The Safety of Forefoot Metatarsal Pins in External Fixation of the Lower Extremity

Barrett, Matthew O.; Wade, Allison M.; Rocca, Gregory J. Della; Grist, Brett D.; Anglen, Jeffrey O.
March 2008
Journal of Bone & Joint Surgery, American Volume;Mar2008, Vol. 90-A Issue 3, p560
Academic Journal
Background: External fixation is widely used for trauma and reconstruction of the lower extremity. External fixator devices spanning the ankle or portions of the foot often utilize pins placed across the metatarsal bases. While this forefoot fixation is occasionally necessary to achieve reduction and alignment, it is also useful to prevent an equinus contracture. We undertook an anatomical study to evaluate the safety of pins placed across the bases of the first and second metatarsals, spanning the first intermetarsal space. Methods: Under fluoroscopy, a single 4.0-mm Schanz pin was advanced percutaneously from medial to lateral across the bases of the first and second metatarsals in ten cadaver feet. This was accomplished in a fashion identical to the application of typical forefoot external fixation as described in the literature. Specimens were then dissected. Injury to the deep plantar branch of the dorsalis pedis artery, when present, was recorded. When injury was not present, the distance from the pin to the deep plantar branch was recorded. Results: In five of the ten feet, the deep plantar branch of the dorsalis pedis artery was lacerated by the transmetatarsal pin. In four feet, the pin contacted the artery but did not visibly damage it. In the remaining foot, the pin was noted to be only 4 mm from the artery. Any pin with a starting point within 18 mm of the first metatarsocuneiform joint placed the artery at risk. Conclusions: Placement of external fixation pins through the proximal bases of the first and second metatarsals, within 2 cm of the first tarsometatarsal joint, consistently places the deep plantar branch of the dorsalis pedis artery at risk. Given the clinical importance of this artery, transmetatarsal pinning in this fashion is not advised. Other methods of obtaining forefoot or midfoot external fixation are recommended in order to avoid vascular injury.


Related Articles

  • The use and efficacy of intra-operative stress tests in supination-external rotation IV ankle fracture fixation. Gill, Sarah L.; Behman, Amy; Cochrane, Lynda A.; Love, Gavin J. // Surgeon (Elsevier Science);Feb2015, Vol. 13 Issue 1, p9 

    This study examines stress radiograph use in SER IV ankle fracture fixation; the efficacy of external rotation (ERST) and lateral hook (LHST) stress tests with incidence of subsequent fixation failure secondary to syndesmotic diastasis. 154 skeletally mature patients were admitted to our unit...

  • Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures. Altamimi, Sahal A.; McKee, Michael D. // Journal of Bone & Joint Surgery, American Volume;Mar2008 Supplement, Vol. 90-A, p1 

    BACKGROUND: Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicular fractures. We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after plate...

  • Lateral Entry Compared with Medial and Lateral Entry Pin Fixation for Completely Displaced Supracondylar Humeral Fractures in Children. Yi-Meng Yen; Kocher, Mininder S. // Journal of Bone & Joint Surgery, American Volume;Mar2008 Supplement, Vol. 90-A, p20 

    BACKGROUND: Closed reduction and percutaneous pin fixation is the treatment of choice for completely displaced (type-III) extension supracondylar fractures of the humerus in children, although controversy persists regarding the optimal pin-fixation technique. The purpose of this study was to...

  • Outcomes of Posterior Wall Fractures of the Acetabulum. Moed, Berton R.; Mcmichael, Jessica C. // Journal of Bone & Joint Surgery, American Volume;Mar2008 Supplement, Vol. 90-A, p87 

    BACKGROUND: The Musculoskeletal Function Assessment (MFA) is a validated, reliable, self-administered questionnaire that is useful for determining functional status. The Merle d'Aubigné score is a clinical measure of hip function. The purpose of the present study was to evaluate the outcome...

  • Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee. Haidukewych, George; Sems, Stephen A.; Huebner, David; Horwitz, Daniel; Levy, Bruce // Journal of Bone & Joint Surgery, American Volume;Mar2008 Supplement, Vol. 90-A, p117 

    BACKGROUND: Locked-plate fracture-fixation techniques and designs continue to evolve. Polyaxial locking plates that allow screw angulation and end-point locking have become available; however, there are no clinical data documenting their strength and efficacy, to our knowledge. The purpose of...

  • Extended anterolateral approach for treatment of posterolateral tibial plateau fractures improves operative procedure and patient prognosis. Hong-Wei Chen; Cong-Feng Luo // International Journal of Clinical & Experimental Medicine;2015, Vol. 8 Issue 8, p13807 

    Purpose: The treatment of posterolateral tibial plateau fracture remains controversial and challenging. Several approaches for this fracture have been applied for direct exposure and support plate fixation. However, several structures are to be at risk via posterior approach, which may affect...

  • Acute Syndesmosis Injuries Associated with Ankle Fractures. Park, Jason C.; McLaurin, Toni M. // Bulletin of the NYU Hospital for Joint Diseases;2009, Vol. 67 Issue 1, p39 

    Ankle syndesmosis injuries frequently occur with ankle fractures, but their treatment remains controversial. Although specific clinical and radiographic diagnostic measures are generally well-accepted, there remains a lack of consensus with respect to the treatment of these injuries. Controversy...

  • Osteoporotic fracture management: closing the gap of knowledge. Goldhahn, J.; Blauth, M. // Archives of Orthopaedic & Trauma Surgery;Feb2007, Vol. 127 Issue 1, p1 

    The author reflects on the increased risk of complications during osteoporosis fracture healing. The reasons for complications during the fracture treatment are largely unknown. The author comments that the journal Archives of Orthopaedic and Trauma Surgery offers informative articles on...


    The objective of this study was the identification of the therapeutic possibilities for the fractures of the distal humerus type B3.3 - classification AO. In a series of 773 cases of distal humerus fractures, only 5 cases were identified with this type of fracture. In the treatment of this type...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics