Case Studies

In February a patient rang from Dubai for some advice following an accident on his motorbike in the desert. He had sustained a severe, comminuted (in many pieces) fracture of his right talus. He was seen at The Clinic four weeks later and had been told by surgeons that he would be non-weight-bearing on crutches for a full year and that ankle fusion was likely.

CAT scans showed severe comminution of the talus, with no possibility of fixing with screws due to the extent of the damage.

The patient was treated with MFT and laser scan and within just four to five weeks, he was allowed by his surgeon to take 50% weight on the right foot. He was treated at The Clinic just once weekly up to the 24th April, by which time he was fully weight-bearing with no crutches.

The patient was able to return to his job as a photographer-filming on glaciers etc, within 3 months of his injury and after only eight sessions of treatment with MFT and laser scan.

The patient sent a postcard after treatment, saying: “What can I say? The NHS said 12 months on crutches. After 3 months of your magic I was walking, earning money in Palma, spending it in Rio, and now earning it again! Shooting on a glacier, trudging around in the snow, wouldn’t have believed it after seeing the scans. Will have to wait till next season to go snowboarding though. Can’t thank you enough, the country may be wishing Beckham had attended too! Big thanks and peace.”

A patient suffered a very complicated (comminuted) fracture of the neck of talus in a Superkart racing accident at the end of May. He had surgery with 3 screws to stabilise the fracture.

He was told of the strong possibility of death of the talar dome (avascular necrosis) and non-union due to the poor blood supply to the talus, and also that he was likely to need a joint fusion in the future. He initially came to the Clinic non-weight-bearing in mid August after recent x-rays showed no sign of union of the fracture. He attended the Clinic for regular treatments of pulsed electromagnetic field therapy, laser therapy and LIPUS and he also had regular sessions of HBO closer to home.

X-rays in mid October showed an increase in density of the whole of the talus and no sign of any avascular necrosis. By mid November he was partially weight-bearing, and increased to fully weight-bearing over the next 2 months. Most recent x-rays have shown that the fracture has healed well and there is no avascular necrosis- the surgeon told Kevin he was very surprised at this result. He is now back at work and walking normally, and not a candidate for joint fusion.

A young man had suffered with right hip pain for two months prior to treatment at the Clinic. He was struggling considerably with normal activities and walking and was unable to run about with his children. He was initially told of ‘soft tissue damage’ but Brian was not happy with this and requested further investigation. MRI scans confirmed more serious damage, showing avascular necrosis (dying off) of the head of femur due to a compromised blood supply (the whiter area on MRI). Avascular necrosis of the head of femur can often result in early hip replacement.

Immediately following the diagnosis, we began treatment with pulsed electromagnetic field therapy and interferential therapy in order to create a new blood supply and prevent further dying off of the femoral head. After the first of these treatments, the young man felt 75% better.

The young man was virtually pain free and able to walk normally after 5 sessions of MFT and interferential therapy. He continued to progress over the next 6 weeks and final MRI scans at this stage showed ‘significant’ improvement and revascularisation of the femoral head (the previous whiter area now looking much more like the left side). He is now back to normal activity.

The Patient writes: “My first visit to the clinic and Brian immediately diagnosed my injury as a hip problem. Brian advised that I should have blood tests and an MRI scan which confirmed his diagnosis that I had avascular necrosis of the right femoral head. I cannot express my gratitude highly enough to Brian and his team for their professional treatment, positive encouragement, and dedicated support.

A patient aged 36 fractured his left humerus in an off road buggy accident on the 4th September. The fracture extended over the distal and middle thirds and was comminuted (in many pieces). X-rays (shown to the right) taken over three months later, on the 9th December showed delayed union with no callus. the patient could feel the fracture moving. He was fitted with a mid-shaft plastic brace.

The patient first came to see us on the 19th December and was given MFT and Pulsed Scanning Laser. He had two more treatment sessions before further X-rays showed early milky callus high on the fracture. It was decided to boost his treatment by giving Tom Hyperbaric Oxygen Treatment along with the MFT and Laser and the first session was given on the 17th January in the following year. Tom went on to have a further five treatment sessions and when he had further X-rays on 10th February there was extensive callus – or in the patient words “there was callus just everywhere!”

Case Study “A” (PMFT & LASER TREATMENT)

Image below – Fractured clavicle in motorcycle racing accident. The clavicle is in four separate pieces

Image below – Following 1st treatment one day after fracture

Image below – This picture was taken following treatment – 4 days after fracture (although we do not recommend doing this) – He raced the same day! Virtually all our racing motor cyclist patients with a classic clavicle fracture race within 14 days and many have won Championship races on their return.

