How serious are shin splints?

Our college-aged daughter is a dance major. This semester she had to add a modern dance class to her already tight schedule. Now she’s developed shin splints. Should we encourage her to take the semester off before something worse happens?

Shin splints refers to pain and swelling of the lower leg. Sometimes this condition is also called chronic exertional compartment syndrome (CECS). The lower leg is divided into four sections or compartments.

Each compartment contains muscles, blood vessels, and a major nerve. The compartments are surrounded by stiff connective tissue called fascia. This helps keep the sections separate.

As the muscles are used, they expand in size and volume. In fact, muscle fibers can swell up to 20 times larger during and after exercise than when in a resting state. If the inelastic compartment doesn’t respond to the expansion, pain and loss of blood supply can occur. Athletes such as dancer or runners use muscle activity that repetitively stresses one or more of the compartments.

Compartment syndrome can be a very serious condition. Loss of blood to the area can lead to death of muscle tissue. In extreme cases, gangrene can even occur. Once the diagnosis is made, stopping the aggravating activities is required. Physical therapy can be a successful conservative approach.

If symptoms aren’t improved after six to 12 weeks of therapy, then surgery may be needed. Some experts claim that only surgery can cure compartment syndrome. The fascia is split open to allow muscular movement and expansion inside the compartment. This procedure is called a fasciectomy. In some cases, the fascia may be removed (fasciotomy) or a combination of the two procedures may be needed.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

How often do hip resurfacings fail?

I am very disappointed because I had a hip joint resurfacing in order to avoid having a total hip replacement. At 38, my surgeon thought I’m too young for a total hip replacement. Unfortunately, my hip fractured shortly after the operation. I ended up with a total hip replacement anyway. Does this happen very often?

Premature failure is the main complication of a hip joint resurfacing procedure. Loosening of the implant and fracture of the femoral neck are the two most common causes of early failure.

A recent study by orthopedic surgeons using the hip resurfacing technique may help us understand what’s going on. It seems that the round head of the femur that fits into the hip socket doesn’t have a very good blood supply normally.

Hip resurfacing requires the surgeon to dislocate the hip joint. Then the head of the femur is smoothed with a tool called a cylindrical reamer. The reamer prepares the femoral head for a smooth metal cap that is fit over the bone.

During this process of dislocation, preparation, and reaming of the femoral head, the blood supply to the head is decreased by as much as 70 per cent. This loss of blood flow is a major risk factor for loosening of the implant or fracture of the bone.

Although it’s not common, enough cases have been reported to bring this to the attention of orthopedic surgeons using this technique. Future studies will help surgeons identify ways to prevent this from happening.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

How is a neck fracture treated?

What is a femoral neck fracture and how is it treated? We just got word that our elderly father is in the operating room having surgery for this problem.

In a recent article, Dr. Robert Probe, an orthopedic surgeon in Texas offered a review of and some insight into surgical treatment of femoral neck fractures.

There are different types of hip fractures based on location. The femur is the long thigh bone with a round bony “head” at the top. The femoral head fits inside the acetabulum or hip socket. Fractures can occur anywhere in the long shaft of the femur, the neck (between the shaft and the femoral head), and the acetabulum. There is also intertrochanteric fractures. The intertrochanteric region of the hip is just below the femoral neck.

Two of the major problems that develop with femoral neck fractures are loss of blood to the femoral head and shortening of the femoral neck. Unless the patient cannot tolerate surgery for some reason, femoral fractures are best treated surgically. But that’s where the decision becomes much more complicated. Is the fracture stable enough to pin it back together until it heals? Will it heal? Are there patient factors that might result in a nonunion? How likely is a nonunion? Should the femoral head be replaced? If the decision is made to replace the femoral head, then the surgeon must choose between a cemented or uncemented stem (the piece that fits down into the shaft of the femur). That’s not the end of the possibilities.

The femoral head is available in several different models with different options (e.g., unipolar, bipolar) for achieving movement of the femoral head. It may be necessary to perform a complete hip joint replacement (femoral head and stem along with replacing the acetabulum). Should the surgeon try and save the hip knowing the patient may end up in surgery again in order to replace a failed fixation? Fixation refers to the use of screws, nails, pins, and metal plates to hold the broken pieces of bone together until healing can take place. This option is only available to a limited number of patients. The fracture must be stable.

If displaced (separated), it must be possible to bring the pieces together and precisely match them up again. Dr. Strobe describes the technique he uses when placing screws in the hip for a stable femoral neck fracture. He also discusses the use of a fixed-angle hip compression screw fixation. The compression screw keeps the femur from further bone displacement that would change the angle of the femur as it places the femoral head in the acetabulum (hip socket).

If the surgeon sees reasons and predictive factors that point to the strong possibility of nonunion and failed fixation, then hip replacement is the treatment of choice. Older adults who are active and wish to remain active may prefer this approach as well. It bypasses the possibility of a second surgery (from fixation to replacement). Current studies show fixation failure at 25 per cent right now.Results of total hip replacement (measured by pain, function, and revision rates) have been good-to-excellent for the “active and fit” older adults. Benefits and risks of this surgery for this age group with femoral neck fractures are still being investigated and reported.

Dr. Probe summarizes the article by saying that femoral neck fractures in older adults can be complex and challenging to treat. The surgeon makes every effort to save the natural anatomy. Patient health, strength of the bone, mobility, level of community activity, and predicted life span are all taken into consideration when making a decision about fracture fixation versus hip replacement.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

I dislocated my hip and it popped right back in. What should I do?

