title: Use of a Percutaneous Pointed Reduction Clamp Before Screw Fixation to Prevent Gapping of a Fifth Metatarsal Base Fracture: A Technique Tip.
abstract: Intramedullary screw fixation has become widely accepted as the standard of care for operative treatment of Jones fractures, allowing not only accelerated rehabilitation but also reduction of the risk of repeat fracture. The unique anatomy of the fifth metatarsal--mainly its inherent lateral curvature--makes fixation technically challenging. In general, surgical fixation should be performed with the largest screw possible, in both diameter and length, which will provide the strongest possible construct. However, an increased screw length and width have been associated with complications, including lateral gapping and distraction of the fracture site and malreduction of the fracture. The use of a pointed reduction clamp is a simple, yet effective, method of preventing iatrogenic displacement and gapping at the fracture site during placement of an intramedullary screw. Percutaneous reduction and stabilization of the fracture using this technique could help limit the complications associated with large screw fixation of Jones fractures.
authors.affiliation: Orthopaedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Tan
authors.affiliation: Orthopaedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Cata
authors.affiliation: Orthopaedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address: lyn.camire@medstar.net.
authors.forename: Lew C
authors.initials: LC
authors.lastname: Schon
mesh_terms: D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D004867:Equipment Design; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D008682:Metatarsal Bones / Q000293:injuries / Q000601:surgery*; D011859:Radiography; D053441:Suture Anchors; D013536:Suture Techniques / Q000295:instrumentation*
keywords: Jones fracture; malunion; nonunion; percutaneous reduction; trauma