Post-­traumatic & post­operative problem cases in orthopaedics

Dr. med. Wolfgang Rohrer, Klosters, Switzerland

Introduction

After a fracture or orthopaedic surgery the body’s biological system has to rebuild the injured bone function.

In the case of a fracture a position as close as possible to real human anatomy needs to be achieved using appropriate measures. This is achieved through the repositioning and fixation of the fractured parts in an anatomically correct position. In the case of repositioning which cannot be implemented externally, a surgical procedure is usually the method of choice. In so doing, the fracture fragments are repositioned during surgery and fixed using various options.

With many orthopaedic interventions (for instance realignment osteotomy) the bone is intentionally injured. This injury, unlike the fracture, is a planned and less traumatic injury to the bone.

This presentation is intended to give you ideas about how you can efficiently aid problematic bone healing using the BICOM® method. However, first of all a word or two on physiology.

Fracture healing

The healing process for both types of bone injuries (fracture or orthopaedic surgery) is in principle the same. It takes place in four partially overlapping phases.

a) Inflammatory phase: Immediately after the occurrence of an injury to the bone a proliferation of very fine blood vessels starts, accompanied by a rapid spread of different inflammatory cells. This leads among other things to an increase in blood supply, which after about two weeks can be as much six times above the norm. The inflammatory phase itself has normally already calmed down after 2 – 3 days.

b) Granulation phase: After the inflammatory phase has died down the bloody effusion, in which a network of fibrin and collagen has formed, is replaced by granulation tissue containing fibroblasts. This brings about an initial bridging of the fracture ends. Osteoclasts begin to break down dead bony substance, not supplied with blood, while osteoblasts begin to form new bone in the region of the periosteum. This reaction is called “primary callus response“. After 3 – 4 weeks a soft join forms between the fracture ends, partly made from connective tissue and partly from bone. The X­ray shows a soft focus image of the fracture gap and indistinct shadowing in and around the fracture line.

c) Hardening to form a callus: At this stage the callus is hardened by mineralisation. This happens essentially through deposits of calcium. In this way a mesh of bone is created which spreads out like a network along the newly formed capillaries.

d) Modelling phase: The callus is then gradually replaced by lamellar bone. Fracture healing is completed by the partial regeneration of the normal bone structure through a slow build up, breakdown and conversion process.

While at one time it was thought that it was important to achieve absolute immobility, today it is understood that good and rapid bone healing is accelerated by very slight micro movement in the fracture gap.

Fracture healing, which takes longer than 4 – 6 months is described as delayed fracture healing (delayed union).

Complications in bone healing

Pseudarthrosis

If bony consolidation has not taken place six months after injury, this is called pseudarthrosis (non union). At the same time a so­called “false joint“ is formed.

Possible causes of pseudarthrosis:

  • mechanical factors ( such as for instance incorporation of soft tissue parts in the fracture gap)
  • too low a compression on the fracture gap
  • incorrect immobilisation
  • mobilisation too soon
  • delayed callus formation
  • inadequate blood supply
  • Infections
  • too much tissue loss
  • systemic diseases (Diabetes mellitus, PAOD)

Pseudarthrosis often leads to continuous pain and permanent functional restrictions. In the case of so­called vital, active pseudarthrosis (the cause of which is often instability) an improvement in mechanical framework conditions should be given consideration, even in the early stages.

The atrophic, avital type of pseudarthrosis is characterised by an absence of revascularisation, mostly because of necrotic fragments. Frequently the bone defect has to be rebuilt (for example by spongious bone grafts). This, however, requires further surgical intervention.

Complex regional pain syndrome – CRPS (Sudeck’s disease, Sudeck’s dystrophy)

The term CRPS incorporates the synonymously used terms, reflex dystrophy, Sudeck’s disease, Sudeck’s dystrophy, algodystrophy and sympathetic reflex dystrophy.

This clinical picture is characterised by an external action taking place over a long period of time leading to dystrophy and segmental limb atrophy.

The mechanisms are not yet fully understood. The following models of origin are being discussed: The inflammation mediators arising during an inflammatory response are not broken down in sufficient numbers and this then prolongs the inflammatory response. This in turn gives rise in the central nervous system to a sensitisation of the central pain­processing group of nerve cells. This produces a malfunction in neuronal control, i.e. in the vegetative nervous system. (The change in blood supply to the skin and the tendency to sweat occur because of a malfunction of the sympathetic nervous system originating in the central nervous system.)

