Valerie wrote:
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Do you think I should avoid surgery? maybe give it more time?
I have this fracture of my Tibial sesamoid since Feb. 2004. I have been to several docs, walking boot, bone stimulator, cortisone and nothing has improved!
I just had my second MRI and the fracture is exactly the same and it has not healed whatsoever. They doubt there is Avascular Necrosis but still not quite sure.
Please, any info would be great!
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THE FOLLOWING IS OFFERED AS GENERAL INFORMATION ONLY, AND MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER'S PROBLEM. IT IS NOT BASED ON ACTUAL KNOWLEDGE OR EXAMINATION OF THE QUESTIONER AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION. ONLY THROUGH HANDS ON PHYSICAL CONTACT WITH PATIENTS CAN ACCURATE MEDICAL ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER SHOULD CONTACT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS FORTHCOMING HEREIN.
The certain diagnosis of a fractures of a sesamoid is fraught with much difficulty. This is due to the nature of how a sesamoid ossifies. It is very common that a sesamoid does not completely ossify, and there remains fibro-cartilage which never disappears on x-ray and can be easily confused with a fracture. This is commonly known as a "bipartite" sesamoid, and is rarely, if ever, the source of problems. So I wouldn't hang my hat on the diagnosis of fracture.
On the other hand, often in medicine, treatments and/or procedures are employed because, in spite of there being no precise evidence as to why or how they work . . frequently they still work. As an analogy, most medications, even though they may be very effective, have never been shown, on a molecular level, as to exactly why and how they work. The removal of a sesamoid is not really a big deal. (Even though I understand that "minor" surgery is often defined as "surgery done on someone else.") If adequate conservative management has not proven effective, and if the problem is adequately bothersome to you, I think that the risk of this surgery does not over-ride its potential benefits. As long as your doctor makes it clear to you that surgery is the next logical step in the ATTEMPT at mitigation of symptoms, and makes no promises or guarantees as to positive results, I think that he would be well within the bounds of medical ethics. Few, if any things in life, come with a guarantee. |
