Authors:
Vivek Mahajan, MD, Hyun Wook Chung, MD, and Jin
Soo Suh, MD
Journal: Clinics in Orthopedic Surgery
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.
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Keywords: Fifth
metatarsal, Proximal metatarsal fracture, Percutaneous fixation, Bicortical
fixation.