Because of a vascular constriction, the tissue receives an inadequate oxygen supply (hypoxia), causing increased acidic degradation products (acidosis). The localised over­acidity causes an increase in pain and prevents the migration of leukocytes through the tissue.

It is certain that some factors favour the development of CRP: instability, secondary displacements, multiple attempts at repositioning and troublesome plaster dressings restricting freedom of movement. Most frequently post­menopausal women are affected.

Symptoms are very non­specific initially so that a diagnosis is generally slow in coming. This means unfortunately that treatment during the remaining course of the illness starts late. Frequently the long­-term results from delayed treatment are poor and it is not uncommon for it to result in invalidity with the associated consequences for the afflicted patient and the cost bearer.

The course of the disease varies considerably from individual to individual. Circulatory disorders, oedema, skin changes, pain and functional restrictions are the presenting symptoms. In more than 75% of cases there is weakness in an

affected extremity caused by pain. At the chronic stage contractures and fibrosis develop. Usually there is a strong increase in the sensation of pain and in 75% of patient there is also pain at rest.
Xray images detect typical changes:
patches of lighter areas in the bone and later signs of inactivity osteoporosis.

Overall, the prognosis should be regarded unfavourable.

CASE STUDIES

a) General Comments 
Every patient is an individual. Therefore your treatment procedures should also be individually adapted to the patient. Check out all your therapy parameters including the frequency of therapy sessions and supportive therapeutic measures. In particular, check out the number and position of the applicators (both at the input and output).

b) Programs which are frequently suitable (BICOM® 2000)

Programs which are frequently suitable (BICOM® 2000)

c) Ampoules of the CTT
Please consider the many options available with the pink ampoules from the various test sets. In the CTT orthopaedics test set you will also find very useful ampoules (e.g. “bone fractures“ or “bone stabilisation“ ampoules).

d) Accompanying measures 
Here you should consider in particular the orthomolecular test set (especially Vitamin D)!

Case 1: Pat No. 4645, female, 1930, 5 BICOM® therapy sessions
History, Findings, Evaluation
30.11.1999: open repositioning and plate osteosynthesis of the tibia in the case of a fracture of the lower leg.

January 2000: on the advice of the surgeon who operated, weight bearing to be increased. Three days later she had severe pain in the distal medial lower leg as well as severe swelling of the whole right foot.

7.2.2000: She came to see me for a consultation (9 weeks after surgery). The clinical picture points to a CRPS and the X­ray confirms the suspected diagnosis, in addition radiologically fracture healing is clearly delayed with absence of the formation of a callus.

Therapy and Progression

  • Intensive physiotherapy
  • In total five BICOM® therapy sessions using programs in accordance with testing: Basic programs, lymph activation (930), postoperative program (920)
    Start of therapy on 8.2.2000. Within 10 days (after three BICOM® therapy sessions) there is a clear improvement in symptoms, five week later (after 4 BICOM® treatments) the X­ray showed clear beginnings of union, enhanced callus formation with ossification of the fracture.

Evaluation by the surgeon on 11.4.2000 (4 ½ months after the operation): “After suffering Sudeck’s disease, things are progressing as would be expected from a time perspective, even if somewhat protracted. We will invite the patient for an annual clinical check­up and for X­rays. Best regards and many thanks for taking such good care of the patient.“ (In my referral letter for a further check up I wrote nothing to the orthopaedic specialist about BICOM® therapy but today I would!)

In total 5 BICOM® therapy sessions.

On 19.3.2001 the osteosynthesis material was removed without any problems.

Case 2: Pat No. 00853, female, 1950, 6 BICOM® therapy sessions
Patient history, findings and evaluation
29.12.2001: The patient fell onto her hand resulting in a loco classico radius fracture to the right hand. Initial care in the local hospital (plaster).

X-­rays dated 30.12.2001
X-­rays dated 30.12.200

X-­rays dated 30.12.200

Therapy and Progression

4.1. and 9.1.2002: Hospital check­up, position adequate.

17.1.2002 (barely 3 weeks after the accident): Check­up in my practice, thumb area rather swollen, dysaesthesia (pressure on the N. radialis, Ramus superficialis), fenestration of the plaster.

