Name of the Procedure:

Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)

Summary

This surgical procedure is designed to correct improperly healed fractures of the metatarsal bones in the foot. It involves realigning the bone and may also include taking a bone graft from another part of the body to ensure proper healing.

Purpose

This procedure addresses nonunion (a failure to heal) and malunion (improper healing) of metatarsal fractures. The goals are to restore normal function, alleviate pain, and improve the structural integrity of the foot.

Indications

• Persistent pain or discomfort in the foot
• Difficulty walking or bearing weight on the affected foot
• Visible deformity or misalignment of the foot
• X-ray evidence of nonunion or malunion

Preparation

• Fasting several hours before surgery if general anesthesia will be used
• Adjustments or cessation of certain medications (e.g., blood thinners)
• Preoperative imaging studies like X-rays or MRI
• Blood tests and medical clearance from your physician

Procedure Description

1. Administration of anesthesia (general or regional block)
2. An incision is made over the affected metatarsal
3. The bone is carefully realigned
4. If necessary, a bone graft is harvested from another part of the body, usually the hip, and placed in the repair site
5. The bone is secured with screws, plates, or pins
6. The incision is closed with sutures or staples and covered with a sterile dressing

Duration

The procedure typically takes 1-2 hours, depending on the complexity and whether a bone graft is needed.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist
• Surgical technician

Risks and Complications

Common Risks:

• Infection
• Nerve damage
• Blood clots
• Poor bone healing or nonunion

Rare Complications:

• Compartment syndrome
• Deep vein thrombosis
• Difficulty with donor site (if a graft is used)

Benefits

• Relief from pain and discomfort
• Improved foot function and mobility
• Correction of deformity
• Enhanced bone healing and structural stability

Recovery

• Initial immobilization with a cast or boot
• Pain management with prescribed medications
• Limited weight-bearing on the affected foot for several weeks to months
• Physical therapy to regain strength and flexibility
• Follow-up appointments for X-rays and to monitor healing

Alternatives

• Conservative treatments like physical therapy, orthotic devices, and medication
• Less invasive surgical options such as pinning without bone grafting
• Pros and cons: Conservative treatments have lower risk but may not be effective for severe malunions or nonunions; less invasive surgeries might not be as comprehensive in correcting significant deformities.

Patient Experience

During the procedure:

• The patient will be under anesthesia and should not feel pain. After the procedure:
• Initial discomfort, swelling, and bruising managed with pain medications and ice
• A temporary reduction in mobility due to immobilization
• Gradual improvement in pain and function as healing progresses