Executive Editor: Joseph Schatzker, Richard Buckley

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

Metatarsals - 2nd-4th, subcapital fractures, ORIF: plate fixation

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A sterile dressing is applied and the patient is immobilized in a boot or in a below-knee cast.
If the state of the soft tissues is precarious, a padded bandage should be applied initially, and the limb should be maintained elevated until the swelling has subsided and healing of the soft tissues without further problems can be anticipated. The foot is then immobilized either in a boot or in a below-knee cast. The advantage of the boot is that it can be easily removed for inspection of the wound and for regular exercises and mobilization of the joints. 

Weight bearing

Weight bearing is delayed until such time as the wound is healed.
The sutures are removed 2 weeks postoperatively and  graduated weight bearing is started. The degree of loading of the extremity is determined by the severity of the injury and the stability of the fixation achieved. Early loading is important but not at the expense of loss of fixation. Intermittent elevation of the foot and extremity should be continued until such time as the swelling has subsided.

For percutaneous K-wire fixation

Weight bearing in a heel-wedge shoe is permitted. The K-wires are removed in the clinic at six weeks, at which point a flat postoperative or hard-sole shoe is permitted as tolerated.

Follow up

X-rays are taken at 6 weeks postoperatively to assess union and the integrity of the fixation.
The resumption of the use of normal footwear is guided by the clinical signs and x-ray evidence of union.

v2.0 2017-03-22