Musculoskeletal Care of the Mature Athlete
While the majority of fractures will heal with established treatment methodologies, be they operative or non-operative; about 15% will never heal (non-union) or take forever to heal (delayed-union). Recognized causes of delayed and non-union include excessive force at the time of trauma, soft tissue interposition, excessive displacement of bones, post operative infection, smoking, vascular disruption, just to name a few. The recent disaster at the Boston Marathon is the type of setting that might lead to delayed and non-union of fractures sustained. Is there a place for improving the outcome of a serious traumatic event with stem cell intervention?
Four months ago, a 26-year-old woman presented 9 months following a motor vehicle accident in which she had sustained a fracture of her calcaneus (heel bone). For some reason, the physicians in Florida opted to treat her displaced fracture without surgery. When she presented in the office, it was on crutches, in a brace and without the ability to tolerate weight bearing and totally dependent on narcotics to get through the day. After reviewing updated X-rays and an MRI, I determined that she had an impending non-union of the calcaneus in mal-position, with total disruption of the sub-talar joint (the joint between the talus and calcaneus responsible for side to side foot motion). Because she had not walked on her foot in nine months, her bones were severely osteoporotic and therefore surgical reconstruction was not a satisfactory option. I proposed a Bone Marrow Aspirate Concentrate (Stem Cell) intervention to influence fracture healing even at this late time and to perhaps cause a fusion of the sub-talar joint, something that would be necessary in 12 to 18 months to eliminate pain from post traumatic arthritis.
The patient scheduled the procedure after I had clearly explained the desired end results. While I couldn’t correct fracture alignment, I could potentially influence fracture healing and elimination of the posttraumatic arthritis in the subtalar joint. For the first six weeks following the stem cell intervention, the patient used crutches and a brace. For the second six weeks, she walked at home without a brace or crutches and with the brace out side of the home. When I last saw her in early April, she walked without any support, was brace free, no longer had pain; and most important, no longer used any medications for pain. The X-ray was compatible with fracture healing and a subtalar fusion. When last contacted, she was returning to school and a part time job. The stem cells intervention eliminated the need for surgery and influenced maximal medical improvement in weeks and not years.