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Doctors' Answers to "Frequently Asked Questions" - Bones


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Galleazzi Fracture/dislocation [posted 1/7/99]
Question: On 7/1, I suffered galleazzi fracture of left radius and dislocated wrist. On 7/3, had open reduction and internal fixation of fracture (plate and 8 screws). I was casted until 7/23. Since 7/23, I have velcro wrist support and instructed to exercise with hand putty and minor wrist flexing, limited to the point of pain. Wrist mobility is improving - (approximately 60% up, 40% down, 40% right, 40% left), but am concerned about arm muscle and bone strength. What can I do to accelerate bone healing and muscle strength without increasing risk of bone re-injury? What is long-term success rate for full motion/strength of associated wrist and arm muscle/joint? Does the cast removal after 3 weeks seem a bit premature? What are risks associated with this approach aside from an increased chance of re-breaking the arm at the repair site? Answers from my HMO doctor are brief and non-committal. I need to return to work (pilot) ASAP. Does this seem like the best approach? Any insight and advice would be truly appreciated.

Answer: First, don't push it - the surest way to re-breaking it. Frustrating, but give it time. Pushing it won't help and might hurt.

Weak Bones - Osteoporosis? [posted 8/12/98]
Question: At 25 years of age I was diagnosed with Idiopathic osteoporosis of unknown etiology. There is no history of steroid use or eating disorders. I have had 4 bone densitomitries, and a bone biopsy. The results indicate a rapid bone turnover, and that I am 3.5 standard deviations from the norm. The most troubling problem, is the constant pain in my right hip, and low back. The doctors in New York are now prescribing that I take fosamax. However, the doctors in San Francisco were concerned since the long term effects of this drug are unknown. If there are other individuals in my age group who have this bone condition, and are being treated with any biphosphonate drugs, can you please let me know? Since age 24, I began to have calcium carbonate kidney stones, fractures of ribs and vertebrae, meningitis, appendectomy, ovarian cysts, and anaphylactic shock in a time frame of 1 1/2 years. I am now 26, and continue to have constant hip pain, and low back pain. I have been to several physicians and therapists, however, these specialists are not able to figure out the cause for the pain. Could osteoporosis cause dysfunctional hip pain? What can be done?

Answer: First, ensure that you have osteoporosis and not some other metabolic bone disease. This will necessitate a bone biopsy, checking Parathyroid hormone levels, checking Vitamin D levels and thyroid functions. All of these can give metabolic bone disease which mimics osteoporosis. Once these are ruled out, you will need to begin treatment. I would use the Fosamax. Sure we don't know the long term effects of Fosamax, but I sure know the long term effects of untreated osteoporosis. Fractures, pain and disability. This wouldn't be my goal based on a theoretical argument. Take the medications and follow the research. Ensure you have seen a metabolic bone specialist! The thin bones are the cause for the pain.

Bone Growth - Granulotia
Question: I have a friend who was in a severe auto accident almost 6 months ago. He has been in a shock trauma unit for 4.5 months, and has just transferred to an ICU in Atlanta. He was examined and found not to have any brain involvement with his injuries. However, he is having some bone growth, or granulotia, in his trachea and on his hip, which, as I understand it, is consistent with symptoms from a brain injury. Both in his hip and trach, he did sustain injuries, and has had several surgeries on both. The trauma team has told us that they have never seen anyone develop these granulotia without brain injury. Neither have they seen his type. The main problem is his trachea. They have had to do several tracheotomies, due to the fact that he keeps getting bone growth, in a circular fashion, around the outside of his trach, which winds up constricting his lumen to the point of no airway passage. Currently, after about 3 of these emergency corrective surgeries, he has an opening of 5 mm. They have tried to insert a trach tube that the bone can grow around, but it ends up pushing the trach tube up, causing more problems and another surgery. Surely, someone has seen something similar to this, or would be interested in the case from a research perspective?

Answer: Probably right. Contact the National Institute of Health for further leads.

Broken Bones
Question: I need to know the average costs for a broken arm, a broken leg, and a broken hip including crutches, medication, etc.

Answer: This varies markedly from one area of the country to the other and by the type of fracture. For example, certain broken hips can be nailed together. Others will need a complete hip joint. A new hip usually costs $6,000 or so. Nailing is $2,000 depending on your locale.

Treatment of bone cancer
Question: What new medications are now available? I have had radiation, megace, and now arimidex. When it stops working, what's new for me to take? I refuse to take halotestin because of the permanent side effects.

Answer: You fail to mention what type of cancer was the primary that spread to the bone. Generally, when people talk of bone cancer they are referring to the spread of a primary cancer to the bone. This is common in lung, breast, kidney, and prostate cancer. There is primary cancer of the bone-- several in fact. Before I can discuss options, I’d need to know the primary source.

Bones
Question: How do your bones stay together?

Answer: The bones is connected together by a matrix (sort of like a crystal structure). The bones are connected by ligaments and tendons to keep together.

Bones
Question: How many bones are in the body?

Answer:

  

Skull and hyoid: 29

Vertebrae:       26

Ribs/Sternum:    25

Upper limbs:     62             

Lower limbs:     62

**********************

Total:          206

Bones
Question: How do bones bend?

Answer: Bones actually have a lot of flexibility to bend, This decreases with age and the bones becog”Āsore brittle. It is not uncommon for children to have a fracture called a “green stick fracture” that is basically due to a small fracture from over-bending. In an older individual the bone snaps much earlier.


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