29.1.2002 (4 weeks after the accident): Swelling of the hand, removal of plaster, X­ray taken without the plaster: delayed fracture healing, new plaster again for a further two weeks.

X­rays of 29.1.2002 (4 weeks after the accident)
X­rays of 29.1.2002 (4 weeks after the accident)

BICOM® therapy 1 with basic / subsequent program, postoperative program, application of calcium and vitamin C.

1.2.2002 – 25.2.2002: Total of 5 BICOM® therapy sessions (principally activation of elimination, balance of the 5 elements, lymph activitation, postoperative program). (Therapy 2­6)

On 12.2.2002 (6 weeks after the accident) X­ray images taken again which show the beginnings of the formation of a callus with correct axial alignment – the plaster is left on for a further two weeks.

X­rays dated 12.2.2002
X­rays dated 12.2.2002

27.2.2002 (8 weeks after the accident): X­ray check­up, ossification is beginning to take place and there is a slight displacement in plantar direction with an intact joint angle and the plaster is removed. At this point physiotherapy is prescribed as an additional measure.

X­rays dated 27.2.2002
X­rays dated 27.2.2002

Based on testing, no further BICOM® therapy is necessary and the patient is free of symptoms.

On 25.3.2002 (12 weeks after the accident) another X­ray check is carried out. It shows a fracture in the process of consolidation but not yet fully ossified. The patient continues to be symptom­free. No BICOM® therapy necessary.

X­rays dated 25.3.2002
X­rays dated 25.3.2002

As a precautionary measure with the patient being completely free of symptoms and having totally normal mobility of the wrist, a final X­ray check is carried out on 19.6.2002 (5 ½ months after the accident).

X­rays dated 19.6.2002
X­rays dated 19.6.2002

Case 3: Pat No. 02065, female, 1946, 3 BICOM® therapy sessions
Patient history, findings and evaluation

3.4.2006 (10 weeks after the accident): The patient reports that she had fallen on her right side and hip on 23.3.2006 while skiing. Primary evaluation on the day of the accident in the local hospital. Diagnosis: Pelvic contusion. Radiologically no indications of a fracture.

X­ray dated 23.3.2006
X­ray dated 23.3.2006

Weight bearing is impossible for the patient and she still has pain in the pelvic region. Because of severe pelvic compression pain, a scintigram was ordered. The resulting diagnosis is a pelvic girdle fracture (right sacroiliac joint, bilateral superior branch of the pubic bone and right­sided inferior branch of the pubic bone).

Comment from the nuclear medicine physician: In scintigraphic terms a typical pelvic girdle fracture. It is not uncommon for pelvic girdle fractures to be missed by conventional X­rays and sometimes in a CT. The scintigram diagnosis is however unambiguous.

Bone scintigram of 5.4.2006
Bone scintigram of 5.4.2006

Therapy and Course

From the 10.04.06 to the 25.04.06 3 BICOM® therapy sessions were carried out (partly basic programs and partly CTT ampoules from the Orthopaedics test set). While the patient previously had to take anti­inflammatories (with their associated side­effects), she exhibits fewer symptoms after just one therapy session and now no longer needs any medication. 18.4.2006 (5 weeks after the accident): “I am very much better but at nights I still can’t lie on my hip“. Clinical examination: discrete pelvic compression pain, walking on two crutches possible. Registered for physiotherapy. 12.5.2006 (6 weeks after the accident): “I am really well“, standing on one leg is possible. Testing reveals no need for any further BICOM® therapy sessions. 10.7.2006 (14 weeks after the accident): “No symptoms whatsoever, even cycling is possible.“

The clinical examination is absolutely normal and the case is closed.

Case 4: Pat No.00934, female, 1938, 15 BICOM® therapy sessions
Patient history, findings and evaluation

On 19.10.2007 the patient stumbled over a root. Diagnosis: Proximal humerus fracture. Osteoporosis The discharge report of 27.10.2007: Wounds continue to heal well without irritation, however there is a clear swelling of the left elbow and left hand.

X­-rays of 19.10.2007
X­-rays of 19.10.2007

X­-rays of 19.10.2007

Therapy and Course

On the same day primary care in a nearby hospital.

