Surgical Discussion

I had neither seen this patient in the clinic nor had I been made aware of him subsequent to his initial presentation to the emergency department (there's downsides to working in a large trauma centre sometimes I guess). He simply appeared on one of my operative lists one morning and this was the first I'd had the opportunity to think about how I was going to fix it. Of the various operative possibilities that came to mind, I was tending towards a distal fibula locking plate - before it occurred to me that a simple cannulated screw fixation wasn't actually a bad idea. I often use simple cannulated screw fixation for fifth metatarsal avulsion fractures - and this fracture didn’t strike me as particularly different to those that we see commonly in the midfoot. The fracture provided enough interdigitation in itself to be rotationally stable and the compression provided by the screw (with the screw threads biting well into proximal cortical bone) was quite significant. The peroneal tendons were not disturbed by the position of the screw head and washer. So perhaps a bit unusual, but given the anatomic reduction and stable fixation with great compression provided by the screw, I'm quite content with the result. There is very little literature to support this approach. See Reference links.

Orthopaedic implants used:   4.5mm cannulated titanium screw