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Knee Surg Sports Traumatol Arthrosc. 2018 Mar 21. doi: 10.1007/s00167-018-4903-9. [Epub ahead of print]

Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation.

Author information

1
Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
2
Department of Orthopaedics, University of British Columbia, Vancouver, Canada. brianle.ortho@gmail.com.
3
Department of Radiology, University of Calgary, Calgary, Canada.

Abstract

Reamed intramedullary (IM) screw fixation for proximal fifth metatarsal fractures is technically challenging with potentially devastating complications if basic principles are not followed. A case of an iatrogenic fourth-degree burn after elective reamed IM screw fixation of a proximal fifth metatarsal fracture in a high-level athlete is reported. The case was complicated by postoperative osteomyelitis with third-degree soft-tissue defect. This was successfully treated with staged autologous bone graft reconstruction, tendon reconstruction, and local bi-pedicle flap coverage. The patient returned to competitive-level sports, avoiding the need for fifth ray amputation. Critical points of the IM screw technique and definitive reconstruction are discussed. Bulk autograft reconstruction is a safe and effective alternative to ray amputation in segmental defects of the fifth metatarsal.Level of evidence V.

KEYWORDS:

Fourth-degree burn; Iatrogenic burn; Intramedullary screw; Jones fracture; Metatarsal fracture; Osteomyelitis; Segmental bone defect; Stress fracture; Thermal necrosis

PMID:
29564471
DOI:
10.1007/s00167-018-4903-9

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