ORIF Jones fracture

[jane167]

Hiya,
I have undergone surgery for non-union of a Jones fracture and the 2 week post-op xray shows a widened fracture site ( similar to pre op film), the screw is in correct position.
My Qs:- is the aim of surgery to compress the fracture and if so will this increase the risk of non union?
thanks
Jane

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[gcoe]

Hi Jane

The area where a Jones fracture happens on the bone where there is not a great blood supply. The poorer blood supply does mean that a failed union of the bone is a frequent complication

Did you go into a cast first off then it failed to heal and the surgeon subequently operated or did the surgeon operate from the start?

If it was the former the aim of the ORIF is to bring the bone ends close together so that the fracture is more likely to heal. With the bone ends closer together the bone building cells (osteoclasts) have less work to do and it is hoped this will improve matters. So compression should be a good thing.

If the surgeon did the surgery did this at the beginning it may have been indicated for lifestyle factors (eg you are an athlete) or the nature of the break.

The ORIF is unlikely to be a cause of non union.

[jane167]

me again,
fracture 20th January on holiday in Australia, treated with POP slab for 2/52 and 4 weeks ortho shoe. Xray after 6 weeks showed widened fracture line and advised ORIF which I could not have in Oz as would have had to cancel return flight.
Upon return to UK was advised to weight bear to stimulate bone growth but this did not occur and repeat xray showed further signs of non union so underwent ORIF mid May. Post op xray last week shows fracture lines widened again- have been advised once again to partial weight bear to try and stimulate bone growth. I am obviously concerned that this strategy will fail again.
Am I worrying unnecessarily? Is there anything I can do to help situation?
Thanks.
Jane

[gcoe]

Hi Jane 167

Post op xray last week shows fracture lines widened again- have been advised once again to partial weight bear to try and stimulate bone growth. I am obviously concerned that this strategy will fail again.
Am I worrying unnecessarily? Is there anything I can do to help situation?

You have a right to be concerned. It sounds as if the healing process is not going well. At this stage healing could still occur without further surgery but it is becoming less likely.

the partial weight bearing is definitely worth trying again and it is all about trying to stimulate bone growth. When you go back to see the orthopaedic surgeon it is important to have a frank discussion about what is happening, and what are the options.

As for things to do, other than systematically using partial weight bearing there are a couple of physical modalities that have some limited evidence for being effective:

Pulsed electromagnetic energy Fields. this involves Placing the foot it an electromagnetic field generated by a machine. I don't think there any recent studies of this modality so I couldn't really comment on whether it is effective or not. A physiotherapist with the appropriate machine can provide the treatment. It is painless and as safety goes is down the extreme end of safe. the question is whether it really is effective or not - from a biological point of view the regulation of bone growth is contingent on small electrical currents or magnetic fields within the bone tissue so it is plausible that it may work

various types of therapeutic ultrasound has been tried - again with inconclusive results. However again it is plausible that the mechanical energy from ultrasound could stimulate bone growth via a phenomena known as the Piezoelectric effect.

Because of the scant evidence for these sorts of treatments personally I would not strongly advocate them. There may also be safety issues with delivering these treatments where there is metal but your physio could assess this risk for you.

Another thing is to consult a dietician about your nutritional intake. It is beyond the my scope of practice to recommend anything but a certified dietician would be able to assess your diet and make any suggestions.

[jane167]

Thanks for your reply and I will let you know what happens at my follow up appt later this month.
I have seen a dietitian regarding calcium and Vit D intake so nutrition sorted.
Regarding bone stimulation- I shall contact hospital to discuss.
Am not feeling particularly positive about outcome as the burning pain in my foot is 'familiar' (similar to immediately after the fracture) .
You havebeen very helpful.
Thanks again.
Jane