![]() Thus, almost all operations are performed using a C-arm X-ray image intensifier to ensure correct screw positioning.( 6, 7) However, this exposes both the medical staff and patient to radiation. ![]() These methods have high success rates.( 5) The use of lag screws provides an additional mechanical advantage, as they are stronger than single screws.( 6)ĭue to the very small fragments associated with proximal fractures, it is rare to have more than one screw placement opportunity. Commonly used fixation materials include Kirschner wires, tension bands, cancellous bone screws and intramedullary screws, while common surgical methods include fixation with 4.5-mm ankle screws and transplantation of cortex-cancellous bone after the removal of sclerotic bone from the medullary cavity. However, if the bone is displaced more than 3–5 mm or the rotational displacement is greater than 10°, surgery is required.( 3, 4) The choice of surgical method and fixation material varies. Keywords: fifth metatarsal fracture, internal fixation, radiationįracture of the fifth metatarsal base is a common injury that accounts for 45%–70% of all metatarsal fractures.( 1) When the foot is in plantar flexion and ankle inversion, the peroneus brevis muscle or plantar fascia contracts strongly, resulting in fifth metatarsal styloid avulsion.( 2) If the bone fragment is not displaced or only mildly displaced, the injury can be treated by wearing hard-soled shoes or using cast fixation for a few weeks. The use of these anatomical markers could help to reduce unnecessary radiation exposure for patients and medical staff. ![]() The connection line, which is normally perpendicular to the fracture line, provides sufficient mechanical stability to facilitate accurate screw placement. The fifth metatarsal base styloid and third MTP joint can be used as anatomical markers for lag screw placement in fractures involving the fifth tarsometatarsal joint. The proximal articular surface of the fifth metatarsal base intersected with the line connecting the styloid process of the fifth metatarsal base with the second, third and fourth MTP joints at angles of 24.02° ± 4.77°, 30.79° ± 4.53° and 38.08° ± 4.54°, respectively. The line connecting the fifth metatarsal base styloid with the third and fourth MTP joints intersected with the fracture line at angles of 93.28° ± 5.24° and 100.95° ± 5.00°, respectively. The line connecting the styloid process of the fifth metatarsal base with the second metatarsophalangeal (MTP) joint intersected with the fifth metatarsal base fracture line at an angle of 86.85° ± 5.44°. The angles between the fifth metatarsal axis and cuboid articular surface were measured to determine the optimal lag screw placement relative to anatomical markers. METHODSĪ total of 50 patients in Huashan Hospital, Shanghai, China, who underwent oblique foot radiography in the lateral position were randomly selected. This study aimed to identify the optimal anatomical markers and thus reduce radiation exposure. Anatomical markers can help to guide lag screw placement during surgery for internal fixation of fifth metatarsal base fractures.
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