Midshaft metatarsal segmental osteotomy with open reduction and internal fixation

Background: Metatarsalgia is a common source of patient discomfort and has multiple etiologies. Lesser metatarsal osteotomy is a recognized treatment modality for persistent symptoms after conservative care, yet the location and type of osteotomy remain highly debated topics. The current investigation reports the initial results regarding midshaft, segmental osteotomy of the lesser metatarsals with open reduction and internal fixation. Methods: Ninety-five consecutive patients had lesser metatarsal midshaft, segmental osteotomy with open reduction and internal fixation from June, 1999, to October, 2001, representing 102 feet and 126 osteotomies. Patient records were retrospectively reviewed for osteotomy union, symptomatic relief, and complications associated with this procedure. Followup ranged from 5 months to 18 months with an average of 8.8 months. Fixation was achieved with a four-hole, 1/4-tubular, minifragment, plate and four 2.7-mm cortical screws. Results: Five patients had transfer lesions, (five feet, five osteotomies) within the followup period. One patient (one foot, one osteotomy, 0.8%) developed a nonunion. After hardware removal this patient's osteotomy united. This technique produced excellent metatarsal union rates (125 of 126 osteotomies, 99.2%). Conclusions: Although further clinical investigation regarding patient outcome from this procedure needs to be carried out, the data from this preliminary study indicate that midshaft segmental osteotomy of a lesser metatarsal is a useful technique for metatarsal shortening with a high rate of bony union.