![]() The patient was given instructions again for strict non-weight-bearing with the use of crutches and/or a knee roller. Immediate postoperative films demonstrated the metatarsal cage construct (Figure 7). The surgical site was appropriately irrigated and closed, and the extremity was splinted. Following this, a 6-hole straight plate was applied to the lateral aspect of the fifth metatarsal with locking screws, avoiding the site of most comminution and reconstruction via bone substitute (Figure 6). The bone substitute was allowed to set for approximately eight minutes per manufacturer and company representative suggestion.Īt this time, a 7-hole Y-plate was applied to the dorsal aspect of the remodeled fifth metatarsal and was fixated with locking screws. A 3-0 Vicryl suture was tied circumferentially around the distal shaft of the fifth metatarsal in order to further secure the bone fragments and HydroSet together. The HydroSet was allowed to harden and convert to hydroxyapatite prior to fixation being attempted as per manufacturer recommendations. An injectable bone substitute (HydroSet ®, Stryker Corporation) was used to fill the various defects between the fracture fragments and remodel the shaft and head of the fifth metatarsal as close to anatomical position as possible (Figure 5). The decision was made to attempt reconstitution of the fifth metatarsal and large defects secondary to the repeat fracture. ![]() ![]() Appropriate reduction and temporary fixation proved to be difficult due to these changes. Significant comminution and displacement of the fracture fragments was appreciated as well as osteopenic changes of the metatarsal (Figure 4). Dissection was carried through the deeper tissues until the hardware was encountered and removed. Intraoperatively, a longitudinal incision was placed utilizing the previous incision site. The decision was made for revisional surgery and repeat ORIF of the fracture. X-rays were obtained, showing loosening and failure of the hardware with increased diastasis across the previous fracture fragments (Figure 3). About 3 weeks after the surgery, the patient presented to the office with acute pain and swelling after bearing weight on the surgical foot. The patient progressed well in the postsurgical phase with no significant initial events. The patient was instructed to remain non-weightbearing to the surgical foot. Appropriate ORIF was performed utilizing a lag screw and neutralization plate construct (Figure 2). The treatment plan consisted of surgical intervention due to the nature of the fracture. X-rays were obtained, demonstrating a closed, displaced fracture of the fifth metatarsal shaft with a butterfly fragment and shortening (Figure 1). Ecchymosis and swelling were noted to the lateral aspect of the foot. On exam, the patient had palpable 2/4 pedal pulses and no neurological deficits. She was a former smoker with a one-pack-per-day, 18-pack-year history, having quit 20 years ago. Case Report: A Displaced Fifth Metatarsal Fracture of the ShaftĪ 58-year-old female with past medical history of gastroesophageal reflux disease (GERD), hypothyroidism, and bronchitis presented to the podiatry clinic with chief complaint of pain to the lateral aspect of the right foot after suffering a fall. The authors present the intraoperative surgical techniques, materials, and pearls that may be utilized in the future for similar revisional surgical cases. While some research suggests a conservative approach to diaphyseal fifth metatarsal fractures, several practitioners continue to opt for surgical intervention in these cases. The literature is not as robust for revisional surgeries for refracture or hardware failure after prior ORIF of fifth metatarsal shaft fractures in the setting of hardware failure, osteopenia due to non-weight-bearing status, and advanced comminution. 4 Multiple techniques have been reported and utilized for open reduction and internal fixation (ORIF) of fifth metatarsal fractures, particularly of the base. 4 Due to the configuration and inherent instability of this fracture pattern, surgical intervention is typically warranted. 1–3 A spiral oblique fracture of the fifth metatarsal shaft, also known as a dancer’s fracture, is often observed with a butterfly fragment. Fractures of the fifth metatarsal are commonly encountered injuries sustained in the foot and have been abundantly documented in trauma literature and surgical textbooks.
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