X-­rays of 23.10.2007(4 days postoperatively)
X-­rays of 23.10.2007(4 days postoperatively)

 X-­rays of 23.10.2007(4 days postoperatively)
The discharge report of 27.10.2007: Wounds continue to heal well without irritation, however there is a clear swelling of the left elbow and left hand.
30.10. 2007 (11 days after the accident): Check­up in my practice. Discussion on how to proceed. As I have no X­ray facilities in my practice, further check­ups to be carried out by the orthopaedic surgeon. Recommendation for vitamin D injections (300,000 IU/ampoule).
30.10 – 10.12.2007 (just under 8 weeks after the accident): 3 injections of Vitamin D. The patient tells my assistant during this period that the orthopaedic specialist is unhappy with the healing process. According to the patient he is considering a reoperation because of delayed fracture healing. At this point a suggestion is made to the patient for BICOM® therapy to be carried out.

From 11.12­-19.12.2007 3 BICOM® therapy sessions are carried out (basic program, follow­up program such as lymph activation and a postoperative program). In addition CTT ampoules from the orthopaedics test set). (Therapy sessions 1­3) The patient reports less pain, a reduction in swelling and also that she is no longer as tired. She took her planned holiday abroad.

On her return from holiday she reports on 22.1.2008 (12 weeks after the accident) that she had been to see the orthopaedic surgeon and he was happy with how things were progressing. The X­rays show the beginnings of fracture healing.

X­rays of 21.1.2008 (12 weeks after the accident)
X­rays of 21.1.2008 (12 weeks after the accident)

Subsequently 3 BICOM® therapy sessions are carried out from 22.1.2008 to 25.2.2008. In addition 2 further ampoules of Vitamin D are applied. (Therapy 4­6) Another check is carried out on 27.2.2008 (17 weeks postoperatively). The orthopaedist if anything expresses scepticism about the further healing process. The fracture meets the requirements of a “delayed union“.

X-­ray pictures of 27.2.2008 (17 weeks after the accident)
X-­ray pictures of 27.2.2008 (17 weeks after the accident)

 

 X-­ray pictures of 27.2.2008 (17 weeks after the accident)In the period from 3.3.2008 to 28.3.2008, 5 more BICOM® therapy sessions take place. In addition, cupping is done once across the reflex zones of the vertebral segments. On 23.3.2008 the patient reports that she is very happy and she now only has slight pain. (Therapy 7­12)

The orthopaedic follow­up on 28 March is carried out to the satisfaction of the orthopaedic specialist. The X­ray images now show (i.e. five months after the fracture) a clear callus formation.

X-­rays of 28.3.2008 (21 days postoperatively)
X-­rays of 28.3.2008 (21 days postoperatively)

On the 7.4.2008 the patient comes to my practice for a follow­up and reports that she is feeling really well. In the meantime she had even cleaned the windows at home. At this point in time she only needed a very short BICOM® therapy session. (Therapy 13)

On 22.4.2008 another BICOM® therapy is carried out. The patient then went on holiday for a week. (Therapy 14)

On the 13.5.2008 she reports that she is no longer restricted in her everyday life. One more BICOM® therapy is carried out. (Therapy 15)

This next orthopaedic check­up is carried out on 27.5.2008 (31 weeks postoperatively). Both the patient and orthopaedic specialist are very happy and the case is concluded.

At the point in time when this presentation was being prepared, the patient was feeling fine. The metal was left.

X-­rays of 27.5.2008(31 weeks postoperatively)
X-­rays of 27.5.2008(31 weeks postoperatively)
X-­rays of 27.5.2008(31 weeks postoperatively)
X-­rays of 27.5.2008(31 weeks postoperatively)

Case 5: Pat No. 00234, female, 1943, 3 BICOM® therapy sessions

Patient history, findings and evaluation

Consultation on 28.7.2006: On 13.7.2006 the patient suffered a supination trauma causing a non displaced avulsion fracture to the base of the fifth metatarsal bone of the right foot (with joint involvement). Primary treatment was carried out in a local hospital. A conservative treatment procedure is planned.

Therapy and Course

Immobilisation using a stabilising shoe.

Follow­up on 20.7.2006: a callus formation is beginning in the case of a non displaced fracture to the base of the fifth metatarsal.

X­rays of 20.7.2006
X­rays of 20.7.2006 & X­rays of 10.8.2006 (4 weeks following accident)

Check up of 14.8.2006 (4 weeks after the accident: normal clinical progression with the beginnings of ossification.

