
This is also side-wise right?
Follow-up: Isn't hypertrophic union only a temporary process? What is the meaning when you say the bone still grows out after the union and result in lengthening? 5 minutes later
Dear Dr. Wankhede,

Thanks a lot for your answer.
Question 1: So in the part where you said: "But the site where you mentioned, a linear fracture at the base of calcaneum can have possibility of lengthening only if there is hypertrophy"
This is also side-wise right?

Continued:
Question 2:
If you look at an x-ray of someone's foot bone can you tell whether there has been any abnormal phenomenon like this?
Follow-up: Isn't hypertrophic union only a temporary process? What is the meaning when you say the bone still grows out after the union and result in lengthening? 33 minutes later
Dear Dr. Wankhede,

Thanks a lot for your answer.
Please ignore my two previous messages. I'll just put all of them in this one.

Question 1: So in the part where you said: "But the site where you mentioned, a linear fracture at the base of calcaneum can have possibility of lengthening only if there is hypertrophy"
Is this side-wise too?

Continued:
Question 2:
If you look at an x-ray of someone's foot bone can you tell whether there has been or there is any abnormal phenomenon like this?

Question 3:
During the healing process, "hypertrophic union" is it possible for your height to increase by 0.3 cm (centimeters) and reduce to its normal height when the bone heals? OR your height just NEVER increases (0.0 cm)?
Follow-up: Isn't hypertrophic union only a temporary process? What is the meaning when you say the bone still grows out after the union and result in lengthening? 1 minute later
Dear Dr. Wankhede,

Thanks a lot for your answer.
Please ignore my 3 previous messages. I'll just put all of them in this one.

Question 1: So in the part where you said: "But the site where you mentioned, a linear fracture at the base of calcaneum can have possibility of lengthening only if there is hypertrophy"
Is this side-wise too?

Continued:
Question 2:
If you look at an x-ray of someone's foot bone can you tell whether there has been or there is any abnormal phenomenon like this?

Question 3: (the most bottom calcaneus part I showed you)
During the healing process, "hypertrophic union" is it possible for your height to increase by 0.3 cm (centimeters) and reduce to its normal height when the bone heals? OR your height just NEVER increases (0.0 cm)?
 
 
Answered by Dr. Atul Wankhede 1 hour later
Dear XXXXXXX
Good to see your questions.

The answer to your questions are as follows-
1. For linear fracture like you described, side-wise would be axial in nature. Meaning at the bottom of the calcaneum, perpendicular to the line of fracture.

2 .Absolutely. I can look at the x XXXXXXX and tell you for sure.

3. Hypertrophy usually is the end product of union or rather the malunion, so whatever changes they make are more or less permanent. Lengthening or no lengthening. It cannot increase first and then decrease.

If you have this fracture yourself or any one close to you, I request you to post the x XXXXXXX for me to help you better.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Isn't hypertrophic union only a temporary process? What is the meaning when you say the bone still grows out after the union and result in lengthening? 42 minutes later
Dear Dr. Wankhede,


Thanks a million for your help.

So I'm attaching a picture of my xray. Actually I took this x XXXXXXX NOT because I was hurt or anything but I just wanted to see if there was anything wrong with the structure of my foot. The doctors told me there's nothing wrong with the structure of my foot - no deformity, no lesion, nothing. Anyway I'm a very curious person (and a bit obsessive about my body and health), so I took one at the hospital more than four months ago. Fortunately the color of my room wall is white and i also have a desk light so I just used whatever I have in my room to make this xray as close to as it would look in the lamp board (is that what you call it?) at a doctor's office. I used my camera to take it and hope it looks clear to you.

QUESTIONS:

1. HONESTLY, I don't know if I've ever had a stress fracture or hairline fracture but I heard that sometimes people (like athletes) don't know whether or not they have a hairline fracture. How is that possible? So does it mean I could have had one of those as well without myself knowing it? Is it possible to have several hairline fractures without yourself knowing it? And does it mean stress fractures just heal on their own?

2. Does it look like my calcaneus (especially the part I've been talking about) bone has ever suffered from stress fracture, hypertrophy or do you see any signs of that? Do my feet look normal without any signs of past injuries or hypertrophic union or malformation from hairline fracture or anything like that from the past (although I'm not sure if I've ever had any stress fracture)?

3. (NOT RELATED TO THE TWO QUESTIONS ABOVE) - If we have a stress fracture at the calcaneus area I've been talking about, is it possible that during the healing process or any phase between {after fracture --- before healing} our height measures perhaps 0.2cm - 0.3cm taller? Or does our height stay the same (0.0mm change) during the entire healing process?

I know I sound pretty obsessive and thank you so much for helping me out Dr. Wankhede. Also when you give me answers, would you be able to tell me exactly by including the number unit I use for my questions? (eg. 0.0mm increase / decrease)




 
 
Answered by Dr. Atul Wankhede 2 hours later
Dear XXXXXXX
I appreciate you sending me the soft copies of x rays, they were clear enough, even if not on a 'view box'.

I want to thank you for making it more so clear in the other image you sent. The arrow you made in the image (the bulge) is a stage of haematoma formation, which is a temporary phase and does not cause any increase or decrease in height (even by 0.001mm).

1. You have no stress fractures, or any evidence of healed fractures. Not just athletes, many people with undue overuse of feet get stress fractures, which heal without anyone knowing, unless they are symptomatic.

2. Your bones are absolutely normal with no signs of new or old injury.

3. There is no possibility (even of 0.001 mm) for height to increase or decrease in between the aforesaid stages. It stays the same (0.0mm change).

Your obsession is completely understandable and I hope it has met satisfactory answers. For any further assistance feel free to post more questions.
Regards.
Above answer was peer-reviewed by
 
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