Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation

Abstract

Reamed intramedullary (IM) screw fixation for proximal fifth metatarsal fractures is technically challenging with potentially devastating complications if basic principles are not followed. A case of an iatrogenic fourth-degree burn after elective reamed IM screw fixation of a proximal fifth metatarsal fracture in a high-level athlete is reported. The case was complicated by postoperative osteomyelitis with third-degree soft-tissue defect. This was successfully treated with staged autologous bone graft reconstruction, tendon reconstruction, and local bi-pedicle flap coverage. The patient returned to competitive-level sports, avoiding the need for fifth ray amputation. Critical points of the IM screw technique and definitive reconstruction are discussed. Bulk autograft reconstruction is a safe and effective alternative to ray amputation in segmental defects of the fifth metatarsal.Level of evidence V.

Acute foot and ankle injuries and time return to sport

“…Most Jones fractures heal after ORIF but in the event of failure, the contributing factors are identifiable in most cases. Rare complications such as thermal necrosis post intramedullary fixation have been described [26]. The use of bone graft may also be warranted in specific cases when indicated [27].…”