Check up of 28.8.2006 (6 weeks after the accident): still normal course, 100% capacity to work is established as at 31.8.2006.

Other follow­ups:

21.9.2006 (9 weeks after the accident): The patient reports that she has more pain and severe swelling in the right foot. She can hardly put any weight on her foot. The clinical examination shows signs of a CRPS.

An X­ray is requested. The radiologist’s report: “Status following base fracture to the fifth metatarsal of the right foot with slightly increasing fracture ossification. Compared with the previous examination in August, there is if anything better mineralisation. No dystrophic disorders.“

Start of BICOM® therapy, in addition 1 ampoule Vitamin D i.m.

X­rays of 22.09.2006 & X­rays of 31.10.2006 (9 weeks following accident)
X­rays of 22.09.2006 & X­rays of 31.10.2006 (9 weeks following accident)

In the period from 21.9.2006 to 27.9.2006 a total of three BICOM® therapy sessions are carried out (follow­on programs only, especially lymph activation, wound healing, postoperative programs, metabolic activation).

Follow­up on 31.10.06 (15 weeks after the accident: hardly any swelling. No longer any signs of a CRPS. The patient is increasingly able to put weight on her foot. A decision is made to arrange another X­ray. The radiologist’s findings: “Compared with the X­ray images available, not least those of 22.9.2006, there is now obviously increasing fracture consolidation. The fracture gap is virtually completely ossified. There is a clear improvement in decalcification of the feet.“

The case can be concluded.

 
Case 6: Pat No. 04801, female, 1938

Preliminary remarks: The patient lives abroad but is however in Klosters from time to time on holiday.

Patient history, findings and evaluation

A fall on 26.8.2001 when walking. This caused a luxated 4 part fracture of the right proximal humerus. An operation is performed on the same day (open repositioning and osteosynthesis with 4 clover leaf LCP and AP locking screw for the torn tuberculum minus.

Orthopaedic surgeon’s report: Of course the prognosis of this severe fracture of the head of humerus will always be uncertain and future necrosis cannot be ruled out with certainty.

Therapy and Course

Since the patient at the present time is having BICOM® therapy with us for her asthma, this is being extended to cover the fracture healing (as of 1.9.2001). In the period from 01.9.2001 to 1.10.2001, 6 BICOM® therapy sessions took place. (BICOM® Therapy 1­6)

Orthopaedic specialist’s report dated 13.11.2001: Certainly we can say that things are going well considering the severity of the injury. At the present time there are no signs of necrosis of the humeral head.

The patient decides to remain in Klosters until most of the fracture treatment is finished.

At this time titanium tests once again in the H+Di settings and we treat the patient accordingly. The patient returns home over the holidays and is due to return at the beginning of January

Check up on 8.1.2002 by the orthopaedic specialist (18 weeks after the accident): “Radiologically the healing process is going very well, the fracture has consolidated completely and also the inactivity osteopenia has clearly improved compared with X­rays taken in November. Mobility is making clinical progress and an abduction of just below 90% is now
possible. It is apparent that in the last few days thanks to your treatment, the localised pain has clearly improved and the patient was completely free of pain today.“ In the period from 10 January 2002 to 8 February 2002, 5 BICOM® therapy sessions in total

were carried out. (BICOM® Therapy 7­11) We very often test for molybdenum, less frequently for titanium.

The patient has started cross country skiing. Orthopaedic specialist’s check­up dated 11.2.2003: “This is a very pleasing result after this complex proximal fracture of the humerus, which now appears to be fully ossified and the patient consequently is now more or less able to function to full capacity.

The patient subsequently will return to her home country.”

30.6.2003 – 22.7.2003: The patient is very well and 2 BICOM® therapy sessions take place (BICOM® therapy 12­13). Again the patient returns to her home country afterwards. 8.9.2003 – 13.9.2003: The patient asks for metal to be removed. Extract from the hospital

report: Scars without irritation, no pain, very good mobility with virtually equal bilateral range of movement. Preoperative radiological clarification however reveals necrosis of the humeral head, loosening of the implant and formation of a pseudarthrosis (and all this without the patient having any symptoms at all).

