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Suggest Treatment For Recurrent Fractures When Diagnosed With Osteopenia
Question: Two years ago I was diagnosed with stress fractures. Two in my right femoral neck and one in my left femoral neck. I had bilateral hip pinning in XXXXXXX of 2013. There was not clear reason for the fractures. My bone density is mild osteopenia (no change from 2013 to 2015), and I am not a runner. I had PT for 8 weeks after surgery. I was without pain up until 8 weeks ago; pain is in the front of my right hip. The pain went away with anesthesia for the contrast CT. CT indicated a fracture in my right hip; probably never healed. My question is why has it not healed? Did I have the correct surgery? Could there be a problem with the surgery? The doctors say that I don't need to be on crutches (thankfully), but how will it heal? I have been in PT for the past 7 weeks with no releif. Pain starts after walking two blocks; 7 being the highest on the pain scale. Walking seems to be the worst activity.
Brief Answer:
Neck fracture healing difficulties
Detailed Answer:
Hi there.
Welcome to Healthcare Magic.
Thanks for the query.
Kindly answer a few of my queries for me to be in a better position to help you.
Have you had any problems in menstruation ?
How is your appetite for food ?
Do you have constipation ?
Stress Fractures occur when normal stresses are applied to abnormal bone such causes Fractures.
In your case, you have been detected with osteopenia. Osteopenia can occur in a variety of conditions like Vitamin D and Calcium deficiency, Scurvy, Rheumatoid arthritis, Hyperparathyroidism.
Have your ever been tested for Serum Vitamin D and Calcium deficiencies, PTH, Vitamin C, Hormonal tests like FSH, LH.
When you had been detected with the stress Fractures in the right hip and left hip were pinned to fix the fracture. This is seen when you have generalised bone disease as mentioned above.
If you have had less bleeding during menstruation, anorexia then it could be part of the triad of symptoms called The Female Athlete triad. This is due to certain hormonal disorders.
Femoral neck Fractures are notorious to heal if they aren't fixed emergently and solidly. They take time to heal as well, because the neck of the femur is bathed continuously in joint fluid which could prevent a bridge if bone called the callus from forming across the fracture segments.
If could take usually 2 to 3 months to heal a neck but being that goes in favour of non union. On this case the fracture has less chance to unite by itself and requires intervention. An Xray or CT scan needs to be done to confirm the presence of absence of callus bone bridge.
If the callus has not firmed since the surgery, then a second revision surgery may be needed to heal the fracture. Also it would be wise to consult your Doctor about the need for inhaling Salmon Calcitonin spray 200IU which helps to increase the bone density. This helps very much with the pain.
Avoid jerky, heavy contact movements such would disimpact a healing fracture and prevent healing. Eat a diet rich in calcium and Vitamin D like cheese, milk, eggs, cereals, pulses, lean meat, chicken. Keep well hydrated. Perform exercise regularly as per your Doctor's instructions.
Kindly reply to my questions and follow up with me with further queries if you have any.
I hope I have answered your query.
Thanking you.
Regards,
Dr. Aashish Raghu
Neck fracture healing difficulties
Detailed Answer:
Hi there.
Welcome to Healthcare Magic.
Thanks for the query.
Kindly answer a few of my queries for me to be in a better position to help you.
Have you had any problems in menstruation ?
How is your appetite for food ?
Do you have constipation ?
Stress Fractures occur when normal stresses are applied to abnormal bone such causes Fractures.
In your case, you have been detected with osteopenia. Osteopenia can occur in a variety of conditions like Vitamin D and Calcium deficiency, Scurvy, Rheumatoid arthritis, Hyperparathyroidism.
Have your ever been tested for Serum Vitamin D and Calcium deficiencies, PTH, Vitamin C, Hormonal tests like FSH, LH.
When you had been detected with the stress Fractures in the right hip and left hip were pinned to fix the fracture. This is seen when you have generalised bone disease as mentioned above.
If you have had less bleeding during menstruation, anorexia then it could be part of the triad of symptoms called The Female Athlete triad. This is due to certain hormonal disorders.
