Surgery for Metatarsal Fractures

Surgery for metatarsal fractures is usually done as an outpatient. You will require a general anesthetic or spinal anesthetic. The surgery is called open reduction and internal fixation, or ORIF.

During the surgery one or more incisions will be made over the area of the fracture, usually 2 - 3 inches in length. The fractured bone ends are exposed, and then put back together, or “reduced”. The bones are then held together with some combination of screws, wires or plates.

The reason to do surgery is to put the bones and joints back together as close as possible to how they were before the injury.

Day of Surgery
At the end of the surgical procedure the wound is stitched-up, and covered. A short leg plaster splint is applied. That dressing gives support to the foot, holding it securely. That should be left in place until I change it at the first post-operative office visit.

You will be given crutches at the surgery center, and I want you to not put any weight on that leg during the first 6 weeks. Do not walk on the splint.

Look here for things to watch for after Outpatient Surgery, or here if you had Inpatient Surgery.

Post-operative Course
Dealing with post-operative pain will be your major concern for the first few days. 

Most people find that for the first few days after surgery their foot will feel better if it is elevated. Generally, if you let it hang down for any period of time it will throb and you may have more swelling. You can put it into whatever position feels best, but usually that will be elevated with a pillow under the foot.

The first post-operative visit is usually 7 – 10 days after surgery. I will remove the splint and dressings, wash your leg, and take out the skin stitches.

I will put you into a short leg cast. This is not a walking cast, so you will still need to use the crutches or walker. You will wear this until 6 weeks after the surgery.  Do not walk on this cast.

The second post-operative visit is at the 6 week point after surgery. I will remove the cast, and check to make sure that everything is healing satisfactorily. I will get Xrays of the foot to make sure that the bone is healing well. You will then go into a CAM Walker, and you will wear that for protected weightbearing for an additional 6 weeks. You must wear it when you do any walking.

I will ask to see you one more time after an additional 6 - 8 weeks. If there are any problems or questions then we will deal with them as they present.

Most patients have swelling about the surgical area that lasts for about 4 months after surgery. You should not resume athletic activities for about 4 months after surgery.

Final Results
The goal of the surgery is to leave you with a painless foot that will allow normal activities. You should be able to regain full strength and power in the leg and ankle, and have no restriction of motion. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes. It will usually take 6 – 9 months to reach maximum improvement.

Complications can occur with any surgery.  Go here for a general discussion of Surgical Complications.

Specific risks of this surgery include the possibility of the bone not healing, or non-union and implant problems.

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