To screw, or not to screw...
September 30, 2016 1:00 PM Subscribe
I have a stress fracture in the compression side of my femoral neck at my hip. My doctor has given me the options. I'm wondering if anyone happens to have experience (personal or otherwise) with this type of injury, and how did it go?
A couple of weeks ago I ran a 4-miler with what I thought was tendonitis, by the end of the race I could not walk, and had to get on crutches just to get around. Turns out, it was more than tendonitis, and after an MRI, found that I have a stress fracture. Apparently a fracture on the compression side is the better location to have it, otherwise surgery would be immediately indicated. As it stands, the standard of care is to have 6 weeks of total non-weight bearing (I have only been partial non weight bearing so far), follow up, see if its healed, and re-evaluate from there. If it is not healed options being, stay off of it even longer, or put the screws in. From the forums I have perused online, it seems like a lot of people still end up requiring the screws, but that may not be a fair reflection. I am heavily leaning toward having the screws put in now. I shall explain my rationale below:
Having screws PROS: I am a medical assistant at a dermatology clinic. I have been working on crutches partial weight bearing the past 2 weeks, but its a challenge. Non-weight bearing, I'm not sure it would be possible. I know my work would accommodate me, but I just started with a new doctor, and I don't really want to be down for more than 6 weeks. Another thing that shouldn't be relevant but still is, is that I am finally going to Harry Potter World at the first of November. I've been waiting for this for literal years. I'm also a little bit of a klutz. I feel like I would live in terror for 6+ weeks that I was going to further stretch the crack one way or another. There are also the pros of the screws: I could walk safely almost immediately (at least after my pain subsides enough), and I would not have to stress about it not healing properly all this time.
Surgery CONS: Surgery, of course, can always have complications. But I do have age on my side. Its a simple out patient procedure. Post-op pain, which I can always manage (this has been pretty intensely painful at times and I haven't taken anything, so I think I can manage). Other complications like infection etc.
I don't want to dive in head first, but I feel like it is the best thing for my lifestyle. Has anyone else had screws put in anywhere? Especially in this particular place? What was it like post operative? Any complications then? Or further in the future? For the record I am only 32, so I am assuming that the standard of care usually applies to people that are a lot older than I am, which would make surgery more complicated, but I don't really know. I like my doctor, but he is a little fast paced, and likes to give the patient control in their care, so I don't get as much advice or discussion as far as that goes. Any advice helpful!
A couple of weeks ago I ran a 4-miler with what I thought was tendonitis, by the end of the race I could not walk, and had to get on crutches just to get around. Turns out, it was more than tendonitis, and after an MRI, found that I have a stress fracture. Apparently a fracture on the compression side is the better location to have it, otherwise surgery would be immediately indicated. As it stands, the standard of care is to have 6 weeks of total non-weight bearing (I have only been partial non weight bearing so far), follow up, see if its healed, and re-evaluate from there. If it is not healed options being, stay off of it even longer, or put the screws in. From the forums I have perused online, it seems like a lot of people still end up requiring the screws, but that may not be a fair reflection. I am heavily leaning toward having the screws put in now. I shall explain my rationale below:
Having screws PROS: I am a medical assistant at a dermatology clinic. I have been working on crutches partial weight bearing the past 2 weeks, but its a challenge. Non-weight bearing, I'm not sure it would be possible. I know my work would accommodate me, but I just started with a new doctor, and I don't really want to be down for more than 6 weeks. Another thing that shouldn't be relevant but still is, is that I am finally going to Harry Potter World at the first of November. I've been waiting for this for literal years. I'm also a little bit of a klutz. I feel like I would live in terror for 6+ weeks that I was going to further stretch the crack one way or another. There are also the pros of the screws: I could walk safely almost immediately (at least after my pain subsides enough), and I would not have to stress about it not healing properly all this time.
Surgery CONS: Surgery, of course, can always have complications. But I do have age on my side. Its a simple out patient procedure. Post-op pain, which I can always manage (this has been pretty intensely painful at times and I haven't taken anything, so I think I can manage). Other complications like infection etc.
