$5th metatarsal fracture screw fixation$

After removing the screw, we were able to determine through direct visualization and intraoperative fluoroscopy that enough bone remained to preserve the viability of the fifth metatarsal. After using a mini-power burr to create a small window along the length of the screw at the lateral aspect of the fifth metatarsal, we had adequate visualization of the screw, which we further loosened with an osteotome and mallet. This technique did not work and resulted in further stripping of the screw head.Īt this time, we opted to perform the intramedullary screw extraction through a cortical window technique. In another approach to remove the screw, we burred the bone around the screw head in an attempt to advance the screw forward prior to reversing it out. For the intramedullary screw removal, all standard techniques failed including the use of a screwdriver, pliers and a needle driver. We sharply excised the fractured bone, taking care not to damage the tendon.ĭue to an underlying metatarsus adductus deformity, the screw head became more prominent after excision of the fractured fragment. We carried dissection down to the level of the fifth metatarsal tuberosity where we encountered the avulsed fracture fragment and noted it to be partially incorporated into the peroneus brevis tendon. Use of a thigh tourniquet facilitated hemostasis. Under general anesthesia, the patient was in the lateral decubitus position. After failing conservative measures, the patient elected to have surgical removal of the painful hardware and the fractured base of the fifth metatarsal. Radiographs revealed an avulsion fracture of the fifth metatarsal tuberosity. The significant past medical history included hypertension, hyperlipidemia, anxiety and smoking. The patient had suffered a Jones fracture approximately 15 years prior, resulting in open reduction internal fixation with the use of a cannulated, partially threaded cancellous screw. What You Should Know About The Patient And The Surgical TechniqueĪ 57-year-old female presented with pain at the base of the fifth metatarsal after she sustained an inversion injury to her foot. To our knowledge, this is the first cortical window technique described for removal of an intramedullary screw of the fifth metatarsal. Utilizing a similar approach, we present a case and technique for performing an extraction of an intramedullary screw fixation of the fifth metatarsal. 9,10 In this technique, a cortical window is created through the anterior aspect of the femur for removal of stem implant followed by impaction with an allograft which is secured using cerclage wire. The use of a windowing technique has had wide discussion in the orthopedic literature for performing a total hip arthroplasty revision. However, when removing a partially threaded intramedullary screw, one should anticipate complications with hardware removal. This often results in removal of the intramedullary screw after osseous union has occurred. 3,5-8 A concern with utilizing the intramedullary screw technique is the presence of painful hardware once the individual has resumed full activity. When surgical intervention of a fifth metatarsal base fracture is required, authors have described numerous techniques including the use of intramedullary screw fixation, tension band wiring, plating and crossed Kirschner wires. Non-displaced acute fractures of the fifth metatarsal tend to respond better to conservative treatment whereas authors recommend surgical intervention in athletes and active individuals due to increased failure rates of conservative treatment. 2,3 Although controversial, conservative or surgical management of the fracture is primarily based on the severity of displacement and the patient’s activity level.

$5th metatarsal fracture screw fixation$

1 Acute fractures of the fifth metatarsal metaphyseal-diaphyseal junction generally present as transverse fractures due to a low energy force when the individual experiences a fall or twisting motion to the foot.

$5th metatarsal fracture screw fixation$

These authors describe a cortical window technique for extracting a failed intramedullary screw in a 57-year-old patient with a fifth metatarsal fracture.įifth metatarsal base fractures are the most common metatarsal fractures of the foot.

$5th metatarsal fracture screw fixation$