Fracture Fixation: When to Consider Surgical Options

Fracture fixation?

I live in Yilan and sought medical attention for a tear fracture in my heel.
The doctor only used a cast for stabilization, but after 7 weeks, there has been almost no improvement.
I feel pulling pain when sitting or lying down, and it seems that the area is not properly stabilized.
In this situation, would it be necessary to use a steel pin for fixation? Thank you!

A Dong, 30~39 year old female. Ask Date: 2004/03/30

Dr. Yang Zhengfan reply Orthopedics

Dear A-Tung, since you are in Yilan, can you come to our hospital for an outpatient visit? If the fracture is a severe displaced fracture, surgical treatment may be necessary.
A detailed evaluation must be conducted with X-rays.
I hope you can come to the outpatient clinic.

Reply Date: 2004/03/30

More Info

When it comes to managing fractures, particularly in cases like yours involving a torn heel bone (calcaneus), the decision to consider surgical options often hinges on several critical factors. Your situation, where a plaster cast has been used for seven weeks without significant improvement, raises valid concerns about the adequacy of non-surgical treatment.

Understanding Fracture Healing
Fractures typically heal through a biological process that involves inflammation, repair, and remodeling. The healing timeline can vary based on the type of fracture, the patient's age, overall health, and the specific bone involved. In your case, a torn heel bone can be particularly challenging due to its weight-bearing function and the stress it endures during daily activities.

When to Consider Surgery
1. Lack of Improvement: If there is no significant improvement after several weeks of conservative treatment, as you described, it may indicate that the fracture is not healing properly. This could be due to inadequate stabilization, misalignment, or even non-union (where the bone fails to heal together).

2. Persistent Pain: The pain you experience while sitting or lying down suggests that the fracture may not be adequately stabilized. This discomfort can be a sign that the fracture fragments are not in the correct position or that there is excessive movement at the fracture site.

3. Functional Limitations: If your ability to perform daily activities is severely impacted, surgical intervention may be warranted. Surgery can provide better stabilization, allowing for a more effective healing process and quicker return to function.

4. Type of Fracture: Certain fractures, especially those that are displaced or involve joint surfaces, may require surgical fixation to restore proper alignment and function. In your case, if the fracture is unstable or if there is significant displacement, surgical options such as the insertion of pins, screws, or plates may be necessary.

Surgical Options
If surgery is deemed necessary, the common procedure for a calcaneal fracture might involve:
- Internal Fixation: This can include the use of screws or plates to hold the bone fragments together. This method allows for immediate stabilization and can facilitate earlier rehabilitation.

- External Fixation: In some cases, an external fixator may be used, especially if there are concerns about soft tissue integrity or if the fracture is complex.

Risks of Surgery
While surgery can provide significant benefits, it is essential to consider the associated risks, which may include:
- Infection: Any surgical procedure carries a risk of infection, particularly if the surgery involves open reduction and internal fixation.

- Non-union or Malunion: There is a possibility that the bone may not heal correctly, even after surgical intervention.

- Nerve or Blood Vessel Injury: Surgical manipulation near the heel can pose risks to surrounding nerves and blood vessels.

- Rehabilitation Challenges: Post-surgery, a structured rehabilitation program will be crucial to regain strength and mobility. Failure to adhere to rehabilitation protocols can lead to suboptimal outcomes.

Conclusion
Given your current situation, it would be prudent to have a thorough discussion with your orthopedic surgeon. They can evaluate your X-rays and clinical findings to determine whether surgical intervention is necessary. If surgery is recommended, it can provide a more stable environment for healing and potentially alleviate your pain and functional limitations. Always ensure that you are comfortable with the treatment plan and that all your questions are addressed before proceeding.

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