Executive Editor: Joseph Schatzker, Richard Buckley

Authors: Michael Castro, Richard Buckley, Andrew Sands, Christina Kabbash

Metatarsals - 1st, shaft, transverse or oblique

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Glossary

General considerations

Minimally displaced fractures may be treated nonoperatively.

A transverse fracture, if displaced, requires an open reduction and internal fixation to reconstruct the anatomy of the foot.

ORIF: lag screw and plate fixation
Main indication Skill Equipment
Displaced first metatarsal shaft or multiply displaced metatarsal shafts Some specialized surgical experience Basic equipment only

Indications

  • Displaced intraarticular fracture (> 2 mm)
  • Multiple intraarticular fractures
  • Dislocations of lesser MTP joints with first metatarsal intraarticular fracture
  • Combination Lisfranc and metatarsal fractures that are displaced
  • Open fractures

Contraindications

  • Severely compromised soft tissue or contamination

Advantages

  • Early motion
  • Less pain
  • Anatomic reconstruction of foot anatomy

Disadvantages

  • Occasional painful scarring with ORIF
  • After open fracture increased chance of infection
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2017-03-22