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Old 04-24-2010, 07:40 PM   #1
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Unusual application of IM Rod (Intramedullary Rod) for suspect stress fracture.

I wanted to post something online for the rare chance that someone else will face a similar problem. I've searched high and low, but I seem to be fairly lonely out there with this medical situation.

In 2002 while I was training aggressively for an Ironman I developed an odd pain on the front and middle of my right tibia. I was xray'd and a ever so slight line showed up and I was diagnosed with stressfracture due to overtraining. The treatment was 3 months off my legs. 3 months passed and the line showed absolutely no change, and pain was the same when running.

To abbreviate this story, I went from doctor to doctor, took Fosamax for slight osteopenia, wore a bone stimulator for 3 months, stopped running completely - and by 2004 the line on the tibia had made absolutely no sign of improvement. And pain persisted. I was told by doctors that there was nothing more they could do for me - but I was really counting on being able to run again and kept pushing.

By then I had made it to a surgeon who suggested an IM rod. There was some hope that it would stimulate the bone around the suspected stress fracture (and no doctor ever question if it really was a stress fracture). I was open to all ideas and agreed to surgery in March 2004.

After waking up from surgery I was told the rod never got screwed in place since it had been a tight fit (and it might have saved me some discomfort over the years). But... quite soon after surgery I started to experience a different kind of pain. It was very difficult to describe, and quite honestly it felt different at different times. Back to the doctor! Now they started guessing it could possibly be compartment syndrome, although this was never proven. This was in the later part of 2004.

The pain never stopped me from going on with every day life, but it kept me from the thing that I love the most - running!! But around this time I also got pregnant (twice, back to back) and I put off any form of treatment for these years. But in 2008 I went back to at least have a bone scan done, and the result was: abnormal. Doctor could not say why, just that it was not what they expected to see if it was healthy. No infection was found though.

It's interesting to note that this doctor that I saw in 2008 recommended the following treatment: Removal of existing rod, placing in a new, thicker one, screw it in place, do a bone graft on the suspected stress fracture (that still looked the same) and for recovery EIGHT weeks completely non-weight bearing (no swimming even). Overall a pretty disruptive and invasive option! I live in a 3 story house with 2 kids under 4 - so I opted to wait since it still was not a matter of urgency or unbearable pain.

About a month ago I saw surgeon #555 (or so it feels!) and by now I have increased pain. Not bad, but to the point where I take anti-inflammatories at night to escape what now feels like dull ache or even like growing pain. The new approach - he does NOT believe that what I have is a non-union stress fracture! Wow! That's a thought - I never responded to anything that was done to stimulate it to heal so it makes sense. But after that many doctors all believe the same thing, so did I. Until now... now I'm just not sure. This new doctor suggested some possible bone abnormality around this area, but he was also cautious with saying that he knew for sure. Which I appreciate.

He took a look at the xray and basically told me the truth - this rod will be a pain to take out - it is very deep into the bone, and my previous surgeon did not cap it, meaning there might be bone growth down into the rod, and it will be difficult to get to and grab it. But other than that he is fairly convinced, based of new xray's that the rod is LOOSE in there! And my pain might be coming from the movement.

This particular type of pain from an IM Rod is impossible to find any info on. If you happen to come across this and have felt misdiagnosed and/or mistreated with an IM rod, please post! It would be very interesting to hear other situations and possible solutions.

PS.
I will have my rod out at the end of April, 2010 (in less than a week) and will try to post something about that experience during recovery.

 
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Old 05-29-2010, 08:03 PM   #2
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Re: Unusual application of IM Rod (Intramedullary Rod) for suspect stress fracture.

An update on the progress. I am 4 weeks post op today, and am doing well. The rod was more difficult to get out than first anticipated. 3 pieces of bone was cut out to serve as a window, or an access point to get a solid grip on the rod. Recovery was a bit more painful than I had imagined and I did end up spending the night due to pain levels. But... the following day things turned around quite drastically and I left with your normal pain meds. I took the meds for about 3 weeks due to the pain but have since almost no pain when walking etc. The remaining pain is all in the site (lower knee) where the bone was compromised. There are some pain when lifting/bending leg upward and I sense that it is mainly soft tissue related at this point.

I did spend about 2 weeks in a full leg brace, with crutches. Doc thought about 3 weeks but I was really ready to get my freedom back and felt OK to let them go around 2 weeks.

I'm not "cleared" for any strenuous activities so there are additional updates to come on that part. But it's been nice to walk around without the pressure or pain in the lower tibia that I had with the rod in place. The x-rays post surgery showed a "ghost" image of the rod in place. The bone had grown around the rod and created an illusion of it still being in place. Doc said it was because the rod had room to move and the bone kept growing in on it to stabilize it. Interesting!

