Broken Foot

[trevorg]

Hi, after the top advice I received here last year, I have afriend with a broken foot after a scooter accident 6 weeks ago.

the accident it was 6 weeks ago, the firs Dr put half cast for 2 weeks then I went back got a new Dr he put full cast and tell me 3 month in cast . Yesterday I went back got a new Dr, he tell me 2 month but the x-ray is not on film only digital, they x-ray with cast and he say it was good ,but you only see the cast and it still hurts so I don't think its ok. I read on web if it was over 1 mm fracture you need operation (it looks bigger then 1mm

Thanks in advance for any guidance.

[FBN]

This looks like a fracture of the medial cuneiform bone. Not a common fracture but usually associated with more extensive injuries to the mid foot such as an initial partial dislocation of the "first ray" where the front foot joins the mid-foot.

Search a bit on "Lisfranc's fracture"; not sure if this was one but the basics are the same. Open reduction and fixing it with a screw may have been the properway to fix this but it should habe neen done soon after the injury; within 10-14 days, depending on the swelling.

After 6 weeks, a CT scan will give more info and show if there has been a non-union of the fracture. Not uncommon in foot fractures. Reason for this is that the extremely strong ligament support structure of the foot, as a weight bearing structure, tends to keep pulling the fracture apart. There may be an indication to operate at this time but you will need better radiological investigations and a good foot orthopod.

This kind of injury often leads to chronic longterm disability due to the extent of the damage in the first instance but also due to the weight bearing function of the foot.

[thaipan2000]

the bone is celled navicular bone. is that the same as cuniform bone

This looks like a fracture of the medial cuneiform bone. Not a common fracture but usually associated with more extensive injuries to the mid foot such as an initial partial dislocation of the "first ray" where the front foot joins the mid-foot.

Search a bit on "Lisfranc's fracture"; not sure if this was one but the basics are the same. Open reduction and fixing it with a screw may have been the properway to fix this but it should habe neen done soon after the injury; within 10-14 days, depending on the swelling.

After 6 weeks, a CT scan will give more info and show if there has been a non-union of the fracture. Not uncommon in foot fractures. Reason for this is that the extremely strong ligament support structure of the foot, as a weight bearing structure, tends to keep pulling the fracture apart. There may be an indication to operate at this time but you will need better radiological investigations and a good foot orthopod.

This kind of injury often leads to chronic longterm disability due to the extent of the damage in the first instance but also due to the weight bearing function of the foot.

[pjclark1]

Even if the treatment is entirely effective, it is still likely to hurt a lot for up to 2 years.

[FBN]

the bone is celled navicular bone. is that the same as cuniform bone

Sincere apologies; always pays to look at the bigger picture!!

It is indeed the navicular bone (not the same as the cuneiform). The main problem here is the navicular bone is the site of attachment of the tibialis posterior tendon which will tend to pull the bone fragments apart. It would probably have been better if an open reduction and internal fixation could have been performed as the fragment is large enough.

Principles as in the first reply remains the same however..