Revision Surgery for 5th Metatarsal Fractures

Abstract

Repairing fractures of the 5th metatarsal (MT) between the proximal metaphysis and diaphysis poses a challenge to physicians due to the low blood supply and high forces experienced in the area. Fifth MT fractures can be treated nonoperatively or operatively; however, operative treatment typically results in faster recovery and a lower rate of re-fracture and is especially recommended for athletes. Intramedullary screw fixation is the most commonly used operative repair technique. Re-fracture of the 5th MT following screw fixation can occur and is common particularly in the athletic population, occurring in 4–12% of athletes. Causative factors are thought to include the high demands and stresses placed on the repair upon return to sport and improper screw length or positioning during initial repair. Thus, during revision surgery, it is essential to determine the proper screw length and ideal screw positioning to achieve a successful and lasting repair. The primary author’s practice advocates the use of shorter screw lengths due to the curvature of the 5th MT bone as opposed to the longer screw which is historically recommended and used with a “high and inside” technique.