Minimally invasive intramedullary fixation with flexible nails in the treatment of metatarsal neck fractures

Abstract

Objective: This study was designed to retrospectively assess patients with deviated central metatarsal neck fractures subjected to reduction and fixation with flexible intramedullary nails. Methods: Thirty-six patients (36 feet) diagnosed with acute fractures of one or more metatarsals and whose therapeutic indication was exclusively surgical were evaluated between June 2010 and August 2011. Considering the metatarsophalangeal joint, such injuries should be located up to two centimeters in the proximal direction of this segment, with plantar deviation greater than 10 degrees and translation greater than three millimeters in any plane. Minimally invasive intramedullary fixation with two flexible titanium nails was used when adequate stability was not obtained with the use of one nail. The visual analog scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) forefoot score and specific statistical tests were used. Results: There was a significant (p<0.001) improvement in the results until 6 months of follow-up. There was no significant difference (p>0.05) in the results between 6 and 12 months of follow-up. The average time of consolidation was 8 weeks, and there were no complications during the period evaluated. Conclusion: This technique provided a significant (p<0.001) improvement in the VAS and AOFAS forefoot scores at 6 months of follow-up. Between 6 and 12 months of postoperative follow-up, we did not observe a significant (p<0.05) difference in the results of the analysis due to stabilization of the condition and fracture consolidation. Although the results were considered excellent, the level of evidence of studies should be increased to effectively demonstrate the efficacy of this technique. Level of Evidence IV; Therapeutic Studies; Case Series.