I don't want to dive in head first, but I feel like it is the best thing for my lifestyle. Has anyone else had screws put in anywhere? Especially in this particular place? What was it like post operative? Any complications then? Or further in the future? For the record I am only 32, so I am assuming that the standard of care usually applies to people that are a lot older than I am, which would make surgery more complicated, but I don't really know. I like my doctor, but he is a little fast paced, and likes to give the patient control in their care, so I don't get as much advice or discussion as far as that goes. Any advice helpful!
I broke a small bone in my wrist and elected to have a screw put in. The surgery was two weeks after the break, so it was frustrating to suddenly be "re-injured" by the screw, and it took a few months to really heal. But now, a year later, I have more confidence in my wrist's strength because the screw is in there.
posted by scrubjay at 2:57 PM on September 30, 2016 [1 favorite]
posted by scrubjay at 2:57 PM on September 30, 2016 [1 favorite]
Has your surgeon even offered to operate on you without a trial of six weeks of non-weight bearing? If that's the standard of care, especially since you are otherwise young and healthy, I would not be at all surprised if he would refuse your request to skip ahead to surgery immediately.
posted by telegraph at 3:10 PM on September 30, 2016
posted by telegraph at 3:10 PM on September 30, 2016
Response by poster: He doesn't have a problem doing the surgery if that's the route I decide. I get the impression that this typically happens in the very young or very old, and the typical standard of care isn't as hard set.
posted by Quincy at 3:20 PM on September 30, 2016
posted by Quincy at 3:20 PM on September 30, 2016
I would get the hardware. If you are unable to do the 6 weeks of non-weight bearing time, will be putting stress on it going forward by your lifestyle, why waste the six weeks when it is likely you are going to end op there anyway?
(Credentials: I have hardware in my neck and back, opted to not get a screw put into my foot and wrist.)
posted by AugustWest at 4:17 PM on September 30, 2016 [2 favorites]
(Credentials: I have hardware in my neck and back, opted to not get a screw put into my foot and wrist.)
posted by AugustWest at 4:17 PM on September 30, 2016 [2 favorites]
OK, you wanted personal experience?
I broke my femoral neck in a M/C accident around 1981, age 22 or so, and was offered the compression bolt repair, or a body cast. I chose the screw.
Shortly after the operation I started having a great deal of pain in the hip. Turned out the ball was necrosing. Doctor swore up and down the bolt didn't have anything to do with it. It just got worse, three years on crutches with a great deal of pain. Tylenol 4 washed down with Bacardi gold wouldn't touch it kind of pain.
I was going to college at the time, was classed as disabled - doc told me I'd never walk again w/o at least a cane, more likely crutches. Another disabled person told me the good experience they had with getting a metal plate out of their elbow.
I had the bolt removed - against my doctor's advice - he of course said it would not make any difference.
I clearly remember the intern or anesthesiologist who was prepping me in the operating room asking me if I was having the surgery hoping the ball would re-hematize. Yes. he said it probably would. It did. 6 months later I was walking unaided.
My hip ball joint still looks like an orange left too long in the refrigerator when seen on an Xray- kind of shrunken and lumpy. It's still weak, the current crop of orthos have told me to just call them when I want it replaced and they will set me up at the hospital.
If I had to do it again, the 6 months in bed would have been a much better choice. 6 months is a vanishingly small part of the time I have had to deal with this hip.
Whatever you do, if you do have metal put in, *get it back out when it has served its purpose*.
posted by rudd135 at 4:21 PM on September 30, 2016 [2 favorites]
I broke my femoral neck in a M/C accident around 1981, age 22 or so, and was offered the compression bolt repair, or a body cast. I chose the screw.
Shortly after the operation I started having a great deal of pain in the hip. Turned out the ball was necrosing. Doctor swore up and down the bolt didn't have anything to do with it. It just got worse, three years on crutches with a great deal of pain. Tylenol 4 washed down with Bacardi gold wouldn't touch it kind of pain.
I was going to college at the time, was classed as disabled - doc told me I'd never walk again w/o at least a cane, more likely crutches. Another disabled person told me the good experience they had with getting a metal plate out of their elbow.
