Femur fractuce wont heal. Need some of the best orthopedic surgeons in Thailand.

[alexpoker]

Hello,

Im in real of some urgent help. Ive been a patient at Rajavej hospital in Chiang Mai with a femur fracture that hasnt been able to heal for 17 months now. I am now looking for a better doctor who can make sure that I can actually heal instead of the incompetency I witnessed at Rajavej.

I originally broke my leg in a traffic accident in Chiang Mai in October 2012, where I currently reside.

The surgeon at Rajavej put a plate on my femur and everything seemed fine. However 2 months later in December, the plate came off because I started to be more active as my muscles had healed. When I went to the hospital as I had pains in my leg, they found out I had an infection in my leg and therefore the femur had not healed. The infection in the bone was apparently keeping the femur from healing and with antibiotics once the infection was gone the femur would go back to healing again.

The surgeon put in a longer plate this time and started me on daily antibiotics via IV. This continued untill end of April 2013, where the surgeon wanted to put in bone grafts and possibly remove the plate.

However when I woke up from the operation I was shocked to see that the surgeon had put in an external fixation. He said that when he opened me up the femur had not healed at all, even tho test results were showing that the infection I had in my bone should have been gone. He then made the decision on the spot to put in an external fixation which is apparently the best kinda of structure to combat infection.

ive been doing monthly xrays and blood tests to monitor infection rate and bone healing, which has been quite slow. Ive been told this kinda of infection in the femur is the worst kind and it can take up to 2 years to heal. However I truly feel that my doctor has made some blunders along the way and therefore am looking for a new orthopedic surgeon of the highest calibur here in Thailand.

Especially because of the fact that healing has stopped again AND my femur has started to shift its structure and started to become deform in that sense that my leg is becoming shorter than the other,

Im in dire need of one of the best orthopedic surgeons/doctors in Thailand. Preferably Chiang mai as I live there but if I have to go to bangkok obviously Im going to do that.

Ive been recommended Dr. Suti at Chiang Mai Ram hospital. I dont know if anyone knows how good he is, but when I once went to see him for a second opinion about my leg he seemed very competent and confident, unlike my doctor at Rajavej who keeps quiet most of the time when I ask him hard questions.

If any of you can recommend someone who can make sure that I can get my leg fixed properly, I would really appreciate it.

Im in huge need of help and assistance.

Thank you for listening.

[macleans]

In case you need to come down to BKK, I'd like to suggest Dr. Chanin Lamsam.

Dr. Chanin Lamsam is one of the most sought after sports related surgeons in Thailand and is a head doctor of Thailand national soccer team, who has operated on hundreads of knees of professional atheletes. I found him to be very thorough and detailed oriented when he examined my knee. I went to see him at Thonburi hospital near Siriraj as I was seeking a second opinion (didn't trust my first doctor as he seemed to overly prescribe meds). He threw away a few meds given to me by my first doc and said those weren't necessary and that the knee would heal by itself. He even declined to charge me eventhough he spent 20 mins examining my knee and teaching me how to self rehab. He said since I didn't need any med, there would be no charge. He's in a doctor at Siriraj hospital but has private hours at both Thonburi hospital and Bangkok hospital.

https://www.bangkokhospital.com/index.php?p=doctor_profile&DrID=243〈=TH〈=EN

http://www.thonburihospital.com/2013/Doctor_Detail.aspx?Id=456 (in Thai but he's basically available on Wed 6-7 pm and Sun 9-12 am)

Thonburi hospital is much cheaper than bangkok hospital (surgery costs 50% lower in general)

Since I'm no medical expert and if he turns out not to be a suitable doctor given your conditions, you may also consider siriraj private hospital's orthopaedic center. It has a vast array of orthopaedic surgeons with extensive experiences. Someone on here maybe able to help your select the appropriate doc.

http://www.siphhospital.com/ortho/index.php/centers/doctors

Though it's in Thai but the docs' bios are in English. You can call the hospital to check the docs' visiting times.

