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Hello Dr. Stoll,
In an earlier post, you wrote
>If I had a broken bone (other than the junction between the >upper 2/3 & lower 1/3 of the tibia or the scaphoid bone in
>the wrist) I would use hydroxyapatite ...
What would you recommend for a broken scaphoid? After 15 weeks, my scaphoid fracture feels good - it has been out of a cast and in a splint for 4 weeks now, so I could get accupuncture - but the crack is still visible in radiographs. The radiologist says it's "not healing" and the hand specialist thinks it's a fibrous union that should be bone-grafted and screwed together.
The hand specialist has been unenthusiastic about using a bone-growth stimulator, but I will certainly try that ASAP. What else would you recommend?
Thanks,
Ted
In Reply to: scaphoid frx - clinical vs radiographic healing posted by ted greenwald on March 27, 2002 at 12:40:54:
Hi, Ted.
Your docs need to have more respect for your intelligence than they are showing.
They need to show you pictures and fully explain why this is happening to you.
Basically, the problem with scaphoid frectures is that the bone only has one blood suppply which is frequently damaged by the fracture to the fragment. This means that the fragment DIES. The only known (by me) treatment is surgical removal of the fragment. Screwing this dead piece of bone to the still viable piece of the bone will not make the fragment viable. Youe wrist will be weakened some by the surgical removal (like removing a brick from a wall) but you need to get on with your life.
I, too, would be "unenthusiastic about using a bone-growth stimulator" because the fragment is DEAD.
You need to corner these guys and get them to explain all this to YOUR satisfaction and not only to THEIRS.
Let us know what you learn.
Walt
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by Walt Stoll on March 28, 2002 at 10:30:50:
Hello Dr. Stoll,
Thank you for your reply.
>I, too, would be "unenthusiastic about using a bone-growth >>stimulator" because the fragment is DEAD.
I should have addressed this in my post. Although I do indeed feel as though the hand surgeon has not properly respected my intelligence, we have discussed the possibility of avascular necrosis throughout treatment. Three radiologists have looked at my MRIs to determine whether or not necrosis was a factor. The first believed he saw necrosis; the second said he didn't; the third agreed with the second. All three consulted and concluded that both fragments were viable. Since then, the hand surgeon has said he sees no evidence of necrosis in my radiographs, which have been taken every two weeks.
However, the crack between the two fragments is not disappearing with time, as would indicate so-called radiographic healing. The hand surgeon's diagnosis is a fibrous union that has not yet progressed to a bony union; in his view, if I understand it correctly, healing is possible but has stalled. Since only a small percentage of such cases heal after 12 weeks, he thinks I have more to gain though surgery than through continued immobilization and waiting, which in all likelihood would end in surgery anyway.
I would prefer to heal the fracture, if the fragments are still viable.
Does this information affect your opinion? Thank you for helping me think this through.
Regards,
Ted
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by Walt Stoll on March 28, 2002 at 10:30:50:
Dr. Stoll,
I should add that the fragments are well stuck together as far as the hand surgeon can tell. They stay together and don't flop around when he moves the wrist under his fluoroscope. I have no pain when he palpates the snuffbox area or when he compresses the thumb.
Best,
Ted
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by ted greenwald on March 28, 2002 at 14:34:53:
Thanks, Ted.
This clarifies the waters considerably. IF you are fortunate enough to still HAVE a viable fragment, someone should be able to explain why it has not healed to the other fragment.
IF this is a fibrous union (possible) surgery may help it heal. It is really hard for me to advise you from a distance. You are just going to have to go with the guy that makes the most sense.
Let us know what you decide.
Walt
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by ted greenwald on March 28, 2002 at 14:34:53:
By the way, if they are considering Dr Becker's machine for stimulating malunions. I wonder why they did not use it in the beginning?
Walt
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by Walt Stoll on March 29, 2002 at 13:56:11:
>By the way, if they are considering Dr Becker's
>machine for stimulating malunions. I wonder why
>they did not use it in the beginning?
The hand surgeon is considering it only because I asked him to. I came across references to it on your site and elsewhere and wondered why the doc hadn't mentioned it. (He didn't mention nutrition either, of course, and I'm still wondering whether I'm doing that part as well as I could be.)
As far as I can tell, the doc doesn't have any experience with bone growth stimulators, but he seems to think they can't hurt. Today he told me he's trying to arrange to get me one.
Best,
Ted
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by Walt Stoll on March 29, 2002 at 13:53:51:
>IF you are fortunate enough to still
>HAVE a viable fragment, someone should
>be able to explain why it has not healed
>to the other fragment.
The hand surgeon only says "some of these injuries don't heal properly" due to limited blood supply and/or displacement of the fragments. He can't tell me why _my_ injury isn't healing, and thus I don't have any guiding principles to use in trying to heal it. I don't know who else to ask.
Assuming the fragments are viable, then they're getting at least some blood. Assuming my blood calcium level is healthy (I plan to have blood work done next week), why isn't the calcium sticking?
I've been doing accupuncture and massage to increase circulation. The only other thing I can think to do is try to increase calcium absorption. I recently cut sugar and coffee entirely and increased calcium citrate intake from 1000mg to 1600mg, vitamin D from 200IU to 600IU, and magnesium from 500mg to 1600mg.
Best,
Ted
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by ted greenwald on March 29, 2002 at 15:39:32:
Hi, Ted.
If there is a fibrous union Dr Becker's machine may not work.
You could read up on his work. At least then you would know more about it than your "specialist" who should have been the first one to know about it.
Most teaching centers are already using this technique, routinely, for scaphoid and tibia fractures (the most difficult ones to heal). They no longer wait for the union to fail before using the machine.
Walt
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by ted greenwald on March 29, 2002 at 15:49:50:
Ted,
Bones are NOT made of pure calcium!
They are a complex webwork of many minerals and they are fit together with a complicated set of enzymes and catalysts.
ONLY hydroxyapatite with boron has that unique complex of substances. This is the only stuff that has been shown to actually reverse osteoporosis. ALL fractures first develop a physiologic osteoporosis at the site of the fracture in preparation for healing.
Walt
In Reply to: Re: scaphoid frx - clinical vs radiographic healing (Archive.) posted by Walt Stoll on March 30, 2002 at 09:05:56:
Dr. Stoll,
Thanks for your advice. I'm doing 1600mg/day hydroxyapatite (plus multivitimin/mineral) and 10 hours/day bone stim. We'll see...
Best,
Ted
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