Well, proof is in the pudding. I've not been running for almost 7 years and I am still hopeful. I just ordered a pair of Vibram Five Finger shoes, thinking there's something about the theory of barefoot running that applies to my injuries and situation. I also have a morton's neuroma in the right foot (same as tibia injury) that I am hopeful to get past. I'll add updates at another date.

In conclusion; If you do happen to have this rare situation of considering an IM rod for some non-traditional purpose, please think long and hard about it. The doc might be out of options, but that does not mean an IM rod is going to solve anything for you.

 
Old 06-20-2010, 10:07 PM   #3
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Re: Unusual application of IM Rod (Intramedullary Rod) for suspect stress fracture.

Just want to add a quick note...

I just now started jogging very lightly, for very short durations - with this new shoe (Vibram Five Fingers' Bikila) and it feels amazing!! On the first few walk/jogs I had some pain flare up in the knee area where the rod was taken out, which didn't surprise me one bit.

The FANTASTIC news is that the pressure in my lower tibia is not there anymore! I almost forgot how it felt to not have that pain. Amazing.

Now, I've done some serious reading on Barefoot Running (Bestseller Born To Run is a good source of inspiration!) and find that my injury - the stress fracture - could very well have been avoided when applying the idea of barefoot running. Something to keep in mind for those with similar types of injuries.

Think about how your heel strikes in the ground - bam! Complete impact! That is why the heel needs to have this extreme cushioning, and the shoes these days are just getting more and more advances, yet injuries are not getting less and less... anyway, the idea is very interesting to me.

After 2 weeks in my Bikila's (and I wear them almost all the time) I'm much happier on my feet. I also have a Morton's Neroma that I can barely feel with these on. And once on the trail, I can't feel the non-union stress fracture at all. Beware that you will be sore in feet, ankles and possibly calfs from the new style you adapt before your body has gotten used to it. There are muscles in your feet and legs who's not used to being used that way or that much when you switch to a midfoot or ball of foot strike. Please study other barefoot runners too. I practiced these new strides at home, 5 min at the time for a few weeks before I even put the shoes on.

It's too early to tell if this will my path to success - becoming an active runner again. But, again, I want to put something here on the web about my own journey to overcome this and if you do share a similar story, I'd love to hear it.

Updates will come - I just started thinking that perhaps a 5k race might be doable! That will be a huge deal for me - now 7 years away from the sport!

 
Old 06-21-2010, 05:09 AM   #4
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Re: Unusual application of IM Rod (Intramedullary Rod) for suspect stress fracture.

Hi

I just wanted to ask how the non-union stress fracture was detected? Did it show up on your bone scan? I've been suffering from severe chronic pain at the top of my tibia for the past 7 years which no one has been able to resolve.

I now know that I've got osteopenia and my orthopaedic surgeon thinks I'm probably suffering from stress fractures, but they're not showing up on either x-rays or bone scans.

Thanks

 
Old 06-25-2010, 07:52 PM   #5
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Re: Unusual application of IM Rod (Intramedullary Rod) for suspect stress fracture.

Quote:
Originally Posted by island monkey View Post
Hi

I just wanted to ask how the non-union stress fracture was detected? Did it show up on your bone scan? I've been suffering from severe chronic pain at the top of my tibia for the past 7 years which no one has been able to resolve.

I now know that I've got osteopenia and my orthopaedic surgeon thinks I'm probably suffering from stress fractures, but they're not showing up on either x-rays or bone scans.

Thanks
Hi Island Monkey!

It was this tiny, tiny... (did I mention tiny?) line or even a dent in the bone on the x-ray. I had xrays, bone scans, MRIs, and they all showed an ever so slight abnormality in the area. But again, it was tiny. And it's still there, after 7 years and all those "treatments." But like I mentioned above my new doctor who now took out the IM rod is not quite sure he believes it ever was a stress fracture. So who knows.

Ironically I ended up marrying an orthopedic PA (not related to my injury, haha) but I do know they get a lot of cases where they simply scratch their head. You can go to 10 doctors and get 10 diagnoses for other other things, but when it comes to bones they are generally limited to a few guesses.

Good luck in finding your own cure or way around this. I've not had any pain in the stress area yet, and I am ever so slowly starting to jog again. Time will tell...

BTW - I did have osteopenia too, and was treated with Fosamax (had to fight the insurance company due to my low age though) and have since reversed the osteopenia!!

Last edited by crimson4154; 06-25-2010 at 07:56 PM.

 
Old 06-29-2010, 05:22 AM   #6
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island monkey HB User
Re: Unusual application of IM Rod (Intramedullary Rod) for suspect stress fracture.

Thanks - that all sounds pretty familiar

 
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