While out dirt biking, I broke my 4th metatarsal 7 weeks ago. So far so good I think. A week in a half cast…then 5 weeks in an Exos Cast. Finally I was able to take my stinky hand outa that thing and start rehab.
Of course, it was a Sunday when I did it so after riding 7+ miles back to the truck and loading the bike, I went home, iced things up, and waited to see what happened hoping it was just bruised or something. When the Monday morning rush passed I went into the Custer clinic for a x-ray. Upon seeing it, the nurse rightfully guessed something was broken. After living with the pain for 24 hours, I’d guessed it was my 4th metatarsal and as correct. The x-ray verified what the nurse suspected. The doc at the clinic knew I was an active person and suggested the Exos Cast. It’s a modern day version of the old gauze and plaster cast of my youth that I’d expected to get. I think they use fiberglass now and I was hoping for something in neon green, but after being through it all think the Exos was OK.
It turned out that after they tried to fit me in the wrong version of the Exos they realized they did not have the right one one at the clinic for the boxers break. As they were about to put me in a normal cast for a 4th metatarsal I inquired if they could find one of them new fangled Exos Cast in the area and I’d go get it. After discussion and a few phone calls and a fair amount of waiting they found what I needed at Black Hills Orthopedics. So off I went.
Upon arrival there, they got me in pretty quick and had a look for themselves. The PA did a good movement check and I think they took some more X-rays. She explained the break better…the bone was in fact in 2 pieces, but so far not displaced so that was great news…no surgery if we could keep it there. I promised to be a good boy and not go biking, climbing or run the chainsaw. The hand was pretty swelled so she suggested I go home with a normal half cast and wrap for a week till the swelling went down then return for the Exos. In hind site, this was a fine suggestion.
The Exos Cast is a good piece of kit, but after living with a half cast for a week and the Exos for the rest of the healing, I would not say that the Exos is all around better, just different.
Pros of the Exos
It’s smaller - Its prolly 3/4 of an inch in diameter smaller them a normal cast. Still a total pain in the butt to get shirts and jackets on, but there are lots more of them that I can wear compared to the cast.
It’s lighter - Right away I noticed that I moved around and functioned just a bit more normally. When I hiked, my stride was more normal. I could do more exercises more normally then I could of with a regular cast. I really wanted to have the bones mend...so I stayed active hiking and some jump rope towards the end, but didn't really go running in the Exos. #1 because I didn't want the jostling around to set back my healing and #2 because it was winter with ice and snow and I didn't want to fall while wearing the cast. Yes, makes me sound like some old guy I know, but setbacks were not something I wanted to have happen.
Vents better - even with the limb sock (which is critical I believe). There is just way less material and with the some small vent holes it just works better. Such that you don’t seem to sweat as much in the thing when sleeping or exercising.
Some adjustment - and ability to reform - Since there is little to no padding, fit is everything. With the Exos instead of the thick gauze padding there is just a MM or so of dense foam between my rather tender skin and the ridged thermoplastic…so anywhere that it was incorrectly formed, I got uncomfortable rub spots on my skin. While I’m sure this happens with a regular cast, with the Exos there is less padding, therefore less room for error by whoever is putting it on. I’ve done a bit of reading online and understand that creating a cast for this, the Boxers Break or Brawlers Break is a bit of a difficult one. If your doc is not a sculptor or psyched about the art of forming the Exos or a cast you will suffer no matter what they try to create for you. My favorite Doc was actually a dentist by trade and an artist by choice. The crowns and fillings he created were great…they fit better then average, meshed together and always worked better then most. He was the type of person that would do great at sculpting the Exos or a traditional cast. The Exos has a mean tendency to create uncomfortable folds where the fingers bend if the person fitting and forming aren’t careful. After watching the company fitting and forming videos, I know my caretakers have room to improve how they are doing things. I lasted only a day before I attacked the huge flap they left me with, and 4 days before I had to do something about the constriction of my pinky. I carefully and patiently warmed things up again and tried to open up the fold. It took me a few tries to keep the 70+ degree bend they seem to strive for. Apparently I did OK without messing anything up. When the PA saw it again she would have liked a little more bend, but didn’t really think reforming was worth it. I’d been able to make it pretty comfortable, and my healing time for such a break seemed normal so I cannot complain.
After the 4 week mark, my PA said I could start taking it off to bath and work to regain some finger movement. Those little piggies were stiff and stinky.
The Half Cast seemed to smell worse after one week then the Exos did after 3 weeks.
The Cons
Again…Your healthcare provider needs to be psyched about it for you to get the max benefit. If your provider is bias towards a traditional cast for whatever reason, that may be your best bet. Most people are resistant to change and healthcare is no different. Just like the guys who poured concrete for me when we were building....they wanted to do things the way they'd always done them rather then try something different.
The Exos advertising touts its waterproofness. Yes, the thermoplastic is waterproof but that doesn’t seem to actually allow you to swim or shower with it as they let on. As I understand it…you need to keep pressure from messing with the break in your bone for max healing. IF you are taking the Exos off to let it dry after showers or swimming you are prolly increasing your healing time. Keeping your had in a wet Exos while things dried out seems like it would have resulted in more messed up skin and pain via some sort of rotten rash. So, not really a con, but more of false advertising and a real let down after looking at things online in the waiting room.
In Conclusion
If you hope to stay active, and don’t think you’ll mind the lack of padding…the Exos if prolly worth it. I’d guess for overall comfort, the traditional cast might be better for some people. I was SUPER ready to get outa the thing, but all and all happy it was suggested to me as an alternative to a normal cast. After 6 weeks in anything…expect inflammation and to be really weak and really stiff. That is just the reality of a human body. My grip strength after being in the cast was over 100 pounds different between my healthy hand and my recovered hand.
After being out of the Exos only 3 days, and a few PT sessions my fingers are coming around but I’m still a long ways from being able to make a fist or even think about many “normal” movements such as a push up. REALLY REALLY happy to be out of it though, and on the way to full recovery. Hurt bodies are to be expected if you live an active and adventurous life so I cannot complain. Its part of the trade off if you expect to really live your life vs just exist. And heck…I heard tail of more then one person breaking bones slipping on ice in the driveway, so at least this little mishap in my motorbike was way more exciting then that.
If all continues to go well, we should be back on the motorbike soon and ready to guide this season starting in mid April. Hopefully be doing some climbing in the southwest between now and then in preparation. For now though, I'm just hoping to be able to bend my fingers and wrist enough to make a fist and do a pushup soon.
Here is a link for the Exos cast for boxers fracture that I had.
