Radiographic and clinical comparison of two methods for diaphyseal metatarsal fractures fixation

Abstract

Objective: The goal of displaced metatarsal fracture treatment, is to restore metatarsal length and height to avoid metatarsalgia. The most commonly used fixation method is intramedullary nailing, but has the risk of losing fracture reduction when the wire is removed, or metatarsophalangeal joint stiffness or residual claw deformity, complications probably less oftenly seen in plate and screw fixation for this fracture. The purpose of this study is to compare this two methods of fixation for displaced metatarsal fracture. Methods: We performed a retrospective comparative study of patients treated for this fracture in the Foot and Ankle Unit at HCC between January 2006 and July 2013, who were treated with open reduction and internal fixation with Kirschnerr wire through the metatarsophalangeal joint or distal phalanx and patients treated with open reduction and internal fixation with plate and screw fixation. Presence of radiographic bone healing, and loss of fracture reduction was evaluated. We evaluated mobility and metatarsophalangeal joint deformity, metatarsalgia and presence of complex regional pain syndrome with a minimum follow-up 12 months postoperatively. Statistical analysis was performed with T-student test. Results: Fifty-one patients with closed diaphyseal metatarsal fracture with an average age of 37 years (15 to 72) were evaluated. 18 patients were treated with open reduction and internal fixation with Kirschnerr wire through the metatarsophalangeal or distal phalangeal joint, appreciating loss of fracture reduction in 8 patients, metatarsalgia in 6 patients and deformity with residual claw toe in 16 patients, five showed some degree of complex regional pain syndrome. In 33 patients we performed open reduction and internal fixation with plate and screws, showing nonunion in 2 patients, delayed union in 6 patients, and metatarsalgia metatarsophalangeal claw toe deformity in 2 patients. 4 showed some degree of complex regional pain syndrome. Conclusion: Kirschner wire fixation through the metatarsophalangeal joint or distal phalanx for displaced metatarsal shaft fracture, generates higher incidence of stiffness and residual metatarsophalangeal claw deformity, as well as fracture reduction losening when the kirschnerr wire is removed, therefore we recommend this fracture fixation with plate and screws.