Choosing Between Steel Nails and Plates for Toe Fracture Surgery

Should a toe fracture be treated with a nail or a plate?

Hello, doctor.
I was in a car accident on December 4th, and the emergency department diagnosed a closed fracture at the second phalanx of my right big toe.
I underwent surgery on December 5th.
During my follow-up appointment on December 18th, the doctor informed me that the bone had shifted by 2mm and recommended another surgery to realign it, suggesting the use of a self-funded plate for treatment, which would also allow for faster recovery.
I have a few questions for the doctor: 1.
In a situation where I can afford it, would you recommend using the self-funded plate more strongly? 2.
After healing, would you recommend removing the plate? 3.
If I opt for the self-funded plate, how long will it take before I can start walking again? Thank you for taking the time to answer my questions.

Miss Lin, 20~29 year old female. Ask Date: 2023/12/20

Dr. Chen Yongxue reply Orthopedics

Hello, toe fractures are generally not as severe as finger fractures.
Typically, as long as the fracture is stabilized, it can heal properly.
Usually, toe fractures rarely require self-funded plates, but it also depends on the severity of your fracture.
If possible, please visit our orthopedic outpatient clinic for an examination and to discuss this in person.
Thank you.

Reply Date: 2023/12/20

More Info

When it comes to choosing between steel nails and plates for toe fracture surgery, there are several factors to consider, especially in the context of your recent injury and surgery. Here’s a comprehensive overview of your questions and some additional insights based on medical knowledge.

1. Recommendation for Steel Plates: If you can afford the cost of a self-funded steel plate, it is often recommended due to its advantages in stability and recovery time. Steel plates provide a broader surface area for fixation, which can lead to better alignment of the fractured bone. This is particularly important in cases where the fracture has resulted in misalignment, as in your case where the bone is reported to be 2mm off. Plates can help maintain proper alignment during the healing process, which is crucial for optimal recovery and function of the toe.

2. Removal of Steel Plates: After the bone has healed, the decision to remove the steel plate depends on several factors, including the type of plate used, the location of the fracture, and any symptoms you may experience. In many cases, if the plate is not causing any discomfort or complications, it may not be necessary to remove it. However, if you experience pain, discomfort, or if the plate is prominent, your doctor may recommend its removal. Generally, plates can be left in place indefinitely if they are not causing issues, but this is a decision best made in consultation with your orthopedic surgeon.

3. Recovery Time and Weight Bearing: The timeline for resuming weight-bearing activities after surgery can vary based on the specific fracture and the surgical technique used. Typically, after a toe fracture surgery involving plates, patients may be advised to avoid putting weight on the affected foot for a period ranging from a few weeks to several weeks, depending on the severity of the fracture and the stability of the fixation. Generally, you might expect to start walking with assistance (like crutches or a walking boot) within 2 to 6 weeks post-surgery, but full weight-bearing may take longer, often around 6 to 12 weeks. Your surgeon will provide specific guidelines based on your healing progress.

Additional Considerations:
- Post-Operative Care: After surgery, it’s essential to follow your physician's post-operative care instructions closely. This typically includes keeping the foot elevated, managing pain with prescribed medications, and attending follow-up appointments to monitor healing.

- Physical Therapy: Once the initial healing phase is complete, physical therapy may be recommended to restore strength and range of motion to the toe and foot. Engaging in rehabilitation exercises can significantly enhance recovery and help prevent stiffness.

- Potential Complications: As with any surgical procedure, there are risks involved, including infection, non-union of the fracture, or complications related to the hardware used. It’s important to be aware of these risks and to communicate any unusual symptoms, such as increased pain, swelling, or fever, to your healthcare provider promptly.

In conclusion, opting for a self-funded steel plate for your toe fracture can provide better stability and potentially faster recovery. The decision regarding the removal of the plate should be made based on your individual circumstances and in consultation with your orthopedic surgeon. Always prioritize following your doctor's advice and attending follow-up appointments to ensure the best possible outcome for your recovery.

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