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Jones Fracture

Discussion in 'Ask your questions here' started by Unregistered, Aug 26, 2008.

  1. FootDoc

    FootDoc New Member


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    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    So you are saying that the doctor took an x-ray and told your husband that he had a JONES FRACTURE, not just a fractured toe? As I advised in my initial response, if one's husband is untrusting or or uncomfortable with his doctor's advice regarding ANY medical problem, unless he is a minor or has been adjudicated as incompetent, HE should be the one to seek a second opinion. If he doesn't have that much sense, I hardly think any case a wife might make by virtue of supposition by anyone on the Internet would matter.
     
    Last edited: Aug 20, 2009
  2. Unregistered

    Unregistered Guest

    To DOC:

    You seem a little testy but here goes.

    I am helping care for an alzheimer's patient (she was early onset 6 years ago and now ten months into assisted living at 63) who suffered a jones fracture 4 weeks ago (described to me as complete but not displaced at the midline of the 5th metatarsal). She is due back for her 4 week assessment on Friday but has already worn out two casts. First she was in a plexiglass cast and wheelchair (non weight bearing) but refused to comply and ruined that cast in a week. Next they went to plaster and a walking boot with a walker (partial weight bearing) and she won't/can't comply with that either (part personality and part simply cannot remember or grasp significance). She is slowly picking her plaster cast apart as well as walking outdoors without the boot (or walker...).

    Problem is the more we get on her (we have increased her companion hours and alerted the staff at the facility to monitor her) the more she stresses and that stress effects her overall condition. We have talked to her neurologist and surgery (because of the potential effects of anesthesia and a stint in rehab) could be devastating to the progression of her alzheimer's so she has advised us that is an absolute last resort.

    So my question is what is the downside of not treating this fracture long term? Obviously she would have some pain (has some now but insists it's because of a non existent corn...). She is somewhat the diva, alway's has been, so even complying with wearing appropriate footwear is a pipedream. We want to do what's best for her but given the advancing alzheimers it's become somewhat debatable.

    I will be with her Friday for her appointment. She is scheduled for cast removal and ex-ray which given her discomfort and non compliance I already assume will involve us being told there is little or no healing going on. We assume they will re-cast it again for now. I will have this conversation with the orthopod (but have been told by the woman who accompanied her on the first two visits that he appeared somewhat impatient with her situation). Would just like to know in advance what the long range consequences of non healing (including not persuing the surgery) would entail.

    Thanks for any insight.
     
  3. FootDoc

    FootDoc New Member

    I have no connection with this site, I get nothing for my participation here and only a tiny fraction of the several thousands of responses which I have offered over several years on this forum and the non-defunct version which this current iteration has replaced have been anything but well-received and appreciated. My responses are responsible and professionally accurate but sometimes unrestrained in the frankness which both I and most all doctors, but for business reasons, would, from time to time rightfully LOVE to express to a selected few of our private patients.

    But just as you have found it acceptable if not necessary to prefix your question addressed specifically to me with a derogatory characterization, so too, I feel unrestrained in responding in kind. Nothing elicits testiness, especially when soliciting free advice from a professional who normally gets paid for that service, but has chosen instead to spend some of his time and efforts in attempting, for gratis, to help folks, then to prefix his or her question with an insult. So, instead of supplying you with the answer which I might otherwise have given, I will live up to your assumptions and indeed offer you nothing but the testiness you expect. Asking nicely NEVER hurts and when solicited in such a manner I have absolutely no compunction about not being remunerated. If I did, I wouldn't spend my time here. Honest appreciation is more than enough payment for me, but insults will not do the trick.
     
    Last edited: Aug 25, 2009
  4. Unregistered

    Unregistered Guest

    Hi Footdoc,

    Ive just come out of a non weight bearing cast which i had on for 6wks due to a jones frature 5th metarsal due to football!! been to the hospital to have cast off and have a x-ray to see how the frature is!? went to see the doctor and see said it hasnt heeled but is heeling?? i saw the x-rays and the fracture looks the same as the 1st x-rays 6wks ago!!? now the doctor said give it another 5wks using the crutches for 1-2 weeks then start walking without them! sureley this will cause more damage not help heal the fracture? i used crutches for 6wks not put any weight on my cast and it didnt heal now doctor say walk!!? i dont feel confiedent that this will be healed in another 5wks time!! can you PLEASE give me some advise as it means im still on the sick from work where im a postman and im also a semi pro footballer ive got a feeling it wont be healed after the 5wks!!

