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Suffered Evulsion Fx Of L Ishial Tuberosity. Having Pain In Buttocks And Thighs. Help?
Question: I suffered an evulsion fx of L ishial tuberosity. I am 53 yrs old & have been suffering for 4 yrs. Slipped on wet floor and Workman's comp surgeon did l4 l5 fusion even though my chief complaint from day 1 was buttock & thigh pain. The surgeon said I was crazy so I went out on my own & found Dr. XXXXXXX XXXXXXX in Charlottesville, VA. He did moving xray & found this fx, but was told it couldn't be repaired because it had been too long. I can't live like this anymore. I have searched every website for answers. HELP
Hello,
Thanks for writing.
This is Dr Vivek, a radiologist with 10 years experience relpying to your question.
History of L4 L5 fusion surgery noted but you present problem relates to ischial tuberosity avulsion fracture.
I understand you want to get rid of your buttock and thigh pain at the earliest.
As you have already had a word with your surgeon and want further treatment options we need more details of the fracture.
May I let you know that some fractures can be treated by tendon repair while in some conservative treatment is most suitable.
Fracture of ischial is classified into various types.
May I request you to kindly send in your x XXXXXXX and ct scan images and available reports. That will help us to discuss in detail.
Await your reports for furthering the discussion.
Regards,
Dr Vivek
Thanks for writing.
This is Dr Vivek, a radiologist with 10 years experience relpying to your question.
History of L4 L5 fusion surgery noted but you present problem relates to ischial tuberosity avulsion fracture.
I understand you want to get rid of your buttock and thigh pain at the earliest.
As you have already had a word with your surgeon and want further treatment options we need more details of the fracture.
May I let you know that some fractures can be treated by tendon repair while in some conservative treatment is most suitable.
Fracture of ischial is classified into various types.
May I request you to kindly send in your x XXXXXXX and ct scan images and available reports. That will help us to discuss in detail.
Await your reports for furthering the discussion.
Regards,
Dr Vivek
Above answer was peer-reviewed by :
Dr. Raju A.T
I don't have the image with me. The doctor still has it in his office, however I did get to see it. I was a nurse and I believe that it on fractured with the initial fall. I was a dialysis nurse & worked sometimes 16 hr days in 3 day a week clinic. I have always been healthy & was very muscular. After back surgery, I ended up with 2 seromas; one at surgical site which was drained & one on left buttock. During a PT session I had a different therapist who pushed me until I was in tears. I went home & did normal ice/heat & medication, but the pain became so severe as time went on, I ended up in the ER. They did nothing but drug me. After that things went downhill. I was seen by my surgeon's PA who immediately noticed my pelvis was misaligned and leg was 3/4 inch shorter. I was then sent to another facility & was given a heel lift. Her findings were the same with left leg being 3/4 in shorter & did exercises to correct pelvis. Sitting was still impossible & the therapist could only do massage therapy & ultrasound. This was a Workman's Comp case & I was allowed only a certain number of visits. My surgeon refused to x-ray my pelvis & didn't believe that I ever had leg length discrepancy. I did reflexology, acupuncture, and numerous chiropractors. One of these chiropractors referred me to Dr. XXXXXXX XXXXXXX in Charlottesville, VA. My lawyer stated he knew him well & would get me an appt. My quality of life was little to none. I made my own appt. & described my symptoms. He did a set of moving x-rays & when I twisted the bone could be seen away from the pelvis. I also suffered from dermatomal pain at my sacrum. Dr. XXXXXXX said that I only had a 12 month window for this to be repaired, & the hamstring muscle is attached to the bone fragment & above it. Also, Workman's Comp would not accept this diagnosis because my assigned surgeon did not find it.
It has now been 4 yrs of suffering. I have attempted suicide once before I found out what was causing my pain. No one believed me & my surgeon stated that I must be bipolar. I had been engaged to be married, but he left me because he didn't want to have to take care of me. I am bedridden when it rains. I don't know how much more I can take.
I have prayed for some kind of miracle, but have gotten nowhere. I don't leave the house unless I have to & my leg muscle has atrophied. I can't live like this anymore & I need hope. I don't understand why they can't remove this bone & attach my hamstring muscle to the other. Can anyone help me? I would do anything to relieve this pain.
It has now been 4 yrs of suffering. I have attempted suicide once before I found out what was causing my pain. No one believed me & my surgeon stated that I must be bipolar. I had been engaged to be married, but he left me because he didn't want to have to take care of me. I am bedridden when it rains. I don't know how much more I can take.
I have prayed for some kind of miracle, but have gotten nowhere. I don't leave the house unless I have to & my leg muscle has atrophied. I can't live like this anymore & I need hope. I don't understand why they can't remove this bone & attach my hamstring muscle to the other. Can anyone help me? I would do anything to relieve this pain.
Hello,
Looks you have many questions to which you need answers.
First dealing with the avulsion fracture of ischial tuberosity itself:
In general if there is displacement of fragments exceeding 2 cms, then surgery is recommended, else conservative treatment is first choice. That’s why I would have been happy to see your images before suggesting surgical treatment.
Second is the terrible pain and weakness that you are having:
Some of the long term effects of avulsion fracture ischial tuberosity include chronic pain with leg weakness, sciatica, muscle weakness. The hamstring muscles originate from ischial tuberosity and if there is avulsion (tearing out of the attachment of muscles to the pelvis) then hamstrings will surely get affected.