Femoral neck Fractures are notorious to heal if they aren't fixed emergently and solidly. They take time to heal as well, because the neck of the femur is bathed continuously in joint fluid which could prevent a bridge if bone called the callus from forming across the fracture segments.
If could take usually 2 to 3 months to heal a neck but being that goes in favour of non union. On this case the fracture has less chance to unite by itself and requires intervention. An Xray or CT scan needs to be done to confirm the presence of absence of callus bone bridge.
If the callus has not firmed since the surgery, then a second revision surgery may be needed to heal the fracture. Also it would be wise to consult your Doctor about the need for inhaling Salmon Calcitonin spray 200IU which helps to increase the bone density. This helps very much with the pain.
Avoid jerky, heavy contact movements such would disimpact a healing fracture and prevent healing. Eat a diet rich in calcium and Vitamin D like cheese, milk, eggs, cereals, pulses, lean meat, chicken. Keep well hydrated. Perform exercise regularly as per your Doctor's instructions.
Kindly reply to my questions and follow up with me with further queries if you have any.
I hope I have answered your query.
Thanking you.
Regards,
Dr. Aashish Raghu
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
No problems with menstruation. Good appetite. Chronic constipation and previous surgery for rectal prolapse. I am not anorexic or an athlete. I used to jog under 3 miles and do yoga 3 days a week. Now I just do the excersise prescribed by my PT. Was low on D when fractures detected; now normal with supplements. All tests for thyroid and calcium are normal. I am 5'7" and 125 lbs.
I dont understand why the pain showed up again two years later. I understood that the pinning should take the pressure off. The recent CT showed a fracture. Is it true that the fracture never healed? I limp when I walk which makes healing very difficult. I teach and walk a ton at work. I don't want to take medication because of the side effects, my age, and my bone density is not that bad. Is the bone medication the only way?
Thank you so much for the information. XXXXXXX
I dont understand why the pain showed up again two years later. I understood that the pinning should take the pressure off. The recent CT showed a fracture. Is it true that the fracture never healed? I limp when I walk which makes healing very difficult. I teach and walk a ton at work. I don't want to take medication because of the side effects, my age, and my bone density is not that bad. Is the bone medication the only way?
Thank you so much for the information. XXXXXXX
Brief Answer:
Fresh Complete fracture or Non union
Detailed Answer:
Hi there.
Thanks for the follow up query.
It is possible that the fracture such was pinned would have given away or the stress fracture would have been converted to a full blown fracture.
If you could upload Xray or consult your Doctor regarding the result of the Xray or CT Scan to confirm non union or fresh fracture.
I hope I have answered your query.
Thanking you.
Regards,
Dr. Aashish Raghu
Fresh Complete fracture or Non union
Detailed Answer:
Hi there.
Thanks for the follow up query.
It is possible that the fracture such was pinned would have given away or the stress fracture would have been converted to a full blown fracture.
If you could upload Xray or consult your Doctor regarding the result of the Xray or CT Scan to confirm non union or fresh fracture.
I hope I have answered your query.
Thanking you.
Regards,
Dr. Aashish Raghu
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your quick reply. My final question is can it be positively determined by my CT if it is non union or new fracture? It only showed on CT not the X-ray.
Thank you for helping me to understand this more clearly. XXXXXXX
Thank you for helping me to understand this more clearly. XXXXXXX
Brief Answer:
Xray CT Scan
Detailed Answer:
Hi there.
Non union of they neck of femur can be seen on Xray or CT Scan. If it is so, surgical intervention may be required to heal it.
Kindly discuss this with your Surgeon to decide the best treatment for your pain and disability.
Thanking you.
Regards,
Dr. Aashish Raghu
Xray CT Scan
Detailed Answer:
Hi there.
Non union of they neck of femur can be seen on Xray or CT Scan. If it is so, surgical intervention may be required to heal it.
Kindly discuss this with your Surgeon to decide the best treatment for your pain and disability.
Thanking you.
Regards,
Dr. Aashish Raghu
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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