Case study B

John Reynolds fractured his left clavicle (collar bone) in a British Superbike race at Thruxton on June 6th. He was knocked off in an incident with his stand-in team mate Gregorio Lavilla. John came for PMFT and Laser treatment on June 7th, 8th and 11th and raced, 14 days after fracture, at Brands Hatch where he not only competed but won the first race with little or no pain from the fracture. John went on to win the British Championship that season.

A young man who was involved in a road traffic accident. He suffered a fractured distal tibia and fibula. He had surgery four days following the accident to plate both tibia and fibula and was put in a BKPOP.

The POP was removed three months later.

Four months after fracture infection was found in the bone plus exiting screw. The screw was removed.

At Six to eight months the fracture started deviating and he was referred to St. George’s Hospital, Tooting.

He had surgery in May the following year where an osteotomy was performed and he was fitted with a Taylor Spacial frame with micrometer adjustment for correction of the deviation.

In August the Taylor Spacial frame was removed and replaced with an ex-fix with 2 superior and 3 inferior bolts. He was full weight bearing from the 15th September but with the ex-fix not dynamised. Nearly six months after surgery the X-rays still showed non-union.

The patient approached the clinic early November and came for consultation and treatment on the 10th November. His treatment involved pulsed magnetic field therapy at a frequency of 200 Hz pulsed at 50 Hz for 20 minutes at an intensity of 100 gauss followed by a 3 watt pulsed scanning Laser at a wave length of 850 Nm for 14 minutes. He then had one session of Hyperbaric Oxygen Therapy at a pressure of 2 ATA’s for a period of one hour. Following a lunch break he returned and continued with one further treatment of Magnetic Field Therapy and one session of pulsed Laser.

He returned for further treatment eleven days later on the 21st November and stated he had had X-rays at the hospital four days earlier which appeared to show early signs of bridging callus. The ex-fix was removed and replaced with a functional brace. He was full weight bearing and off of NSAID’s. He received the same treatment modalities as previously.

The patient young returned for further treatments on the 30th November and the 7th December.

He returned on the 10th January the following year whereby X-rays showed extensive callus visible all around the fracture. He is now well on the way to a full recovery.

Prognosis for Recovery 6 – 8 weeks

Another Hockey player suffered this fracture during a game. He could not sleep or eat semi-solid food because of pain. After two sessions of HBO he was able to sleep through the night and began eating semi-solid foods. After his third treatment he found his jaw could be slapped without pain. X-rays confirmed greatly accelerated healing.

One of our patients, A World Champion Speedway rider sustained this severe fracture while racing. He had surgery the same day where the humerus was plated.

Prognosis for Recovery 18 – 20 weeks minimum.

The patient came to see us four days after his injury and started with one treatment of pulsed laser and pulsed MFT. Two days later he commenced on a ten day course of HBO for 1 hour sessions plus pulsed 800 nM laser and pulsed MFT. Continued for a further 12 sessions of pulsed MFT and pulsed 800 nM laser and the patient rode again 12 weeks after fracture, and won the race.

Prognosis for recovery 4 – 6 weeks (possibly longer)

Patient was treated within 40 minutes of injury with a 70 minute session of HBO. Following his treatment his thigh circumference was reduced by 3 cm from its pre-treatment measurement. He also reported reduction in pain. When patient reported for treatment the following day he had discarded his crutches he relied on the day before and had already regained about 50% of his flexion. Following a further five HBO’s he had regained 90% of his range of motion and was able to ride an exercise bike and stairmaster. He resumed his sporting activities at full fitness eight days after injury.

Blunt arterial injuries secondary to bone fractures are frequently associated with nerve, vein and soft tissue lesions. A delayed diagnosis or treatment is the main cause of high amputation rate. Porcellini et al (1977) described 34 patients who presented with acute arterial occlusion (15 cases), false aneurysms (13 cases) or arterio-venous fistulas (6 cases) of the extremity. Various procedures were performed to repair injured arteries associated venous lesions were treated. External fixation of long bone fractures was made in 29 patients before vascular reconstruction to prevent further injury during orthopaedic stabilisation. Fasciotomies were made to treat compartmental compression where necessary. Hyperbaric oxygen therapy was applied in 7 patients to control bacterial contamination and improve wound healing. The authors emphasised that a multidisciplinary diagnostic and management strategy is required to improve limb and patient survival. HBO is an important component of such multidisciplinary strategies.

Certain bones have an inherently poor blood supply such as scaphoid which has its blood supply from one end only as does the ankle bone called the talus. The junction between the lower and middle third of the tibia also has a poor blood supply and all three of these types of fracture frequently suffer delayed or non-union.

