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

[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. ImageUploadedByThaivisa Connect Thailand1395999139.247397.jpg

Theres one of these machines on ebay now.

http://www.ebay.co.uk/itm/EXOGEN-ULTRASOUND-BONE-HEALING-SYSTEM-/201061392012?pt=LH_DefaultDomain_0&hash=item2ed0315e8c

Sent from my iPad using Thaivisa Connect Thailand

[Dellboy218]

I believe you mean Dr. Sudhee. He is semi retired but works out of Chiang Mai Ram Monday and Thursday mornings. He was surgeon to the Kings late mother and a teaching professor. He bolted my spine back together and got me walking again plus a couple of minor operations. He is one of the best people that you could possibly see.

[nithisa78]

Dr. Hann, 045-712546. I've been where you now are. Best of everything and healing, Quickly.

[lossiemouth]

Hi, I can recommend Dr Piya, Orthopaedic surgeon at Bangkok Hospital, Bangkok.

He is excellent. I needed a hip replacement and he did the operation. Absolutely first class. This was done in June 2011and I have not had a days problem with it.

I can recommend him. First Class doctor.

[BWPattaya]

Alexpoker, I think that you started weight bearing too early and that influenced the healing process. Due to the length of time since the original fracture, which would probably have been better treated using a Kuntscher Nail in the first instance, it will need some drbridement of the bone ends at the fracture site, then some bone grafting from your iliac crest (your pelvis) and a Kuntscher nail. Whatever course of action your new surgeon does it will take a long time. Even after the operation you will need to be non-weight bearing for a minimum of 6, preferably 12 weeks.

If however, you continue to have an infection at the site of the fracture then that must be cleared up prior to any further intervention. That is itself can takes many months.

Rejection of Titanium rods or plates is not a worry.

Good luck with it.

[HughJass]

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.

it was your own fault as u should have stayed off the leg until the break was showing signs of calcium formation and even then only 30% weght bearing after given the ok by the doctor

I had a broken tibia that took over a year to heal and was fixed by Dr Preecha at CM Ram as mentioned by another poster..i would also recommend talking with him

what they neglected to tell me was that in order to promote bone growth u need to take calcium and vitamin D supplements along with a healthy diet....u need to google this

it was only when I looked at the nutritional aspect and took supplements that the bone growth began in earnest

anyway good luck and stay strong

[ggt]

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

Listen to this voice of reason...it is urgent...you have FXXked around here long enough...you may be looking at being crippled the rest of your life if you do not get extraordinary help immediately...good luck...

[atyclb]

The priority is getting rid of the infection since it impedes healing. Typically hardware thought to be associated with infection is removed.

A bone scan used to be the standard for evaluating bone infection. Not sure today, maybe MR?

Bone infection is infamous for slow resolution.

Have you been evaluated for normal immune function? vascular status ? may not be the case or pertinent but just a thought.

As far as one leg being shorter(if that is the case) there is special hardware that lengthens bone via expanding callus formation. I dont know if it can be used in your case.

I checked my private messages looking for a retired US orthopedic i used to communicate with. Looks like messages were too old and tv system deleted them.

Lastly should you be a Swiss national, Swiss orthopedic doctors are world renowned for their expertise and innovation.

Good info in some other posts.

[akentryan]

The insertion of an IM nail is not exactly "new school." I had it done in 1962. They insert the rod through the hip, and slice ypur thigh open to line up the bone parts. They also leave a threaded end sticking out of the end of the bone to make possible the extraction of the rod after healing. Mine was complicated by falling down the iced steps of aircraft loading ramp and bending the rod. They later removed the rod but leaving me with a 1.5 inch short leg. Cool it during the healimg period ia a must. If it were me I would go home to have it done but that depends on your cash/insurance situation. Good luck in any event.

[alexpoker]

Thanks for all the responses guys.

Yesterday we went to see Dr. Anupong Loahapoonrungsee at CM Ram Hospital and he took a look at all my Xrays and my shortened leg and recommended I go with the Ilizarov technique to fix it.