I had the bolt removed - against my doctor's advice - he of course said it would not make any difference.
I clearly remember the intern or anesthesiologist who was prepping me in the operating room asking me if I was having the surgery hoping the ball would re-hematize. Yes. he said it probably would. It did. 6 months later I was walking unaided.
My hip ball joint still looks like an orange left too long in the refrigerator when seen on an Xray- kind of shrunken and lumpy. It's still weak, the current crop of orthos have told me to just call them when I want it replaced and they will set me up at the hospital.
If I had to do it again, the 6 months in bed would have been a much better choice. 6 months is a vanishingly small part of the time I have had to deal with this hip.
Whatever you do, if you do have metal put in, *get it back out when it has served its purpose*.
posted by rudd135 at 4:21 PM on September 30, 2016 [2 favorites]
I am normally anti-screw. I know too much about what metals can do to the body and I have read too many operative reports and seen too many surgeries redone and hip surgery is pretty darn invasive.
But I also spent 3.5 months bedridden. It took years to recover weight bearing stamina. You might google up some articles about what weightlessness does to astronauts in terms of muscle wasting, bone softening, etc.
Just get the screws. Six weeks non-weight-bearing scares me more than screws in an otherwise healthy individual.
posted by Michele in California at 4:25 PM on September 30, 2016 [1 favorite]
But I also spent 3.5 months bedridden. It took years to recover weight bearing stamina. You might google up some articles about what weightlessness does to astronauts in terms of muscle wasting, bone softening, etc.
Just get the screws. Six weeks non-weight-bearing scares me more than screws in an otherwise healthy individual.
posted by Michele in California at 4:25 PM on September 30, 2016 [1 favorite]
I did twelve weeks not weight bearing due to hip injury ... six weeks is doable. Rest, reschedule your trip, and rent a wheelchair for work.
posted by crazycanuck at 10:05 PM on September 30, 2016
posted by crazycanuck at 10:05 PM on September 30, 2016
This is kind of bizarre. A close relative had this precise injury, at the same age as you, that also occurred while running. In his case, tests didn't reveal the stress fracture until it started to crack open, so he had to get screws put in.
Initially he was informed that they would remove the screws after the fracture healed, but subsequent imaging indicated that removing them would be a mistake. So, many years later, you can actually see the bumps of the screws sticking out of his hip. Once the healing period was over he went right back to running, bootcamp, yoga, gymnastics, and pilates. However, the immediate aftermath of the procedure was obnoxious enough that he needed some assistance with getting his groceries and work items up the stairs to his apartment. He started with crutches, graduated to a cane, and then slowly started easing back into strenuous physical activity over a period of several months.
posted by xyzzy at 2:42 AM on October 1, 2016 [1 favorite]
Initially he was informed that they would remove the screws after the fracture healed, but subsequent imaging indicated that removing them would be a mistake. So, many years later, you can actually see the bumps of the screws sticking out of his hip. Once the healing period was over he went right back to running, bootcamp, yoga, gymnastics, and pilates. However, the immediate aftermath of the procedure was obnoxious enough that he needed some assistance with getting his groceries and work items up the stairs to his apartment. He started with crutches, graduated to a cane, and then slowly started easing back into strenuous physical activity over a period of several months.
posted by xyzzy at 2:42 AM on October 1, 2016 [1 favorite]
My husband had a nasty comminuted spiral fracture of his femur last year. He had an IM nail rather than a DHS as luckily the fracture was just below the neck, but it took six months to get back to normal activity, just as his surgeon predicted.
Very little of that delay was due to pain (he was off painkillers after two weeks). The surgery itself disrupted quite a lot of muscle, and it was several months before he could lift his leg unaided, even though he was weightbearing straight after the op.
You aren't going to have the op and be straight back to normal activity. You'll have months of rehab. I would really advise you to give the six weeks non-weightbearing a proper try if your surgeon thinks there is a chance of success - orthopaedic surgery is something to avoid if at all possible.
posted by tinkletown at 3:53 AM on October 1, 2016
Very little of that delay was due to pain (he was off painkillers after two weeks). The surgery itself disrupted quite a lot of muscle, and it was several months before he could lift his leg unaided, even though he was weightbearing straight after the op.
