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.
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References
Giannoudis PV, Snowden S, Matthews SJ, Smye SW, Smith RM (2002) Temperature rise during reamed tibial nailing. Clin Orthop Relat Res 395:255–261
Rudloff MI, Smith WR (2009) Intramedullary nailing of the femur: current concepts concerning reaming. J Orthop Trauma 23:S12–S17
Boffeli TJ, Abben KW (2012) Complete fifth ray amputation with peroneal tendon transfer—a staged surgical protocol. J Foot Ankle Surg 51:696–701
Boffeli TJ, Smith SR, Abben KW (2016) Complete fifth ray amputation with peroneal tendon transfer to the cuboid: a review of consecutive cases involving lateral column neuropathic foot ulceration and osteomyelitis. J Foot Ankle Surg 55:1148–1157
Carlson RM, Smith NC, Stuck RM, Sage RA (2012) Dislocation of the fifth metatarsal base following partial fourth and fifth ray amputation: a case report. J Am Podiatr Med Assoc 102:71–74
Roukis TS (2010) Minimum-incision metatarsal ray resection: an observational case series. J Foot Ankle Surg 49(1):52–54
Chow LTC (2016) Metatarsal leiomyosarcoma masquerading as acute osteomyelitis—a diagnostic trap unveiled by vigilant clinical, radiologic and pathologic analysis. Foot 27:10–15
Min Lee H, Sung Kim Y, Pil Kim J, Im Lee J, Soo Uhm K (2016) An unusual presentation of verrucous carcinoma of the foot with bone invasion. J Am Podiatr Med Assoc 106:427–429
Firat C, Aytekin AH, Erbatur S (2016) Management of composite tissue defect of the midfoot with a free anterolateral thigh flap and iliac bone graft: a case report. J Foot Ankle Surg (Elsevier Ltd) 55:263–266
St. Hilaire H, Steele TN, Delatte S, Hebert CK, Canizares O (2014) Metatarsal reconstruction with a fibular osteocutaneous flap: a novel approach utilizing virtual surgical planning. Plast Reconstr Surg Glob Open 2:e258
Makridis KG, Theocharakis S, Fragkakis EM, Giannoudis PV (2014) Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique: a case report. Foot Ankle Surg Eur Foot Ankle Soc 20:19–22
Yamashita Y, Hashimoto I, Goishi K, Fukunaga Y, Abe Y, Nakanishi H (2013) Reconstruction of metatarsal bone defects with a free fibular osteomyocutaneous flap incorporating soleus muscle. J Plast Reconstr Aesthet Surg (Elsevier Ltd) 66:277–280
Giannoudis PV, Snowden S, Matthews SJ, Smye SW, Smith RM (2002) Friction burns within the tibia during reaming. Are they affected by the use of a tourniquet? J Bone Jt Surg Br 84:492–496
Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin N Am 41:27–37
Kuzyk PR, Dhotar HS, Sternheim A, Gross AE, Safir O, Backstein D (2014) Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes. J Am Acad Orthop Surg 22:153–164
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Andrea Veljkovic has stocks in AIC and Therapia; is a speaker for Arthrex; receives research funding from Acumed, Zimmer, and Amniox. Kevin Wing receives financial/material support from Acumed, Arthrex, Biomimetric, Synthes, DePuy, and Zimmer; is a paid consultant and speaker for Wright Medical; is a board/committee member for the Canadian Orthopaedic Association and Canadian Orthopaedic Foot and Ankle Society. Murray Penner is a paid consult and speaker for Amniox and Wright Medical; receives research support from Amniox and Wright Medical; receives royalties from Wright Medical and Springer; receives financial or material support from Zimmer, Arthrex, Cartiva, Springer, and Synthes; is a board/committee member of the Canadian Orthopaedic Foot and Ankle society and International Federation of Foot and Ankle Societies. Alastair Younger receives research support from Amniox, Bioventus, Synthes, Acumed, Zimmer, and Wright Medical; is a paid consultant or speaker for Acumed, Ferring Pharmaceuticals, Wright Medical, and Zimmer; is a board/committee/editorial member of the American Orthopaedic Foot and Ankle Society, Canadian Orthopaedic Association, Foot and Ankle International journal, and Wolters Kluwers Health–Lippincott Williams & Wilkins.
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This project was not funded. Vu Le, Mario Escudero, and Peter Salat have no conflicts to disclose.
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Veljkovic, A., Le, V., Escudero, M. et al. Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation. Knee Surg Sports Traumatol Arthrosc 28, 1595–1599 (2020). https://doi.org/10.1007/s00167-018-4903-9
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DOI: https://doi.org/10.1007/s00167-018-4903-9