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2010-03-15 11:42 AM

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Subject: Ever heard of an occult fracture?

Hi all,
2 weeks ago I took a hit in a hockey game to the outside of my knee. My knee hyperextended to the inside. I've actually had this happen numerous times but this one was much more painful than ever before. The ER diagnosed me with a possible ACL and MCL tear. So, I made an appointment with an orthopedic surgeon. He originally thought the ACL was just stretched and the MCL was a grade 2 tear. So, he ordered an MRI and most likelly surgery to follow. The MRI revealed that all ligaments and cartilage were okay. However, I had an occult fracture of the lower portion of my femur. He discribed this as basically crushing the inside of the bone without fracturing the outside of the bone. He said it would take at least 3-5 months to heal. He prescribed no weight bearing for at least the next two weeks. Then gradually increasing the amount of weight on it and using crutches for at least the next 6 weeks. He said I'd be lucky if I could run on it in three months. Just wondering if anyone else has had this or heard of it. And if so, what was your recovery like? I'm registered for a half ironman on August 28th and am just trying to figure out if that's still possible.



2010-03-24 11:43 PM
in reply to: #2726908

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Subject: RE: Ever heard of an occult fracture?
it's more commonly known as a 'Bone Bruise.'  it's something that often happens with a hyperextension or plant/and/twist type of injury to the knee (or also with a varus or valgus directed force, in more medical terms.)  your injury "hyperextended to the inside" is known as a valgus injury and can injury the MCL and/or the ACL (especially if there's a twisting component to the injury.)  

these bone bruises come from basically the same type of forces/mechanism as an ACL, MCL or LCL (or posterolateral corner) injury ranging from a mild sprain to a complete tear of any or all ligaments.  

basically it's not a very *serious* injury, per se, but it is quite painful and most people find it takes nearly 3 months for their knee to feel better.  we tend to recommend 2 or so weeks with crutches and weight bearing only touchdown, progressing progressing to active range of motion exercises, with weight bearing as tolerated soon after that.   

i wouldn't generally say this will put you "out" for 3-5 months, but i am not your physician nor have i examined you or seen your imaging studies.  this injury will hurt for a couple months, and recovery after the very initial couple of weeks is usually dependent on how much pain a patient has.  these bone bruises heal just fine, usually, and healing is faster in younger patients who don't smoke and are healthy.  (uh, triathletes?)   

just some basic info from your friendly ortho resident here .... hope i helped a little bit.  sorry i can't be more specific on when you should expect to be back in the game.  best of luck in your recovery.   
2010-03-25 9:14 AM
in reply to: #2726908

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Subject: RE: Ever heard of an occult fracture?

I thought you were talking about groups of witches splitting into factions.

Too bad about the knee, but the hockey player in me has to ask: Did you miss any shifts on the ice?

2010-03-25 10:05 AM
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Subject: RE: Ever heard of an occult fracture?
I'm not sure that's entirely correct... as far as I understand it, an actual "bone bruise" only involves the marrow, whereas an occult fracture breaches the osteochondral surface or the cortex of the bone.

Both injuries are "occult" in that they do not show up on the xray, but there is a distinction. (Although I think it's one that is not always made.)
2010-03-31 1:42 PM
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Subject: RE: Ever heard of an occult fracture?

Novas, thanks very much your feedback. When the Ortho explained all of this at my last appointment it sounded so odd, almost rediculous, (and embarassing) that a "bone bruise" could cause this much swelling and pain. It makes me feel better that your explanation of the sutation is almost dead on with his diagnosis. At this point I think I've excepted that the HIM is out and I might as well work on swimming as much as possible while that's about all I can do. I have a follow up next week. I'm really hoping that he says I can get back to riding. It's funny, I've worked so hard for the last couple of years to learn the proper swimming technique. Now all of the sudden I've got to teach myself to swim without kicking since my knee doesn't really bend. Guess it should making learning a two beat kick much easier when I can finally start kicking again.

@ChicagoMan65 - I gimped back to the bench, drank some gatorade, rubbed some dirt on it, and assumed that it was no big deal. Next shift I hopped over the boards and upon landing my knee flopped out to the inside again. It was then that i decided I'd better work the door for the rest of the game. We ended up losing and falling out of the playoffs. Might be the first time I've ever been excited for an off seasonSmile

2010-04-01 6:05 PM
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Subject: RE: Ever heard of an occult fracture?

I'm kind of confused as to if they dx'd it as a fracture or a bone bruise.  I have watched radiologists change their nomenclature of these injuries over the last few years and its been intersting to watch the primary care guys first completely dismiss the bone bruises and then completely freak out over the 'fracture' nomenclature when they look exactly the same on MRI.  I usually don't call it a fracture unless there is a fracture line.  Part of it is a nomenclature issue but regardless to what they call it you had an injury to the bone.  Since MRI technology is ever evolving and we didn't have it as it exists today 30 years ago no one can really tell you the long term meaning of the injury.  We know lateral compartment bone brusies and ACL injuries typically go hand in hand. 

At any rate certainly a period of non  weightbearing is in order and a longer period of no running is in order.  These are not visualized on plain films so I would get a new MRI about 6-8 weeks after your injury to be sure its resolving.  They can take up to a year to heal.  (I know you don't want to hear that)  You MAY be running in 3 months.  Swim, bike aqua jog.



2010-04-02 9:32 AM
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Subject: RE: Ever heard of an occult fracture?
Thanks very much Socks. I've been wondering about ACL damage as well. The doc ruled it out but the majority of my pain (other than the throbbing in my thigh) is right in the middle of my knee just slightly under the knee cap. I go back in a week for a follow up. I've officially been on crutches for about 5 weeks. This week is my first week of 10% weight bearing. So, far it's not too bad. I'm really hoping that the doc will say I can start biking again next week. 
2010-04-04 7:58 PM
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Subject: RE: Ever heard of an occult fracture?

TriDude2 - 2010-04-02 10:32 AM Thanks very much Socks. I've been wondering about ACL damage as well. The doc ruled it out but the majority of my pain (other than the throbbing in my thigh) is right in the middle of my knee just slightly under the knee cap. I go back in a week for a follow up. I've officially been on crutches for about 5 weeks. This week is my first week of 10% weight bearing. So, far it's not too bad. I'm really hoping that the doc will say I can start biking again next week. 

Find out where it is and report back   Hope you feel better soon

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