    Regards
    Chris
     
    Last edited: Sep 1, 2009
  5. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    By now you are surely aware that Jones fractures are notable for their often stormy healing process, but though I am not willing to accept that by viewing an x-ray you are capable of determining whether or not any healing is occurring, it is not uncommon for full healing to take several months. Definitive advice offered by anyone without specific knowledge of your status by examination would be unwarranted, meaningless and perhaps dangerous, and such cannot be deemed to be a valid second opinion of which you might rely. My best advice would be that if your have questions about the appropriateness of your doctor's treatment, choose another well-vetted doctor for a hands-on second opinion.
     
  6. Unregistered

    Unregistered Guest

    Doc,

    Ive just come out of my cast which i had on for 6 weeks thanks to a jones fracture but on having my cast of its not healed fully as yet! so my doctor has said to use one crutch and start putting weight onto my foot.ive goto go back in 4weeks for another x-ray.do you think its worth my while buying a aircast boot? as im getting alot of aching in my foot at the moment due to walking is this normal?
     
  7. FootDoc

    FootDoc New Member

    As you are currently under the care of a doctor who is managing your injury, all questions regarding your care should be directed to that doctor. If you do not have confidence in his/her response or care, then seek a second hands-on opinion from a qualified and well-vetted specialist.
     
  8. Unregistered

    Unregistered Guest

    So I am wandering how do you find the right specialist? As I have recently had surgery for carpal tunnel on both wrists and I am very disappointed with the surgeon and his office-then this...a jones break that 3 different emergency room doctors have told me needed surgery 3 weeks ago..Began with the intial emergency room visit, the doctor gave me a surgeons number and told me that it was going to need done, so I visited this (surgeon) who put me in a walking cast and told me to walk on it (no problems) I asked him if he was sure about that-and yep he was fine. So a week goes by and the pain is increasing (unbearable) so I called him and told him that I my child had also jumped on the couch where I was laying (per docs instructions: remove the boot at night, relax, and sleep without it. His response (what do you want me to do about it-& I wouldn't recommend returning to the ER they will do nothing for you) So against his advice I went back to the same er-who did nothing (wouln't even re-exray it to insure it hadn't gotten worse. So being stubborn I went to a neighboring city hospital-who treated me very well including new exrays & said (I NEED SURGERY now not later) so I called me doctor with the news, and took him the exrays that showed it had split more-he said no it hadn't and that all three doctors were wrong-he would do surgery in 6 weeks if it hasn't healed....SIX weeks later I go back to the doctor and he tells me I need surgery (supposed to be scheduled for 9/18-so I need to know how to choose the right doctor. It is almost impossible to find out anything about a doctors history, successes, cases, or how many complaints they have ad against them. I don't want to continue going through more than necessary so if someone could help I would appreciate it. (by the way the pain is bad ut no where near what it was and I have waited the pain out six weeks just to go start over when he could have done this like I was told he should have then and I wouldn't be going through it twice.
     
  9. Unregistered

    Unregistered Guest

    Most states have information about all licensed professionals including doctors. On the website, you can confirm that they are indeed licensed in the state and whether there are any complaints or license revocations etc. Just go to you states website and you should be able to find the info. Did you go to a general orthopedist or one that is certified in foot and ankle surgery? You mentioned being unhappy with the results of your carpal tunnel surgery. Did the same Dr. treat you for your foot? I recently (7 weeks ago) had carpal tunnel surgery done by a board certified hand surgeon (reccomended by my primary). I have had a very smooth recovery and am completely pain free now. I had a podiatrist perform my modified kidner four weeks ago.
     