I accidentally dislocated my hip this morning. It popped right back in but I am freaked. This has never happened to me before. Should I use crutches? What should I do?

You may be experiencing a condition referred to as hip instability. Hip instability can include subluxation (partial dislocation), complete dislocation, and microinstability. The last classification (microinstability) is just what it sounds like — too much looseness in the joint but without a big enough shift in hip position to cause a subluxation.

Many people with hip instability have a known etiology (cause). It could be from a stretching of the ligamentous joint capsule that helps hold the hip in the socket. Or a tear in the labrum (fibrous cartilage around the rim of the hip socket). If there’s no known history of injury, then the condition is referred to as atraumatic (without trauma) instability.

With atraumatic hip instability, there may not be a specific injury but there is still usually a reason the problem develops. There could be an underlying systemic disease affecting the soft tissues (e.g., Ehlers-Danlos, Marfan, or Down syndrome). Abnormal anatomy of the bones or soft tissues could also contribute to the problem. Whether or not you should be putting weight on that leg after a dislocation event is something many experts debate. Studies don’t show that weight-bearing leads to loss of blood supply to the hip — or even to another hip dislocation. Even so, the best thing is to see an orthopedic surgeon and have him or her take a look at what’s going on. There may be a simple explanation and treatment for the problem.

There may be an anatomical explanation for what happened (e.g., perhaps you have a shallow hip socket from birth or loose ligaments that have gotten overstretched).

Whatever the cause, the goal is to prevent further hip instability (dislocations). You may benefit from a short course of physical therapy. Even with hip capsular laxity (looseness), physical therapy to improve core (trunk and abdominal) strength can be helpful. But the first step remains to find out what’s going on and why this may have happened. Once that information is obtained, the course of treatment will follow.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

If I have one bad hip from osteonecrosis, does it necessarily follow that the other hip will go bad too?

If I have one bad hip from osteonecrosis, does it necessarily follow that the other hip will go bad too?

Osteonecrosis means “bone death”. Loss of blood supply, bone death, and collapse can occur over a period of months to years. The femoral head is the round ball at the top of the thighbone that fits into the hip socket. Osteonecrosis can be caused by steroid use, alcohol, trauma, and blood-clotting problems like Sickle Cell Disease. In some cases, no cause can be found. Many people who have been diagnosed with osteonecrosis of the femoral head already have the same problem in the other hip. They just don’t know it because the disease can be “silent” or asymptomatic. In other words, there’s no pain. If it wasn’t for the telltale signs on X-ray, the affected individual wouldn’t even know there was a problem.The majority of people who have femoral osteonecrosis in one hip will go on to develop the same problem in the other hip. But this isn’t always the case and even if it does happen, treatment may not be needed.So how does a person decide what to do? The first goal in treating symptomatic (painful, limiting) osteonecrosis of the femoral head is to save the bone. The second goal is to keep function while relieving pain. Your surgeon will be able to advise you as to the best course of action for you. That still doesn’t answer the question about what to do for that asymptomatic hip. Is treatment needed at all? What’s the natural history (i.e., what happens over time if it is NOT treated)? In a recent systematic review of the literature, surgeons who conducted the study concluded that large lesions along the outer two-thirds of the femoral head are in the greatest danger of further destruction and collapse. Those should be treated right away. Small-to-medium lesions can be watched carefully and treated conservatively at first. Any sign of progression of disease should be addressed immediately. Anyone with known risk factors (Sickle cell disease, prolonged use of steroids, alcohol abuse) should be watched closely as well.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Does it make a difference in recovery for patients based on the type of hip fracture they have?

Does it make a difference in recovery for patients based on the type of hip fracture they have? My aging aunt has what’s called an intertrochanteric hip fracture. I got the impression from the hospital staff that this is the worst kind. Why is that?

There are many different types of fractures classified by location and specific type. For example, in the hip, the most common fractures in older adults affect the femur (thigh bone). These fractures include: ty

  • femoral neck
  • femoral head
  • subtrochanteric
  • intertrochantericFemoral neck fracture is a fracture in the femur (thighbone). The break is between the (long part of the femur) and the round round head at the top of the femur. This is where the femoral neck attaches the shaft to the head. These fractures often damage the blood supply to the femoral head. Loss of blood to the top of the bone can lead to death of the bone cells. This condition is called avascular necrosis.

    Femoral head fracture is a break in the femoral head. This is usually the result of high-energy trauma. Dislocation of the hip joint often occurs with this fracture. Subtrochanteric fracture involves the shaft. The break is right below the lesser trochanter (bony knob on the femur). Subtrochanteric fractures may also go down the shaft of the femur.

    When the break is between the greater and lesser trochanter, it’s considered an intertrochanteric fracture. This is the most common type of hip fracture. The prognosis for bony healing is usually pretty positive if the patient is in good health.

    But older age, poor nutrition, and poor health (especially combined together) puts a patient at risk for a poor prognosis. Immobilization after a hip fracture increases the risk of infections that can be life-threatening. A simple urinary tract infection or pneumonia can compromise the health of an older adult hospitalized with hip fracture. Deep vein thrombosis (blood clot) is also a risk in these cases.

    Many people beat the odds. So just having the risk factors doesn’t guarantee that your aunt will have a poor outcome. There may be other health issues or concerns that caused the hospital staff to react this way. You may need more information before coming to any firm conclusions.

    For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.