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What Does "bony Unions Not Expected In 6 Weeks" On An X-ray Mean?
Question: Hello Dr. Kumar: Thank you for your reply to YYYY@YYYY
Questions I have now:
1. when you say "bony unions not expected in 6 weeks" do you mean that the bones would not join/heal in 6 weeks?
1. b: avulsion type fracture on anterolateral corner of calcaneum- I don't know what bone this is - heel?,,, nor what avulsion type fracture is - please explain.
2. The tip of the lateral malleolus i think is on outside of right ankle correct? This was the area of the new fracture but I think it was only identified on the latest Dec04 xray and not on the Oct 24 xray tho all the swelling was on right side. I thought it was odd it was not noted on the earlier xray when that was where the pain was after the fall/ankle roll on Oct. 19.
Do you think I can walk around in house/office with only one crutch. The pain only creeps in at the end of the day. (for the first couple of weeks I had to be on tramodol Hydrochloride 100mg the pain was so strong on the outside (right) ankle.) I have not needed these since the first 2 1/2 weeks.
Thank you again Doctor. I will follow up with your reply in the morning - I am off to bed as I am getting up early for a bone scan tomorrow morning. I promise I will follow up :-). Good evening and thank you for your answers.
XXXX
Questions I have now:
1. when you say "bony unions not expected in 6 weeks" do you mean that the bones would not join/heal in 6 weeks?
1. b: avulsion type fracture on anterolateral corner of calcaneum- I don't know what bone this is - heel?,,, nor what avulsion type fracture is - please explain.
2. The tip of the lateral malleolus i think is on outside of right ankle correct? This was the area of the new fracture but I think it was only identified on the latest Dec04 xray and not on the Oct 24 xray tho all the swelling was on right side. I thought it was odd it was not noted on the earlier xray when that was where the pain was after the fall/ankle roll on Oct. 19.
Do you think I can walk around in house/office with only one crutch. The pain only creeps in at the end of the day. (for the first couple of weeks I had to be on tramodol Hydrochloride 100mg the pain was so strong on the outside (right) ankle.) I have not needed these since the first 2 1/2 weeks.
Thank you again Doctor. I will follow up with your reply in the morning - I am off to bed as I am getting up early for a bone scan tomorrow morning. I promise I will follow up :-). Good evening and thank you for your answers.
XXXX
Brief Answer:
Can take partial weight on air cast.
Detailed Answer:
Hi,
Thanks for your query.
I'm Dr. Sudhir Kumar,
After going through your query I concluded that you have transverse undisplaced fracture with intraarticular extension at the base of proximal phalanx (one of the bones) of little toe. There is avulsion type fracture on the anterolateral corner of calcaneum . Besides this radiologist has suspected another fracture at the tip of lateral malleolus (ankle) which is also undisplaced. He has requested for bone scan for confirmation. Answers to your queries are as follows.
1."Bony unions not expected in 6 weeks" means bones unite by soft callus which is later consolidated in hard callus by calcium deposit. So, bony union is visible clearly after calcium deposit only. At 6weeks as callus (union) is soft so they are not much visible on x ray. So bone will clinically partially united but it will not be seen as united on x ray as calcium in not deposited in it.
1. b: You are correct, calcaneum is heel bone. Avulsion fracture means a chip of bone has been pulled apart by ligament/tendon attached to it. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
2. You are correct; the tip of the lateral malleolus is on outside of ankle. This was the area of the new fracture identified on the latest Dec04 x-ray and not on the Oct 24 x-rays .Still it is only suspected by radiologist so he advised bone scan. As fracture was undisplaced so probably not visible in previous x ray.
I think you can walk around in house/ office with one crutch with air cast applied as your all fractures are UN displaced or minimally displaced and 6weeks already past. You can take partial weight on air cast. Elevate the limb on pillow during sleep and resting hours. Active toe movement is advisable. Analgesics can be taken for pain relief. Fosomax 70 mg per week can be continued for osteoporosis.
You can discuss with your treating Doctor about it.
Hope I have answered your query.
If you have any further questions I will be happy to help.
You can also write to me directly on below link:
https://www.bit.ly/askdrsudhirortho
Wishing you good health
Take care.
Thank you.
Can take partial weight on air cast.
Detailed Answer:
Hi,
Thanks for your query.
I'm Dr. Sudhir Kumar,
After going through your query I concluded that you have transverse undisplaced fracture with intraarticular extension at the base of proximal phalanx (one of the bones) of little toe. There is avulsion type fracture on the anterolateral corner of calcaneum . Besides this radiologist has suspected another fracture at the tip of lateral malleolus (ankle) which is also undisplaced. He has requested for bone scan for confirmation. Answers to your queries are as follows.