  10. FootDoc

    FootDoc New Member

    Due to the fact that time is generally of the essence, it is difficult if not impossible to be able to adequately research the selection of a doctor who is needed to treat a trauma emergency, but when time can appropriately be taken . . .

    HERE'S WHAT I GENERALLY ADVISE ONE TO LOOK FOR IN A PODIATRIC SURGEON:

    1. Real board certification . . There is ONLY ONE recognized surgical board in podiatric medicine, and that is the ABPS (American Board of Podiatric Surgery), the "American Board Division" and not simply the "Ambulatory Sub-Section" or some other so-called "Ambulatory" group. Don't be impressed by all the other organizations which the doctor claims to be a member of or even certified by. If your surgeon is board certified by the "American Board Division" of the ABPS he/she surely will have a certificate to that effect pridefully displayed in the office.

    2. Hospital privileges at a well-respected hospital in your area. State Licensing Boards, which grant podiatric graduates license to practice within its state, really demand insufficient proof that the doctor is a good one. In fact, most licenses are granted prior to the private practice of the doctor, and unless he/she had done or subsequently does something R E A L L Y bad, and does it often enough, and has been reported for same, the doctor will remain in good standing. Hospital privileges offer at least two advantages. Firstly, hospitals have a vested interest (financial and reputation) in providing good care. To obtain privileges on a hospital staff, a doctor must supply the credential committee with proof of adequate training, and an essentially clean record in practice. Then the individual department "credentials" the individual with a process know as "delineation of privileges," and so specifies which procedures he/she is qualified to perform, frequently based on actual surgical assessment by a qualified staff member. (Not all surgeons on a hospital staff will necessarily be permitted to perform all procedures for which he/she is legally allowed). Also, when surgery is performed in a hospital setting, rather than behind the walls of an office, the surgeon and his/her technical abilities are on display for peers to see, and they can't very easily or for very long be swept under the rug as can easily be done in the office.

    3. Find out to what degree of respect your surgeon is held within the local medical community . . Not by his/her friends, but by his/her peers. Many states keep a database, available to the public, where the doctor's malpractice and disciplinary record may be checked.

    4. In my opinion, the very last place to go is patient references, as most patients have no way of assessing the skills of their doctors. If they had successful surgery, he/she must be good, and if not, he/she must not be good. But more importantly, since most folks do not know what makes a good or bad doctor, they rate the personality, and when a surgeon is coming at your body parts with a sharp knife, personality is absolutely no consideration.

    Surgery, as well as all medical treatments, always has the potential for failure and undesirable results. Part of being a good surgeon is in knowing how and when to deal effectively with the untoward event which do occur. There is no one best method for most surgeries, as not all similarly named conditions are exactly alike, and so procedures should be tailored to the individual case. That's another skill necessary for the good surgeon . . knowing what needs to be done and doing it effectively.
     