Dr XXXXXXX is right in his opinion regarding window period for the surgery, the success rate decreases with time.
Well, regarding your personal relationships and suicidal attempt, I suggest you could contact suicide helpline in your country and they could arrange for a mental health professional near your residence to help you out. This is the most important thing that you require at the moment.
Coming to the pain and muscle atrophy, I can suggest you to do yoga exercises. This as you may be aware of, is an ancient system of harmonious exercises to be done slowly and benefit a lot of people.
Hope this helps. Further questions are welcome.
Regards
Looks you have many questions to which you need answers.
First dealing with the avulsion fracture of ischial tuberosity itself:
In general if there is displacement of fragments exceeding 2 cms, then surgery is recommended, else conservative treatment is first choice. That’s why I would have been happy to see your images before suggesting surgical treatment.
Second is the terrible pain and weakness that you are having:
Some of the long term effects of avulsion fracture ischial tuberosity include chronic pain with leg weakness, sciatica, muscle weakness. The hamstring muscles originate from ischial tuberosity and if there is avulsion (tearing out of the attachment of muscles to the pelvis) then hamstrings will surely get affected.
Dr XXXXXXX is right in his opinion regarding window period for the surgery, the success rate decreases with time.
Well, regarding your personal relationships and suicidal attempt, I suggest you could contact suicide helpline in your country and they could arrange for a mental health professional near your residence to help you out. This is the most important thing that you require at the moment.
Coming to the pain and muscle atrophy, I can suggest you to do yoga exercises. This as you may be aware of, is an ancient system of harmonious exercises to be done slowly and benefit a lot of people.
Hope this helps. Further questions are welcome.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
So are you saying that this fracture cannot be repaired? Why can't the bone be removed & the hamstring muscle attached to another muscle. I'm sure that it has shortened so I know that it can't be attached above fracture. I am thin & don't have any padding on my buttock. If I could find a surgeon somewhere who could help me, I would give up everything I have. The fragment pulls away if I overtax it which causes spasms in my thigh & calf. If I sit more than 20 minutes, it feels like the tissue is on fire. I can't take anymore steroids because they have messed up my thyroid. I also don't want to damage my kidneys with strong anti-inflammatory drugs. I am not suicidal. I am just desperate for some quality of life. I live alone & now have to pay people to do the things I always have done. No help from family. They don't understand the pain and I feel like a burden if I ask them to go to the store for me. Please help me find someone that has a treatment for me. Is it possible to numb the buttock?
Hello,
Thanks for writing in.
Its not that the fracture cannot be repaired but the fact that with delay the complications and success rates of this procedure is debatable. Without seeing your images, it is difficult to entirely rule out the possibility of surgical repair. Surgery is reserved for severe fractures. The hamstrings (biceps long head, semitendinosus and semimembranosus) are a group of important muscles of the lower limb. In surgical repair, the avulsed part of the ischial tuberosity is surgically re-attached to the main bone with the help of plates and screws. The fragment is displaced in your situation and there is every possibility that the muscles go in for spasm when you over use them.
I recall that you had fusion of L4 L5 after a slip on wet floor. This also needs to be thought of when talking about your pain. Since nerves supplying your legs also emanate from the L4 L5 levels, and with avulsion fracture of ischial tuberosity, the possibility of sciatica pain always exists.
I would suggest you request a change in your painkillers, many newer non steroidal medicines are available in sustained release formulation, to give you pain relief for a longer duration.
I am relieved to learn that you are not suicidal and can understand your desperate need for an urgent cure. You surely are surely entitled to a pain free and better quality of life and I hope that is achievable with a little support from family and your employer.
Hope I have answered your queries.
Though I fully agree that some aspects of your problem could have been treated earlier and better resolved with full co operation from your employer.
Further questions welcome.
Please close this thread if you are satisfied.
Regards and wishing you an early pain relief.
Dr Vivek
Thanks for writing in.
Its not that the fracture cannot be repaired but the fact that with delay the complications and success rates of this procedure is debatable. Without seeing your images, it is difficult to entirely rule out the possibility of surgical repair. Surgery is reserved for severe fractures. The hamstrings (biceps long head, semitendinosus and semimembranosus) are a group of important muscles of the lower limb. In surgical repair, the avulsed part of the ischial tuberosity is surgically re-attached to the main bone with the help of plates and screws. The fragment is displaced in your situation and there is every possibility that the muscles go in for spasm when you over use them.
I recall that you had fusion of L4 L5 after a slip on wet floor. This also needs to be thought of when talking about your pain. Since nerves supplying your legs also emanate from the L4 L5 levels, and with avulsion fracture of ischial tuberosity, the possibility of sciatica pain always exists.
I would suggest you request a change in your painkillers, many newer non steroidal medicines are available in sustained release formulation, to give you pain relief for a longer duration.
I am relieved to learn that you are not suicidal and can understand your desperate need for an urgent cure. You surely are surely entitled to a pain free and better quality of life and I hope that is achievable with a little support from family and your employer.
Hope I have answered your queries.
Though I fully agree that some aspects of your problem could have been treated earlier and better resolved with full co operation from your employer.
Further questions welcome.
Please close this thread if you are satisfied.
Regards and wishing you an early pain relief.
Dr Vivek
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Above answer was peer-reviewed by :
Dr. Shanthi.E
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