February 2013

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   Study co-author Stephan J. LaPointe, DPM, PhD, prefers two-screw fixation for fifth metatarsal osteotomies. He cites the Acutrak cannulated screw (Acumed), saying its guide pins function as temporary fixation and the guide for the screws.

   “I use two screws because I am concerned mostly with rotation since there is little bone to bone contact at the osteotomy site due to the size of the bone,” says Dr. LaPointe, who is in private practice in Rome, Ga.

   Dr. LaPointe says the Chevron itself is fairly stable and he adds to that stability by applying two screws. He allows full weightbearing but has patients use a modified controlled ankle motion walker to offload the osteotomy site for at least four weeks. Following that, Dr. LaPointe may remove the felt insert or transition the patient into normal shoe gear depending on the quality of bone and X-rays. He cautions his patients that erythema, edema and pain are signs that they should spend less time on their feet. Dr. LaPointe says he has yet to require complete non-weightbearing for a patient.

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