bone graft, anyone??

I suffered a spiral fracture to my right femur on June 15, 2009 which was repaired with a plate and 13 pins. One year later, it is still classified as "non-union", in other words, not healing. I was on Actonel for about 3 yrs and Fosamax for the past 4 yrs. The fracture happened from a standing position, nothing fancy like water skiing or hang gliding. I really don't know if my leg broke and I fell or I fell and my leg broke. I had no idea about the side effects of the osto meds I was on and none of the ortho's mentioned it. It was only when I needed some dental surgery that the oral surgeon had me check it out on line. I saw the ortho dr. yesterday and he says that basically my only choices are to hope for a miracle, or have a bone graft to hopefully stimulate bone growth. I really don't want another surgery, but may have to go that way since I don't want to stay in this wheelchair the rest of my life either. Has anyone else had a non healing femur fracture that required a bone graft, and if so, how is it doing now.
Thank you for any helpful input.

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Hi aquamama, sorry to hear about your frax! Did you try a bone stimulator? Some people have success with those.

I don't know how you feel about Forteo, but it is used a lot for non healing fraxs, for a short period of time.

I've had many fraxs but none in the femur. I took Forteo and haven't fractured since finishing it. If you want more info just look up Forteo or bone stimulators and non-healing fractures.

Good luck...

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I guess I should have mentioned that I have been using an electrical stimulator for the past 7 months, the only thing they are seeing is scar tissue. Thank you for the info, I will ask the ortho about Forteo. He just talked like a bone graft was pretty much my last option, and there is no guarantee that it will do the trick, he says sometimes they have to repeat it..........that sure didn't inspire confidence, lol.

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Hi again, be sure to do some research on this, because this is a tricky question. I've had 7 bone grafts and not all of them worked, actually more failed than not. That said, the femur is a different location than mine and you may have a totally different outcome. If you aren't totally opposed to Forteo (your decision) look into it and do a lot of reading on this.

I sure hope something works, best of luck to you!!

Here's a link on Forteo and non-healing fractures, if you want to read it. I couldn't find the original link but this one should explain, by Dr. Bukata and Puzas in NY.

http://www.mskreport.com/articles.cfm?articleID=3327

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Thank you for the link, I will check it out. I really appreciate your help and input. I feel like the doctors just kind of let you sit and spin your wheels.

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Hi again, it's too bad you don't live near NY...I think they are still recruiting for the trial on Forteo and non-healing fractures at NY Presbyterian Hospital. The problem with this, even though it works well for many, is it's very expensive apprx $1,000.00 a month, and it's usually not covered by insurance when it's used off-label which this indication would be.

You can still look into it, and see if it's something that interests you, and if your insurance might pay for it. The link explanation, on how it works, sounds so similar to your problem.

Good luck again I know how hard this must be!!

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Hello, there is a support group of "Fosamax Femur" victims headed by physician who also suffered a fracture. Go to http://jenniferschneider.com/ and click on "contact Dr. Schneider" to get in touch with the group. Many of us have experienced slow healing or non unions and may be able to share experiences. I am currently on Forteo due to non union after 5 months. Also, most of us have an Intramedullary rod or nail as opposed to a plate...you might discuss that with your surgeon as an option.

Best of luck,

John

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Hi John, I'm sure glad you jumped in here. I wasn't sure if it was the right thing to do to give out your info, so I was hoping you'd see this to give aquamama more info on this, and Dr. Schneider's web site info.

Thanks so much!!

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Thank you for the link, I will check it out. The reason they used a plate and pins in my leg is because I have also had a total knee replacement, the dr says this prevents them from using a rod.
Thank you for your reply, I really appreciate any input I can get.

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Another important point is to have your other leg examined for a potential stress fracture that could become a complete fracture. Bilateral fractures occur in 60-70% of subtrochanteric femur fracture patients. The most reliable imaging method is a nuclear bone scan.

Hope to see you on the "femur sister's group"

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So far, I haven't seen any mention of Physical Therapy here. Have you seen a physical therapist. The single best stimulator for bone is muscle contraction--it might help if you were doing specific exercises to assist the healing process.
What about pool therapy? If you are allowed partial weight bearing it's possible you could exercise in the pool.
There is more than likely much you can do other than sit in a wheelchair and wait for drugs and electrical stim to to the entire job.
If you would like to, you can contact me privately, and I might be able to lead you to some good therapists, exercises etc to assist with your healing.

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Sara, thank you for your response. You are right, I didn't mention physical therapy, don't know why, I guess it slipped my mind, what little of it I have left. I am a certified water fitness instructor and have seen miracles happen in the pool. I worked for Easter Seals as a pool supervisor until the local program was closed. I now teach at a city pool in the next town, but am on leave due to the fracture. I do get to the pool to exercise as often as I can, but since I am not driving yet, I have to rely on friends to take me, which doesn't always work out. I did have a PT who came to the house for a couple of weeks after I was released from rehab. I try to do as much walking with my walker as possible around the house, but have alot of pain from my left hip, which needs to be replaced. I did tell the dr. on friday that I was having thigh pain in my left leg and was worried about it possibly being a stress fracture. He told me that the hip pain can radiate down the leg, should I be more assertive and insist that they check it out? How do I go about contacting you privately to discuss exercises etc...? Thank you for your note, I really appreciate all the input I am getting. Nice to know that I am not alone with this problem.
Karen

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Karen,

I would insist on a nuclear bone scan of the lower extremities, especially since you are having thigh pain. As I mentioned, the majority of Fosamax femur fracture patients have stress fractures in the bilateral leg....common sense says that the pathologies that caused on femur to fracture would not ignore the other.