Edited March 25, 2014 by macleans

[thepool]

Looks like a classic case of malunion which has been competently managed.

It would appear to be a wise decision to avoid further attempts at internal fixation.

The external fixation does not "treat" infection and if your Surgeon had any concern about the bone being infected he would continue with an antibiotic most likely something similar to Clindamycin.

However , if you have lost confidence in your surgeon then a transfer to an alternative provider may be a good idea.

Do not expect any significant change in management. At some point a bone graft may be offered again.

You have been "unlucky" in suffering a well known complication.

Others will may have suggestions for an alternative surgeon/hospital....

Edited March 25, 2014 by thepool

[alexpoker]

Looks like a classic case of malunion which has been competently managed.

It would appear to be a wise decision to avoid further attempts at internal fixation.

The external fixation does not "treat" infection and if your Surgeon had any concern about the bone being infected he would continue with an antibiotic most likely something similar to Clindamycin.

However , if you have lost confidence in your surgeon then a transfer to an alternative provider may be a good idea.

Do not expect any significant change in management. At some point a bone graft may be offered again.

You have been "unlucky" in suffering a well known complication.

Others will may have suggestions for an alternative surgeon/hospital....

I didnt mean that the external fixation would treat the infection, but my doctor told me that the external fixation was needed as the internal plate so close to the fracture site was keeping the infection from being eradicated by the antibiotics.

I did IV antibiotics for 9 months+.

Currently my doctor says he wants to put a rod thru my femur which I guess also means that he would possibly have to realign(break) the femur. He said that the external fixation might not have been strong enough to keep the femur from deforming and when he says that I just feel like hes being incompetent.

Im very frustrated at the moment as I havent been able to walk for nearly 18 months now and have definitely lost confidence in him

[hagler]

18 months.

For Gawds sake get on a plane and go home and get the thing sorted out or get your ass down to Bangkok or Singapore and get it sorted there.

Unbelievable

[thepool]

An intramedullary rod (AKA Küntscher nail) +/- bone grafting may indeed be a possible solution.

Your femur will not need "Breaking" to achieve the nailing .

Clearly , whatever is suggested by your surgeon will be mistrusted and you should, for your sake as well as his, identify an alternative source of advise ASAP.

[Sheryl]

Infection in the bone (osteomyelitis) does take many, many months to resolve and will definitely delay healing.

But regardless of whether any mistakes have been made or not, it is important that you have confidence in your doctor and that your doctor be one willing and able to communicate with you in detail.

Many TV members have reported favorable on this doctor, a retired professor who now has his own clinic:

Dr Sudhee Sudasna
Clinic:38/4 Chiang Mai - Lampang Road.
Mon , Tues, Thurs 1700 - 2000 hrs
Su: 0930 - 1200 hrs
Phone: 053 - 214 139

He is US trained and speaks fluent English. Usually doctors trained in the US will be good re communications/explanations to the patient since US patients expect this.

Otherwise, one of the following at SriPat (the private wing of CMU Hospital). All are professors with training in the west and specialty in orthopedic trauma:

Theerachai Apivatthakakul

Anupong Loahapoonransri

Siripong Cheuchantanakit

[JDGRUEN]

18 months.

For Gawds sake get on a plane and go home and get the thing sorted out or get your ass down to Bangkok or Singapore and get it sorted there.

Unbelievable

OP ... hagler is CORRECT... Do it ... as soon as possible... I have considerable education and experience in medical subjects... you could have a much worse problem happen if you do not get expert assistance quickly ...

[thepool]

Alex

Just as a matter if interest are you mobile on crutches ?

If so you may be able to arrange your discharge as an in-patient if you have accessible home arrangements and access to the help you will need .

Staying in hospital for long periods of time can become extremely debilitating and very frustrating.

If you are able to negotiate a discharge make sure you understand how to care for the external fixation pins and be prepared for regular outpatient attendances

Just a thought !

