Treating A Non-Union Of A Second Metatarsal Fracture

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Author(s): 
H. John Visser, DPM, Dan Thouvenot, DPM, and Jackson Crough, DPM

   A major issue with the patient’s dementia is that it was not possible to keep him non-weightbearing. Accordingly, the operative approach was based on a technique that could allow weightbearing with immobilization. We then scheduled the patient for an inlay bone graft with internal fixation to repair the non-union.

   Upon examination, the second metatarsal position was in appropriate alignment in respect to the third metatarsal. Due to this, repositioning would not have to occur. The surgical approach was to “cut out” the non-union while maintaining the medial, lateral and plantar cortices that would supply structural support. We resected the area and then “backfilled” it with demineralized bone matrix to allow osteoinduction. Calcaneal bone marrow aspirate provided osteogenesis. A dorsal plate acted as a bridge or strut to protect the bone cross stress risers created by early weightbearing.

In Conclusion

Traditionally, the treatment of non-unions has involved surgical fixation with autogenous or allogeneic bone graft. This method allows for stability at the fracture site and provides the biologic components necessary for healing. However, the management of non-unions can become difficult due to the multiple risk factors that can lead to the problem. Understanding the importance of reducing the risk factors can lead to improved outcomes in treatment plans. Although conservative treatment options do have good results, having an understanding of surgical treatment options such as the inlay bone graft are a must.

   Dr. Visser is the Director of the Mineral Area Regional Medical Center Residency Program in Farmington, Mo. and the Director of SSM DePaul Residency Program in St. Louis.

   Dr. Thouvenot is a second year resident at Mineral Area Regional Medical Center in Farmington, MO.

   Dr. Crough is a second year resident at SSM DePaul in St. Louis, MO.

References
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2. Novicoff WM, Manaswi A, Hogan MV, et al. Critical analysis of the evidence for current technologies in bone healing and repair. J Bone Joint Surg Am. 2008; 90(Suppl 1): 85-91.
3. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma. 1989; 3(3):192-5.
4. LaPointe SJ. Nonunions. In: Southerland JT, Boberg JS, Downey MS, et al (eds): McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, fourth edition, chapter 86. Lippincott, Williams and Wilkins, Philadelphia, 2012, pp. 1309-21.

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