SLR - November 2023 - Bettag
Title: Evaluation of Internal Fixation of Base of Fifth Metatarsal Fracture of the Foot by ScrewReference: Abdelsalam AE, Mautog AFA, Gerges FSF, Abdelkader SM. Evaluation of Internal Fixation of Base of Fifth Metatarsal Fracture of the Foot by Screw. Egyptian Journal of Hospital Medicine. 2022 Apr; 87.
Level of Evidence: Level 3
Reviewed by: Sarah Bettag
Residency Program: East Liverpool City Hospital- East Liverpool, Ohio
Podiatric Relevance: Fifth metatarsal fractures are a common podiatric problem with treatment ranging from CAM walker boot to surgical intervention. Even while fifth metatarsal fractures are frequent complaints, the high rates of nonunions and refractures show the challenges involved in healing these fractures.
Methods: This study observed the outcomes of a percutaneous screw and washer fixation for fifth metatarsal fractures. 18 patients aged 18-50 years old with an acute, closed jones fracture type 2 of the fifth metatarsal base. A 4.00mm cannulated screw with a washer was implanted percutaneously along the fracture line with spinal anesthesia for pain control. Before implantation, an ultrasound guided incision was made in the peroneus brevis and the plantar fascia.
Results: After 6 weeks, 44.4% of fractures were united, and 22.2% of fractures required more than 8 weeks for complete radiographic union. The mean time for full union was 6.9 weeks and ranged from 5-10 weeks. Mean AOFAS score was 87.2, and scores ranged from 72 to 91. All patients avoided any post op complications including infection and nonunion.
Conclusions: Authors support percutaneous screw fixation for successful treatment of fifth metatarsal base fractures. This study needs more patients and a control group for better results. A percutaneous approach is becoming more popular with decreased complications compared to open procedures. It’s important to compare and contrast various techniques for common complaints. Considering a percutaneous fixation for a fifth metatarsal fracture could be a better option for patients who have an increased risk of infection or complications with open surgery.