Clin Orthop Surg.  2011 Jun;3(2):140-146. 10.4055/cios.2011.3.2.140.

Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation

• Mahajan V
• Chung HW
• Suh JS

• KMID: 1719311
• DOI: http://doi.org/10.4055/cios.2011.3.2.140

Abstract

BACKGROUND
Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures.
METHODS
Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months.
RESULTS
Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases.
CONCLUSIONS
The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.

Keyword

Fifth metatarsal; Proximal metatarsal fracture; Percutaneous fixation; Bicortical fixation

MeSH Terms

Adolescent
Adult
Aged
Bone Screws
Female
Follow-Up Studies
Fracture Fixation, Internal/*methods
Fractures, Bone/radiography/*surgery
Humans
Male
Metatarsal Bones/*injuries/radiography/*surgery
Middle Aged

Figure

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  Fig. 1 Schematic representation of the fracture zones for fifth metatarsal base fractures by Lawrence and Botte3) (zone I, zone II, zone III) and the gray-colored area represents the zone II and intraarticular zone I fractures for surgical intervention in this study.

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  Fig. 2 Intraoperative radiographs. (A) Stab incision. (B) Guide wire introduction. (C) Bicortical guide wire placement. (D) Bicortical screw fixation (oblique). (E) On the lateral view, note the compression at the fracture site following bicortical fixation.

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  Fig. 3 (A) Zone I fracture. (B) The fracture during the immediate postoperative period. (C) Solid union at 6 weeks. (D) Implant removal at 6 months. Note that compression was achieved.

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