Fifth metatarsal displaced fracture type 3 share your experiences.

Hi Ana,

I'm sorry to hear that your recovery is going slowly! Before my surgery I got 3 opinions and all pointed to surgery. Well, after JP's replies I got paranoid and started feeling the screws in my soft tissue every second of the day! I talked to the surgeon about removing the hardware and he said I should not need to ever remove it. Still, JP scared me, so I sought another opinion. Finally I went to a dancer's clinic in my city (San Francisco) and the surgeon there said that the screws are indeed long and ther are too many of them, and they will likely cause pain in the future (confirming JP's comments). The dancer surgeon also said that he probably would have discouraged surgery in the first place. He has seen many dancers with this injury and the bone eventually heals okay. That being said, he agrees that the alignment in my bone is looking very good at this early stage becasue of the surgery. My last xray was at 5.5 weeks. The dancer doctor told me that I could start low-impact exercise. So, at 5.5 weeks I started walking, and at 6 weeks I started light biking and swimming. At 10-12 weeks I will get another xray and the doc will let me know if I can start more high impact exercise again. At 16-20 weeks, we will evalaute again to decide if the hardware should be removed. 

The incision from the 1st surgery has healed well and I didn't have any problems from the surgery itself. There is still a line several inches long, but it is flat and should blend in over time. No matter what people say about my first surgeon's too long of scews, I have to give him credit for being good at stitching me up!

 

This is one of my 6 week xrays.

Hey patty!

I'm from/live in San Francisco too! Small world. UCSF is my primary hospital, ranked 8th in the nation. You've gotten a plate and screws, I only got one screw. Maybe you misinterpreted what your doctor said? My Orthopedic surgeon and the sport medicine/PT doctors told me that, "You can keep the screw in indefinitely because people don't USUALLY get discomfort from them BUT you can get them removed after a year if it does hurt". You have a different type of treatment though. I find it a little weird that your dance doctor said that. Football players get the surgery because the re-fracture rate is higher with out, so imagine you cutting the floor up with your dance skills will use a lot of your feet to move around. In my opinion, your dance doctor probably has less information about you overall than your orthopedic surgeon. I've heard the stories of the second opinion, be it from the podiatrist or a guy like jp, that have people getting on their foot too early and not healing for a full year. You did the right thing. Get the screws out later, listen to your ortho, take some calcium, vitamin D, and magnesium, and kick back. Let us know how it goes

Hi Maurice,

The surgeon who operated on me is near Sac (it made logistical sense at the time of surgery). I'll be doing my follows ups in SF. I'm curious who your surgeon is.

Dan Thullier, UCSF Orthopedic Institute

Thanks. I'll make note of his name for my follow ups.

Hi.  Thanks so much for your reply. How interesting that everyone suggested surgery. Of course once you mentioned you are American that made sense. All American sites recommend surgery for the reasons Maurice has mentioned. The vast majority of British sites (I live in England) suggest the "conservative approach".  And I would agree with this if it wasn't such a long area that would be weakened in my metatarsal and the fact that mobility would be so limited for a long time. Compare your nice tidy slim metatarsal with my lumpy, chunky one that almost touches the forth one? Filling all that with bone that is strong is going to take time. And would such a bulky mass where there should be none not impact negatively in th long run ( no pun intended)? We'll see what the consultant says next week. It is not so easy to get various opinions here but it seems that the guy I will see is a good specialist. I am surprised by what you say about the dance clinic. Your X-ray showed quite a displacement. Did he think it would heal well like that?!?!  Anyway, Happy New Year!

Hi Maurice. Have you any pics of your fracture? Just to get an idea. 

Do you mean you'd recommend waiting for about a year for full healing before doing more strenuous, weight bearing exercise? What a coincidence that you an Patty are in the same part of the world. I am miles away geographically and it would seem in terms of medical options too!

Happy New Year!

Happy New Year!! Both of you

Ana, you gave a unique perspective. I appreciate that. I forgot that things aren't the same everywhere. It's always good to be sure, I guess my "inner american" is saying," Screw it, get screwed." Haha

Ha ha ha. I'll bear this in mind when I see the consultant next week.  I'll say "please, I want to get screwed".  Time for bed in this part of the world. I hope I don't dream of operations, plates and screws.  Good night.

Ana,

There are a lot of people here that recopmmend the conservative approach. It just so happened that I found them after my surgery! From what I've read, the results are almost always okay for the nonoperative approach, but it might take longer. I almost wish that I had not had the surgery because now I might need a 2nd one to remove the screws. Plus it was expensive, so I have to worry about paying the bill (even with insurance we have to pay thousands out of pocket). That being said, I'm happy the alignment is good and that I'm able to do moderate exercise now at just under 8 weeks.

