Medical Questions > Conditions and Diseases > Broken Bones Forum

Displaced fracture fifth metatarsal going on 4 months

Hello all-

I broke my fifth metatarsal like a carrot playing soccer... completely snapped in half. I went to a conservative doctor, who rarely does surgery unless necessary. He said there was a chance it would mend without surgery, but gave me the choice. I decided on surgery and he put in a plate with 5 screws and some wire. The bone was apparently in 3-4 pieces and not just two. Anyway, this happened in early May 2012. I had surgery in late May and was on crutches for months after... a plaster cast for a few weeks, then an air cast. After 3 months, there was still a large area of no growth, so he suggested a bone stimulator, but did not think it necessary that I remain in the air cast at all times. I used it sometimes, but not all. Well, today I went back and found that the plate is now cracked and there is still little bone growth to fill in the blank areas. He said to go back to the bone stimulator and I am back in the air cast. However, I am pretty low on hope at this point and my health insurance will run out at the end of January unless I get another job pronto (and even then, pre-existing condition clauses being what they are will likely be a large problem).

Any thoughts out there?
Did you find this post helpful?

User Profile
replied September 26th, 2012
Especially eHealthy

Sorry about your problems.

The reason that the plate broke, is because the bone under it was not healed (duh, no kidding). I know that was obvious. The internal fixation is just an internal splint, until the bone is healed. It is always a race: the bone will heal or the hardware will fail.

Because the bone had not headed, the plate was repeatedly bent back and forth, ever so slightly, until it broke. Just like a paper clip will eventually break if you bend it back and forth.

As to the use of bone stimulators, the results are not much better than chance. If you read the literature put out by the manufacturers of the devices, it will say that the use of stimulators is wonderful and that they will always help stimulate of bone to heal. However, in well controlled studies, done by independent entities, there is no evidence that they work at all. If you think about it, if they really worked to actually significantly increase the rate of union, they would be slapped on every fracture that occurred, immediately. Unfortunately, they really don't work all that well.

So, you have given the communited fracture the best chance of healing on its own. Metatarsal fractures are usually united within 6-8 weeks. You have now gone basically four months (twice what it expected), and the bone has not healed.

By definition, a fracture is not a nonunion till six months have gone by without union. But, most surgeons will see that the writing is on the wall, when there is not a lot of callus by four months. They usually will put on a stimulator and schedule the patient for a bone grafting procedure in a couple of months (the six month mark). Then, at six months, if the bone has united, great, cancel the surgery and go on to rehab. If it has not, then go ahead with the scheduled bone grafting procedure.

So, if you want to give it a couple more months, that is quite okay. But, the bone most likely will not heal (but that is not 100%, if the future could be predicted, more people would be at the race track).

Since you are losing your insurance in a few months, you might want to speak with the surgeon about going ahead with the bone grafting. This basically entails taking the hardware off; removing any fibrous tissue from the fracture site, back to clean, raw, bleeding bone; replate the fracture; and pack any defects with cancellous bone graft. It is usually best to use your own bone, harvested from the proximal tibia or anterior iliac crest. But, you can use banked bone or artificial bone graft substitute with bone morphogenic protein added in. That is a choice between you and your surgeon.

This procedure basically puts you back at square one, but hopefully this time the cancellous bone graft will bring in enough of the needed osteoprogenitor cells to jump start the healing process.

You have a lot to think about. Discuss it with your surgeon. Good luck.
Did you find this post helpful?

replied May 4th, 2013
Bone stimulator fifth metatarsal
I broke my fifth metatarsal in May of 2012. I wore a walking boot and probably rushed things, and re-injured it. I went to a bone doctor (having first seen a podiatrist) who said it was still broken, and put me in an air cast and prescribed a bone stimulator. I began using the bone stimulator as prescribed for 20 minutes twice a day--40 minutes total. I stopped wearing the air cast when it began to cause hip and knee problems in the opposite side of my body. At this point I had no pain, the doctor however said the bone still had not joined, and he wanted to do surgery and put a screw in. Because I travel extensively in business, and had no pain, I resisted. This was February of 2013. I upped the bone stimulator use to 2 hours per day--just went back-- bone is joining--small area still not joined but I don't need surgery. Use that stimulator! I exhausted the battery in the Exogen model I had; the company replaced my unit.
Did you find this post helpful?

replied July 11th, 2014
Hello, I broke my fifth metatarsal a little over a week ago. It was a spiral fracture. The first thing I did was go to the ER. They gave me a boot and crutches and told me to follow up with a foot specialist. The ER doctor also said that I would likely need surgery. My wife and I have a 15 month year old and we both need to go to work so I was so scared of having to have surgery. Unfortunately, it happened right before a holiday weekend so I could not make an appointment till a week later. I was in pain, but followed the doctor's R.I.C.E. orders. If I had to walk I would use crutches and if I needed to put any pressure on the boot, I put pressure through the heel. But mostly, I rested it. It was painful. I took ibuprofin during the day and the pain killers I got at the ER at night. Luckily, I am able to work from home and I have a desk job where I can rest it. It was a rough week, but the pain kept getting better each day. During the week up until my appointment I also got two additional consultations. The first consultation said I did not need surgery and the second said I did. The third said that I did not and at that point, I decided to put it in a hard cast for 6 weeks. That was today. I do feel I made the right decision. The doctor said that even though the bones are a little displaced they were lined up and would heal. She gave me a walking cast with a cast boot and told me to continue to keep off it as much as I could for a week or two. Then, I could start putting more weight on it. She said to eat well and keep up with my calcium and vitamin D. I have a back yard and she encouraged me to go out with the family and sit and enjoy the days. The only thing I can say is I know it hurts and I know it is scary, but I would try to get as many professional opinions as you can (3-5) before making any decisions.
Did you find this post helpful?