1."Bony unions not expected in 6 weeks" means bones unite by soft callus which is later consolidated in hard callus by calcium deposit. So, bony union is visible clearly after calcium deposit only. At 6weeks as callus (union) is soft so they are not much visible on x ray. So bone will clinically partially united but it will not be seen as united on x ray as calcium in not deposited in it.
1. b: You are correct, calcaneum is heel bone. Avulsion fracture means a chip of bone has been pulled apart by ligament/tendon attached to it. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
2. You are correct; the tip of the lateral malleolus is on outside of ankle. This was the area of the new fracture identified on the latest Dec04 x-ray and not on the Oct 24 x-rays .Still it is only suspected by radiologist so he advised bone scan. As fracture was undisplaced so probably not visible in previous x ray.
I think you can walk around in house/ office with one crutch with air cast applied as your all fractures are UN displaced or minimally displaced and 6weeks already past. You can take partial weight on air cast. Elevate the limb on pillow during sleep and resting hours. Active toe movement is advisable. Analgesics can be taken for pain relief. Fosomax 70 mg per week can be continued for osteoporosis.
You can discuss with your treating Doctor about it.
Hope I have answered your query.
If you have any further questions I will be happy to help.
You can also write to me directly on below link:
https://www.bit.ly/askdrsudhirortho
Wishing you good health
Take care.
Thank you.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
hello : Thank you for your recommendations and information above. Very helpful. I had a bone scan today and will have results either late today or WEd. evening. Can I send results to you for comment? Also, do you think I could swim in a week or so if I tensored up the injured ankle? Thank you. XXXX
Brief Answer:
Can swim after 2 weeks
Detailed Answer:
Hi, XXXXXXX
Welcome back
After going through your query and follow up queries I am happy to know our conversation was helpful. You are welcome to send your bone scan report. I will be happy to help.
You can swim after 2 weeks with the care that you does not hit your injured foot to floor or walls of swimming pool and avoid weight over injured foot while going in and coming out of swimming pool. You can discuss with your Doctor about it.
Hope your query gets answered.
If you have any clarification then I will be happy to help you.
If you have no clarification then you can close the query and rate the answer.
Wishing you a good health
Take care.
Can swim after 2 weeks
Detailed Answer:
Hi, XXXXXXX
Welcome back
After going through your query and follow up queries I am happy to know our conversation was helpful. You are welcome to send your bone scan report. I will be happy to help.
You can swim after 2 weeks with the care that you does not hit your injured foot to floor or walls of swimming pool and avoid weight over injured foot while going in and coming out of swimming pool. You can discuss with your Doctor about it.
Hope your query gets answered.
If you have any clarification then I will be happy to help you.
If you have no clarification then you can close the query and rate the answer.
Wishing you a good health
Take care.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hello Dr. Kumar: I have uploaded the bone scan from Dec 09. Thank you for having a look at it. I appreciate your comments and care instructions for swimming as well.
I am thinking of starting physio - not on the ankle, but to get some exercises to build up strength in my leg (right) that has the injured ankle. Comments?
My Dr. is back in the country after the 17th so I will see him then re - taking the air cast off at times.
Have a nice evening/day.
XXXX
I am thinking of starting physio - not on the ankle, but to get some exercises to build up strength in my leg (right) that has the injured ankle. Comments?
My Dr. is back in the country after the 17th so I will see him then re - taking the air cast off at times.
Have a nice evening/day.
XXXX
Brief Answer:
New non displaced fracture of medial malleolus
Detailed Answer:
Hi, XXXXXXX
Welcome back
After going through your query and follow up queries I am satisfied that our conversation was helpful. Your bone scan discovered another non displaced fracture of tip of medial malleolus which is inside of right ankle. Your suspected lateral malleolus fracture seems to be contusion (simple bone injury).
However as all fractures are UN displaced so these does not change your treatment in anyway.
You can start Physiotherapy in form of active toe movements, quadriceps strengthening exercises and knee mobilization. However ankle should be kept in air cast.
Rest already discussed and remains the same. You can discuss with your Doctor about it.
Hope your query gets answered. If you have any clarification then I will be happy to help you. If you have no clarification then you can close the query and rate the answer.
Wishing you a good health
Take care.
New non displaced fracture of medial malleolus
Detailed Answer:
Hi, XXXXXXX
Welcome back
After going through your query and follow up queries I am satisfied that our conversation was helpful. Your bone scan discovered another non displaced fracture of tip of medial malleolus which is inside of right ankle. Your suspected lateral malleolus fracture seems to be contusion (simple bone injury).
However as all fractures are UN displaced so these does not change your treatment in anyway.
You can start Physiotherapy in form of active toe movements, quadriceps strengthening exercises and knee mobilization. However ankle should be kept in air cast.
Rest already discussed and remains the same. You can discuss with your Doctor about it.
Hope your query gets answered. If you have any clarification then I will be happy to help you. If you have no clarification then you can close the query and rate the answer.
Wishing you a good health
Take care.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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