Basically they would cut out all the infected parts of my femur and make two clean breaks and put them together whereafter they would make another break on a lower part of my femur and use the Ilizarov frame around the leg to re-lengthen the femur to the correct length so it matches my other leg. Ive been doing some researching and it looks like a painful experience. You basically have a round frame around your leg with pins going into the bone and use screws to move the fracture apart 1mm per day as the bone tries to catch up and finally heals together once youre done moving the two pieces apart via the screws.

Question is, shoud I do this here in Thailand or go back home to Denmark or possibly England.

[sweatalot]

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 completely agree with this poster. There is no guarantee that every broken bone will heal (most of the time they do, fortunately). Statistics say, that after operation always a certain percentage will have complications (Even with the most experienced surgeon). Yours is not uncommon. Bone infections are always difficult to heal and take a long time. After your accident - was there a wound on the site of the fracture?

I agree in particular with this sentence of thepool: "Looks like a classic case of malunion which has been competently managed." I understand that you are disappointed, but I doubt it's a fault of the doctor.

My recommendation for a good orthopedic surgeon in Chiangmai: Dr. Sattaya, he works in the private Siripat hospital and has also an office at Thapae road.

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

And: When another operation is recommended and you are not sure - seek a second oppinion

I wish you good luck - and patience

You also need to have a positive attitude - it always helps healing

Edited March 29, 2014 by sweatalot

[sweatalot]

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.

The healing problems of smokers are caused by decreasing circulation. Good circulation (Oxygen supply) is needed for wound healing

Alcohol in minor amount is not a prblem for wound healing.

[thepool]

alexpoker

Thanks for the update !

Speaking purely from a personal viewpoint I would suggest concentrating on the getting the fracture healed .

Creating a 2nd deficit in the femur is not something I have ever seen done while an existing malunion is present !

I would urge another opinion .

[sweatalot]

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

Listen to this voice of reason...it is urgent...you have FXXked around here long enough...you may be looking at being crippled the rest of your life if you do not get extraordinary help immediately...good luck...

I think the doctors in Thailand are state of the art and not worse then doctors in the west. Anyway, you need to find a doctor whom you trust. This is very important.

Edited March 29, 2014 by sweatalot

[HooHaa]

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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.

i would say the exact opposite is likely to be true.

weed has never been shown to decrease the efficacy of antibiotic treatment or healing, whereas alcohol most certainly has.

the healthier choice if one vice must be sacrificed is clearly alcohol.

[HooHaa]

alex, i have no comment on the treatment, but i do sympathize, sounds like a living hell.

I also you have some amazing insurance, because that has to cost.

[Thai at Heart]

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.

Well.. He's got one of the most pooyai of surnames in the country.

[Sheryl]

To my understanding, the Ilizarov technique is the treatment of choice nowadays when there is chronic osteomyelitis (bone infection) and non-union of the femur due to infection. But by all means get additional opinions.

Whether to have this done in Thailand or back home is up to you. Need to consider cost implications as well as the support systems available to you as it is going to be a long process.

I believe you can get competent surgical care here, but the quality of physical therapy/rehab services afterwards will be low compared to what you can get in the West.

[thepool]

A full explanation of the Ilizarov technique can be found here. It is fairly easy to comprehend.

http://www.ouh.nhs.uk/limbreconstruction/information/documents/Ilizarovtechniqueforlimbreconstruction.pdf

[alexpoker]

Thanks for all the suggestions guys.

I will be contacting more doctors here in CM and also FedExing my medical records and Xrays ASAP to Bangkok Hospital and Bumingrad in bangkok.

[alexpoker]

hey all.

Just an update.

I ended up staying in Chiang Mai and getting treated by Dr. Yuddhasert at Sripat Hospital, who was recommended to me by Dr. Anupong Loahapoonrungsri (specialist in Orthopedic Trauma).

Dr. Yuddhasert has done over a 100 operations using the Ilizarov method and was certain he would be able to make sure my femur would finally heal and also take care of the issue of having a shorter leg than the other.

Surgery was done about two weeks ago and I remained at the hospital for another week before being discharged. The bill was 300k baht.

During surgery they removed all the infected area on the femur basically cutting it out and also made a cut lower down on the femur so the middle part is movable and will be needed to lengthen the femur back to normal length.

