Metatarsal fracture

A fracture is called a metatarsal fracture when one of the long thin bones of the foot is fractured. It is also known as broken foot, and can be classified as Jones fracture, stress fracture of the foot, Lisfranc fracture dislocation, marcher's fracture, tennis fracture and dancer's fracture. Human foot has five metatarsal bones. Depending on the extent of injury and displacement, metatarsal fractures can be classified as minor or severe injuries. When this fracture occurs in an area of the foot where there is poor blood flow, the healing is more difficult. Jones Fracture is of this type and requires surgery to position the bones.

Twisting and dropping a heavy object on the foot are the two major causes for most of the metatarsal fractures. Direct impact of the falling object will result in a metatarsal fracture. Since the symptoms of this type of fracture may be similar to an ankle sprain, a metatarsal fracture may be missed at times. Though X-rays will help to confirm the fracture, a CT scan or MRI is needed only when there are other injuries.

Keeping the injured foot at an elevated position will help to reduce the pain. One can use crutches to avoid pressure on the foot. Stiff soled shoe or a walking cast can be used as part of the treatment. A non-weight bearing cast for several weeks is prescribed for more severe fractures.If a metatarsal fracture has occurred in an area of the foot that has poor blood supply or if the bones are very much out of place, surgery is recommended. Maintaining good balance, good coordination and strength of the foot are some tips one should remember to avoid metatarsal fractures.

Scaphoid bone fracture

Scaphoid bone fracture occurs normally when a person falls on an outstretched hand. With the palm bearing the weight, there is the risk of forearm bone (distal radius) fracture too. The symptoms are pain and swelling in the wrist. If there is no deformity of the wrist, people generally tend to think that it is only a sprain. If symptoms like pain and swelling on the thumb side of the wrist after a fall last a few days, then it is advisable to see a doctor and get treated for the broken bone. Located where the wrist bends towards the thumb, Scaphoid bone is at the base of the small depression made by the thumb tendons. When the Scaphoid is injured, pain or tenderness is associated with it.

Consult a doctor if the pain on the thumb side of the wrist persists even after few days of medication. The orthopaedist will prefer to take X-rays, but sometimes a broken bone of this type does not show up clearly on an X-ray. A MRI helps in confirming scaphoid bone fracture. Minimize the risk of broken bones around the wrist by using wrist guards while performing activities like snowboarding and inline skating.

Depending on the location of the break in the bone, an orthopaedist starts the treatment. If it is broken at the end near the thumb which has good blood supply, healing takes place within a few weeks if it is protected properly. A CT scan or X-ray will confirm that the fracture has healed. A cast that may or may not include the thumb is a good option to heal this kind of Scaphoid fracture. If the Scaphoid is broken in the middle or at the proximal pole which does not have good blood supply, it is difficult to heal. The doctor places a cast that includes the thumb and index finger and extends up to the elbow.

In some cases, wrist arthritis may develop following a Scaphoid fracture. This may be due to the cartilage injury at the time of the fall or accident, or due to wear and tear from changes in the alignment of the joints. It may also be due to a cut off in blood circulation. Deterioration of the bone (avascular necrosis) at this part will lead to degenerative arthritis. Physiotherapy exercises and special exercises will improve movement and strength of the Scaphoid bones. Stiffness in the wrist and finger is not unusual after this injury.

Osteotomy

Osteotomy is a procedure wherein a bone or a portion of the bone is cut. Osteotomy refers to a variety of bone cutting procedures that are used to correct deformity, relieve pain from arthritis and for cosmetic changes. It is an elective surgical procedure and is performed under general anesthesia. The damaged bone near the affected joint is removed surgically.

The bone is fixed by either cutting it short or lengthening it or correcting the damage. The damage may be caused by trauma, arthritis or growth abnormalities. Cutting through the bone allows repositioning of the bone thereby remodeling the appearance, position and transferring the point of stress. Osteotomy procedure helps in shifting the weight from the area of the damaged cartilage to the area where there is normal or healthy cartilage.

This surgical procedure is carried out mainly for the knee and the hip joints. Though any bone can be repaired or repositioned using this procedure, the list includes hands, vertebrae, arms, middle ear, hips, jaws, ankles, toes and shoulder blades.

Osteotomy corrects various deformities such as bow legs, knock knees and deformity of the big toe. This procedure is usually performed on those who have a broken bone that has healed crookedly Or when the bone plate experiences a trauma and heals unevenly. This procedure is effective only when one side of the joint is affected. People suffering from osteoarthritis often prefer an osteotomy over a total replacement of the joint.

• If osteotomy is performed on the inner knee, the surgeon removes the bone from the outer side of the tibia/large lower leg bone near the knee.
  
• Osteotomy of the hip includes removing bone from the femur/upper thigh bone.
  
• This procedure tilts the body weight of the person towards the healthier cartilage that is located on the outer knee.
  
• The weight is spread evenly across the joint cartilage.
  
• Once the bone wedge is removed, the remaining bones are secured with pins or staples.
  
• If the procedure is for the outer knee, the bone from the inner side of the lower leg is removed so as to shift the weight towards the inner knee.

Osteotomy helps in postponing joint replacement for a few years; this procedure is usually carried out on young people. Post surgery, for about 4-8 weeks a splint or cast is used to limit the movement. Once the cast is removed, physical therapy is advised for a few weeks. Post surgery - it may take up to 12 weeks for the person to apply complete weight on the joint and may take up to a year for the joint to adjust to the corrected position.