Femur
fractures are difficult fractures to deal with in our setting of mostly
nonoperative orthopedics. Femur
fractures (break of the big long bone of the upper leg) require our patients to
be in a bed for about 2 months. We put a
pin - a metal nail - through the bone of their tibia (lower leg) and then
attach weights to this pin in order to straighten their leg. As the bones straighten out, it aligns the
ends of the fracture and then over time it forms new bones and it heals. The majority of our patients do fine with this
and in 2-3 months they have new bone that healed over the fracture site and
they walk home.
Unfortunately,
it doesn't always work in everyone. We
currently have a young man who sustained a bad fracture of his femur and the
bones haven't aligned yet, despite being in traction for a few months. This femur is in a couple pieces, so putting
a rod or a plate is difficult in our setting, where we don't have an xray
machine in our operating room to assist with the surgery.
Dr. Jim
asked a fellow surgeon for help and he recommended that we try to do a
"bone marrow transplant." He
said to take some of the bone marrow from his hip and put it into the fracture
site. He has had success with it
generating new bone growth. We have seen
the success in one of our workers, who also had a nonhealing femur fracture and
had this done by this doctor and he is now walking without difficulty. So we knew it can work, we had just never
done it before.
Jim was
conveniently going on vacation, so Mark Crouch, our new doctor and Bill McCoy,
our doctor who we all go to for help, agreed to give it a try. Looking at some medical journals online, they
found reports of success from India, but the fractures they were healing were
significantly smaller than the huge gap they had before them. Not letting the size of the deficit deter
them, they set out to give it a try.
They used
the ultrasound machine to find the ends of the bones and made marks on the skin
to indicate where the needle would go to place the bone marrow on the ends of
the bone. They put the patient to sleep
and then extracted the bone marrow from his hip and then using the marks on the
skin, put the needles into his leg along the ends of the bone and pushed the
marrow inside.
It will
take a few weeks to know if this works, but we are excited to see if it will.