They took out about 7cm, which the doctor says would take about 10.5 months before they would take off the Ilizarov frame. Basically Im using a spanner lengthening the femur 1mm per day untill the desired length has been reached and thereafter there is a consolidation period where the femur solidifies. After the Frame is taken off, Ill have to wear a cast for a month.

Here are some pics and here's hoping the next year goes by fast as Ive already had 1.5 years of dragging around a broken leg

Edited May 3, 2014 by alexpoker

[thepool]

Thanks for he update !

No callous formation to be seen as yet on the pics. but hopefully that will begin developing soon .

Best wishes !

[Goat Roper]

Dr. Chusak, Vichayut Hospital Bangkok. He has helped me through three major injury's and to my satisfaction. 100% my choice.

[Sheryl]

Thanks for the update. As you progress, let us know how it goes.

[paz]

I want to send you a word of encouragement from someone that had many fractures in a single accident about which i won't go in detail as this thread is about you not me. None turned out to be so complicated like your but I've spent quite some miserable time being literally nailed down in an hospital bed with frequent operations. Only the deep the love of my relatives, the good doctors and my very young age helped me get out of it, and looking at the young amputees laying in the next bed helped me take things in perspective. Like you, at some point I had lost trust in the doctor that was treating me, traveled to another country to get a second opinion, only to be told I was being treated correctly. I went back to the original surgeon and healed the best way possible given the objective conditions. Then I fractured the same femur a second time and again I was treated well and healed. Be strong and deal with it even it the treatment timeframe that you face seem an eternity now, you will heal. Best of wishes.

[alexpoker]

Thanks a lot for the encouraging post paz.

What is bringing me through this with some positivity is the fact that my girlfriend and her family have taken good care of me. The selflessness of thai people doesnt cease to amaze me. Im sure if I was stuck in the west with no immediate family, it would be a miserable experience.

My plan is to work a lot from home and make as much money as possible so I can take a long vacation(Maldives comes to mind) and spoil my girlfriend as much as I can when this is over

Ill keep updating this thread so it can help others as much as possible in the future.

So far the plan is to just re-lengthen the femur, which Im hoping can happen without too many complications. The doctor told me the other day that after the frame is taken off, they will put a cast on my leg, which I will need to wear for a month as there is a risk of refracture if a cast is not used.

[HughJass]

don't forget your calcium and vitamin D3 supplements if u want that bone to heal up quick

[Sheryl]

Vit C and zinc also important - try Redoaxn.

And adequate protein.

[Romanek72]

Alex

Thank you for sharing your expirance.

How are you doing with your leg?

I'm very interested because I have similar situation(left femur is 1 inch shorter)

Regards

Roman

[kuma]

hey all.

Just an update.

I ended up staying in Chiang Mai and getting treated by Dr. Yuddhasert at Sripat Hospital, who was recommended to me by Dr. Anupong Loahapoonrungsri (specialist in Orthopedic Trauma).

Dr. Yuddhasert has done over a 100 operations using the Ilizarov method and was certain he would be able to make sure my femur would finally heal and also take care of the issue of having a shorter leg than the other.

Surgery was done about two weeks ago and I remained at the hospital for another week before being discharged. The bill was 300k baht.

During surgery they removed all the infected area on the femur basically cutting it out and also made a cut lower down on the femur so the middle part is movable and will be needed to lengthen the femur back to normal length.

They took out about 7cm, which the doctor says would take about 10.5 months before they would take off the Ilizarov frame. Basically Im using a spanner lengthening the femur 1mm per day untill the desired length has been reached and thereafter there is a consolidation period where the femur solidifies. After the Frame is taken off, Ill have to wear a cast for a month.

Here are some pics and here's hoping the next year goes by fast as Ive already had 1.5 years of dragging around a broken leg

IMG_7705.JPG

IMG_7598.jpg

Alex

Wow what a story and a journey, hope all is working out and you are back on your feet.

I saw this thread while looking for solutions to my torn rotator cuff. It seems like the most insignificant of issues now after seeing your story.

From my perspective, looking beyond your story, what struck me is the cost of the Ilizarov procedure you had done. I need just a simple rotator cuff repair and have quotes exceeding the 300k you say that major surgery cost you....it must be a whole different world there compared to Bkk for surgical costs. Maybe I need look into getting treated there.

Hope all is well.