Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation
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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.
KeywordsMetatarsal fracture Intramedullary screw Segmental bone defect Osteomyelitis Iatrogenic burn Thermal necrosis Fourth-degree burn Jones fracture Stress fracture
Compliance with ethical standards
Conflict of interest
This project was not funded. Vu Le, Mario Escudero, and Peter Salat have no conflicts to disclose.
As this is not a clinical study or trial and not a research project, there is no institutional ethics approval required.
Consent was given directly by the patient for publication of this material.