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12 Mar 2024
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5th Metatarsal Zone 1 Fracture Repair with Dynamic Tension Band

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Clinical Details

Clinical and radiological findings:  A 66-year-old female presented with a displaced Zone 1 fracture of the 5th metatarsal. The injury was isolated with no significant soft tissue involvement. Neurovascular examination was within normal limits. Initial radiographs confirmed the diagnosis.

Preoperative Plan

Planning remarks:  The preoperative plan included the use of a dynamic tension band technique to address the significant tension forces exerted by the peroneus brevis tendon, utilizing a combination of a cannulated screw and a knotless tension band system for fixation.

Surgical Discussion

Patient positioning:  The patient was positioned supine with the affected leg externally rotated and slightly elevated to facilitate lateral access to the 5th metatarsal.

Anatomical surgical approach:  A lateral approach to the 5th metatarsal was employed. A longitudinal incision was made over the lateral aspect of the 5th metatarsal, carefully preserving the sural nerve and peroneal tendons.

Operative remarks: 

Given concerns regarding screw fixation alone and hardware prominence with claw plates, a dynamic tension band was fashioned using Fibertape and a Bio-Tenodesis screw, in conjunction with a QuickFix cannulated screw for fracture stabilization. This approach aimed to neutralize the forces of the peroneus brevis while minimizing hardware prominence and facilitating early mobilization.

Postoperative protocol:   Postoperative rehabilitation protocol allowed for weight-bearing at 2 weeks post-surgery in a Tall CAM boot, following incision healing. Transition to regular footwear was planned for 6 weeks postoperatively, with gradual increase in activity as tolerated.

Follow up:   Not specified

Orthopaedic implants used:   Arthrex 2.4mm QuickFix cannulated screw, Arthrex Fibertape, Arthrex 3.0mm Bio-Tenodesis Screw. Originally posted on LinkedIn by William Crawford, MD FAAOS

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