Radiofrequeny Ablation of Stress Fracture

[Collegerunner123]

I am a college freshman who has been suffering from pain in my right shin for the last year now. I am a competitive distance runner who had hopes of running in college but my injury has made even walking a struggle. I was diagnosed October of last year with a stress fracture...took 8 weeks off, no luck. My doctors then decided what they saw on my tibia was never a stress fracture, but rather an osteoid osteoma. I underwent radiofrequency ablation in February, and  was told I would be back to running within a few weeks. Unfortunately, my pain only got worse, and all I was left with was a bump on the inside of my shin. Now, over year since the initial injury, I am still in significant pain, even with walking (let alone running). I went to see some specialists in bone and soft tissue tumors over this weekend, and I was informed that I most likely never had an osteoid osteoma, but a stress fracture the whole time - and he had the imaging to prove it. So basically I had a stress fracture ablated. Now I understand this could delay healing of the fracture, because the ablation has just killed a large chunk of bone. I'm not looking for malpractice or anything - what's done is done. But I do want to get better. So I have a few questions:
I still have a stress fracture, but it is of course complicates by the RFA, so will it ever heal? Do I need surgery again? Am I just left with a permanent hole in my leg and a sfx? I have been cross training this whole time, and my doctors have recommended I cease all activity. Could this help? What kind of time frame am I looking at for a return to running (if ever)?

Thanks a ton for your time. I appreciate any advice/suggestions!

-Zach

[Michael L Gross, MD]

Dead bone has a distinctive appearance on imaging studies. Viable bone look different. Another suggestion is a bone scan.

Shin splints are usually on the medial (inside) border of the tibia, so this ios probably something else.  One thought is exertional compartment sydrome.

[Michael L Gross, MD]

Difficult problem.  The potential for healing depends on the size of the defect, the vitality of the surrounding bone and soft tissue, and the blood supply. This can be evaluated with X-ray, MRI, and if necessary, angiogram. Once this is determined, a decision can be made as to the best treatment.  Options include further rest and observation, stimulation with pulsed magnetic or electrical energy, or surgical treatment with bone graft, internal fixation, and implanted bone stimulators. See an orthopedic trauma specialist with experience treating non-unions and delayed unions.

[Michael L Gross, MD]

If all else has failed, I agree that is the best approach.

[Collegerunner123]

Thanks again for the response. I have actually had the compartment pressure test done twice, and both times the results suggested compartment syndrome was unlikely. It almost seems like too much of a coincidence for there to be something else going on when there is a clear fracture line and a lot of inflmmation/edema around the site of the RFA. If the bone is dead, what do you believe would be the best alternative to resolve this issue and get me back running (surgically, I mean)?

[Collegerunner123]

Thanks a ton for the response. How exactly could an X-ray/MRI determine the potential for healing? I have had both taken multiple times but am yet to hear about the vitality of the surrounding bone and soft tissue. And I do intend to see an orthopedic trauma specialist.

Last question: Throughout this entire injury, I have had significant pain on the outside of my shin in what seems to be the muscle. Even during cross training. Is this significant with a tibial fracture, or could this be something else on top of the fracture causing the muscle pain?

Thanks again.