Plate Fixation With Autogenous Calcaneal Dowel Grafting Proximal Fourth and Fifth Metatarsal Fractures: Technique and Case Series.

Document Type


Publication Date


Publication Title

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons


Adolescent; Bone Plates; Bone Transplantation; Combined Modality Therapy; Female; Fluoroscopy; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Injury Severity Score; Male; Metatarsal Bones; Middle Aged; Prognosis; Radiography; Sampling Studies; Treatment Outcome; Young Adult


Metaphyseal and proximal diaphyseal fractures of the lateral column metatarsals can have problems with healing. In particular, those involving the fifth metatarsal have been associated with a high nonunion rate with nonoperative treatment. Although intramedullary screw fixation results in a high union rate, delayed healing and complications can occur. We describe an innovative technique to treat both acute and chronic injuries involving the metatarsal base from the metaphysis to the proximal diaphyseal bone of the fourth and fifth metatarsals. The surgical technique involves evacuation of sclerotic bone at the fracture site, packing the fracture site with compact cancellous bone, and plate fixation. In our preliminary results, 4 patients displayed 100% radiographic union at a mean of 4.75 (range 4 to 6) weeks with no incidence of refracture, at a mean follow-up point of 3.5 (range 1 to 5) years. The early results with our small series suggest that this technique is a useful treatment choice for metaphyseal and proximal diaphyseal fractures of the fourth and fifth metatarsals.

Clinical Institute

Orthopedics & Sports Medicine