Prolotherapy for post-fracture pain
Post-fracture pain can be caused by many issues. These issues are discussed in our articles on:
- Complex regional pain syndrome type I (CRPS I),
- Vertebral compression fracture
- Lisfranc injuries
- Ischial tuberosity pain and ischiofemoral impingement
This article will concentrate on post-fracture pain caused by ligament and tendon instability.
When a bone sustains enough force to be fractured, it is quite likely that ligaments and tendons are damaged as well. And while bones generally heal quite well on their own with the help of a cast, ligaments and tendons usually do not heal completely.
Doctors in Switzerland expressed their concern regarding ankle fractures and ankle ligaments.
“…great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.”1
Doctors in Germany warned fellow surgeons that they MUST look for ligament damage when there is elbow fracture.
Radial head fractures are the most common fractures around the elbow. Because they are often accompanied by ligament injuries, we recommend considering them to be osteoligamentous (bone and ligament) injuries rather than simple fractures, even in undisplaced or minimally displaced fractures. Surgeons should always suspect ligament tears.2
According to University of Virginia Health Sciences Center radiologists, the problem of ligament injury following fractures are just the “tip of the iceberg.”
Their research suggests:
Several small and seemingly unimportant fractures are associated with other more serious injuries, usually to adjacent soft tissues. . . Some fractures should be considered the tip of an iceberg. Their recognition is important because the commonly associated injuries, which are often more serious than the fracture itself, are typically not evident on radiographs and require advanced imaging for accurate diagnosis and treatment.3
Prolotherapy for post-fracture pain
Prolotherapy stimulates ligament and tendon repair once the cast has been removed. This will help ensure the complete healing of the injury so there are no long-term sequelae such as arthritis.
If post-fracture pain is due to the outside of the bone not having completely healed, Prolotherapy can be used to strengthen the fibro-osseous junction near the source of the pain, which will cause the nerve endings in the periosteum to stop firing.
Prolotherapy will also speed up the recovery process and has even been known to make the injured side stronger than the uninjured one, a benefit highly valued by many athletes, who are always eager to return to their activities as soon as possible.
Prolotherapy for pain decades after fracture surgery
We often see patients with pain many years after a fracture as well. The area healed up well enough to continue on with their lives, but years later the joint becomes stiff, painful, and arthritic. These typically respond very well to a Prolotherapy treatment series, approximately 4-6 treatments. The following video demonstrates treatment in such a case:
1 Lötscher P, Lang TH, Zwicky L, Hintermann B, Knupp M. Osteoligamentous injuries of the medial ankle joint. European Journal of Trauma and Emergency Surgery. 2015;41(6):615-621. doi:10.1007/s00068-015-0548-2.
2 Burkhart KJ, Wegmann K, Müller LP, Gohlke FE. Fractures of the Radial Head. Hand Clin. 2015 Nov;31(4):533-46. doi: 10.1016/j.hcl.2015.06.003. Epub 2015 Aug 25.
3 Pierce JL, McCrum EC, Rozas AK, Hrelic DM, Anderson MW. Tip-of-the-Iceberg Fractures: Small Fractures That Mean Big Trouble. AJR Am J Roentgenol. 2015 Sep;205(3):524-32. doi: 10.2214/AJR.15.14739.