Percutaneous Screw Fixation of Proximal Fifth Metatarsal Fractures

Area of Science:

• Orthopedic surgery
• Foot and ankle trauma
• Fracture management

Background:

• Fifth metatarsal fractures, particularly zone 2 (Jones fractures), are common and challenging due to retrograde vascular supply, leading to high nonunion rates with nonoperative treatment.
• Surgical management, including intramedullary screw fixation and plate fixation, demonstrates higher union rates compared to nonoperative modalities for zone 2 Jones fractures.

Purpose of the Study:

• To describe a minimally invasive surgical technique for open reduction and internal fixation (ORIF) of zone 2 intra-articular Jones fractures with minimal to moderate displacement.
• To highlight the advantages of percutaneous intramedullary screw fixation in reducing soft-tissue damage, infection rates, and operative time.

Main Methods:

• Meticulous marking of anatomical landmarks (distal fibula, fifth metatarsal) under fluoroscopic guidance for precise guidewire placement.
• Percutaneous insertion of a guidewire into the center of the medullary canal, followed by drilling and fixation with a 5.0-mm headless compression screw.
• Minimally invasive approach with a small incision, protecting surrounding nerves and tendons, followed by closure and a soft wrap.

Main Results:

• The described technique aims for primary bone healing through compression of the Jones fracture via the headless compression screw.
• Expected outcomes include high union rates (89-100% in meta-analysis) and improved functional recovery.
• This technique is not recommended for comminuted fractures or those with proximal split fractures.

Conclusions:

• Percutaneous intramedullary screw fixation is a low-risk, highly successful surgical approach for zone 2 intra-articular Jones fractures with minimal to moderate displacement.
• This technique offers significant advantages over nonoperative treatment due to high nonunion rates associated with the latter.
• Early operative intervention with screw fixation is strongly supported by evidence for improved outcomes in acute Jones fractures.