All the best .

Edited March 25, 2014 by thepool

[alexpoker]

I was discharged only a few days after I got my external fixation. Been living with it for 11 months now

Right now the plan is to see Dr. Sudhee at Chiang mai Ram hospital.

Sheryl do you know if its the same doctor as the one you recommeded in an earlier post in this thread?

Gonna go see him on Thursday in the morning at Chiang Mai Ram.

[Sheryl]

I was discharged only a few days after I got my external fixation. Been living with it for 11 months now

Right now the plan is to see Dr. Sudhee at Chiang mai Ram hospital.

Sheryl do you know if its the same doctor as the one you recommeded in an earlier post in this thread?

Gonna go see him on Thursday in the morning at Chiang Mai Ram.

If the name is Sudhee Sudhasana then yes, the same. Though the CM Ram website does not seem to show him (or any other Dr. Sudhee) in the ortho dept there. But their website isn't worth much so maybe not up to date or complete.

Be sure to bring all your records and most recent Xrays etc when you go.

[Lancelot]

OP, good luck to you, hope your fracture heals properly. I broke my collar bone and was treated with a figure eight brace. It healed, but with an over lap at the fracture and, as a result, my shoulder blade is out of alignment. I have some upper shoulder pain, that massage and physical therapy will not alleviate. Two Thai docs and one US doc have advised me to not seek corrective surgery, because of the risk of the new fracture not healing.

I'm going to make an appointment with the doc Sheryl first recommended

[NancyL]

Yes, that is the same doctor. Very well regarded in Chiang Mai.

[NancyL]

Of course, I don't have near the medical experience of Sheryl and I'd love to hear her opinion of the connection this common complication and smoking. I've known several people who have had problems with healing of fractures of bones of the leg, eventually needing bone grafts and in every case they were heavy smokers.

Are you a smoker alexpoker?

[Sheryl]

Smokers definitely have problems with the healing of fractures, but this poster had osteomyeltitis (infection of the bone) which is likely the main problem.

[alexpoker]

Im not a smoker but I do smoke weed sometimes altho without tobacco mixed in. I did some research on that and it weed didnt seem to inhibit healing of fractures. Not sure about alcohol tho. I like my beers so I will probably have to not drink for a while since I dont know what else to do on my own end.

[thepool]

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Im not a smoker but I do smoke weed sometimes altho without tobacco mixed in. I did some research on that and it weed didnt seem to inhibit healing of fractures. Not sure about alcohol tho. I like my beers so I will probably have to not drink for a while since I dont know what else to do on my own end.

You would be wise to give the "weed" a miss but a couple of beers will not go amiss!

The best that you can achieve for yourself is to ensure that you eat a good varied diet ( bet you have lost weight ) and maintain your hydration.

[alexpoker]

For some reason I never looked before but yesterday I sat on a chair and alligned by legs up against the other and indeed what I had suspected for a few months was true. My right leg is shorter than the other

This seems to be a problem that could be hard to fix. Should I trust some of these surgeons in CM? Or should I go straight to bangkok and find the best surgeon there is to help me with this problem?

Im feeling quite depressed about this and dont know if I can even trust a good orthopedic surgeon about this anymore or if I should try and get the best of the best here in Thailand to help me.

Does anyone have any suggestions on surgeons who have experience in this kind of problem before?

[thepool]

Your photo may in fact be misleading !

See below for information on measuring leg length.

True leg length discrepancy is found by measuring from the anterior superior iliac spine to the medial malleolus. Apparent leg length discrepancy is measured from the xiphisternum or umbilicus to the medial malleolus.

• True leg length measurement
• Apparent leg length measurement

Ref

http://www.osceskills.com/e-learning/subjects/hip-examination/

Edited March 27, 2014 by thepool

[alexpoker]

Thanks for this. Then I hope I wont be too much of a freak

I went to see doctor Sudhee today and he said that I need to see a colleague of his since Dr.Sudhee doesnt do surgeries anymore. His friends name is Anupong Loahapoonrungsee and specializes in Trauma Orthopedics.