An example of lower/middle third tibial fracture suffered by a patient is as follows:

The patient suffered a severe fractured Tibia & Fibula in a Moto X accident on 16th November and first came to see us on the 3rd December with no sign of callus formation (see X-ray right).     xray
The whole middle segment of the fractured Tibia was displaced out of line making internal fixation with an intra-medullary nail impossible.

The double fracture of the tibia severely compromised the blood supply and healing ability of the middle segment. Because of the distinct possibility of necrosis (dying off) of the middle segment it was decided to treat with Hyperbaric Oxygen, Pulsed Laser and Magnetic Field Therapy.

At the end of December, following ten sessions of Hyperbaric Oxygen, laser and MFT the patient saw his consultant who removed the plaster and, after expressing surprise that the fracture appeared stable, X-rayed the leg and was further surprised at the remarkable callus formation. Another month later the patient was holidaying in America with no walking aids.

Note: The patient suffered a less severe fracture of his other Tibia and Fibula thirteen years ago and it took him seven months to heal!!

Two professional footballers both having surgery on their Achilles tendons by the same surgeon with outcomes as follows:

Prognosis for Recovery 9-10 weeks

Without HBO:

Patient trained for the first time 64 days after surgery. Earlier training was impossible due to pain and oedema when cast was removed and was unable to weight-bear until 3 weeks after cast removal.

With HBO:

Patient trained after 34 days following 13 one hour sessions of HBO while still in his cast. He was able to fully weight-bear immediately the cast was removed, had no swelling and had full ankle movements.

A National Hockey Player sustained this injury when he crashed into the boards and fell to the ice with left arm being pushed back

Prognosis for Recovery 4 – 6 weeks

Player commenced HBO 2 days after injury with virtually no range of motion in abduction or forward flexion and there was a constant ache. After four days of HBO patient had regained full range of movement and the pain was dramatically reduced. Played in game 21 days after injury.

A retired gentleman attended the clinic complaining of a nine year history of low back and neck pain with no history of any trauma. He had been seeing a chiropractor regularly for several years with no lasting benefit. He had limited neck movement and was found to have inflammation of two of the joints (atlanto-axial and C5/6) in the neck due to arthritic changes. He had one treatment with Shortwave Diathermy, Interferential Therapy and Acupuncture and was almost pain free when he attended his follow up appointment 5 days later. He also had limited movement in the lumbar spine and pain arising from the sacro-iliac joint on the right side. He was again treated with Shortwave Diathermy, Interferential Therapy and Acupuncture and after three treatments he reported a 70% improvement and he felt better than he had in years. He now only attends the clinic if and when his back pain flares up.

A care worker attended the clinic complaining of a 4 month history of left heel pain with no history of trauma. She said that sometimes the pain was so severe that she could barely weight-bear and would have to take time off work and use a crutch. She was found to be suffering with Plantar Fasciitis (also known as Policeman’s Heel). She was treated with Pulsed Magnetic Field Therapy, Interferential Therapy and Ultrasound and given exercises to restore her foot arch. She reported feeling better even after the first treatment session and attended treatment after this to improve things further. She now has no problem weight-bearing, she has not had to use her crutch and she is back at work.

A patient in her early fifties attended the clinic complaining of a several month history of bilateral (both sides) increasing hip and thigh pain with no history of trauma. Her left hip was worse than the right. She was found to have two significantly arthritic hips, with virtually no internal rotation movement. The patient was given a session of Pulsed Magnetic Field Therapy, Interferential Therapy and Acupuncture and came back a few days later feeling approximately 70% better, just after one treatment session. Although she obviously still has her arthritis, she is now able to sleep and walk more comfortably and has been discharged.

A young student attended the clinic with a 7 year history of right shoulder and arm pain and an ACJ (acromio-clavicular) dislocation following a fall. He was continuing to complain of a stiff neck and tingling down the arm and into the little finger and ring finger on the right hand. He had been to see several people who were treating his ACJ, with no improvement. On examination it was found that his symptoms were actually coming from his neck and brachial plexus (the group of nerves that supplies the arm and hand). One particular nerve, C8, had been stretched when he fell and he had fibrosis (thickening) of the nerve which was giving him his symptoms down his arm and into the hand. He was treated twice with Pulsed Magnetic Field Therapy, Laser Therapy and Ultrasound through his neck and the plexus. He was then given Acupuncture in his neck and had an immediate and significant reduction in symptoms.

This patient complained of a ten month history of right outer thigh/hip pain following two bunionectomies. She complained of aching and pain in the thigh when standing and then she could not lie on that side afterwards. She was found to have irritation of the gluteus medius muscle which was giving her pain. She was treated with Shortwave Diathermy, Interferential Therapy and Acupuncture and attended the clinic 3 days later, feeling 50% better. She then came back for a check up 5 days later and reported that she was able to stand and iron for the first time in several months. She was then discharged.