Reduction and fixation of the fourth and fifth TMT
When the more medial TMT joints are reduced, the 4th and 5th TMT joints often move medially and are reduced along with the rest of the foot. As stated previously, having some motion at these joints is helpful for normal foot function.
The 5th metatarsal is positioned with a pointed reduction (Weber) clamp if further positioning is needed. The joint is then held with percutaneously placed K-wires from the proximal metatarsal into the cuboid.
Alternatively, screws can be placed from the base of the 4th or 5th metatarsal into the cuboid. However, as these joints are best left mobile, the screws will have to be removed in the immediate postoperative period (8 weeks). The K-wires, which are placed percutaneously, are removed at 6 to 8 weeks in the office/clinic.