Non healing humerus break ... need to bend a few ears again ....

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GermanyJo

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Ok... now for the next depressing installment of 'Jo's arm' ..... for the entire saga (if you are really bored ..) you can see the previous installments below

http://www.horseandhound.co.uk/forums/showthread.php?611485-Sodding-Arm-doesnt-want-to-heal-(

http://www.horseandhound.co.uk/forums/showthread.php?590865-broken-arm-screws-and-plate-(

Anyway .. was back to my 'second opinion' Hospital for what I was hoping was going to be my last x ray ... oh, how wrong I was :-(

X ray looked more or less the same as the last time ... so more or less the same as directly after op
As today is the 6 month anniversary of my accident , it is getting a bit 'old' and boring now ..

Knew it was bad news when there were 3 doctors suddenly in the consulting room checking out the x rays
To cut a long story short I have 2 options
1) .. bone graft op ... result should be good ... should be healed in 8 weeks ...but of course .. no op is without risks (they would take bone from my hip and use for grafting on the humerus

2) Ultrasound therapy .. apparently not proven.. and looks like no health insurance company in Germany will pay for. .. I would need to pay 1800€ for the machine , which I would then have at home and would do 20 mins a day for 4 months. Apparently if it does not work after 4 months you get your money back (?) .. call me cynical, but would be a bit worried if there was a bit of healing , or if they wanted to discuss that somehow they would wrangle out of paying out..

The doctor who suggested the Ultrasound therapy was convinced about it and was really pushing it .. to the point of telling me that he would make money for the OP but not for the Ultrasound .. so it was not a cost reason why he was suggesting it.

I spoke to another doctor (independant - friend of a friend) who was much more sceptical about it and was saying he would go for the op and get it sorted sooner.

... was never great at major decisions,and being really pi**ed off anyway, am not in the best frame of mind either ..

I am currently riding my horse a bit , but only in the indoor school and he is still being schooled twice a week as i am only able to do 30 mins or so. clearly with the Op I would then be off games again for at least 6 weeks , maybe more - but then hopefully would be fully better ... with the Ultrasound I would be able to carry on as I am , but with the risk that in 4 months I am still in the same situation .. plus I need to find a spare 1800€ :-(

current plan of action is wait for some feed back from a sports ortho. surgeon re his opinion on the Ultrasound and then make a decision

anyone any experience with Ultrasound for kick starting bone healing ? ... I know alot of you gave me some really good advice and encouraging mails in my previous mails so thought I would bend your ears again ..

found a ton of 'promotional' internet sites which all sound really good, but then found this as well ...
http://doctorskeptic.blogspot.de/2012/05/does-ultrasound-make-bones-heal-no.html

can offer some 'comfort food' chocolate ice cream which has been in the freezer a bit too long so seems to have alot of ice on it .. but despite that is still quite nice :-)
 
Blimey...so sorry to hear what you are going through:(

I can offer no advice other than if it was me I would go for the op.....but I am not you....so you have to make the choice that is best for you....TBH I cannot see how the ultrasound would work as in my experience it only really seems to act well on soft tissue...and not bone....but I am ready to be corrected.

What I would suggest is a herb called Comfrey or Knitbone. You can drink it as a tea...which IMO is the best .....but it does taste a bit pants:) sweeten it with honey......or you can buy tablets....it is incredible at healing broken bones....I swear by it.....you can probably by it over the Interweb....loose as tea or in the tablet form.

I wish you all the very best at what must be a very frustrating and painful time for you right now.

Bryndu
 
OP I was thinking of you this week and wondering how you're getting on. I really feel for you, I'd be going spare by now! If it were me, I'd be inclined to go for the Op. I don't know anything about bone grafts though, so that would depend on whether there were significantly increased risk. The reason for this is that it's kinda clear they didn't do the best job possible first time around and I'd be thinking they would be better going back in and getting a chance to put anything that wasn't ideal, right. So for long term outcome AND quicker improvements AND more proven treatment, there is little to recommend the ultrasound apart from avoiding risk of operation, from what I can see. I really hope you can get it sorted, that must be really depressing :(
 
thanks for the replies so far .. and thanks philamena for thinking of me :-) If I do go for the Op, it will be done at the hospital where I have been the last 2 times for a second opinion, not back to the original one, might not be completely fair of me, but with all the umming and ahhing and strange comments about the plate not being quite long enough etc etc .. I have lost a bit of faith in them.
 