X­rays of the 12.9.2003 (54 weeks after the accident)
X­rays of the 12.9.2003 (54 weeks after the accident)

The osteosynthesis material is not removed. A second opinion is sought from a specialist clinic. Extract from the specialist clinic’s report: “In view of the patient being virtually pain­free at the present time and that she also demonstrates astonishingly good shoulder function, I would advise against any deliberate surgical procedure at the present time.“

9.1.2004 – 12.2.2004: The patient is feeling well and we carry out 3 BICOM® therapies (BICOM® therapy 14­16), this time however to treat a cold. She does not need any therapy for her shoulder.

Once again we carry out a clinical check­up (3.2.2004, 3 ½ years after the accident).

Extract from the orthopaedic specialist’s report: “The patient continues to do extremely well and is completely free of symptoms and pain and her shoulder is unchanged in terms of having virtually full shoulder function. Surprisingly today’s X­ray when compared with the last check in September 2003 shows progressive ossification, and in my opinion also healing of the pseudarthrosis. It is hard to believe that such good shoulder function is possible in view of the position of the humeral head.“

Comment: The patient is completely free of symptoms, with full functional capacity and is playing sport more and more, including swimming and golf.

X­rays of 3.2.2004 (3 ½ years after the accident)
X­rays of 3.2.2004 (3 ½ years after the accident)

 X­rays of 3.2.2004 (3 ½ years after the accident)
5.8.2004 – 27.8.2004: The patient reports that she has suffered repeated infections. She has virtually no symptoms from her shoulder. We test again primarily titanium and molybdenum. 3 BICOM® treatments are carried out (BICOM® therapy 17­19).

X­rays of 27.7.2004 (just under 4 years after the accident)
X­rays of 27.7.2004 (just under 4 years after the accident)

X­rays of 27.7.2004 (just under 4 years after the accident)

13.1.2005 – 7.3.2005: The patient reports being totally happy and apart from infections there were no problems to record. She continues to play golf. We once again treat metals and eliminate (4 BICOM® treatments, Therapy 20­23).

25.7.2005: Purely a consultation and a BICOM® therapy (therapy 24), elimination, amalgam and titanium.

8.2.2006 – 13.3.2006: The patient is feeling really well. There are somewhat increased shoulder symptoms. We test amalgam and titanium once again. Total of 4 BICOM® treatments (Therapy 25­28).

4.8.2006 – 22.8.2006: The shoulder on the right is somewhat more painful. The patient has the feeling she is experiencing increased sensitivity to changes in the weather.

On 2.8.2006 an orthopaedic follow­up is carried out. Extract from the orthopaedic specialist’s report: “Now it is five years on following the known fracture. Essentially things are unchanged, practically no symptoms and the patient has her full performance capabilities. Only slight localised pain is caused when pressing in the area of the distal plate. Surprisingly her shoulder function is unchanged and completely without restrictions. From the orthopaedic viewpoint treatment can be finished for the time being.“

X­rays of 2.8.2006 (5 years after the accident)
X­rays of 2.8.2006 (5 years after the accident)

X­rays of 2.8.2006 (5 years after the accident)

The patient stays twice a year for 4 to 8 weeks in Klosters and comes regularly for BICOM® therapy. She continues to be very well and her shoulder mobility continues to be amazing – the osteosynthesis material is in situ. During the summer she plays golf and swims regularly (the crawl!) and has now cut down somewhat on the cross­country skiing.

In the meantime for the last 8 ½ years she has been astounding every orthopaedic specialist …

And incidentally: This is how the X­ray appeared after her accident on 26.8.2001:

X­ray picture dated 26.8.2001 (date of the accident)
X­ray picture dated 26.8.2001 (date of the accident)

Case 7: Pat No.06402, male, 1945, 5 BICOM® Therapies 
Patient history, findings and evaluation

23.5.2005: The patient presented at my surgery on the advice of a friend because of pain in his knee, left side.

In 1990 an arthroscopic meniscectomy was carried out and in 2002 he once again had meniscus problems. Subsequently gonarthrosis developed and therefore in April 2004 a realignment osteotomy was performed.

A referral letter to me dated 17.5.2005 from a renowned orthopaedic clinic says:

“Status post arthroscopy of the left knee joint with subsequent resection on the medical meniscus, micro fracturing on the medial condyle and medial plateau. Valgising open­wedge osteotomy, fixation with Tomofix, additional refilling of the defect by means of a spongious allograft on 31.3.2004.