  11. Unregistered

    Unregistered Guest

    In response to my disappointment with my hand surgeon-I must admit that I WAS pretty niave in the beginning of all of this. My doctor sent my for an EMG a year before it got really bad, then he told me that when it started to get worse I would need surgery. A year later it got really bad and I was attempting to enter the army so I figured it needed corrected grabbed a phonebook-& yep you got it-problems. I met with the surgeon who had another emg done-telling me I needed surgery. I told him of my plans, that I was a single mother, and in college with finals approaching. He said everything would be fine I could have one surgery and as soon as the stitches came out I could have the other. Well the next surgery was the day after the removal of the stitches from the other. I had asked him what the pain would be like, if I would be able to continue with my daily living, what the healing time was like, and if it was a wise idea to have them back to back. He made everything seem like it would be a breeze-and I repeated that I had essays to do the following week (of the second surgery) essays, I was a single mother blah blah blah...He knew very well that I had an active life and wanted the truth so that the burden would be minimal. Listening to him tell his other patients the same thing (with doors open) he was in the office on Tuesday and Wed and at the HAND THERAPY CENTER on Mon and Wed-Fridays as I would find out later were his personal days. So second surgery-I tell the nurses at the surgery center that I had been struggling with pain and asked for pain medication after the surgery was complete-the nurse asks me how I expect to make it in the Army if I can't handle this????where did that come from? I was a patient there paying them to help me???? I go home and a huge knot (scar tissue) had formed over the 1st hand-it hurt bad and I had to complete my exams and essays-I went to the doctor the day I completed them and told him how bad both hands were hurting-I sat there crying-he turned his tape recorder off the moment he told me that I needed to calm down just alittle....I got angry and told him I was calm-but that I had asked him all about this-and now his nurse just showed me a paper that says I will be at this level of pain until it gets worse at six weeks and then starts to drop down over 6 to 9 months?? After the second surgery he had forgotten to put a stitch in it-so it poured blood had to call the office-go in and let his nurse put a strip across it because it was to late to stitch-he was off for the day-1st of many....the next friday i got the stitches out of that hand-went home and hour later my hand was pouring blood again---it had ripped open bad... This led up to the conversation where he told me I needed to calm down==I wasn't being rude I was crying? I had gone to the ER the day it ripped open (I called the doc first "it's Friday he's not here-come on in we'll help u) no thanks second opinion time-er.....sitting there during the calm down conversation his nurse got really rude with me (SO DO U WANNA TELL ME DID U GO TO THE ER BEFORE OR AFTER U LEFT HERE) before because the doctor wasn't here & I wanted a doctor to help me and give me a second opinion on all of this...then the doc tells me to calm down-i got rude he turned the recorder off---then he tells me ok, it's ok-no its not---he tells me that I should go down to Physical therapy to allow them to teach me wound care--he said he had already called they were expecting me...I go down there they tell me (no no one has contacted us-we can see u but not until WED....This was Monday-it split open on Friday-and while the doctor had been looking at it he asked me how I had been caring for it over the weekend-I said I followed what the nurse did (cuz no one told me) he said what was that-pour peroxide over it, ointment, strip, wrap.....he said no-that they dilute their peroxide---that home stuff is horrible for wounds like mine (well how was I to know that) so I was furious when they said Wed that was two more days on top of the three that it hadn't been cared for right (my hand-my scar) I threw a fit, they seen me, the doc blamed the physical therapy department for all the problems. Still have some pain today-and there is a not on my hand still. He was a meat market chopping block-every appointment after he was just scheduling every person I heard (with doors open) for the following days that he was in the Surgery center---had to have all the slots filled up.
     
  12. Unregistered

    Unregistered Guest

    As far as with my foot break: Day one of seeing him he gave me a walking cast and told me to stop using the crutches and walk on it-I have read up on it and talked to the other three doctors who said this was not correct because of the blood flow to the area of my break I would need surgery (and if surgery wasn't the first step I should never have been walking on it immediately! (off of it for six weeks) this doctor then was extremely rude-again I went to the er (the good one in a neighboring city) he was not happy with that-I didn't care it's my body-I have to live with it...and I told him so in a less insulting way. I repeated what he had said to me on the phone-and then he began talking over me and when he asked me something and I began to answer he cut me off again-I asked him if he would please allow me to finish-he was just mad...(this has me scared about him doing the surgery-seeing how this week when I went back he was again intolerant-he told me that as expected it had not healed at all- I told him the ligament up the back of my ankle was stiff and hurting bad-he just kind of gave me a dirty look-said that it did need surgery but he didn't know if he should do it or wait and give it more time to heal? what did I want to do....I said surgery I don't want to go through another few months of pain just to have to do this again-so he got really rude---I WILL DO THIS SURGERY as long as you stay off of it for 7 days straight (bed rest) ok no problem....but the way he is talking to me I am assuming is still over the previous incidents and I am not comfortable with this. I was told that I had a law suit in the beginning because of the actions he took, the way he spoke to me when I called him, and telling me to walk on it immediately--the fracture had increased in size--I don't believe in stuff like that-so I called the doctor back to correct the situation- but I don't believe he sees it that way (the appointment after the er visit being really rude) so I plan to find another doctor...This has all happened within the last three months (carpal and fracture) so to fill in what I think this is over--I couldn't work anymore my hands were horrible-couldn't hardly move them....so I quit---I am still in college, with two children, graduating in December with every intention of going back to work-but I applied for and received state assistance for the medical issues I am having---I believe thats the reason for the difference in my treatment and its aggravating because I didn't plan this-and I have pain into it, I just didn't have insurance and couldn't continue working. Both doctors are from the same area (which have these board-committee things) and I don't know if that has something to do with this or not.
     
