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What to expect Ortho dr. to do with fusion with loose screw?

Discussion in 'Ask your questions here' started by RedwoodsMama, Feb 7, 2018.

  1. RedwoodsMama

    RedwoodsMama New Member

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    Hi, I ended up in emergency room yesterday, Feb. 5th with severe foot.leg pain of slightly more than two weeks duration, along with hypertensive blood pressure due to severe pain. I had my foot broken in 2011, was in a cast for more than seven months, Jones fracture. This is my right foot and have had failed bunionectomy also on this foot, overcorrection resulting in Hallax Varus, failed correction, fusion of big toe as well as removal of both sesmoids due to constant pain severe degeneration, tailors bunion on same foot, a fall down stair with dislocation of fused big toe and also fracture of big toe at same time and several other operations. Here is my question.

    Yesterdays results ruled out a blood clot in my right leg which is great. An Xray did reveal that one of the screws in my fused foot , came out of the plate and I was given a referral to see an Orthopedic surgeon. I did make an apt to see the orthopedic dr. that has done my last five surgeries as he knows my case well. My question is what can I expect what will happen, as far as the screw being loose, how will he remove it and since my big toe is obviously fused and healed after more than five years, will he likely remove the plate and other four screws, will my big toe be stable enough even though I have Osteopenia widely diffused in my whole foot and severe Osteoarthritis, will their be any other procedures he may want to do? I do have photos from yesterdays Xray so can post them if that helps. At least this explains my long going foot pain, esp under big toe but not sure if this is why my leg is in severe pain esp when walking which I never had before. Thanks
  2. Craig Payne

    Craig Payne Active Member

    Its hard to say without seeing it; different surgeons handle it differently

    Removing the screw is not a big deal and relatively simple and could be done (but that will depend on other issues)
  3. RedwoodsMama

    RedwoodsMama New Member

    Thank you, since I do not know how to upload a photo of the xray itself, perhaps if someone could explain in simple laymans terms, what the xray itself means. Some I know,but other terms as to where the loosened screw is, I can't picture in my mind even though I can visually see it on the report myself, the cd in the computer. Here is the report itself.
    No acute fracture or dislocation of the right foot. Prior fusion of the right first metatarsophalangeal joint with a plate and fixation screws well postitoned and intact.with complete bony union. Status post screw fixation of the first distal phalanx with a screw extending from the tuft, terminating at the mid proximal phalanx level. There is a subtle linear lucency between the screw and bone interface suggesting mild screw loosening. Advanced degenerative arthritic changes at the distal interphalangeal joint of the right great toe, the sequeala of old fractures. prior resection of the distal aspect of the fifth proximal phalanx. Disffuse osteopenia. The soft tissues are unremarkable.
    The other questions I have relating to this is in the last year or so, I have noticed that my toenail of the big toe, has become bent into a tent or upside down V shape, but not as sharp as a v, but it is not flat anymore, wondering if this is because of a screw under it? Also when they put the screws in, do they always go through bone , through the plate, or sometimes do they go through tissue itself.? If a screw is loose, and appears to be from the XRAY, does the screw move around or stay stationary usually? Would it be more likely that the dr. would remove the screw or repostion it with a cut where the original scar was, length wise on base of big toe, or come in under big toe or? Is it possible to just leave the plate and remaining screws in or ? my foot is now completely fused after more then five years, since I have widespread Osteropenia, are my bones strong enough with the screws and plate removed? The dislocation and fracture I suffered in Dec. 2012 was "an oblique intra articular fracture of the base of the distal phalanax of the first distal.The fusion I had was of the first metatarsal and proximal phalanx. Only other thing significant in 2012 was that my degenerative Arthritis was "mild and age appropriate' so in five years it is advanced degenerative arthritis. Thank you for any feedback. I see my ortho dr. on Monday, The 12th.

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