Do I Need Bone Grafting After a Severe Leg Injury?

Is there a need for bone grafting?

Hello, doctor.
I had a car accident in January 2006, resulting in a comminuted open fracture of my right calf, with both the tibia and fibula fractured.
As of now, the bones have not healed.
In March 2008, based on the doctor's recommendation, I underwent a procedure to intentionally break the healed tibia to facilitate the growth of the femur, with the expectation that my bones would grow back in three months.
However, after the surgery, I experience pain in my right calf when walking, sometimes to the point where I can barely walk, and I often feel a lot of soreness in my foot.
Is this normal? Now that it is August, I have noticed that bone growth is very slow, and it still hasn't healed.
When I consulted the doctor again, he mentioned that he would need to help me with bone augmentation.
I am concerned whether undergoing another surgery so soon could harm the injured area.
If bone augmentation is necessary, what are the differences between artificial bone and my own bone? How long will the recovery take? I also want to know if it is appropriate for me to work given that my foot often hurts and I sometimes walk with a limp.
How long can the metal pins remain in my calf? Will it be difficult to remove them later? I appreciate your help in answering these questions.
Thank you very much.

pinggu, 20~29 year old female. Ask Date: 2008/08/06

Dr. Shi Qiming reply Orthopedics

According to what you mentioned, it may be a tibiofibular fracture.
If the tibial fracture has not healed for over a year, a bone graft surgery using your own bone is preferable; if there is not enough, then artificial bone can be used.
The duration of rehabilitation needs to be determined through outpatient follow-up.
Currently, whether you can work with an unhealed fracture depends on the healing status of the fracture.
Whether the steel pins can be removed or not requires an X-ray examination to find out.

Reply Date: 2008/08/06

More Info

Based on your description, it sounds like you have been dealing with a very challenging recovery process following a severe leg injury from a car accident. The fact that you sustained a compound fracture, which is a serious injury, can lead to complications such as delayed healing or non-union of the bone, which seems to be the case for you.
In your situation, the recommendation for bone grafting is a common approach when there is a significant delay in bone healing. Bone grafting involves taking bone from another part of your body (autograft) or using synthetic materials (allograft or synthetic bone substitutes) to stimulate healing in the affected area. The goal of this procedure is to provide a scaffold for new bone growth and to enhance the healing process.

Regarding your concerns about pain and difficulty walking, it is not uncommon for individuals with non-union fractures to experience ongoing pain, discomfort, and functional limitations. The pain you describe, especially if it is severe enough to affect your ability to walk, indicates that your body is still struggling to heal properly. This can be due to several factors, including the severity of the initial injury, the presence of infection, or inadequate blood supply to the area.

As for the timing of the proposed surgery, it is essential to weigh the benefits against the risks. While undergoing another surgery may seem daunting, if your doctor believes that bone grafting is necessary to promote healing, it may be the best option for your long-term recovery. It is crucial to discuss with your orthopedic surgeon the potential risks and benefits of the procedure, including the possibility of further complications and the expected recovery timeline.

When it comes to the differences between using your own bone versus synthetic materials, autografts typically have a higher success rate because they contain living cells that promote healing. However, they require an additional surgical site, which can lead to more pain and recovery time. Synthetic materials can be advantageous as they eliminate the need for a second surgical site, but they may not integrate as well as autografts in some cases.

Regarding your question about returning to work, it is essential to consider your pain levels and functional abilities. If you are experiencing significant pain and difficulty walking, it may be wise to discuss with your employer about accommodations or taking time off until you are more stable.
As for the metal hardware (like screws or plates) used in your surgery, these can typically remain in place for an extended period, but your doctor will monitor their condition and determine the best time for removal if necessary. Removal is usually done if they cause discomfort or if there are concerns about their long-term effects on your recovery.

In summary, it is crucial to maintain open communication with your healthcare provider about your symptoms and treatment options. If you have concerns about the proposed surgery or your current condition, do not hesitate to seek a second opinion or ask for more detailed explanations from your orthopedic surgeon. Your recovery is a priority, and understanding your options will help you make informed decisions about your health.

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