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Healing a Fracture with a Fracture | Penn Medicine

February 5, 2020

(slow inspiring music) – Heather’s case is actually
fairly typical of what we see in our Limb Salvage and
Extremity Reconstruction Center. Young, active individual,
unanticipated injury. Roller derby for Heather was a passion, and she broke her tibia. She went to a local hospital, and she had a rod placed, and from a technical perspective, everything looked great, and Heather went on for several months, rehabing, trying to recover, but continued to have
pain at her fracture site. Why didn’t this young, healthy person, with a well-aligned
tibia, heal her fracture? We did a fairly extensive work-up on her. We looked at the way her
fracture was aligned, and then we got a CT scan of her leg. And her CT scan clearly showed a nonunion. The two ends of the bone
were not coming together. And so, we had a very lengthy conversation at that point about what
to do for her nonunion. And there’s lots of options, right? We talked about things like do nothing, you might do okay, the
hardware might break, and if it breaks, then we know we have to
do something, it may not, you’ll always have a little bit of pain, and just don’t do the
activities that cause pain. We talked about doing something as simple as injecting the bone, the nonunion site with
bone marrow aspirate. Taking bone marrow from the body, concentrating it and injecting
it into the fraction site, giving the biology a
kickstart, if you will. We talked about taking out
the screws and dynamizing her. What that means is basically
we take the screws out, and let the fracture
compress itself over the rod. Almost like it slides
and squeezes itself down. But getting into the technical
aspects of it a little bit, she had broken her tibia,
but not her fibula, and because the fibula hadn’t broken, my hypothesis at least was
the fibula was taking some of the load from the tibia and not allowing the tibia
to compress and heal. So when we did her surgery, we took out the existing
rod that was there, we actually broke her fibula, we did what’s called a
osteotomy of her fibula, to create a fracture there. Then we put a new rod in and
from a technical perspective, we compressed the fracture
in the operating room. We’re not talking inches
or centimeters here, we’re talking a millimeters
of bone compression, put new screws in the rod, and let her walk on it right away. Now, some would argue that breaking the fibula is somewhat
controversial as well, but based on her symptoms, based on her CT, based on the mechanics, based on what was already done, it made the most sense. She was aggressive with her rehab, she was an active participant in her care, she was motivated, she was enthusiastic. At six weeks, she had no pain. By three months, we
had her back in skates, and by four and a half months, we had her back to contact sports. I think for Heather, Penn Medicine really provided
a unique opportunity, because of our approach to complex malunions and nonunions, infections, and complex polytrauma. We leverage our
experience, our technology, and our various clinical partners to optimize the outcome
for patients like Heather. (slow inspiring music)


  • Reply Larnie Deocampo May 27, 2019 at 5:07 am

    Can i ask? I have a fractured tibia almost 6weeks now but i can feel my bones grinding each other again at my fractured site. I have been using cast for almost 6weeks without surgery. Can you help recover fast?

  • Reply Technical Humen October 23, 2019 at 2:16 am

    i had a broken femur few months ago… but now i saw something in the joint while x ray

  • Reply Richard Price December 27, 2019 at 4:39 pm

    Brilliant common sense and yet great analysis and thinking just broken my olecron bone right elbow and boy am I fed up with K wires and pins more painful than actual break cycling, great medicine drives us forward

  • Reply Adnan Jelani January 2, 2020 at 10:50 am

    I also broke my Tibia.

  • Reply priyank sahoo January 15, 2020 at 7:29 pm

    one of the I for non union causes is Intact Fellow Bone

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