Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation

  • Andrea Veljkovic
  • Vu Le
  • Mario Escudero
  • Peter Salat
  • Kevin Wing
  • Murray Penner
  • Alastair Younger


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.


Metatarsal fracture Intramedullary screw Segmental bone defect Osteomyelitis Iatrogenic burn Thermal necrosis Fourth-degree burn Jones fracture Stress fracture 



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.

Compliance with ethical standards

Conflict of interest

This project was not funded. Vu Le, Mario Escudero, and Peter Salat have no conflicts to disclose.

Ethical approval

As this is not a clinical study or trial and not a research project, there is no institutional ethics approval required.

Informed consent

Consent was given directly by the patient for publication of this material.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
  2. 2.Department of RadiologyUniversity of CalgaryCalgaryCanada

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