Case for small group discussion

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Presentation transcript:

Case for small group discussion Metatarsal fracture Case for small group discussion AOTrauma—Foot & Ankle Module 5: Forefoot trauma Stefan Rammelt, DE

Case description 21-year-old marathon runner 8 weeks after sustaining a stress fracture Nonunion of fifth metatarsal proximal metaphysis

10 months post injury Debridement, plate fixation

14 months postinjury—persistent nonunion

Revision

1-year follow-up x-rays Solid fusion Patient is pain free

Take-home messages Low healing potential (watershed area) Look for foot deformities in stress fractures Revision—intramedullary screw with cortical thickening Resection and bone grafting for complete nonunion (obliteration of medullary canal) Reference: Torg JS, et al. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984;66(2):209–214. Rammelt S, Heineck J, Zwipp H. Metatarsal fractures. Injury. 2004 Sep;Suppl:SB77–SB86. Torg JS, et al. J Bone Joint Surg Am. 1984;66(2):209–214. Rammelt, et al. Injury. 2004;Suppl:SB77–SB86.