Exposed Bone Screws After Metatarsal Fracture Surgery

Extruded portion of the metatarsal bone screw?

Hello Doctor, I was in a car accident on February 7th and sustained fractures to the first through fourth metatarsals in my left foot.
On February 18th, I underwent surgery where external fixation pins were inserted into the first and third metatarsals.
However, part of the pin is exposed.
On March 2nd, I woke up to find that the external fixation pin for the third metatarsal (oriented vertically from the toes towards the heel and through the sole) is protruding longer than it was immediately after surgery, but there is no discharge.
Should I continue to monitor it to see if it becomes more exposed, or should I wait until my follow-up appointment with my attending physician? Thank you.

monk35725, 30~39 year old female. Ask Date: 2023/03/02

Dr. Shi Guozheng reply Orthopedics

Further medical evaluation may be necessary; please consult the attending physician for assessment.

Reply Date: 2023/03/02

More Info

After undergoing surgery for metatarsal fractures, it is understandable to have concerns about the exposed bone screws. In your case, you had surgery on February 18, where external screws were placed in the first and third metatarsals. You noted that the screw in the third metatarsal has become more exposed since your surgery, although there is no sign of infection such as pus.
Firstly, it is important to understand that some degree of screw exposure can occur after surgery, especially if the screws are placed in a manner that allows for some movement or if the surrounding soft tissue is thin. The fact that there is no drainage or signs of infection is a positive sign; however, it is crucial to monitor the situation closely.

Here are some considerations regarding your situation:
1. Observation: Since you have noticed that the screw has become more exposed, it is advisable to keep a close eye on it. Look for any changes such as increased exposure, redness, swelling, or any signs of infection. If the screw continues to protrude significantly or if you experience increased pain, it would be prudent to seek medical attention sooner rather than later.

2. Consulting Your Surgeon: It is always best to consult with your orthopedic surgeon regarding any concerns about surgical hardware. They can assess whether the exposure is within acceptable limits or if it requires intervention. If your next appointment is not soon, consider contacting their office to discuss your observations and possibly schedule an earlier visit if necessary.

3. Potential Risks: Exposed screws can pose risks, including irritation to the surrounding soft tissue, potential for infection, or even the risk of the screw loosening or migrating. If the screw is significantly exposed, it may need to be removed or adjusted to prevent complications.

4. Pain Management: If you experience any pain associated with the exposed screw, it is important to manage it appropriately. Over-the-counter pain relievers may help, but if the pain persists or worsens, you should reach out to your healthcare provider.

5. Post-Surgical Care: Continue to follow any post-operative care instructions provided by your surgeon. This may include keeping the area clean and dry, avoiding putting weight on the foot until cleared, and attending follow-up appointments for monitoring.

6. Long-Term Considerations: If the screw remains exposed and does not cause any complications, your surgeon may decide to leave it in place until it is time for removal, which is typically done after the bone has healed sufficiently. However, if there are ongoing issues, they may recommend removal sooner.

In summary, while some exposure of bone screws can be normal, it is essential to monitor the situation closely and maintain open communication with your healthcare provider. If you have any doubts or if the situation changes, do not hesitate to seek medical advice. Your health and recovery are the top priority, and your surgeon is the best resource for addressing your specific concerns.

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