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X-ray did not show stress fracture healing. Could there have been remodelling before taking x-ray?

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

Hi, how are you?
Thank you so much for all your clear explanations. I think the way you explained to me so far was absolutely super convincing and I will not ask you the same question I asked you so far. This time it's just a bit different question and I hope you are not bothered or annoyed by them. I tend to ask so many questions when I start asking questions about a topic but I'll try my best not to be obsessive (asking exactly the same thing over and over). IF SOME QUESTIONS SOUND LIKE I'M REPEATING THE SAME QUESTIONS LIKE BEFORE, PLEASE LET ME KNOW DOCTOR. I REALLY RESPECT YOU AND REALLY DO NOT WANT TO BOTHER OR ANNOY YOU =) Thank you in advance.

1. Since the x-ray I took did not show any signs of stress fracture healing, does it mean that THERE COULD 'NOT' HAVE BEEN any stress fracture that occurred, healed, and finished remodelling ONE TO TWO MONTHS before taking the x-ray I showed you? In other words, if something like that happened a few months before taking the x-ray (regardless of how small the fracture), does some kind of healing sign have to show on the x-ray?

2. If everything happens side-wise, then does it mean the soft callus, hard callus, and remodelling will also happen inside the calcaneus bone despite the hairline fracture being on the very outer surface like the ones I showed you through pictures last time? (picture attached for this question)

3. According to one of the websites I read, it says that "Bony callus begins forming after 3 to 4 weeks after injury and is prominent 2 to 3 months following the injury. Continued migration and multiplying of osteoblasts and osteocytes results in the fibrocartilaginous callus turning into a bony callus.
AND THEN IN - Remoldeling - "Any excess material of the bony callus is removed and compact bone is laid down in order to reconstruct the shaft. Remodelling is the final stage" - THIS DOES NOT MEAN THAT THE BOTTOM OF CALCANEUS BONE IS LENGTHENED TEMPORARILY DURING THE PREVIOUS PHASES AND DECREASED DURING THE FINAL REMODELLING PROCESS, RIGHT? LIKE YOU SAID FROM THE VERY BEGINNING OF THE HEALING STAGE (RIGHT AFTER FRACTURE) TO THE LAST STAGE (COMPLETE REMODELLING STAGE), IT'S 0.0mm change right? (Sorry, sounds like I'm repeating the same question again)

4. (imaginary situation) If the x-ray reveals the formation of callus during healing process of stress fracture, then it would show very foggily 'inside' the calcaneus bone right? And even if outside, no effect on the height right? (sorry, sounds like repeating again too)

Thank you and please let me know if I'm repeating the same questions again. I'll avoid them in the future.

Posted Sat, 21 Jul 2012 in Bones, Muscles and Joints
Answered by Dr. Atul Wankhede 3 hours later
Happy to hear from you.

Honestly, the questions are more or less on same lines we discussed previously. But I'm far from being annoyed or bothered and shall gladly be of service once again.

1. There are signs that show previous healing, but not necessarily every time. Especially small hair line or stress fractures.

2. The formation of soft bone and its transition to hard bone depends upon the fracture pattern. For small fractures its usually not documented since they are never noticed and accounted.

3. Absolutely right, its the same question again and any amount of convincing isn't going to help. But no, there is no lengthening due to fractures of calcaneum, temporary or permanent. The early you accept this fact the better.

4. Yes, same question again. No changes in length whatsoever.

I hope this answer finally proves to you the point. For any further queries, I'm available for follow up.
Good luck.
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