Chun Lok Chow, M. B. Ch. B. , M. R. C. S. Ed. , Tun Hing Lui, M. B. B

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Endoscopic Management of Nonunion of the Tuberosity of the Fifth Metatarsal Chun Lok Chow, M.B.Ch.B., M.R.C.S.Ed., Tun Hing Lui, M.B.B.S.(H.K.), F.R.C.S.(Edin.), F.H.K.A.M., F.H.K.C.O.S. Arthroscopy Techniques Volume 8, Issue 2, Pages e105-e109 (February 2019) DOI: 10.1016/j.eats.2018.10.001 Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 1 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of left foot. The patient is in lateral position. The base of the fifth metatarsal and the nonunion site is outlined. The medial and lateral portals are marked. (LP, lateral portal MP, medial portal; N, nonunion site; T, tuberosity of the fifth metatarsal.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 2 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of left foot. The patient is in lateral position. (A) Endoscopy of the working space dorsal to the nonunion site is performed via the portals. The nonunion site is marked with a G18 needle. (B) Lateral portal is the viewing portal. Endoscopic view shows insertion of the needle into the nonunion site. (C) Fluoroscopy confirms the position of the needle into the nonunion site. (LP, lateral portal; MP, medial portal; N, nonunion site; nd, needle; T, tuberosity of the fifth metatarsal.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 3 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of the left foot. The patient is in lateral position. The lateral portal is the viewing portal. The tight fibrous tissue at the medial part of the nonunion site is released with an arthroscopic osteotome via the medial portal. (N, nonunion site; nd, needle; Ot, arthroscopic osteotome; T, tuberosity of the fifth metatarsal.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 4 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of the left foot. The patient is in lateral position. The medial portal is the viewing portal. The tight fibrous tissue at the lateral part of the nonunion site is released with an arthroscopic osteotome via the lateral portal. (N, nonunion site; Ot, arthroscopic osteotome; T, tuberosity of the fifth metatarsal.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 5 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of the left foot. The patient is in lateral position. The medial portal is the viewing portal. The fibrous tissue of the nonunion site is loosened and curetted out by a fine-tipped mosquito hemostat. (mh, mosquito hemostat; N, nonunion site; T, tuberosity of the fifth metatarsal.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 6 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of the left foot. The patient is in lateral position. The lateral portal is the viewing portal. The fibrous tissue of the medial half of the nonunion site is curetted out with the hemostat via the medial portal. (mh, mosquito hemostat; N, nonunion site; T, tuberosity of the fifth metatarsal.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 7 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of the left foot. The patient is in lateral position. The lateral portal is the viewing portal. The sclerotic bone surfaces of the nonunion site are freshened by microfracture with an arthroscopic awl. (aw, arthroscopic awl; S, sclerotic bone surfaces of the nonunion site.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 8 Endoscopic management of nonunion of the tuberosity of the fifth metatarsal of the left foot. The patient is in lateral position. (A) The guidewire is transfixing the nonunion site. A cannulated drill is inserted along the guidewire. (B) The 4-mm cannulated screw is inserted along the guidewire. (cd, cannulated drill; cs, cannulated screw; gw, guidewire; N, nonunion site; T, tuberosity of the fifth metatarsal.) Arthroscopy Techniques 2019 8, e105-e109DOI: (10.1016/j.eats.2018.10.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions