Surgical correction of metatarsal malunion

Central metatarsal malunion is sparsely described in the literature. There are differing opinions on the importance of open reduction and internal fixation for lesser metatarsal fractures and possible complications from lack of appropriate treatment for these common fractures. In general, little emphasis is placed on performing open reduction and internal fixation of displaced central metatarsal fractures. In this report, we describe 2 cases in which displaced lesser metatarsal fractures were not reduced and were treated with only immobilization. Both of the patients presented later with pain and stiffness in the area of the fractures and at the metatarsophalangeal joints. In both cases, treatment consisted of metatarsal osteotomies with realignment and fixation. In each case, this treatment provided relief of pain, increased range of motion, and return to normal activity. In cases of painful metatarsal malunion, restoration of anatomic alignment may be necessary for resolution of pain and disability.