Three-wire Fixation Technique for Displaced Fifth Metatarsal Base Fractures

Authors: James L. Thomas & Barry C. Davis

Journal: Journal of Foot and Ankle Surgery

Abstract: Fractures of the tuberosity of the fifth metatarsal are the most common type of fifth metatarsal fractures. This particular fracture usually produces low morbidity and low rates of nonunion when treated nonoperatively. However, on occasion, significant displacement, comminution, or significant intra-articular involvement may warrant operative intervention. Multiple techniques have been described for the operative care of this fracture. We present a somewhat simplified fixation method for displaced fifth metatarsal fractures in a small set of patients who were all followed up to final healing of the fracture.

Keywords: bone, foot, injury, surgery, trauma

Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation

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.

Keywords: Fifth metatarsal, Proximal metatarsal fracture, Percutaneous fixation, Bicortical fixation.

Cannulated Screw Fixation of Jones Fifth Metatarsal Fractures: A Comparison of Titanium and Stainless Steel Screw Fixation

J. George DeVries, DPM, AACFAS 1, Daniel J. Cuttica, DO 2, Christopher F. Hyer, DPM, FACFAS 3

The Journal of Foot & Ankle Surgery: 50 (2011) 207–212

The classic Jones fracture involves the fifth metatarsal at the level of the proximal diaphyseal-metaphyseal junction. The mainstay of surgical treatment for the Jones fracture is intramedullary screw fixation. There is no consensus of the type or material of screw that should be used. The purpose of this retrospective cohort study was to test the hypothesis that there is no clinical difference in the incidence of healing, or complica- tions, when comparing stainless steel to titanium cannulated screws used in Jones fracture open-reduction internal fixation (ORIF). Data were collected on a total of 53 patients (fractures) that were fixed with either cannulated titanium screws (Ti group) or cannulated stainless steel screws (SS group). The postoperative protocol was standardized. The mean time to radiographic union was 11.7 ` 5.1 weeks in the Ti group and 13.4 ` 5.7 weeks in the SS group (P 1⁄4 .333). The overall union rate for the Ti group was 36/37 (97%) and 14/16 (88%) in the SS group (P 1⁄4 .213). Complications were rare in both groups, and the prevalence was not statistically significantly different (P > .05). There was 1 patient with an asymptomatic radiographic nonunion in the Ti group, and this patient elected not to undergo revision. There were 2 nonunions in the SS group. One was revised and went on to heal and the other is awaiting revision. Our study has demonstrated the decision to use stainless steel or titanium can be left to patient constraints, such as allergies, or physician preference without compromising the clinical result.

Level of Clinical Evidence: 3 

Keywords: biomechanics injury ORIF nonunion surgery trauma

1 Staff Surgical Podiatrist, Ripon Medical Center, Ripon, WI 

2 Orthopaedic Surgeon, Center for Orthopaedic Surgery and Sports Medicine, Indianapolis, IN 

3 Fellowship Co-director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center, Westerville, OH