I found some papers that support the conservative approach:

http://www.injuryjournal.com/article/S0020-1383(12)00098-8/abstract

http://fai.sagepub.com/content/34/12/1619.short

And this one supports the surgical approach:

http://bjsm.bmj.com/content/47/12/754.short

Hi Patty.  Thanks so much for your very frank comments. I have been revisiting the information I have gathered from various sites and have found an X-ray that looks so similar to mine that it is uncanny but then it is a very common fracture. it shows the healing 3 months later, which is bumpy, lumpy but it is shown as a very good recovery and an example of how even in fairly displaced fractures there is no need for intervention.  So maybe I'll just need to be patient.

There is discomfort still but the pain is pretty well gone except for in bed at night when I don't use the boot. I took some paracetamol last night and slept like a baby.  I'll also start some upper body and ab work today. I have been completely lazy about this.  I know I was a flippant talking to Maurice about getting a screw. Obviously ops are not to be taken lightly. The main plus, besides quicker healing, is the lowering the risk of re-fracture but then it is only the second time I have twisted my ankle badly in my whole life. The first time, more than 15 years ago,  I didn't break anything. 

I will talk to the consultant and if he advises waiting I will go along with that. It is not like I am dancing in Covent Garden any time soon!

I haven't received your second post, as you probably know.  I look forward to reading it. 

It's definitely up to you. If I wasn't planning on continuing to play various sports, or do intense workouts, or if I was rich enough to miss a lot of work, I'd risk the possible non/mal union. I thought that since you wanted to dance, it would make since. Remember, this injury happens various ways. Although, the popular theory is an inverted foot while falling forward, you can get this injury by simply stepping of of the block wrongly or by simply have high arches. Call me "new fashion" but a displaced bone would make my OCD kick in and I'd want to straighten that out lol Let me be fair though.

"What signs indicate surgery may be needed?

All foot fractures are different, but generally speaking if a fracture is significantly displaced it is likely to benefit from surgery. This is especially true if a fracture enters a joint and the joint surface is disrupted and displaced. Restoring the alignment and stabilizing the fracture in its anatomic position will decrease the risk of future problems.

 

In some cases, surgery may be appropriate for non-displaced or minimally displaced fractures if the fracture is likely to be unstable. In such cases surgery can maintain the alignment and encourage healing in the right position.

 

Even some non-displaced and stable fractures may benefit from surgery. One such fracture, called a Jones fracture, is often treated surgically in active and athletic individuals because it is likely to get them back to their activities more quickly than treating them without surgery.

 

When should I avoid surgery?

You should avoid surgery if you have significant soft tissue swelling, infection, diabetes, skin or vascular problems, a non-functional extremity due to paralysis or stroke, or multiple medical problems that would increase the risk of anesthetic complications."

-American Orthopedic Foot & Ankle Society

 

Thanks Maurice for taking the time to send me this info. Yes, I definitely plan on carrying on dancing and I do about 6 to 8 hours a week plus lwalking and swimming when I can. So I'll make sure the consultant understands that. I'd hate to have another fracture because of a weakened bone. If I could choose and comfortably pay for my surgeon and the best hospital, I would not hesitate. Our National Health Service is brilliant but the very good consultant I am seeing soon may not be the one who operates. In theory you can ask that no trainee perform your treatment but once you are out who knows. I'll just have to discuss this and trust they'll give me the best advice in my specific circumstances.  Ah for a crystal ball!

Just got your links. Thanks. Unless I am reading it wrong they both seem to favour surgical intervention. i have to say the first link was a bit hard to understand so I found the longer version http://www.sciencedirect.com/science/article/pii/S0020138312000988  and that's what makes me think they actually prefer the surgical method which they call functional. But maybe I got it wrong. 

This is the one I found which really looks just like my X-ray is definitely in favour of a non surgical approach. http://www.aafp.org/afp/2007/0915/p817.html  

if you have time scroll down to figure 2. Now, if I am getting like 2 b in 12 weeks and that is a good outcome well, I am half way there and would not be gaining much in terms of time as I'll be back to square one on the day of the operation. However that X-ray may well be that of a super fit 20 year old and it might take me considerably longer to get there. Also I have always done well with operations. Common things like a hysterectomy.  Gosh I put that off for so long but it was the best thing for my health. I think I have got the main points for and against. See my reply to Maurice below. We'll  what the consultant advices. Thanks again 

Hi, I just sent you a link but I guess it will be a while before you get it as the links are being checked. I have said something that I have realised is wrong. So apologies and disregard my comment that the first link is actually pro surgery.  You are right. In fact the sage pub one makes a really good case for not operating, doesn't it? This plus the one I have sent you, with an X-ray  almost identical to mine, really make a strong case for the moderate approach. I shouldn't have read them before my very late lunch. Duh.

Have a lovely weekend.

