Potts Fracture Case Study

                                                                        

Fractures Treatments - Case Studies 1 and 2
Steven Gershman, DPM

     Case Study of Wei FASTT Patches
on Ankle Fractures


This is the tale of 2 women who inadvertently broke their
left ankles at the same time , providing me with an
opportunity to test whether the Wei FASTT Patches can
speed up healing and return to function.  As these are
two women with similar ages and medical history and
fracture type, it provided a perfect laboratory for a clinical
trial of the patches against a control . To sum up the
results, the woman who had the patches added to the
standard immobilization treatment was the ‘lucky’ one.
She healed and returned to her normal activities 2
weeks or 33% earlier. In sports terms it was a 4 to 6 win.

Patient 1 is 69 year old female in good health who
fractured left fibula when she twisted ankle and inverted
foot /ankle suddenly at home .  The fracture was stable
non displaced oblique type with good alignment.  She
was treated with simple 6 weeks of walking cast. She
was checked every two weeks and xrayed at the visits.
She was having pain walking without the cast until near
6 weeks and the X-rays showed slow healing
consistant with clinical healing at 6 weeks. This is
standard for this type fracture.  She is now discharged
from treatment and doing well. The orthopedic text book
“Surgery of the Foot” by Roger Mann, MD.  (fifth edition),  
states, “undisplaced  stable fractures of the lateral
malleolus can begin immediate weight bearing in a
short leg walking cast , which should be left in place for
6 weeks.”   This has also been my experience with
these fractures. They can require up to 8 weeks or
longer in some cases.

Patient 2 sustained a vertical compression fracture of
her distal left malleolus at the same time period. She
fell down stairs at home jamming the foot into ground
with high impact causing a comminuted fracture that
was more complicated then patient 1. It was however
stable and non displaced. She is a 58 year old post
menopausal female in fairly good health also. She was
treated with a similar program of walking cast
immobilization, recheck visits and X-rays at every 2
weeks.  IN ADDITION SHE WAS GIVEN  WEI FASTT
PATCHES TO PLACE OVER THE FRCTURE SITE
STARTING AT DAY 1. She used a total of 9 patches over
4 weeks. She followed the WEI protocol of 2 days on, 1
day off with each patch.  At 2 weeks the X-ray showed
bone callus formation way ahead of the expected and
ahead of patient 1.  At 4 weeks the X-ray showed  a
clinically healed fracture and complete resolution of
pain to palpation of the fracture site and no pain walking
barefoot and in shoes. She was discharged with no
further care other than instructions on strengthening the
muscles and  slowly returning to normal activities. In
comparison of the 2 patients, the only difference in
treatment was the Wei FASTT Patches. The FASTT
Patch treated patient healed clinically and on X-rays 2
full weeks earlier. This is 33% faster.  This was despite
a more complicated fracture and more intense initial
trauma. This is profound .

Steven Gershman, DPM
(207) 786-4430
280 Minot Ave.
Auburn, ME 04210

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Case 2 :  15 Year old male hockey player with fractured clavicle

A 15 year old male hockey player was checked heavily into the boards during a hockey game
and suffered a complete, distracted mid-clavicular fracture.  The distraction or separation
between the fragments was about a half inch which is quite significant.

The initial ER physician recommended surgical repair due to the distance between the
fragments.  However a subsequent orthopedist recommended an attempt at conservative
treatment via rest and partial immobilization via sling and harness.  The orthopedist advised the
family it would most likely be 6 to 8 weeks at a minimum before he could play hockey again
assuming it healed without surgery which was by no means assured.

I advised the family to utilize the WEI FASTT patches in addition to the orthopedist treatment to
attempt to speed up the process and possibly return him to hockey games sooner to salvage
the end of the season.  They agreed.  They utilized a total of 6 FASTT patches in the manner
recommended by WEI labs.  Basically, 2 days on and 1 day off per patch.

