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Nonunion fracture of calcaneus bone

Posted by Jane H. on 6/13/05 at 18:39 (176712)

I had a bone graft lifted from my left heel to reconstruct my right foot (infected nonunion 4th and 5th metatarsals)3/28. Right foot has tons of hardware and seems to be heeling OK (this was 4th surgery). Left foot gave continuing pain and was diagnosed as having a stress fracture at the graft procurement site on 4/23. I took a fall off my wheelchair ramp yesterday and wound up in the ER for X-rays. The ER Dr. said the right foot looked OK (i.e. everything aligned all right). He then told me I have a nonunion fracture on the left heel --not from the fall---he said it was older than that. I have an appt. with my surgeon in a few days. My question: If this is truly a nonunion on the left heel, am I facing more surgery or are there other treatment options out there? Thank you for your time. Jane H.

Re: Nonunion fracture of calcaneus bone

Ralph on 6/13/05 at 19:25 (176717)

Jane,
I hope Dr. Zuckerman responds to your post. He just returned from an ESWT conference in Vienna and in his brief post I think he mentioned it's use in
treating nonunion bone conditions.

I'm not a doctor, but hopefully Dr. Zuckerman could tell you about this treatment and it might save you from another surgery. Wouldn't that be good news.

Re: Nonunion fracture of calcaneus bone

Ed Davis, DPM on 6/13/05 at 21:19 (176723)

Jane:
I am a pro-union man and support the AFL-CIO. Beyond that, nonunions of the heel bone are rare but can often be treated via eleic or ultrasonic bone stimulation (Exogen). I will get you the link.
Ed

Re: Nonunion fracture of calcaneus bone

Ed Davis, DPM on 6/13/05 at 21:20 (176725)

Jane:
Click on the link: http://www.exogen.com/

Ed

Re: Nonunion fracture of calcaneus bone

Jane H. on 6/13/05 at 23:08 (176732)

Thank you, Ed, for the response and the laugh! (I probably gave you one with the visual of falling off a wheelchair ramp!) I HAVE been using an Exogen ultrasound bone stimulator. I started 9/04, but was still on PICC line getting Vancomycin and oral Levaquin, so I think they were just hoping for a break (no pun intended). Discontiued use 12/04 when it clearly wasn't working on right foot fractures. I started using it again after the 3/28 surgery and now have been using it on both feet since 4/23 when I found out the left heel was broken, too. I have also been taking Forteo injections since 12/04 (and of course, taking Ca++ supplements). I am NOT diabetic and have been healthy and reasonably active til this happened. I guess I'm just incredibly unlucky---just praying I can dodge any more surgery at this point! Thanks again.....Jane

Re: Nonunion fracture of calcaneus bone

ld on 10/28/05 at 00:30 (185986)

Clin Orthop Relat Res. 2003 Sep;(414):95-100.
Levofloxacin and trovafloxacin inhibition of experimental fracture-healing.
Perry AC, Prpa B, Rouse MS, Piper KE, Hanssen AD, Steckelberg JM, Patel R.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Conclusion:
'These data suggest that experimental fractures systemically exposed to levofloxacin or trovafloxacin have diminished healing during the early stages of fracture repair. The administration of quinolones during early fracture repair may compromise fracture healing in humans.'
see also:
Ulus Travma Derg. 2005 Jan;11(1):17-22.
A comparison of effects of fluoroquinolones on fracture healing (an experimental study in rats).
Tuncay I, Ozbek H, Kosem M, Unal O.
Karaelmas University School of Medicine, Orthopaedics and Traumatology Department, Zonguldak, Turkey. ibrahimtuncay at hotmail.com CONCLUSIONS: The current histopathological study has shown that all the studied fluoroquinolones retarded fracture healing in rats.'

J Bone Joint Surg Am. 2000 Feb;82(2):161-73.
Ciprofloxacin inhibition of experimental fracture healing.
Huddleston PM, Steckelberg JM, Hanssen AD, Rouse MS, Bolander ME, Patel R.
Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. 'The administration of ciprofloxacin during early fracture repair may compromise the clinical course of fracture-healing'

Orthop Res. 2000 Sep;18(5):721-7.
Inhibitory effects of the quinolone antibiotics trovafloxacin, ciprofloxacin, and levofloxacin on osteoblastic cells in vitro.
Holtom PD, Pavkovic SA, Bravos PD, Patzakis MJ, Shepherd LE, Frenkel B.
Department of Orthopaedic Surgery and Medicine, University of Southern California School of Medicine, Los Angeles 90033, USA 'Further in vivo studies are advocated to evaluate the relevance of the in vitro cytotoxicity reported here to bone healing in orthopaedic patients.'