Challenges in Healing: Managing Severe Bone Defects and Nerve Damage

Bone defects, nerve injuries, ligament tears, and vascular ruptures! Prolonged non-healing?

Hello Dr.
Wang! I would like to ask about a serious car accident I had in early November last year, where my leg was trapped inside the vehicle.
When the firefighters rescued me, I saw that my right calf was completely mangled and bloodied.
Later, at the hospital, the doctor informed me that I had a severe open, comminuted fracture! Although they performed emergency disinfection and debridement, I had to wait in the emergency room for 6 to 7 hours before going into surgery.
Initially, due to the large area of the open wound, they could only use external fixation to clean the wound inside.
I then underwent several debridement surgeries.
At the end of November, I had internal fixation surgery, where they used donated bone from a bone bank to fill the bone defect, along with a flap transfer surgery to cover the wound.
After two weeks of observation, it seemed that the flap transfer failed due to poor blood circulation.
I then had another surgery where they took a blood vessel from my left calf and connected it to the severed vessel in my right calf, and also took muscle from my thigh to repair the injured area.
This surgery was finally successful, and blood circulation was restored! Following that, I had a skin graft surgery and was discharged to rest at home at the end of December.
However, it has now been over 9 months since the internal fixation surgery, and there has been no progress in the bone defect area; the bone is not healing.
Additionally, due to damage to the nerves, ligaments, and soft tissues, I have almost lost sensation in my foot, which is constantly sore and feels like gout or rheumatic pain! I have been taking B12 to see if it can help with nerve repair, but I am now more concerned about the bone defect.
I do not want to undergo another surgery! Therefore, I would like to ask Dr.
Wang for any good suggestions! I regularly take calcium supplements and drink milk.

Hsieh Chun-Chih, 30~39 year old female. Ask Date: 2021/09/10

Dr. Wang Jiacheng reply Orthopedics

If the bone does not grow back after a full year, it may be considered nonunion, and at that point, it will be necessary to consider bone grafting, which means another surgery will be required.

Reply Date: 2021/09/10

More Info

Dear [Name],
I’m truly sorry to hear about the severe challenges you have faced since your accident. It sounds like you have been through an incredibly difficult journey with multiple surgeries and ongoing pain. Managing severe bone defects and nerve damage can be a complex and frustrating process, and it’s understandable to feel overwhelmed.

From what you’ve described, it seems you have experienced a significant open and comminuted fracture of your right lower leg, which has led to extensive surgical interventions, including external fixation, internal fixation, and vascular and muscle grafting. The fact that you have had multiple surgeries indicates the severity of your injury and the challenges associated with healing.

In terms of bone healing, it is important to understand that the process can be influenced by several factors, including the extent of the injury, the quality of blood supply to the area, and the presence of any infection. In your case, it appears that the initial open wound and subsequent surgeries may have complicated the healing process. Bone grafting from a bone bank is a common procedure used to fill in defects, but the success of this procedure can vary. If the graft does not integrate well with your existing bone or if there is insufficient blood supply, it may lead to non-union or delayed union, which seems to be a concern for you.

Regarding your nerve damage and the loss of sensation in your foot, it is crucial to recognize that nerve healing can be a slow process. Vitamin B12 is known to support nerve health, and continuing to take it may be beneficial. However, the recovery of nerve function can take months or even years, and in some cases, the recovery may be incomplete. Physical therapy can also play a vital role in nerve recovery, as it helps to stimulate the nerves and improve function.

You mentioned concerns about undergoing another surgery. It’s understandable to be apprehensive, especially after enduring multiple procedures. However, if the bone defect is not healing, it may be necessary to consider options such as revisiting the surgical site for further evaluation. Sometimes, additional interventions, such as bone stimulators or even revising the graft, may be recommended to promote healing.

In the meantime, here are some suggestions that may help you manage your situation:
1. Regular Follow-Up: Ensure you have regular follow-ups with your orthopedic surgeon. They can monitor the healing process through imaging studies and assess whether any interventions are necessary.

2. Physical Therapy: Engage in a structured physical therapy program. A physical therapist can provide exercises tailored to your condition, which may help improve circulation and nerve function.

3. Nutrition: Continue to focus on a balanced diet rich in calcium and vitamin D to support bone health. Foods such as dairy products, leafy greens, and fortified foods can be beneficial.

4. Pain Management: Discuss your pain management options with your healthcare provider. They may recommend medications or alternative therapies to help alleviate your discomfort.

5. Mental Health Support: Given the emotional toll of your situation, consider seeking support from a mental health professional. They can help you cope with the psychological aspects of your recovery.

6. Explore Other Treatments: Inquire about alternative treatments such as electrical stimulation or ultrasound therapy, which may promote bone healing.

7. Stay Informed: Educate yourself about your condition and treatment options. Being informed can empower you to make decisions about your care.

Remember, healing takes time, and it’s essential to be patient with yourself during this process. Surround yourself with supportive friends and family, and don’t hesitate to reach out for help when needed. You are not alone in this journey, and there are resources available to assist you.

Wishing you strength and healing,
Doctor Q&A Teams

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