Does anyone know how good this doctor Is? Its re-assuring that at least he specializes in trauma.

Also has anyone had any experiences with Dr Olarn Arpornchayanon?

A friend recommended him but looks like he is just a normal Orthopedic doctor. Not sure how important the Trauma part is.

[Sheryl]

Dr. Anupong Loahapoonrungsee is an Associate Professor in the OPrth Dept at CMU Medical School. He completed 3 fellowships abroad, one in the US, one in Germany and one in Japan. As you will see here he has published in peer reviewed international journals, including research on fracture of the femur http://www.biomedexperts.com/Profile.bme/775876/Anupong_Laohapoonrungsee.

So he seems well qualified. Also, I would give considerable weight to Dr. Sudhee's recommendation, especially since he has seen you and thus knows the details of your case.

[abrahamzvi]

In case you need to come down to BKK, I'd like to suggest Dr. Chanin Lamsam.

Dr. Chanin Lamsam is one of the most sought after sports related surgeons in Thailand and is a head doctor of Thailand national soccer team, who has operated on hundreads of knees of professional atheletes. I found him to be very thorough and detailed oriented when he examined my knee. I went to see him at Thonburi hospital near Siriraj as I was seeking a second opinion (didn't trust my first doctor as he seemed to overly prescribe meds). He threw away a few meds given to me by my first doc and said those weren't necessary and that the knee would heal by itself. He even declined to charge me eventhough he spent 20 mins examining my knee and teaching me how to self rehab. He said since I didn't need any med, there would be no charge. He's in a doctor at Siriraj hospital but has private hours at both Thonburi hospital and Bangkok hospital.

https://www.bangkokhospital.com/index.php?p=doctor_profile&DrID=243〈=TH〈=EN

http://www.thonburihospital.com/2013/Doctor_Detail.aspx?Id=456 (in Thai but he's basically available on Wed 6-7 pm and Sun 9-12 am)

Thonburi hospital is much cheaper than bangkok hospital (surgery costs 50% lower in general)

Since I'm no medical expert and if he turns out not to be a suitable doctor given your conditions, you may also consider siriraj private hospital's orthopaedic center. It has a vast array of orthopaedic surgeons with extensive experiences. Someone on here maybe able to help your select the appropriate doc.

http://www.siphhospital.com/ortho/index.php/centers/doctors

Though it's in Thai but the docs' bios are in English. You can call the hospital to check the docs' visiting times.

I entirely agree, but would prefer Bangkok Hospital to Thonbury hospital, and I am saying this from experience. I would strongly recommend you go to Bangkok, as I sincerely believe, again based on my personal experience, that one is in far more qualified and experienced medical hands in Bangkok, than in Chiang Mai.

[DiamondKing]

Sounds like you did not rest the leg long enough which may caused this infection. The femur is the biggest and strongest bone in the body and needs time to heal the muscles will heal much faster.

Sorry about your situation as someone that split my femur and broke my leg in 4 other places I know what your going through and 3 years later it still give me issues even a stint in hospital for blodd infection

good luck

[misterphil]

I broke my femur here in Pattaya 12 years ago. The Pattaya Memorial hospital put a steel plate in just like you had before and its still in now. I was on holiday here at the time and a week after the surgery I flew back to the UK. I went to a local hospital to get the work checked out, and have the stitches removed, and Drs in the UK told me that a plate is old school. They said that the way they treat broken femurs now is with a steel rod that goes down the centre of the femur with 2 pins at the top and 2 at the bottom. They drill down the centre of the femur to fit the rod. They told me that its best to leave the plate in unless I have any problems with it they will take it out.

My leg took over 2 years to heal. I was back and forth to the hospital getting X rays many times until they gave me an ultrasound machine that sends pulses to the fracture site. This generates small vibrations and helps the broken bone fuse back together. Heres a link to a similar machine.

http://www.exogen.com

http://www.ncbi.nlm.nih.gov/pubmedhealth/

If you google "broken bone healing machine" theres some info on these machines.

