G'day colleagues,
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I was hoping to get some opinion and suggestion to manage this case I came across last week.
Basically the gentleman presented to the clinic with:
History of fractured junction of 3rd met head-shaft from trauma/fall right foot
38 years old
Occured in feb 2008
Was in an air walker for 4 weeks after
Took x-ray after and was told the fractured has healed
Based on x-ray the fracture resembles a simple fracture
However residual pain was still present till today Sept 2008
Pain is felt wb and especially in the dorsum area of 2-3-4 met head area
Pain pronouced especially in the 3rd met head
Wearing shoes helps a bit with the pain
Pain is more severe after a period of rest and when start walking again
Pain is about level 6-7 not getting better or worst overall
I've seen his x-ray taken in late March 08 when the air walker was removed. There is still a sclerotic margin present. I've requested the most recent x-ray again for this present time.
My differential or possible complication would be
AVN
Possible degenerative changes
Fracture have not healed up well
I would like to know any opinion for further managing this patient.
Is it possible for the fracture to not heal after many months? If it is would putting him back in an air walker be appropriate? for 4-6 weeks?
Or an orthotic to offload the 3rd met and shift the GRF towards the MLA be suitable?
When surgical intervention be necessary?
At the moment I am just waiting to review the latest x-ray films before proceeding any further?
I anticipate and would value any opinion that may guide me through this case management.
Many thanks.
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