Hi,

I'm a physio (both humans and animals). I've had some very limited success with ultrasound on a non healing metatarsal fracture, it is very time consuming as you normally have to do it several times a day. Long term benefits don't seem any different to the op version.

You also run the risk of being in the same position after a couple of months of ultrasound whereas if you had opted for the operation you may be well on your way for recovery.

I had lots of success post op from bone grafts and the incision in your hip is very small. There are of course the normal op risk factors but for this would be fairy minimal I imagine.

Hope this helps

Jules

p.s. be careful what you read on the internet as always.
 
Just had a quick search and this popped up on Journal of Orthopaedic Trauma:

They showed that LIPUS (low intensity pulsed ultrasound) accelerated the fracture healing rate from 24% to 42% for fresh fractures. Some literature, however, has shown no positive effects.
For delayed union and nonunion, the overall success rate of LIPUS therapy is approximately 67% (humerus), 90% (radius/radius-ulna), 82% (femur), and 87% (tibia/tibia-fibula). LIPUS likely has the ability to enhance maturation of the callus in distraction osteogenesis and reduce the healing index. The critical role of LIPUS for fracture healing is still unknown because of the heterogeneity of results in clinical trials for fresh fractures and the lack of controlled trials for delayed unions and nonunions.

Hope some of that makes sense

Jules
http://www.jgphysio.co.uk/
 
Jules, please be careful putting your name and website on your posts - it might be classed as advertising, which is against T&Cs.


OP, sounds awful, I hope you aren't feeling too rough. I haven't read the other two posts, but it might also be worth looking up Pulsed Magnetic Field Therapy (also known as Pulsed Electromagnetic Energy). There is some evidence for it helping with fracture healing.

http://www.ncbi.nlm.nih.gov/pubmed/6607442
http://www.ncbi.nlm.nih.gov/pubmed/10758655
http://www.bjj.boneandjoint.org.uk/content/72-B/3/347.short
http://www.cytotron.com/pdf/Therapeutic uses of pulsed magnetic-field exposure, a review.pdf

There are machines available for plenty less than 1800 euros. Worth having a read about, anyway. :) Wish you the best with your recovery!
 
GermanyJo said:
Forgot to ask how you were doing philamena?
Click to expand...

I'm good thanks for asking Jo. It's now exactly five months since the fall, or four months three weeks since the operation. I'd reckon I'm at 90% range of movement (can't get it to rotate fully behind me ie for backstroke-type move it comes out to the side when it's behind me, and still have to assist it up my back to do bra strap etc) and about 60% strength back in the easy directions (ie I can lift and push the wheelbarrow with two water containers in it, but I probably couldn't chuck a heavy shovel of muck up onto the muckheap). Did my first gym class yesterday: just a body balance 'stretchy' type class and managed all but a couple of stretches / holds, including felt fine supporting my bodyweight in some planks.. so the shoulder seems pretty decent - but the rest of me had seized up good and proper, stiff as a board! Ached this morning - everywhere other than the shoulder (how terrible!). From a day to day life point of view, things have been 'normal' (except not mucking out) for probably 6 to 8 weeks, so I'd be really inclined to go for the op if I were in your shoes I think. It really sounds like you'd get a quicker, more reliable result. Not least because although you can do a bit at the mo, the effect the injury is having on the rest of your fitness, your straightness and your flexibility is quite marked and you'll probably only really notice the full extent of it when you start trying to get fully back to normal. And the longer that goes on, the longer it'll take to come back.

When do you have to decide by?
 
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