I was booked in to have a bone graft done but after using this machine you could see on the X ray that it was starting to heal. They were going to take out the plate, fit a rod and take bone from my hip and graft it to my femur.

I had a lot of muscle loss in my right leg and still today its thinner than my left. Ive been into weight training for over 25 years and I could never get my right leg as big as my left again. I now accept that its going to be like that so I don't try anymore.

The only issues I have with it now is when I go to the UK and its cold I can feel a small pain at the top of the plate, and when I go for a massage here and they elbow my right leg I can feel pain where the plate is.

That scar will be with you forever, heres a picture of mine 12 years old.

Sent from my iPad using Thaivisa Connect Thailand

[SLESQ]

I have used this excellent diagnostician for a few years and find he is both knowledgeable, compassionate, a brilliant surgeon and a wonderful resource. From 1999 to at least 2010 he was (may still be) Head of Department of Orthopedics, Faculty of Medicine, Chiang Mai University. Since 1993 he holds short clinic hours at Chiang Mai Ram Hospital and may thus not be as well known to the expat community as others.

While primarily a hand surgeon, follow his education and work history cited below and accept my recommendation that you will not be injured and most likely find Dr. Preecha to be that knowledgeable resource you need to gain confidence in your approach to better health.

I strongly recommend you at the very least consult with Dr. Preecha Chalidapong whose CV can be found here

http://www.chiangmairam.com/NEW%20CMR/Physician%20Th/CV%20th/Preecha.pdf

Dr. Preecha's clinic hours at Ram are on Saturday and Sunday, 9 AM to 1 PM so please make an appointment and go early. Meeting with this man is well worth the waiting time.

Edited March 28, 2014 by SLESQ

[ianf]

I was discharged only a few days after I got my external fixation. Been living with it for 11 months now

Right now the plan is to see Dr. Sudhee at Chiang mai Ram hospital.

Sheryl do you know if its the same doctor as the one you recommeded in an earlier post in this thread?

Gonna go see him on Thursday in the morning at Chiang Mai Ram.

Alex:

I broke my femur two years + ago. I saw Dr Sudhee at Chiang Mai Ram. As a racing cyclist I needed to get mobile again and quickly. Ram put in a plate and I was training on an indoor trainer within 4 weeks and back on the road in 6. I have had no complications. Also, my wife told him that she wanted proper stitches, not the frankenstein stuff they do here! You can hardly see my scar,

The one thing at the Ram that let them down was the physio. She was 100% useless. So I used the Physio at the Ravajeev and she was absolutely brilliant. She understood the protocols needed (and even changed my Ram crutches which were much too small) and had me mobile in next to no time. This physio, undoubtedly the best in Chiang Mai, used to be the physio for the German National Gymnast team. You have to be good to do that.

From what I understand, your complication was not necessarily because of bad work at the initial hospital. I know that an orthopedic surgeon there himself suffered a femur break (I cannot remember his name) on a training ride one evening with me. He is very competent from what I have been told.

I wish you the very best of luck with this and am so sorry that you have suffered for so long .....

[MikeThaison]

I just came to say this is an amazing thread. Cheers to all the great contributions and alexpoker, I hope get well soon buddy.

[MikeThaison]

.

Edited March 28, 2014 by MikeThaison

[janpharma]

Why I don't read anything in all above reactions about your body might reject the "implants" or external material, this happens in at least 30% of all cases. Of course this is influencing the healing process. Pay attention to that...

[shaurene]

Hi Alexpoker

My son in New Zealand had bad accident on his motor bike and bust his femur in 2 places one piece sticking out of his leg. He had pins and plate inserted he healed quite good but his leg is shorter than the other one because they had to cut away some bad breaks in the bone, he has a shoe with high heal, he gets around quite good.