 

I'm interested to see the paper you found. Yes, there do seem to be many studies that show that non operation is usually fine. I should have read those before I rushed into surgery. You just have to be patient. I know it is difficult. I went through 5.5 weeks of NWB and that was enough to drive me insane.

For the record, I do also support non operative approach but my circumstances drove me to surgery, I hope we all get back to 100% :D

Side note: Different doctors follow different methods. I told my doctor I found a clinic online that says their protocol allows weight bearing 2 weeks after surgery! My doctor said Nope, my method is to wait at least a month. So, you ask 3 doctors, you may get three slightly different answers. :\

If I had just had one screw put in, I would have been fine with the surgery. The problem is that the bone was fragmented in several places and it wass displaced, so he put a plate and a lot of scews, some of which are going into soft tissue that might need to be removed. Another surgery means more post-op recovery time (although maybe not as long as the original operation from what I've read). That is something that I had not been prepared for. If I had known that he was going to do that, I probably would have waited to see how it healed without surgery.

Hi Patty and Maurice,

I see my email with the link is not up yet so here are the details. The article is called Diagnosis and Management of Metatarsal Fractures, and the site is American Family Physician. Look particularly at figures 2 a and b.  It is just like my X-ray even with the little chip forming a kind of triangle.

You are so right about the difference of opinions among doctors.  I think I have done as much research as I can and feel quite clear on options and posiible outcomes.  I will see what the consultant suggests based on my concerns and go with it.  In terms of time I won't save any by having an op now as I am kind of half way there if it all goes smoothly.  I have to be patient. 

I hope you find the article and have a good Sunday. It doesn't feel so bad being stuck inside at the moment as it is raining, windy and cold out there. Small mercies!

I realize that the first link I sent has more to do with fractures closer to the heal - that's whjy it was confusing. The sagepub one is the more relevant one for our cases, I think. At any rate, all the links show that there is not a single clear solution for all cases. Since you are half way there now wihtout surgery, you are right just to be patient and see what happens naturally. We should check back in a month to see how we are both progressing.

Yes, it's a deal.  I'll be green with envy when you tell me you're back dancing as I hope you soon will be. 

Hi Ana Martha.

How are you healing? I saw my new OS (one who works with dancers - not the one who did surgery with too many screws) two weeks ago and he told me to keep refraining from stressful activity, but some walking, biking, and swimming are fine. Same as I've been doing since week 5.5 (I'm at 14 weeks now). He said I could do barre, but no relevees (so what's the pointe [[pun intended]] ?). I was okay with a few more weeks of the same old, but then the other day I stepped on it wrong getting out of my car and had shooting pain that I think is from one of the screws hitting flesh/nerve (but I'm not sure). Tomorrow I will get xrays. I want to know soon if I need to have the hardwre removed. Another doctor forewarned me that after hardware removal I will be NWB for another 4-6 weeks!

This whole experience has been quite humbling. I really want to be able to dance again. Dancing is a major stress reliever for me as I deal with very depressing topics at work. However, I guess I shouldn't be so hard on myself to jump as high and quick as I did when I was 18! Dam entrechats got me down in the first place! When I finally get back to it, it'll be a whole new ballgame for me as far as my expections for myself.

Hi Guys,

Just  a quick, belated note to let you know all is well and I have resumed normal life, including dancing.  A bit of ankle swelling and the odd pain here and there to start with. Often the good foot was painful too.

what I have noticed most is the general lack of strength and flexibility, don't you quickly lose it!  Anyway all is better. It does make you a little afraid in case it happens again but I am trying not to think about this.  

How's your foot, pattycam, can it be left now or will they have to take the screws out?  

I look forward to hearing from you and Maurice. 

Anna 

 

Good to hear that you are back! I started ballet class again about two months ago. Each week I increased what I would do - first just barre, then adagio, finally some turns and jumps. I tried pointe again this week and it is painful. The pain is partly due to muscle weakness and lack of flexibility as you noted. However, I feel the plate and the screws and it is not comfortable. I see my doctor again in May or June to reassess removal. 

Good to hear you are doing so well. It is a bit of a worry about feeling the metal bits! 'll be very interested to follow what happens.  Let me know if you can spare the time.  Happy dancing and best of luck.

Anna 

Hi ANA and PATTY!!

Good to hear you both are getting back to your normal activities. I'm still in PT running on the anti-gravity treadmill at 80% and getting my incision scar massaged. I'm not cleared to run full speed yet but I was told I can play "pick-up" basketball (just shooting around not going 100%). I only feel pain after jogging on the treadmill (which I run for 20 mins at a time) OR when I where my narrower shoes. I honestly think the screw is chaffing in certain types of shoes so I'm thinking in a year I may have it taken out. We should start a "recovering cripple" club haha I'm happy for you two and would love to see you guys dance knowing what injuries yall've had.

Mauricio