Reduction and fixation of the second metatarsal base
Once the dissociation between the first metatarsal and the medial cuneiform has been reduced and stabilized, the medial arch of the foot has been restored and we are ready to reduce the second metatarsal.
The second metatarsal is reduced into the keystone (formed between the base of the first metatarsal and the first cuneiform, the articular surface of the second cuneiform, the lateral surface of the third cuneiform and the third metatarsal).
Once the second metatarsal has been reduced into place in the medial part of the “keystone”, its fixation is accomplished with a lag screw placed from the medial area of the medial cuneiform, through the base of the second metatarsal. A solid fully-threaded 4.0 mm screw gives the strongest fixation. If there is not enough space, a smaller-diameter screw can be used, but this weakens the construct.
If cannulated screws are used, there is an increased incidence of fixation failure and screw breakage. Cannulated screws are not as strong and tend to break with repeated bending forces.