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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...

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Flexor Tendon Injury Risk With Percutaneous Intramedullary Screw Fixation for Lesser Metatarsal Fractures: A

James D Baker1,2, Joseph S Burke1,2, Jantz Arbon1,2

  • 1Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA.

Foot & Ankle International
|July 10, 2025
PubMed
Summary
This summary is machine-generated.

Percutaneous intramedullary screws for lesser metatarsal fractures caused flexor tendon injury in 37.5% of cases, particularly the fourth metatarsal. Further research is needed to understand the clinical impact of these injuries.

Keywords:
forefoot disorderstendon disorderstrauma

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Area of Science:

  • Orthopedic Surgery
  • Foot and Ankle Surgery
  • Surgical Techniques

Background:

  • Percutaneous intramedullary screws offer advantages for lesser metatarsal fracture fixation, including reduced pin site complications and improved stability.
  • Limited data exists on the safety profile and potential complications of this fixation method.
  • Flexor tendon disruption is a potential concern with percutaneous screw placement.

Purpose of the Study:

  • To evaluate the incidence and severity of flexor tendon injury following percutaneous intramedullary screw fixation of lesser metatarsal fractures.
  • To determine the anatomical relationship between screw placement and flexor tendons in the lesser metatarsals.

Main Methods:

  • Cadaveric lower extremity specimens were utilized for the study.
  • A 3.6-mm cannulated screw was inserted percutaneously into the second through fifth metatarsals in a retrograde manner.
  • The plantar aspect was dissected to assess flexor tendon proximity, injury incidence, and degree of disruption relative to the screw's drill hole.

Main Results:

  • Overall, 37.5% (21/56) of flexor tendons sustained injury.
  • The fourth metatarsal showed the highest injury rate (64.3%), with an average tendon disruption of 11%.
  • Mean distance from uninjured tendons to the drill hole varied by metatarsal, with the fifth metatarsal showing the greatest clearance.

Conclusions:

  • Percutaneous intramedullary screw fixation for lesser metatarsal fractures is associated with a significant rate of flexor tendon injury (37.5%).
  • The clinical significance of these partial tendon disruptions (10-20% width) requires further investigation.
  • Modifying screw entry points laterally may reduce the risk of injury; future studies should examine functional and biomechanical outcomes.