Isolated Shear Fracture of the Metatarsal Head in Lesser Toes Treated With ORIF: Case Series

Abstract

Background: Isolated shear fractures of a metatarsal head in the lesser toes are rare in clinical practice. We report the clinical and imaging characteristics, and treatment results, of these fractures. Methods: A retrospective consecutive case-series study was performed on 7 patients with symptomatic isolated shear fracture of a metatarsal head in the lesser toes who were operatively treated using open reduction and internal fixation (ORIF). Radiographs and computed tomographic (CT) scans of the patients were analyzed. The American Orthopaedic Foot & Ankle Society–lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS) score, and passive dorsiflexion range of motion (ROM) of the metatarsophalangeal (MTP) joint were determined preoperatively and at final follow-up. Postoperative complications were also recorded. Results: There were 5 males and 2 females, with a mean age of 21 years (range, 16-36) at the time of surgery. Four fractures occurred at the fourth metatarsal. There were 3 chronic cases, 1 was not diagnosed initially; the other 2 failed conservative treatment. The main symptom of the chronic fractures was limited dorsiflexion at the MTP joint. Preoperative radiographs and CT scans revealed dorsal displacement of the fragment without dislocation of the MTP joint. At the final follow-up (mean, 17.4 months; range 9-27), the AOFAS-LMI scores had improved from 70.6 (range, 59-79) preoperatively to 93.3 (range, 92-100) ( P = .001). VAS scores showed a decrease in pain from 4.0 to 0.0 ( P = .016). Mean passive dorsiflexion ROM of the MTP joint improved significantly from 8.6 degrees preoperatively to 35.7 degrees at final follow-up ( P < .001). All patients returned to their respective preinjury activity levels. Conclusion: Patients with an acute or chronic isolated shear fracture of a metatarsal head in the lesser toes treated by ORIF achieved good short-term clinical and radiologic outcomes. Level of Evidence: Level IV, retrospective case series.