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

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

Training Focus

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

Detailed Content

• Criteria for Surgical Indication: Analysis of the impact of shortening and malalignment on forefoot biomechanics, with rationale for stabilization in a young athlete.
• Safe Anatomic Access: Surgical exploration preserving musculature and avoiding injury to the lateral sensory innervation.
• Control of the Small Distal Fragment: Strategy of distal extension of the approach to allow fixation with a minimum of two locking screws.
• Controlled Reduction in Long Oblique Fracture Line: Combined use of digital maneuvers, reduction forceps, and provisional fixation with a Kirschner wire for temporary stability.
• Management of Segmental Cortical Fragment: Conservative handling of the small lateral fragment to preserve vascularity and prevent failure.
• Rational Fixation Sequence: Initiation with a cortical screw to seat the plate to 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 hardware removal.
• Biomechanical Load Distribution Strategy: Fixation distributed along the metatarsal for global structural protection.
• Implant Protection: Elevation and suturing of the periosteum over the plate, creating additional biological coverage.
• Layered Closure: Anatomic reconstruction of tissue planes with muscular preservation and adequate coverage of the hardware.

Included Material

Detailed PDF

Didactic document that objectively presents the surgical indications, approach planning, reduction technique and fixation with a 2.0 mm locking plate, the 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.