FIFTH METATARSAL [Case 2] · Plate and Minifragment Screws

Displaced fractures of the fifth metatarsal in young patients and athletes require a precise decision between conservative treatment and surgical stabilization, especially when there is shortening and a risk of altered load distribution in the forefoot.

This training demonstrates the complete surgical procedure for anatomical reduction and fixation with a 2.0 mm low-profile locking plate, in a full-length video, from the surgeon's perspective, with an emphasis on tissue preservation, biomechanical stability, and implant protection.

Training Focus

• Surgical indication for displaced 5th metatarsal fracture
• Anatomical approach between the abductor digiti minimi and the sensory plane
• Extensive dissection for control of the distal fragment
• Anatomical reduction in a long oblique fracture pattern
• Fixation with a 2.0 mm titanium locking plate
• Strategy for locking and interfragmentary screws
• Periosteal protection and layered closure

Detailed Content

• Surgical Indication Criteria: Analysis of the impact of shortening and misalignment on forefoot biomechanics, with rationale for stabilization in young athletes.
• Safe Anatomical Access: Surgical exploration preserving musculature and avoiding injury to the lateral sensory innervation.
• Control of Small Distal Fragment: Strategy for distal access enlargement to allow fixation with a minimum of two locking screws.
• Controlled Reduction in Long Oblique Fracture: Combined use of digital maneuvers, reduction clamps, and temporary Kirschner wire fixation for temporary stability.
• Management of Cortical Segmental Fragment: Conservative management of the small lateral fragment for vascular preservation and prevention of failure.
• Rational Fixation Sequence: Beginning with a cortical screw to adapt the plate to the bone, followed by locking and interfragmentary screws according to the fracture pattern.
• Implant Contouring: Precise adaptation of the low-profile plate to avoid prominence and reduce the future need for removal.
• Biomechanic Load Distribution Strategy: Fixation distributed along the metatarsal for overall structural protection.
• Implant Protection: Periosteal dissection and suturing over the plate, creating additional biological coverage.
• Stratified Closure: Anatomical reconstruction of planes with muscle preservation and adequate coverage of the material.

Included Material

Detailed PDF

A didactic document that objectively presents surgical indications, access planning, reduction and fixation technique with a 2.0 mm locking plate, biomechanical principles applied to the fifth metatarsal, and the closure protocol with periosteal protection, consolidating a stable and technically reproducible approach in forefoot trauma.

Refine your decision-making and perform stable fixations in the fifth metatarsal with technical mastery and applied biomechanical reasoning. Enroll and elevate your surgical standard in foot trauma.