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Forum Name: Bone trauma and fractures

Question: JONES FRACTURE, COMPLICATIONS AND INFECTION


 LPERRY - Fri Jan 21, 2005 10:50 am

I am a 46 yr old female with a hx of SLE (lupus), chronic UTIs, osteoporosis, hypothyrodism, severe arthritis and, now, osteomyelitis of the R foot.
I am a physican's assistant and a medical technologist, although I am currently at home with an eight yr old and major health issues.
I have had at least 50 surgeries, many because of ortho problems. What I am concerned about now is my R leg. In 1992 I had a knee fusion, done exterior fixation. This was done because of multiple failed procedures, questionable infection, severe pain, etc with the hope of taking it down in five years and doing a total knee. However, in Dec 1994 I tripped and my femur broke with major displacement. After 10 weeks in a hip spica cast and no signs of any healing, a rod was placed through my femur and tibia. The ortho said it was most likely to remain there.
Now, in Aug 2002, i stepped on a child's toy and ended i[ woth a very tiny fx. refered to as a jones fx. it was aced and i was put in a post op shoe. This, too, did not heal (at 2 weeks after injury it broke through and through). March, 2003 an intramedularly screw was placed. The screw pulled out and in Sept.,2003 a larger intramedulary screw was placed. In Aug 2004 I jumped in the pool (!?) and refractured the bone because the screw broke through. Was told my only option was 5 screws and plate. This procedure was extremely painful, but more painful was shin pain. After being blown off 3 times by this "foot Specialist" (my original ortho was out of the country) my original ortho was back. I told him about this extremely shin pain. He promptly removed the cast and found an abcess through to the tibia. Subsequently 2 surgeries were performed to i and d it. Positive staph was tracked to the femural-tibia rod. Surgery was preformed in Dec 2004 to clean out sight and removal (permanent ?) rod. After this a hickman cath was placed-2 mo. IV antibiotics. Fusion refractured slightly in Jan 2004 and was placed in straight knee splint. And I wish that was ithe end.
Things remained stable until Oct 2004 when foot itself became painful and swollen. An I and D was done. Dx-staph auerus. this was in Oct. Two hospitalizations, I was very sick and really wondered if I would make it home, Since the middle of Oct I have been on IV Ancef 1 gr q8hr. Also cipro 500mg for pyelo Foot is better, but not great. Still red. ESR has come down and C-reactive protein is now neg. I am also on meds for c diff and oral yeast. Still unbelievable foot bone pain and fatigue. What next? Any suggestions? I've talked with multiple ortho, ID, rheum, and the works. I'm still in short leg walking boot and I use a cane. Wound has healed nicely and fully. Very sensitive-I cannot get a shoe on. On Duragesic for pain. Also have C3 herniation and need a total hip and knee on same leg (says primary ortho) I've had to use Actiq for severe breakthrough bone pain. It is very expensive, but fentynal seems to be the only thing that works. Pump isn't an option pain-wise because of infection and small body size (5'3" and 108 lbs) Any and all help would be so greatfully accepted. Thank You for taking the time to read and listen. I want my life back!
Lisa
 Dr. A. Saif - Wed Mar 16, 2005 5:43 pm

User avatar Dear Lisa,

All I can say is "wow". Well perhaps a little more than that...but seems like you have been through enough injuries, procedures and complications to become an expert by yourself!

Starting from the top of your letter...
Osteoporosis makes you more likely to have fractures, and less likely for the fracture stabilistaion procedures to be successful. SLE and hypothyroidism, I suppose can reduce your healing rate. If your SLE was treated with steroids, you become more likely to get osteoporosis and also have further compromise to your healing rate. Steroids and recurrent UTIs may make you vulnerable to infections elsewhere, for exaample in operative sites. Infection slows down healing to some extent. Pheww...so my for the 1st sentence in your post...at this rate we are in for the long haul...

But I will really not drag it on that long. Suffice it to say that you had a common fracture of the foot, that in the UK at least is in the vast majority of situation dealt with without surgery. The fact that it was "through nad through" again doesn't often mean that it definitely needs surgery...we are slightly more slower to react, I think than our colleagues in the US. In any case the fixation, as in your previous bone surgery is complicated by implant failure and infection. You are, as you have seen vulnerable. The same process is what happened to your knee problems, the "temporary fusion". The problem leads to surgery, that leads to complication and further surgery.

Lisa, i can see why you want your life back. The trouble is that you have a lot of factors that make you vulnerable to complications. Infection in bone often never completely goes away, despite modern antibiotics. Further surgery, may just stir it up and bring it up again. I hate to think what I would do in your shoes, but personally I would think that you should try and steer clear of surgery unless it is to deal with acute flare ups of infection, hard as that sounds when you are such discomfort. Of course the docs looking after you are THE best judges. I would try seeing what they think about referral to a pain consultant, and if something like a nerve block gives you periods when the pain is not so bad, and lets you have some breather between surgerical procedures so much the better... Once things look better, AND you feel psychologically prepared to go through surgery again, AND your doc recommends it, it may be worth visiting the OR.

I am really sorry about your discomfort, and I do hope there is light at the end of the tunnel soon for you.

Regards

Saif

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