Can Bone Screws Be Adjusted After Locking Fractured Toes?

Is there a way to adjust the bone after the bone screw threads have locked it in place?

Hello, Director Shih! The patient has a fracture of the distal phalanx of the third toe and the proximal phalanx of the fourth toe on the left foot.
An open reduction and internal fixation with a steel pin was performed on December 24, 2003.
If the surgery failed due to non-traumatic reasons and the threads of the bone screw have locked the bone in place, is there still a way to adjust it? Is there enough time to do so? Thank you for your assistance, Director.

sam, 30~39 year old female. Ask Date: 2004/02/15

Dr. Shi Guozheng reply Orthopedics

To realign it, another surgery may be necessary because the position of the bone screws is usually difficult to change after fixation.
However, if the displacement of the fracture is not severe, sometimes it can be acceptable not to make adjustments.

Reply Date: 2004/02/15

More Info

When it comes to the management of fractured toes, particularly after surgical intervention with bone screws, there are several important considerations to keep in mind. Your situation involves a previous open reduction and internal fixation (ORIF) surgery for fractures in the distal phalanx of the third toe and the proximal phalanx of the fourth toe. Given the complexity of your case, let’s address your question about the possibility of adjusting bone screws after they have locked the fractured bones in place.

Firstly, it is essential to understand that once bone screws are placed and the fracture has healed, they are typically not adjusted. The screws are designed to stabilize the fracture and allow for proper healing of the bone. If the screws are locking the bones in a position that is not ideal, it may be necessary to consider surgical intervention to remove or reposition the screws. However, this decision is contingent upon several factors, including the healing status of the bone, the alignment of the toes, and the presence of any complications.

If the surgery was deemed unsuccessful due to the positioning of the screws rather than an external force causing misalignment, it is crucial to evaluate the current state of the fractures. An X-ray or other imaging studies would be necessary to assess whether the bones have healed properly and to determine the alignment. If the bones are still misaligned and the screws are preventing proper healing or function, a revision surgery may be warranted.

Regarding the timing of any potential adjustments or revisions, it is generally advisable to wait until the bone has sufficiently healed before attempting any surgical intervention. This waiting period can vary based on the individual’s healing capacity, the extent of the fractures, and the type of fixation used. In many cases, bone healing can take anywhere from 6 to 12 weeks, but this can vary significantly depending on the specific circumstances.

In terms of your question about whether it is possible to adjust the screws after they have locked the fractured bones, the answer is that while it is technically feasible to remove and reposition screws, it is not a straightforward process. The decision to do so should be made in consultation with an orthopedic surgeon who specializes in foot and ankle injuries. They will be able to provide a thorough evaluation and discuss the risks and benefits of any potential surgical intervention.

In summary, if you believe that the positioning of the screws is adversely affecting your recovery or function, it is essential to consult with your orthopedic surgeon. They can assess the current state of your fractures, determine whether any adjustments are necessary, and guide you on the best course of action moving forward. Remember, the goal of any surgical intervention is to restore function and alleviate pain, so open communication with your healthcare provider is key to achieving the best possible outcome.

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