First Jones Fracture/Now Bone Marrow Edema

[paintgirl2012]

Hello! It seemed to be taking forever to heal with a hard cast and nwb crutches. In late December I had an MRI. The MRI shows almost complete bony union of the fracture (good) but also shows moderate to severe bone marrow edema all along the shaft and head of the bone. I'm still in a fair amount of pain. It comes and goes but hurts more often than not. It's not severe - maybe a 5 or 6 at its peak - but it's annoying. It's a deep, burning kind of pain. Vicodin (prescribed when I originally broke it) doesn't touch the pain.

My doctor took the cast off this week and let me to go a pneumatic boot but still nwb on crutches. He said if I don't improve dramatically over the next few weeks, he might have me try a bone stimulator or he might do a bone biopsy (core something?).

Have you heard of bone marrow edema after the fracture has healed? I know it is common immediately after a break but my doc said it should have healed within a few weeks of the fracture.

Does a bone stimulator actually work for marrow edema?  Any idea why the edema hasn't healed but the bone has? My doctor - who is intelligent, well-educated, and in whom I have a lot of faith - is stumped. I'm going to another doctor for a second opinion next week but until then, I'm frustrated and tired of the pain.

Thank you!

[paintgirl2012]

Thanks for the reply. Four months of crutches have left me pretty frustrated. How long would you try a bone stimulator before going to surgery? I'm pretty discouraged (ok - depressed) thinking of another few weeks or months of crutches. We just tried Gabapentin to eliminate the possibility of a nerve issue. It was useless so I'm guessing it isn't a nerve issue.

I see my ortho every two weeks. I'm just curious about other people's experience with bone stimulators for edema. I can't find any references to the bone stimulator helping edema and the fracture is apparently almost completely healed (80%+). Thanks for your thoughts! I appreciate your insight.

[S. Kaul, MD]

Hi there!

Bone marrow edema following fractures often results due to inflammation and may be prolonged in a few cases. It usually responds well to conservative management with rest and anti-inflammatory medications. In cases where it fails to get better interventional measures such as steroid injections to reduce inflammation, bone stimulator to promote bone formation and reduce oedema, or a surgical clean up may be tried. It would be best to discuss the situation in detail at the follow-up appointment with your treating orthopedician.
Hope this is helpful.

Take care!

[paintgirl2012]

Part of this post was deleted somehow. I had a Jones fracture in mid-September. That's what started the whole thing. Thanks!