  13. Unregistered

    Unregistered Guest

    I had a Jones Fracture to the right foot about 2 years ago and had a cast for about 8 weeks. After my castt was off and the foot was healed according to the doctor, he recommanded physical therapy for my foot. I was unable to go because I had to take care of my mother who had surgery a couple of weeks afte my cast was taken off. Lately my foot hurst around the area of where the fracture occurred, especially when I spread my toes, or walk a lot. I am unable to wear low heels becuase my foot will hurt even more on occassion my foot has been a little swollen. I have changed jobs so my insurance is not the best. I do plan to go to the doctor, but was wondering if you could give me an idea of what may be going on with my foot or what I need to look for.
     
  14. Unregistered

    Unregistered Guest

    Good Evening,
    I just have a simple question.... how long does it take to heal a jones fracture (ball park)? I am a fairly new runner (since spring) and have also lost over 100 lbs in the last 2 1/2 years. Excerise is very important to me and my ability to manage my weight.
    I got the jones fracture Monday and I am scheduled to have a screw placed on Wednesday.
    I am very frustrated at the whole situation and would like some idea of what to expect. I appreciate any information you have.
    Thank you
     
  15. FootDoc

    FootDoc New Member

    Who better to ask than the doctor whom you are trusting to treat you? The healing of Jones fractures can be problematic, and to rely on a ball park figure offered by someone who has not examined you surely cannot afford you any real comfort and insight into your individual situation. That should have been among the first questions that you asked the doctor you chose. Call him/her first thing in the morning and get an answer based on knowledge of your situation.
     
  16. FootDoc

    FootDoc New Member

    Who better to ask than the doctor whom you are trusting to treat you? The healing of Jones fractures can be problematic, and to rely on a ball park figure offered by someone who has not examined you surely cannot afford you any real comfort and insight into your individual situation. That should have been among the first questions that you asked the doctor you chose. Call your doctor first thing tomorrow morning and ask him/her that and everything else BEFORE your surgery.
     
    Last edited: Sep 26, 2009
  17. Unregistered

    Unregistered Guest

    Thank you for your answer! I have asked the questions and done the research and everything has lead back to the same answer... 3-4 months of healing time with out surgery and 4-6 with surgery. Since I would like to maintain some of my athletic ability I have gained, I am opting for the surgery in hopes that I will heal quickly and be back on my feet. I will have to say that at 1 week since the break, I am able to walk around with my boot quite well... better than expected. I hope that is a good sign that I will be on the mend quickly.
    Thank you again!
     
  18. FootDoc

    FootDoc New Member

    .......................................................................................
     
    Last edited: Sep 28, 2009
  19. Unregistered

    Unregistered Guest

    Doc,

    10 years ago I had a screw inserted in my 5th metatarsal (Jones fracture). For the last few years, I have experienced some localized pain in the screw area when running long distances. I have recently seen my treating surgeon for X-rays and a consultation regarding the pros and cons of removing the screw. The screw also appears to be firmly in place and not backing out.

    I have aspirations of marathons and ironman distance races. I am torn between "settling" for the intermittent pain and the unknown consequences of taking the screw out.

    Any general opinions on the pros and cons of screw removal for long distance runners? Any other thoughts or issues to think about that come to mind?
     
  20. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ************************************************** *********
    In most case, hardware use to maintain stabilization and bone to bone contact in the treatment of fractures serves its purpose only during the healing process, and although most do not require removal unless they present some problems, the only "cons" in removing the hardware is the additional surgical procedure and the risk of possible complications relating to any surgical procedure. It is, of course, first necessary to determine if the screw is participating in whatever latent problem exists before removing it empirically in mere hopes of improvement .
     
    Last edited: Oct 11, 2009
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