Feet > Fifth Metatarsal Fracture > Treatments

 Closed Reduction and Internal Fixation

Treatment Introduction

If your physician cannot put your fifth metatarsal back into position after a fracture, you may need to undergo surgery to reconstruct the bone. Surgery typically is prescribed for severe fractures that have displaced the bone. Surgery also may be needed to treat a Jones' fracture, which effects the area of your fifth metatarsal, an area that has a poor blood supply and may not heal without surgery. Through an open incision, surgeons can return your fractured bone into the normal position and fix your fifth metatarsal bone with what is called an intramedullary screw. This screw is run through the marrow cavity in the center of your fifth metatarsal. Most patients can go home the same day after surgery. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Preparing for Surgery [top]

The actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Prior to your return home from the hospital, make sure that you have received any equipment you will need when you get home. This may include crutches or household items to make movement around the house easier. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any new medications you are taking.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Discontinue the use of any anti-inflammatory medicine, especially aspirin, a week prior to surgery, to prevent excessive bleeding during the procedure.

   To reduce the risk of infection, improve healing, and decrease complications, try to quit smoking or decrease the amount you smoke. In general, smokers have a higher infection and complication rate overall.

   If possible, practice walking with your walker or crutches, as you need to use them after surgery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Day of Surgery [top]

At most medical centers, you will go to "patient admissions" to check in for your operation. There may be separate check-in areas for ambulatory outpatient (patients go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your doctor or an assistant about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed, and your foot may be shaved, though this is not always necessary. You will be asked to change into a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant and meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts, sweatpants, or other clothing that will fit comfortably over your short leg cast or splint when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Surgery Procedure  

Open reduction and internal fixation of your fractured fifth metatarsal can take about an hour to perform. An ankle block anesthetic is injected into your ankle to numb your foot. You usually are sedated so you sleep through the procedure.

   A small, three-centimeter incision is typically made along the outside of your foot, close to the base of your fifth metatarsal.

   A hole is drilled straight through the shaft of your fifth metatarsal with a special device called a reamer. Reaming the bone shaft creates a bone graft, which encourages blood flow and healing.

   Your surgeon puts a screw into the tunnel drilled through your fifth metatarsal. The screw passes through the shaft of your fifth metatarsal into the base of the bone. It protects and compresses the fractured bone.

   Your incision is closed with stitches. A splint is applied to immobilize your foot and ankle, and you are taken to the recovery room.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Recovery Room [top]

After surgery on your fifth metatarsal, you will be transported to the recovery room where you will be closely observed for one to two hours while the immediate effects of anesthesia wear off. Your foot will be elevated and immobilized in a plaster splint when you wake up. There usually is minimal bleeding after surgery. You typically cannot see the incision in your foot because it is wrapped in the splint. After surgery, you usually experience some pain. Adequate pain medications will be prescribed for you. You will be given intravenous (IV), oral, or intramuscular pain medications as needed. Your surgeon will prescribe crutches and you are usually instructed to keep weight off your foot for the four to six weeks. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the help of the doctor, will determine when you can prepare to go home. Make sure to have someone available to drive you home, as you will be unable to drive a car. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Home Recovery  

For four to five days after open reduction and internal fixation of your fifth metatarsal fracture, you should keep off your feet, elevate your foot above heart level, and move around the house as little as possible. You should try to rest and avoid too much movement for at least a week. Crutches usually are prescribed for about four weeks so you can keep your body weight off your foot. Rest as much as possible with your ankle elevated. This helps blood drain away from your ankle and can control swelling. Putting weight on your ankle increases the chance of disrupting the healing process in your foot. Household tasks that require you to be on your feet may be difficult for about four weeks. Try to have someone around the house to help with any physical chores. The dressing covering your wound inside your post-surgery foot splint usually does not need to be changed until the splint is removed. A typical follow-up schedule after you leave the hospital may go as follows:

   Ten to 14 days after surgery – Stitches are removed and your foot and ankle are put into a short leg cast. Most casts need to be kept dry when bathing.

   Four weeks after surgery – Return for a check-up. Receive X-rays and, if necessary, a new cast. You may need to continue using crutches for up to six weeks after surgery, depending on how quickly your fifth metatarsal bone heals. If you show signs of healing, you typically are put into a cam walker or weight-bearing cast, and you can put some weight on your foot.

   For the next four to six weeks - Your physician may ask you to return at regular intervals for X-rays to check your progress. Gradually increase your weight bearing over this time span until you can comfortably walk without crutches. You progress out of the cast, into a removable brace, and possibly into a cast shoe with a hard, plastic bottom as your bone heals. You can begin stretching and strengthening exercises for your foot as pain allows.

   Eight to 10 weeks after surgery – You may be able to bear your full body weight and return to normal shoe wear.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Rehabilitation [top]

Before you return to normal shoe wear after surgery for a fractured fifth metatarsal, your physician usually instructs you to steadily increase your weight bearing exercises. As pain permits, begin with short walks in your weight-bearing cast or cam walker about four weeks after surgery. The key is to avoid pain - do not do what hurts. If pain flares up, use your crutches when walking around so you can modify the amount of weight you put on your foot. When you are put into a cast shoe, your walking exercises typically become more comfortable. You also can ride a stationary bicycle and swim to help improve your fitness. As pain decreases, slowly increase the duration of your walks. A safe way to increase your workouts is by 10-percent increments. For example, if you walk one mile on Saturday, continue walking one mile for about a week, and do not go further than 1.10 miles on the following Saturday. If your workout causes pain, decrease its intensity or duration. Your fracture usually takes about eight to ten weeks to heal before you can return to normal shoe wear. Most patients can return to sports and activities about twelve to fourteen weeks after the injury. Test your foot strength before returning to strenuous activities. You should be able to run, jump, and cut side-to-side without pain. If your foot continues to hurt, talk with your physician before returning to activities, as you may need further physical therapy or medical treatment. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Prevention [top]

To prevent complications after a fifth metatarsal fracture, it is important to make stretching and strengthening exercises part of your everyday routine. A strong and flexible foot will be less likely to suffer reinjury. Though it is difficult to avoid accidents that cause traumatic injuries to your foot, you can be cautious during your training and activities to avoid drastic increases in the duration or intensity or your workouts. Your fifth metatarsal should heal and return to full strength, but if you feel pain return, especially after a period of overuse or high intensity training, you should visit your physician as soon as possible. SHOES Finding a shoe with the proper shape and support for your foot can help prevent abnormal foot strain. Your athletic shoes should have good shock absorption in the heel, good flexibility, and sturdy materials to prevent side-to-side motion. Try to minimize the time you spend walking in unpadded dress shoes or boots. If your physician has prescribed orthotic inserts, you should continue to wear them in all your shoes. Based on your activity level, shoe inserts may wear out within six months and need to be replaced. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Closed Reduction and Internal Fixation
   Treatment Introduction
   Preparing for Surgery
   Day of Surgery
   Surgery Procedure
   Recovery Room
   Home Recovery

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