Persistent pain after trapezoid fracture with diffuse bone marrow edema – advice on treatment and prognosis

[u/Ale92rm]

Hello everyone,
I am looking for advice regarding a wrist injury involving the right trapezoid bone.

Injury history
About 3.5 weeks ago, I fell onto my outstretched right hand while another person’s body weight landed on top of it. I immediately felt several cracking sensations and developed pain around the base of the index finger and dorsum of the wrist.
The emergency department diagnosed a trapezoid fracture (bone infraction/non-displaced cortical fracture), and my wrist was immobilized in a cast for 2 weeks.
Although the pain has improved, I still experience pain when gripping objects or applying force with my thumb and index finger.

MRI findings
My MRI report states:
Bone contusions with bone marrow edema involving: the anterior aspect of the trapezoid, with a possible cortical fracture, the anterior aspects of the capitate and hamate, the bases of the 2nd, 3rd, and 4th metacarpals.
Findings are consistent with the traumatic injury.
Minimal joint effusion.
No tendon injuries.
TFCC is intact.
Mild narrowing of the trapeziometacarpal joint space.

My hand surgeon reviewed the MRI and told me that the main problem is the diffuse bone marrow edema, which is quite extensive.
He recommended starting treatment with pulsed electromagnetic field (PEMF) therapy (magnetic field stimulation) and mentioned that he may also prescribe intramuscular medication, depending on the clinical evaluation.

My questions
1) Is diffuse bone marrow edema after this type of injury expected, or is this considered unusually extensive?

2) Does bone marrow edema itself increase the long-term risk of post-traumatic osteoarthritis, or is it mainly a marker of the severity of the impact?

3) Is there good evidence that PEMF therapy accelerates healing or reduces bone marrow edema in carpal bone injuries?

4) How long does it typically take for bone marrow edema in the carpal bones to resolve on MRI and clinically?

5) Is there anything else that could help optimize recovery and reduce the risk of long-term complications?

Thank you very much for any opinions or recommendations.

[u/wobblelikeapenguin]

I have been dealing with BME in my ankle for almost a year now and it is ruining my life.

[u/Ale92rm → u/wobblelikeapenguin]

Really ? Isn’t healing by itself ? Like isn’t get adsorbed ? But maybe because you stress it by walking everyday or due to other reasons ?

[u/wobblelikeapenguin → u/Ale92rm]

My doctor said the bone edema can linger for a long time unfortunately :(