As regards symptoms, the situation remains unchanged, there is still discomfort with weight bearing, especially in the region of the tibial head. The patient also spoke to Dr. XY [Note: an orthopaedic knee specialist] about treatment options. He would really like to look in­depth at the potential of conservative treatment and then in the second half of September have an X­ray check once again. I think this is feasible as long as he has no more pain. If any pain occurs a check at short notice would be needed. Another therapy as an alternative is planned with Dr. med. Wolfgang Rohrer in Klosters.“

Signed Orthopaedic Consultant.

The X­rays brought along dated 15.3.2005 show non union at the osteotomy (pseudarthrosis), this being 14 months after the operation.

X­ray of 15.3.2005 (12 months postoperatively)
X­ray of 15.3.2005 (12 months postoperatively)

Therapy and Course

On 23.5.2005 a so­called modified “Prolotherapy“ is carried out. This involves sterile water being injected into the medial osteotomy gap. Because of the hypo­osmolar action of the water the injection is in most cases painful. There is an inflammatory response at the injection site. This leads to an improvement in circulation giving rise to what is called a “healing inflammation“.

On 1.6.2005 (a week later) the patient reports that already his knee was feeling much less painful. The prolotherapy is repeated. As the injection on 23.5.2005 was very painful, this was performed under mild hypnosis.

On 8.6.2005 (1 week later) the injection is repeated under mild hypnosis and also on 15.6.2005.

On the 22.6.2005 the patient reports an improvement in score from 7.5 to 4 on the pain scale. After checking the indication, BICOM® therapy is now started. 1st BICOM® therapy: Scar interference, postoperative programs, tissue block, elimination of amalgam and stabilisation of a tooth 4.7 negatively affecting the osteotomy ).

On 7.7.2005 Di therapy is carried out for the amalgam (2nd BICOM® therapy).

On 18.7.2005 an injection is done once again (modified prolotherapy) and because of the anticipated pain, once again under mild hypnosis. No BICOM® therapy necessary (following consultation)!

On 27.7.2005 3rd BICOM® therapy session: Once again tooth 4.7 is decoupled and stabilised, additional tissue block and the yellow amalgam ampoule of the CTT test kit (in the frequency 1240 Hz, setting A).

On 8.8.2005 another BICOM® therapy is carried out (4th BICOM® therapy).

On 24.8.2005 a cerebral imprint is decoupled (so­called Hamer focus), in addition joint stabilisation program. In the meantime the patient is very well and full weight­bearing is more or less possible (5th BICOM® therapy session).

On 22.9.2005 the patient reports that he is still feeling very well, is able to put his full weight on his leg and has virtually no pain.

An appointment is made for 27.9.2005 for an orthopaedic follow­up.

On 28.9.2005 the patient appears for the agreed check­up in my practice and reports that he had made an appointment at the orthopaedic clinic for an operation. Nevertheless I still want to carry out the preoperative examination …

In response to my concerned question as to what the planned operation was for, he replied smiling: To remove the metal!

Here is the X­ray picture:

X­ray dated 27.9.2005
X­ray dated 27.9.2005

Extract from the orthopaedic consultant’s report:

“The patient has undergone two different therapies, one is the so­called prolotherapy and the second bioresonance therapy. It is clear that the symptoms have abated in both knees. The patient is mountain biking and doing Kieser training and takes exercise as regularly as possible. No medication.“

“Evaluation: it is evident that union of the osteotomy has taken place. Clinically the tibial head problem has settled down and gone. The osteosynthesis material can be removed.“

Metal removal takes place without complications on 5.10.2005.

On 20.12.2005 the patient reports that in the meantime he is feeling very well and full weight bearing is possible again. No therapy necessary.

The check­ups take place on 7.3.2006 and 30.5.2006. At both appointments no further therapy is needed and full weight bearing is possible for the patient.

Note: Mid October 2006 a knee endoprothesis is inserted in the right knee because of advanced arthrosis. The patient’s right knee remains without any problems whatsoever. As far as his left knee is concerned, even today the patient is still doing astonishingly well.

Concluding remarks

I hope I have given you some encouragement with my accounts on how to approach difficult orthopaedic and postoperative problems using BICOM® therapy. Your patients will thank you for it.

I wish you all the very best with it and every success in your work.