My nuclear scan revealed a stress fracture in the other leg, as well as several stress fractures in the metatarsals of both feet and one ankle. Conventional Xrays missed all of the above.

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John, thank you for your reply. I am going to email my doctor and request the nuc.bone scan. I have Kaiser, which is a large HMO, don't know if you are familier with it or not. They don't like to do anything they don't feel is absolutely necessary. But I feel you are correct in saying that if it happened to one, what makes the other exempt? Just for instance, they wanted to send me home from rehab last year, I was non wt baring and couldn't get to the restroom by myself, not to mention that I still had a cath in place. They did extend my stay one week, but were not happy about it. I am surprised at all the info and links I am getting from my post, there is some interesting stuff going on out there, some amazing people.
Thanks everyone,
Karen

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Karen,

I know several people who are enrolled with Kaiser and most have similar stories, I hope they will approve the nuclear bone scan as it is the "gold standard" for finding emerging and stress fractures.

Also, if you have not done so please report your fracture to the FDA. The pharmas claim that these events are so "rare" that they are statistically insignificant. Here is the link:

http://www.fda.gov/Safety/MedWatch/HowToReport/default.htm

Cheers,

John

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Hello aquamama
Please click Sara's name from her discussion post.
You will see "Send me a message" which will be private communication between you and Sara.

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Aquamama,

Sorry to hear about your nasty fracture. Years ago my friend had a bad fracture of his leg in a motorcycle accident. It was not healing, and drs tried some kind of electrical stimulation of the bones, which eventually had positive results. I sure hope you can get help too and soon. Take care,

Tom

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Thank you for your post. I have been doing electrical stimulation for 10 hrs a day since Nov. The dr says most of what he is is not new bone growth but scar tissue. I had high hopes for the treatment as I had heard good things about it. I guess I'm just one of those difficult cases. I wish there was something else I could try that didn't include surgery again. I am going to try to get my dr to refer me to a holistic dr to see if anything he might suggest will help.
Have a good day,
Karen

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Hi aquamama, I found your post while researching bone graft surgery as I'm scheduled to get one on my right femur, w/ 6 fractures - none of them healing, caused by an auto accident 6 months ago. Actually, I have a bilateral femur fracture, w/ 2 fractures in my other leg, that's been bearing weight for 3 months now. My docs want to go in and do both legs - at different times - to bone graft because it's been recently found that a med I was taking for nerve pain in my hand inhibits bone growth (an anti-seizure med). Even though there's "some" healing in my weight bearing leg, it's considered "not enough".

I give you a lot of credit for bearing w/ the bone stim for 7 months. I want to get up and walking, so although I'm scared of bone graft surgery, I've spoken to some people who've had it, and it was successful. Therapy has done wonders for my strength in my non-weight bearing leg, I'd advise consulting a PT who can help you! And you may just have to bite the bullet and go with the surgery....because it may be the only thing to really solve the healing issue with your femur. Whatever you do, good luck! Here's an informative link I've found, with supplements that may help.
http://www.betterbones.com/bonefracture/speedhealing.aspx

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I fell and broke my right femur just above my artifical knee in June 2007. Had my first repair surgery the next day with a plate and 10 pins and on top of that 2 units of blood. The bone was not healing even with the continued use of Boniva and an external bone stimulator. I was also taking calcium/vit D daily. According to my doc, my xrays 6 weeks after the break, looked like I had just broken my leg the day before. In Feb 2008, I had a second surgery which consisted of a bone graph and an internal bone stimulator placed. I was in a wheel chair (non weight bearing) for 15 months. My physical therapy consisted of getting in the pool (after the bone graph started to work) and lots of upper body excercies.
The muscle in my right thigh atrophied even with the use of the CPM machine 6 to 8 hours a day. My leg finally healed enough to start putting weight on it in Sept 2008. It is now 5mm shorter so I am having my shoe built up because even though 5mm is not a large difference, it does affect my gait. My right leg still gets very tired when I need to walk long distances. I take a cane with me and use it when necessary.
Hopefully you will not take as long to heal as I did. BTW, I was 53 and working full time as a nurse when I broke my leg. I had to medically retire because of my injury.

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Jaber, good luck with your surgery, I hope it goes well. After seeing my dr and insisting on some lab work, we found my vitamin D level was only at 7, the endo. dr advised me not to have the bone graft until we get the D level up to within theraputic range. I don't relish the thought of another surgery, but I will do it if all else fails. I want my life back. Sitting in this wheelchair is not what I want to do, and I don't have the strength or stamina to do everything with my walker. Thank you for sharing your experience with me, and again, the very best of luck to you on the bone graft.
Karen

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