You aren't going to have the op and be straight back to normal activity. You'll have months of rehab. I would really advise you to give the six weeks non-weightbearing a proper try if your surgeon thinks there is a chance of success - orthopaedic surgery is something to avoid if at all possible.
posted by tinkletown at 3:53 AM on October 1, 2016
Speaking as a thoroughly instrumented person, and one who's been through several 6-8 week periods of non-weightbearing (you will not be bedridden) .... I'd strongly recommend that you do everything you can to get it to heal on its own without hardware. That is certainly what I'd do, and without any regret even if I had to get screwed later.
Plenty of people do fine with hardware in various places. But there are enough ways it can go pear-shaped that it's worth avoiding if possible. If it does go pear-shaped, it goes REALLY pear-shaped, and you may not be able to ever get back to where you were; you could be in problem-land for life. It's a trigger you can't un-pull.
There's very little right now (a conference? a new job?) that's worth being crippled for life. Think long-term, and do what you need to do for the present. You're going to be in for PT in either case, and you need to focus on this for a little while. I know it must be a shock, but please don't let Harry Potter be your deciding factor.
Have docs been concerned that you got this injury? Could you have a thyroid problem that is leeching calcium out of your bones? Friend of mine fractured a hip for that reason in her early 40s, in a completely mundane fall.
I had an ultrasound machine for bone healing at one point. Some studies point to it helping, and for a big bone, it could.
posted by Dashy at 12:51 PM on October 1, 2016 [2 favorites]
Plenty of people do fine with hardware in various places. But there are enough ways it can go pear-shaped that it's worth avoiding if possible. If it does go pear-shaped, it goes REALLY pear-shaped, and you may not be able to ever get back to where you were; you could be in problem-land for life. It's a trigger you can't un-pull.
There's very little right now (a conference? a new job?) that's worth being crippled for life. Think long-term, and do what you need to do for the present. You're going to be in for PT in either case, and you need to focus on this for a little while. I know it must be a shock, but please don't let Harry Potter be your deciding factor.
Have docs been concerned that you got this injury? Could you have a thyroid problem that is leeching calcium out of your bones? Friend of mine fractured a hip for that reason in her early 40s, in a completely mundane fall.
I had an ultrasound machine for bone healing at one point. Some studies point to it helping, and for a big bone, it could.
posted by Dashy at 12:51 PM on October 1, 2016 [2 favorites]
Why did you get this injury?
Had you run a lot or much further than the 4miles in the time running up to the injury? I stress fractured a metatarsal once and I did it running 10-12 miles 4x/week running up to a half marathon on inadequate shoes. I was really bashing the hell out of my feet when I did it and I had probably 3 weeks of warning pains before it actually fractured.
It is relevant because if there is an underlying problem, (thyroid and orthorexia are the two I can think of but there are others) it may also drastically impact healing, whichever route you choose, unless you treat it too.
FWIW I would choose the path of lowest intervention. Surgical hardware is never as good as biological, if you can get the latter functioning well.
posted by intergalacticvelvet at 2:22 PM on October 1, 2016
Had you run a lot or much further than the 4miles in the time running up to the injury? I stress fractured a metatarsal once and I did it running 10-12 miles 4x/week running up to a half marathon on inadequate shoes. I was really bashing the hell out of my feet when I did it and I had probably 3 weeks of warning pains before it actually fractured.
It is relevant because if there is an underlying problem, (thyroid and orthorexia are the two I can think of but there are others) it may also drastically impact healing, whichever route you choose, unless you treat it too.
FWIW I would choose the path of lowest intervention. Surgical hardware is never as good as biological, if you can get the latter functioning well.
posted by intergalacticvelvet at 2:22 PM on October 1, 2016
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I also tend to see more complications than a normal person would, because I primarily work with immuno-compromised adults as a social worker so I see way higher than average complications from similar procedures and the healing times are sometimes greatly increased which is the exact opposite of your situation.
posted by AlexiaSky at 2:22 PM on September 30, 2016