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Managing
Difficult to Heal Fractures
By Jay
Lieberman, DPM Case One Patient 9 years s/p ORIF 4th metatarsal base fracture re-fractures 4th metatarsal This 36 year old female presented to our office nine years status post open reduction and plating of a fracture along the base of the fourth metatarsal right foot. Another physician had performed the initial repair. The injury occurred when the patient took a mis-step while walking on a broken sidewalk. The fracture failed to heal with casting, and she subsequently underwent pinning of the metatarsal. The fracture failed to heal again, and she underwent plating. The patient continued to have lingering pain in the foot, but was able to return to activities of daily living. She presumed that the residual symptomatology was related to the plate and came to our office to discuss removal. Initial x-rays demonstrated a hypertrophic non-union at the mid shaft of the fourth metatarsal.
Interestingly, the fracture appeared at the distal most aspect of the plate. We obtained the old postoperative x-rays to determine whether the current bone defect corresponded to the original fracture site or not. The x-rays suggested that the original fracture was a slightly more proximal than the current presentation. The patient was brought to the operating room and the following procedures were performed:
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