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Questions About Healing a Broken Leg:
Triggering Bone Growth With Weight Training
Background Skip To Questions
Patient is a formerly very active, athletic male in his late 30s. Femoral fracture was sustained in a automobile accident. Force of blow was severe, though original break was clean. Distal segment traveled up and to the right during fracture then flopped all the way down and to the left afterwards. Other than that no major forces acted on the bone. Some scarring of hamstring muscles occurred as a result of bone scraping during fracture.
During surgery IM nail impacted mulitple times on distal cortex, including one blow that dislodged a large segment of bone. (Image below) Surgical incision was required to align segments to complete nailing. Patient lost an estimated 2000 cc of blood during the process. Patient spent 6 days in bed afterwards and was not able to stand until the third day post-op. Walking was limited during first week.
The femur currently has a 48 cm nail in a 47.5 cm femoral space. (SIDE NOTE: Attn. orthopaedists! Femurs with 48 cm nails in them do not fit diagonally on large x-ray films so stop ordering full bone x-rays damnit! Maybe you could ask the patient what x-rays are needed?) Patient appears to be on a slow healing track. Radiographic progress has been steady in places but slow. During a long one crutch walk week 12 patient bent the distal screw and the resulting nail shift appears to have triggered a stress fracture on the front medial condyle of the femur. (Pain on torsion, not point sensitive, tapping triggered pain.) Pain took about 4 weeks to heel. Activity levels were severely reduced during this time. (No biking, two crutch, toe-touch only, gradually increasing leg resistance for extensions and curls.) Residual pain/ache seems to exist somewhere in the knee joint. It requires odd torsional forces to trigger. (Sitting, knee at 90 degrees, can't move foot medially.) Standing upright on two feet does not trigger pain. Ice really helps reduce ache. Patient suspects more funny business from nail or residual stress fracture effects. Biking and most weight training activities not affected during current stage. (Week 16)
The Real Questions Back to Background
Patient likes to avoid both surgery and excessive x-rays. Patient is aware of three unhealed cortices and one slow healing cortex. Images are show below. Small is top view, Large is side view. Detail is approximate. NOTE 1: Bone chip missing in small image can be seen in larger image. NOTE 2: What looks to be a callous in the smaller image is probably scatter from displaced segment behind it.
Remodeling and bone growth have been progressing steadily along the posterior portion. The other three gaps are moving verrrrrry slowly. Patient has seen another x-ray with a similar looking event. The direction of compression stress has bone growth. Since the rod is curved, all walking stress has been compression oriented along the backside. Other directions do not get much stress and do not show much in the way of bone growth or rapid remodeling. Or if they do it is very slow. Here is the theory: If weight training can be used to trigger compression forces in the remaining three directions - medial, lateral, and anterior - bone growth can be stimulated. This is important since weight bearing as an activity presents the risk of poking the nail into the knee cavity. Weights can generate a variety of non-axial loaded forces. Patient would feel much better if the bone were supporting a good portion of the weight before doing serious attempts at walking again. ("Well," says the orthopaedist thoughtfully, We could do a nail exchange." Yeah, right! For the doctor it is a house payment (damn nice house too) and he gets to play with knives and hammers. Patient gets carved up and gets to take more drugs. We would like to avoid that.) Here are the questions:
- How much weight resistence would you guess is needed to generate enough piezoelectric (Cool word! I hope I used it right.) effect to stimulate bone growth?
- What role does rest play in allowing bone growth to occur? Do I need enough strength to be able to lift at estimated trigger rate every day? Is lifting at maximal every other day better?
- If you do not have any answers or suggestion do you know anyone I can contact?
- Any research institutions want the results of this study?
- What other question should the patient be asking himself now?
- What other question should the patient be asking the orthopaedist now?
- It is now week sixteen. Are there any time deadlines of concern to note? (For example, you cannot should a nailed femur fracture non-union until at least the sixth month. Therefore patient might have ten weeks to try other things.)