Fractures of the forefoot

Transverse pinning of concomitant first and second metatarsal fractures using 1.5mm K-wires; case report and technical note

Introduction and importance

Here we represented a new technique of closed reduction and transverse pinning to address first metatarsal comminuted fractures in patients with a concomitant second metatarsal shaft fracture.

Case presentation

The first metatarsal comminuted fracture coincides with the second metatarsal simple fracture in this forefoot injury case. In a new technique, we used close reduction and percutaneous pinning (CRPP) in a transverse direction of pins to achieve a satisfactory outcome.

After performing traditional CRPP to fix the second metatarsal fracture, it served as physical support for the first metatarsal fixation. We drilled two 1.5mm pins through the first metatarsal bone at each proximal and distal side of the fracture site, transversely passed to the second metatarsal bone. Transverse pins came along from the first metatarsal medial side to the lateral. After six-week and 12-month follow-up, the patients had minimal pain with complete radiological and clinical fracture healing and no complication.

Clinical discussion

Here, internal fixation was unsuitable due to extensive soft-tissue injury and inadequate bone support. Despite the many advantages of external fixators, they have drawbacks that persuade us to perform our new technique: using K-wires for transverse pinning fixation of the first metatarsal fracture using an adjacent metatarsal as support. This minimally invasive approach is profitable because of its minimal soft tissue damage, affordable price, and convenient access.

Conclusion

The transfixation technique with K-wires is rarely used to treat metatarsal fractures. It may be helpful in similar cases of comminuted first metatarsal fracture with satisfactory outcomes.

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We introduced an applicable method for fixing comminuted first metatarsal fracture.

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Transverse pinning has appropriate clinical and radiological healing.

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Transfixation technique with K-wires is rarely used to treat metatarsal fractures.

Imaging of sports-related midfoot and forefoot injuries

Sports-related injuries of the foot are common and may result in significant morbidity, particularly if inaccurate or delayed diagnosis leads to improper management. While less common than injuries of the ankle, sports-related foot injuries account for 2% to 18% of athletic injuries. Injury may occur as a result of acute trauma or chronic overuse, and high-impact sports that involve running, jumping, or contact place the athlete at higher risk for injury. Accurate and timely diagnosis of injury is the key to proper management, and diagnostic imaging studies often play a critical role in this regard. While radiographs, computerized tomography scans, and ultrasound are useful in the evaluation of the foot, magnetic resonance imaging provides superior tissue contrast as well as the ability to detect stress reaction in bone that precedes discernible fracture line on radiographs, allowing accurate detection of both osseous and soft tissue pathology. This review focuses on imaging of common sports-related injuries of the midfoot and forefoot, including osseous, ligamentous, and tendinous pathology, with emphasis on magnetic resonance imaging diagnosis.