#767 Biggest danger with popping a broken toe back in place (avascular necrosis) - DOC

#767 Biggest danger with popping a broken toe back in place (avascular necrosis)

Today on the Doc On The Run Podcast we’re talking about the biggest danger with popping a broken toe back in place.



I’ve got a comment and question in one of my YouTube videos where I was talking about a procedure for broken toes called closed reduction. That’s the fancy term for popping it back in place or setting the fracture.

You may have heard this before when somebody says, “Well, I had a fracture and the doctor had to set it or the doctor had put it back in place.” Well, if you don’t have the skin open in the operating room and we just look at it under X-rays and manipulate it, move it back into place, that’s what we call closed reduction.

There is a risk and a benefit to everything. Obviously putting a fracture and a broken piece of bone back where it belongs is more likely to make it heal in the right position, because you put it back in the right position. If you leave it in the wrong position, it may heal and then cause problems later because it’s crooked.

What does this mean though about risk and what’s the biggest risk of this? Well, let’s say this is the toe that you broke. You have a fracture in your second toe. If you break the bone and you put it back in place, if it’s really tilted, it’s really moved out of position, when you realign it, you can basically catch some stuff in the fracture that gets pinched in there and messes you up.

What’s the biggest risk ? Well, the biggest risk for sure is a thing called avascular necrosis. And that is where “avascular” needs no blood flow, “necrosis” means it dies. So obviously if your toe is dying because it doesn’t have blood flow, that would be a bad thing. So, you have little blood vessels that are inside the toe, there are basically four of them there in each toe.

They’re basically, if you think about the toes are in this box, there’s a vessel at each of those four corners, and when you break the toe and it’s really tilted over, everything is stretched. And if it’s been stretched for a while, it can kind of make laxity in those vessels and all the structures on the other side where the fracture was, where it got pulled to the other side. So, if you pull the toe out, and you move it back into position and close the fracture down but the blood vessels, basically got kinked into that space that you’ve pinched down, that can cut off the blood flow in that area.

If you cut off enough of the blood flow, then you can get this thing called avascular necrosis. Also, sometimes because of the trauma of moving the toe around, you get swelling within the toe that increases the pressure so much that the veins collapse and blood can’t get out. But the arterial blood that’s under higher pressure keeps pushing it back in and you develop another thing called compartment syndrome, which basically leads to avascular necrosis, but in a different way. And that is where the blood load gets cut off just like you put a rubber band around your finger.

Believe it or not my son when he was in second grade, one of his idiot friends in class put a rubber band around his finger and left it on that finger about halfway up for the entire day trying to be funny, and he was trying to see how long you could do it. Well, I started to turn purple because you might guess, it hurt and it kept hurting and this poor kid after leaving it on the whole day, after three hours the tissue starts to die and when he took it off, it was very painful. He told the teacher, the teacher called his parents, his parents took him to the doctor. That kid had to have a part of his finger amputated because he put a rubber band on it for that long.

The doctors are going to warn you about discoloration and pain and watching out for things after they fix the toe but this is one of the reasons I really don’t want you to just do it yourself because there is a very serious risk of getting this thing called avascular necrosis if you don’t do it properly and you don’t monitor it in the right way. But if you have a broken toe and this is helpful to you, please like it, please subscribe, and I’ll see you in the next training.