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Second Metatarsal Fracture During Lapidus Hallux Valgus Correction: A Case Report
Alexandra F Flaherty1,2, Jie Chen3
1John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas.
JBJS Case Connector
|March 22, 2023
Summary
A Lapidus hallux valgus correction complicated by a second metatarsal fracture was successfully managed. The fracture was percutaneously reduced and healed, demonstrating a viable technique for managing intraoperative complications during bunion surgery.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
- Podiatric Surgery
Background:
- The Lapidus procedure is a common surgical treatment for hallux valgus.
- Maintaining structural integrity of the metatarsals is crucial for surgical clamp use during Lapidus procedures.
Observation:
- A 67-year-old woman with rheumatoid arthritis experienced an intraoperative fracture of the second metatarsal during Lapidus hallux valgus correction.
- The fracture occurred through a pre-existing K-wire hole when repositioning the surgical clamp.
Findings:
- The Lapidus procedure was completed despite the fracture.
- The fractured second metatarsal was successfully managed with a percutaneous K-wire fixation.
- Both the tarsometatarsal fusion and the second metatarsal fracture achieved solid healing.
Implications:
- This case highlights the importance of considering bone quality and K-wire hole integrity when using clamps during Lapidus procedures.
- Percutaneous fracture reduction, though technically challenging, is a feasible management strategy for intraoperative metatarsal fractures during hallux valgus surgery.
- This approach offers a potential solution for managing similar complications, ensuring successful outcomes in complex foot surgeries.
