What’s the best imaging study to assess non-union stability when you have a fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner and you get a fracture, you broke your foot in a pothole or something and then you don’t really follow the doctor’s directions, or maybe do follow the doctor’s directions but doesn’t really heal and it turns into a thing called a non-union where the bone’s not solid, you can’t see that it’s actually healed on the X-ray. Well, you have to decide whether or not you’re going to live with it or you’re going to try to have surgery to repair it or you’re going to do something else entirely to try to get it to heal without surgery.
But one of the keys to deciding when it’s actually healed enough has to do with stability. If you get a ton of scar tissue in there, and there’s even some spurring of the bone and it really doesn’t move very much, it might actually be stable enough for you to run on it without getting more problems later. Again, don’t just try to run on it, talk to a doctor, talk to a professional. I’m just telling you how I think about it.
When it comes to assessing it, everybody wants an imaging study. Well, an X-ray shows you the position of the bone, but it doesn’t tell you about stability of the bone. Stability has to do with movement. So, if you’re not moving the bone, when you take the imaging study, you cannot assess its stability. You can guess how stable it looks by looking at it but you can’t tell for sure.
If you look at an X-ray and there’s a non-union, there’s a huge lump of bone around the fracture site, that implies that it’s moving a lot because your body’s trying to put a ton of bone around it to just stop that motion. But again, sometimes it looks like that, but it’s actually totally solid and stable.
The imaging study alone is not enough. So, the best imaging study to assess the stability is not an X-ray. It is not a CT scan. A CT scan, by the way is just a whole bunch of slices with X-rays to create what looks kind of like an MRI, just in a very detailed way to look at bone.
An MRI of course uses a magnet, you get over a hundred images of your foot, but that also gives you a lot of information but it doesn’t really assess stability because you’re not moving when you’re sitting in the MRI scanner.
What really is the only the only study that I think really allows you to assess the stability truly is an ultrasound. And we generally think that ultrasound is great for soft tissue imaging but it’s not great for bone because it doesn’t penetrate bone. But you don’t have bone where you have a non-union, you have scar tissue. So, what we can do is we can actually look at the scar tissue area with the ultrasound unit. We can look at the top edge of the bone and then we can move it and see does the bone wiggle or not? And if it does, it tells us that it’s not that stable.
Seeing how much it moves may give us sort of a baseline for later if you let it heal some more and then we try to move and it doesn’t move very much, we know that the stability has improved. But X-rays, MRIs, CTs, they don’t really show you that.
You’ve also got to see a doctor that actually does ultrasound if you want to do that and get that picture. But that is what I really think is the best imaging study to really assess the stability of a non-union if you’re trying to get back to running.
If you want to figure out how I would help you get back to running if you had a non-union and it was becoming more stable, go check out the running injury roadmap. It’s a book I wrote for you. I’ve actually printed a whole bunch of them. I’ll send you one for free. You can get it at www.docontherun.com/roadmap. So go check it out and I’ll see you in the next episode.