Transverse pinning of concomitant first and second metatarsal fractures using 1.5mm K-wires; case report and technical note

INTRODUCTION AND IMPORTANCE: Here we represented a new technique of closed reduction and transverse pinning to address first metatarsal comminuted fractures in patients with a concomitant second metatarsal shaft fracture. CASE PRESENTATION: The first metatarsal comminuted fracture coincides with the second metatarsal simple fracture in this forefoot injury case. In a new technique, we used close reduction and percutaneous pinning (CRPP) in a transverse direction of pins to achieve a satisfactory outcome. After performing traditional CRPP to fix the second metatarsal fracture, it served as physical support for the first metatarsal fixation. We drilled two 1.5mm pins through the first metatarsal bone at each proximal and distal side of the fracture site, transversely passed to the second metatarsal bone. Transverse pins came along from the first metatarsal medial side to the lateral. After six-week and 12-month follow-up, the patients had minimal pain with complete radiological and clinical fracture healing and no complication. CLINICAL DISCUSSION: Here, internal fixation was unsuitable due to extensive soft-tissue injury and inadequate bone support. Despite the many advantages of external fixators, they have drawbacks that persuade us to perform our new technique: using K-wires for transverse pinning fixation of the first metatarsal fracture using an adjacent metatarsal as support. This minimally invasive approach is profitable because of its minimal soft tissue damage, affordable price, and convenient access. CONCLUSION: The transfixation technique with K-wires is rarely used to treat metatarsal fractures. It may be helpful in similar cases of comminuted first metatarsal fracture with satisfactory outcomes.