Metatarsal fracture not healing

[lamandler]

Fractured my fifth metatarsal 8 weeks ago, and was given walking boot, leaflet and discharged from 'virtual fracture clinic'. Made me really uneasy to be left to my own devices but I followed the vague advice about recovery.

Because of ongoing pain I (armtwisted) asked GP for an X-ray, got results today and it is a nonunion, so fracture hasn't healed. I need to see the clinic again to discuss surgical options which has absolutely floored me. It's been so disruptive to family, work, the poor dog

Anyone with knowledge/experience know reasons this can happen and is surgery the only option?

Did you manage to rest your foot much?

I had a stubborn stress fracture and eventually had a month on crutches (not hopping around but using the crutches to reduce the weight on that foot). Following that another month of the boot and since then good supportive footwear at pretty much all times when walking.

Hmm I fractured 5th metatarsal about five years ago. I didn't have it Xrayed again but it was still sore and swollen after 8 weeks. It took a good 6 months to recover. I did a winter in sensible lace ups with orthotics as recommended by physio. These little breaks can take great patience.

I had a non union, fist step was blood tests to find vitamin deficiencies. Then vitamins to rectify this

I was unlucky and in still didn't heal so had surgery with a screw a bone graft. Year on it's better but I can't be as active in it as I used to be

Thanks all, good to know that it isn't automatically a surgery. Interesting about vitamins, I've had vitamin D deficiency in the past and at start of the injury recovery had a stomach bug so appetite and diet was all over the place for ages.

I'll ask about a blood test (and start vitamin d supplement in case)

And I wonder if I ditched crutches too soon, I used them with the boot for a couple of weeks, then just outdoors, and in last couple of weeks haven't used at all

have you used ibuprofen or aspirin as pain relief? that can slow down bone healing.

Definitely had ibuprofen at the start, at A&E was told good to get swelling down. Found out randomly from google that it wasn't a good idea. Quality of advice from hospital pretty atrocious really, not sure how unhealed fractures (as opposed to a proper clinic appointment at the outset) are cutting costs in the long run

every single time someone mentions a fracture on MN someone spouts about NSAIDs causing non-unions. There is no good evidence yet that they cause problems on human in vivo tissue (by 'good evidence' I mean large, randomised control trials). It's probably sensible to avoid them in injuries that are particularly high risk of non-union (and you should have been told if it was at the outset), but generally they are perfectly safe to use.

Smoking is a significant risk factor for non-union (and post-op wound infection if you end up getting that far) so if you smoke it's probably a good time to stop.

Hope it's on the mend soon.

It took mine about 6 months to heal. Even then for another 3 or so months I felt pain if I pushed it against the corner of the sofa or similar.

Not a smoker, and at start was told it was 'minimally displaced' and unlikely to cause any problems.

Did you have it X-rayed during that 6 months tittietinsel? Great name btw

No, they refused to re X-ray so it was only done at the point of diagnosis.

I went to the GP about 4 times and for the same 'it takes time to heal' response, so in the end I gave up (and time) and it did heal

I broke my 5th metatarsal 4 years ago after getting mugged. They stamped on me to stop me getting up. I had it X-rayed and was put in a cast for 6 weeks, followed by a boot for two weeks. I had to be completely none weight bearing on it for the whole time. It healed well but I still have problems with it. Can't wear many high heeled shoes anymore as and soon as the winter comes I get pain in it still. It still feels tender if I knock it.

That's awful muchprefersummer, so sorry you went through that

Metatarsal fractures aren't all the same. The most common form (the so-called "pseudo-Jones" fracture) is treated in a walking boot and usually heals quickly. Some other fractures (e.g. the "true" Jones fracture) heal very slowly and they are usually put in a plaster cast without any weight on the foot.

The possibilities as I see them are:

1. The original diagnosis was wrong and this is actually a Jones' fracture, which should ideally have been in a plaster cast;
2. it really is a pseudo-Jones fracture that is just taking longer than usual to heal or;
3. the fracture has actually healed but not yet calcified and so appears "unhealed" on the x-ray. The x-ray does not have the final say as to whether or not the fracture has healed.

The options available will depend on the type of fracture, your preference, the surgeon's approach, and whether or not there is any evidence of bony healing on the x-rays. Hopefully you'll be seen in fracture clinic soon.

Oh and two random thoughts in no particular order:

I agree with @Walkingthroughawall that most of the talk about NSAIDs is nonsense. There is some very weak evidence from animal studies that they delay fracture healing. I would advise only using them if necessary for fractures that heal poorly (e.g. true Jones' fractures, tibial shaft fractures, etc) but not otherwise. I would certainly say to use them if pain is not controlled by paracetamol and before using opioids (e.g. codeine).

A "non-union" (i.e. no healing and so unlikely to ever heal without intervention) cannot be diagnosed until at least 6 months. I'd be suspicious of any x-ray report that used the term "non-union" at 8 weeks.

Really helpful thank you! I feel armed and ready for the appointment now