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  • SUMMARY
  • Epidemiology
  • Etiology
  • ANATOMY
  • CLASSIFICATION
  • PRESENTATION
  • IMAGING
  • TREATMENT
  • TECHNIQUES
  • COMPLICATIONS
    • Nonunion
      • incidence
        • nonunion rates for Zone 2 injuries are as high as 15-30%
      • risk factors
        • zone 2 and zone 3 fractures due to vascular supply
        • smaller diameter screws (<4.5mm) associated with delayed or nonunion
        • nutritional (vitamin-D) or hormonal (thyroid) deficiencies
      • treatment
        • revision intramedullary screw fixation with use of bone grafting
    • Failure of fixation
      • risk factors
        • elite athletes
        • return to sports prior to radiographic union
        • fracture distraction or malreduction due to screw length
          • screws that are too long will straighten the curved metatarsal shaft or perforate the medial cortex
          • screw that is too short will not compress fracture
      • treatment
        • revision internal fixation
    • Refracture
      • incidence
        • 33% of zone 2 fractures following nonoperative treatment
      • risk factors
        • cavovarus foot deformity, stress fractures, vitamin-D insufficiency, removal of intramedullary screw
      • treatment
        • internal fixation with surgical correction of cavovarus deformity if present
        • leave screw in place until end of patient's athletic career
    • Painful hardware
      • incidence
        • rare complication following intramedullary screw fixation
      • risk factors
        • screw head left prominent can irritate sural nerve branches
      • treatment
        • modified shoewear
    • Sural nerve injury
      • risk factors
        • direct trauma during screw insertion
        • prominent screw head impinging on nerve branches
          • dorsolateral branch of sural nerve within 2-3 mm of tuberosity
      • treatment
        • prevented by using tissue protector during procedure and sinking screw head
    • Chronic pain
      • uncommon, result of zone 1 fracture nonunion after initial conservative treatment
      • treatment
        • fragment excision and reattachment of peroneus brevis tendon
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Foot & Ankle⎪5th Metatarsal Base Fracture
  • Foot & Ankle
  • - 5th Metatarsal Base Fracture
21:21 min
10/15/2019
1715 plays
5.0
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