Titanium Screw broke after surgery of Jones Fracture

by Veronica
(Arizona)

I experienced a Jones Fracture on November 15, 2010. Received bad medical advice…after eight weeks of a Camboot, crutches and non-weight bearing I decided to get a second opinion. Second doctor is great and I had surgery on April 1. I had a hook-plate and three screws put in place. I was able to start bearing weight 33 days ago and then I experienced the worst pain ever. One of the titanium screws broke right in half. Now, there is movement and I have do surgery all over again. In the process of walking for 33 days and the length in this ordeal my Peronoeus brevis is not working and my foot rolls to the extreme outside.

I saw the surgeon last week and he wants to do a procedure that I cannot find any information. The x-ray showed the bone bump on the fifth metatarsal as unhealthy now do to low blood supply. So…he wants to move the Peronoeus brevis to the Cuboid bone and remove that “bump” on the fifth metatarsal.
The CATscan report:
1. Status post open reduction and internal fixation of a transversely oriented fracture involving the base of the right fifth metatarsal.
2. The fracture appears to be a nonunited fracture
3. There are multiple bone fragments noted along the plantar side of the fracture
Have you ever heard of this procedure? And, I don’t understand why he is letting me stay in so much pain. I have pain pills but they are not working and I always thought extreme pain was an indicator of something is wrong and needs to be taken care of….like now. Is it time for a third opinion?
Thank you Kindly

ANSWER
Hi Veronica,

Obviously the best third opinion in one where the doctor can actually examine you and look at xrays.
However, the problem with fifth metatarsal fractures has always been one of poor blood supply to the bone, thus the chances of healing is dramatically reduced. That is why so often the doctor has to go in and internally fixate the broken bone so that the patient stands a greater chance of healing.
In your case, there was a complication, one screw broke loose and the fixation failed, the bone moved and you are in pain again.
One of the problems with this situation is what is known as avascular necrosis, meaning the broken piece of bone has no blood getting to it and it dies. The other possibility is that the broken bone fragmented making it very difficult to put it all back together
So, this piece of bone(s) has to be removed, but depending where the fracture is located in the fifth metatarsal base, there may be tendon partially attached to it. What your doctor appears to be suggesting is that in order to remove the "dead" bone, he will have to cut the tendon away from it and re-attach it elsewhere. The next logical choice would be the cuboid bone which is just behind the fifth metatarsal base.
On the surface this makes sense, but I think a third opinion may be in order to confirm what I have suggested.
There is no reason that you should be in so much pain. This is not an emergency, but by the same token your doctor should be making arrangements to have this repaired as soon as possible.
If you are not walking nonweightbearing you should be as this will reduce some of the pain.

Marc Mitnick DPM
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