The Use of Percutaneous Screw Fixation Without Fracture Site Preparation in the Treatment of Fifth Metatarsal Base Nonunion

Fifth metatarsal fractures: an update on management, complications, and outcomes

“…There is a plethora of non-operative treatment modalities, including elastic bandage support, non-weight-bearing casting, a hard-soled shoe, short-leg walking casts, and a cam walker boot (47,48,49,50,51,52). Various surgical techniques exist, with intramedullary screw fixation (6,13,36,53,54,55,56,57,58,59) with or without bone grafting, tension band constructs (60), and low-profile plates (61,62,63,64,65,66,67).…”

“…One of the problems is that the term 'Jones fracture' has been inconsistently used to include both Zone 2 and Zone 3 fractures (49, 87). In general, the 'true Jones' fractures should be treated with nonweight-bearing, as weight-bearing has been implicated in increased incidence of non-union (54), although there has also been a trend toward 'functional treatment' consisting of full weight-bearing accompanied by full range of motion (49, 50). Several authors have reported successful conservative treatment (50,88,89).…”

“…However, because of the watershed area of the region, non-union rates of Zones 2 and 3 have been reported to be up to 21% after non-operative management (84,90,91,92). Healing starts from a medial to lateral direction and callus is seen Intramedullary screw fixation with or without grafting is being widely performed (6,13,36,53,54,55,56,57,58,59) (Fig. 4).…”

“…Although surgical outcomes are widely successful (6,13,36,53,54,55,56,57,58,59,80,94,97,99,100,101,106), possible complications include hardware failure (Fig. 5) and refracture (102), sural nerve injury (12), malunion, delayed union/non-union, prominence of the screwhead, chronic low level pain (109), and iatrogenic fractures (12,36).…”

The Use of Percutaneous Screw Fixation Without Fracture Site Preparation in the Treatment of Fifth Metatarsal Base Nonunion

“…1. The authors (1) reported their experience with a different pattern of nonunion and described the surgical technique, stressing the concept of screw insertion (90°to the fracture site). This theory is not completely valid, because it is possible to use cannulated screws, in particular headless screws, as an elastic nail rather than a lag screw, as clearly shown in Fig.…”