Release notes of Metatarsal fractures

The content has been revised and extended by Khairul Faizi Mohammad (MY) and Brad Yoo (US), with Markku T Nousiainen (CA) and Richard E Buckley (CA) as executive editors.

Keen-Wai Chong (SG) helped to set up the table of content.

The metatarsal material, third edition, includes a detailed description of the following injury types and their management.

Proximal articular fractures of the 1st–4th metatarsal:

• Nonoperative treatment
• Lag screw fixation
• Nonlocking plate with/without lag screws
• Locking plate with/without lag screws
• Arthrodesis of metatarsals 1–3 (length stable)
• Arthrodesis of metatarsals 1–3 (length unstable)
• Dorsal spanning plate

Simple diaphyseal and proximal extraarticular fractures of the 1st–4th metatarsal:

• Nonoperative treatment
• Intramedullary K-wire fixation
• Lag screw and neutralization plate
• Compression plate (straight plate)
• Compression plate (T-plate)

Wedge diaphyseal and proximal extraarticular fractures of the 1st–4th metatarsal:

• Nonoperative treatment
• Lag screw and neutralization plate
• Compression plate (straight plate)
• Intramedullary K-wire fixation
• Compression plate (T-plate)

Multifragmentary diaphyseal and proximal extraarticular fractures of the 1st–4th metatarsal:

• Nonoperative treatment
• Intramedullary K-wire fixation
• Bridge plate fixation

Distal extraarticular fractures of the 1st–4th metatarsal:

• Nonoperative treatment
• Intramedullary K-wire fixation
• K-wire fixation
• Compression plate (T-plate)

Distal articular fractures of the 1st–4th metatarsal:

• Nonoperative treatment
• Lag screw fixation
• Nonlocking plate with/without lag screws
• Locking plate with/without lag screws
• Arthrodesis of 1st MTP joint
• Excision arthroplasty

Proximal avulsion fractures of the 5th metatarsal (pseudo-Jones):

• Nonoperative treatment
• Hook plate

Proximal extraarticular fractures of the 5th metatarsal (march fracture):

• Nonoperative treatment
• Intramedullary screw or lag screw fixation
• Plate fixation

Proximal articular fractures of the 5th metatarsal (Jones fracture):

• Nonoperative treatment
• Intramedullary screw or lag screw fixation
• Plate fixation

Diaphyseal fractures of the 5th metatarsal:

• Nonoperative treatment
• Intramedullary K-wire fixation
• Bridge plate fixation
• Lag screw and neutralization plate

Distal fractures of the 5th metatarsal:

• Nonoperative treatment
• Intramedullary K-wire fixation
• K-wire fixation
• Excision arthroplasty

Crush injuries:

• Nonoperative treatment
• ORIF

Treatment of Lisfranc injuries

Approaches:

• Dorsal approach to multiple metatarsals
• Dorsal approach to single metatarsals 2–4
• Dorsal approach to the 1st metatarsal
• Lateral approach to the 5th metatarsal
• Medial approach to the 1st metatarsal
• Medial approach to the hallux
• Dorsal approach to the first metatarsal phalangeal joint (MTPJ)
• Dorsal approach to the proximal phalanx

Patient preparations:

• Supine position

Further reading:

• Patient examination
• Timing of surgery
• Complications
• References

The content was revised by Andrew Sands (US) and Christina Kabbash (US), with Richard E Buckley (CA) as executive editor.

Mandeep Dhillon gave feedback on the content. His comments and suggestions were considered and included.

The metatarsal material, second edition, included a detailed description of the following injury types and their management.

1st metatarsal, head, intraarticular oblique:

• ORIF or K-wire fixation

1st metatarsal, head, intraarticular T-type:

• ORIF or K-wire fixation

1st metatarsal, head, intraarticular comminuted:

• ORIF or MTP joint fusion

1st metatarsal, shaft, transverse or oblique:

• ORIF: lag screw and plate fixation

1st metatarsal, base, intraarticular:

• ORIF: lag screw or plate fixation

2nd–4th metatarsal, proximal metaphyseal fractures:

• ORIF: screw and plate fixation

2nd–4th metatarsal, diaphyseal fractures:

• ORIF: screw and plate fixation

2nd–4th metatarsal, subcapital fractures:

• ORIF: plate fixation

5th metatarsal, base (Jones fracture):

• ORIF: screw fixation

5th metatarsal, base, metaphyseal avulsion fractures:

• Nonoperative treatment

5th metatarsal, long oblique diaphyseal fractures:

• ORIF: screw fixation

5th metatarsal, multifragmentary diaphyseal fractures:

• ORIF: plate fixation

Crush injuries:

• ORIF or K-wire fixation

Approaches:

• Medial approach to 1st metatarsal
• Dorsal approach to 1st metatarsal
• Dorsal approach to 1st metatarsal and MTP joint
• Dorsal intermetatarsal approach
• Lateral approach to 5th metatarsal

Further reading:

• Compartment syndrome

The first edition was created by Michael Castro (US), with Joseph Schatzker (CA) as executive editor.