The patient was doing so well with the treatment that he removed the harness at about 3 weeks
and returned to fairly normal activities at under 4 weeks. He returned to full contact hockey
practice at 5 weeks and games a few days after that.  This was a remarkable recovery and
return to sport considering the severity of the fracture and the possibility of requiring surgical
intervention.

He has continued with all normal activities and is pain free.  This was a very impressive
response to the WEI FASTT patches. It should be considered for all athletic teams in an effort to
return injured athletes to the sport much faster then with just standard therapy alone.

In the future I will be testing other patients and will be rechecking weekly to evaluate if the healing may
be sooner than 4 weeks with the FASTT Patches. Perhaps 3 weeks? I will also add another Wei
product , an oral liquid LC Balancer which increases micro circulation . Returning  fracture patients in
less time to their normal activities has a major effect on their lives and economically to them and
society. This study indicates there is a method to do this and should be considered for further study
and testing.

Left is 4 weeks              Right is 2 weeks

Left is 2 weeks                  Right is 4 weeks

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NOTE:  X-ray of patient 1 showed a
normal time-line for healing so they are
not displayed here.

Not to be confused with Pott disease or Dupuytren's contracture.

Pott's fracture, also known as Pott's syndrome I and Dupuytren fracture, is an archaic term loosely applied to a variety of bimalleolar ankle fractures.[1] The injury is caused by a combined abduction external rotation from an eversion force. This action strains the sturdy medial (deltoid) ligament of the ankle, often tearing off the medial malleolus due to its strong attachment. The talus then moves laterally, shearing off the lateral malleolus or, more commonly, breaking the fibula superior to the tibiofibular syndesmosis. If the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also sheared off by the talus. A fractured fibula in addition to detaching the medial malleolus will tear the tibiofibular syndesmosis.[2] The combined fracture of the medial malleolus, lateral malleolus, and the posterior margin of the distal end of the tibia is known as a "trimalleolar fracture."[3]

An example of Pott's fracture would be in a sports tackling injury. The player receives a blow to the outside of the ankle, causing the ankle to roll inwards (so that the sole of the foot faces laterally). This damages the ligaments on the inside of the ankle and fractures the fibula at the point of contact (usually just above the tibiofibular syndesmosis). A better way to visualize this is the two hands of a clock, with one hand facing 12 and the other facing 6. The vertical line they form represents the fibula of the person's right leg. The lateral force approaches from 3 o'clock, sending the lower hand snapping outwards to point at 5 o'clock.[2]

Bimalleolar fractures are less likely to result in arthritis than trimalleolar fractures.[4]

History[edit]

English physician Percivall Pott experienced this injury in 1765 and described his clinical findings in a paper published in 1769.[5][6]

The term "Dupuytren fracture" refers to the same mechanism,[7] and it is named for Guillaume Dupuytren.[8] Pott did not describe disruption of the tibio-fibular ligament, whereas Dupuytren did.[citation needed]

References[edit]

  1. ^Hunter, T., Peltier, L.F. Lund, P. J. (2000). Radiographics. 20:819-736.
  2. ^ abMoore and Agur. Essential Clinical Anatomy. Lippincotts Williams and Wilkins. 2007
  3. ^Moore and Dalley. Clinically Oriented Anatomy. 2006
  4. ^Wilson FC (2000). "Fractures of the ankle: pathogenesis and treatment". Journal of the Southern Orthopaedic Association. 9 (2): 105–15. PMID 10901648. 
  5. ^Pott, P. (1769). Some Few General Remarks on Fractures and Dislocations. London, Howes. Clarke. Collins.
  6. ^synd/1126 at Who Named It?
  7. ^Sartoris DJ (1993). "Eponymic fractures of the ankle". The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 32 (2): 239–41. PMID 8318982. 
  8. ^Dupuytren, G. (1819). Mémoire sur la fracture de l’extremité inferieure du peroné, les luxations et les accidents qui en sont la suite. Ann med.-chir Hôp. Paris, 1: 2-212.

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