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fifth metatarsal non-union (pre-op). I can walk without pain, so why surgery?

by Allison
(US)

I broke my left fifth metatarsal on 9/2/11 (non-union, avulsion fracture) and have been in an air boot ever since. x-rays at 4-week intervals have shown no healing whatsoever. My insurance won't approve a bone stimulator, so my doctor has scheduled surgery for next week. Here's my question: I can walk without any pain (no boot). I don't quite understand how I can have a clean break yet walk without pain - and if there's no pain, why surgery is necessary? (It does hurt when the bone is pressed from the side.) My doctor's assistant hasn't been terribly helpful, and I have questions: Does the surgery (ORIF) require general anesthesia? Will I be in a cast or a bandage? I've looked all over online, but can't find any answers. The anesthesiologist is requiring a thyroid test (I have Hashimoto's) - why? The dr said that I'd be off the foot for 4 weeks - I've seen 6 online. Which is standard? I'm a 45 yr old female, overweight but in reasonably good health. Thank you.


RESPONSE
Hi Allison,
I cannot answer all your questions but will address your fracture on your fifth metatarsal. A non-union is very common on the fifth metatarsal base primarily due to a very poor blood supply to the area and it is adequate blood flow that allows fractures to heal.
In a non-union the fracture site does not close with bone but instead with scar tissue. Obviously scar tissue is not as strong as bone callus which normally bridges the fracture site.
The problem for most people is that without bone formation over the fracture site the fracture site usually is painful.
In your case however, there does not appear to be any pain. You state that you are overweight and in very general terms I am surprised that your foot does not hurt.
From a strictly clinical stand point you have a broken bone that has not healed so your doctor wants to go in and fix it. The idea here being that the broken bone needs to be surgically corrected so there is no pain.
Well....you do not have any pain. So, why have surgery? First of all I do not see any urgency in having surgery, as most people who opt for this surgery do so because they are in pain and they want the problem fixed.
So, as I said you could wait and there is a chance you might never have pain, but again from a clinical stand point, some would argue that because there is a non-union at some point the foot might begin to hurt, but again no one can guarantee that as well as the fact that no one can guarantee there might not be complications from a surgical procedure.
Keep in mind I am an outsider looking in so I cannot offer you a definitive opinion, but you might consider a conversation with your surgeon about the urgency or lack thereof in having surgery right away.

Marc Mitnick DPM
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