After prepping and draping, the leg is placed on a sterile bump or radiolucent triangle optionally with the forefoot on a stack of sterile towels to facilitate imaging in plane of the tarsometatarsal joints. The operative leg is placed on a blanket stack or leg ramp foam radiolucent positioning device. A bump is placed under the ipsilateral hip to internally rotate the lower extremity to a neutral position. The patient is positioned supine on a regular operating table with radiolucent extension. Blanket stack or leg ramp foam radiolucent positioning device.This technique is intended to make a frustrating procedure more efficient, eliminating the need for an assistant and potentially reducing direct radiation to the surgeon’s and/or assistants’ hands. We describe the “toe rodeo,” a simple, effective technique for closed reduction and retrograde percutaneous fixation of metatarsal and phalangeal fractures and dislocations. Manual manipulation of the forefoot for CRPF with use of fluoroscopy exposes surgeons and/or assistant(s) to greater amounts of ionizing radiation, particularly to the hand and digits. 3, 8 Forefoot and midfoot CRPF can be deceptively challenging as a result of difficulty simultaneously controlling the proximal intact segments, distal fracture fragment, and fixation independently with 6 degrees of freedom. Variations include retrograde pinning through the phalanges or metatarsal head, antegrade-retrograde pin insertion, transverse pinning, and combinations with external fixation. 2, 4Ĭlosed reduction and percutaneous fixation (CRPF) with Kirschner wires or Steinmann pins permits restoration and maintenance of normal forefoot alignment with minimal disruption of the adjacent soft tissue and metatarsal blood supply. 4 Conversely, metatarsal fractures of the central 3 rays in isolation are typically managed conservatively with good to excellent results. 4 Metatarsal shaft fractures associated with Lisfranc injuries as well as isolated head or neck fractures appreciably shortened >4 mm or deviated >10 degree in the coronal or sagittal plane may be indicated for operative stabilization to optimize forefoot function by restoring native anatomy and facilitating metatarsal fracture healing in an anatomic position. 2, 4 Severe forefoot and midfoot injuries may include fractures or dislocations associated with open soft tissue disruption ligamentous injuries such as traumatic tarsometatarsal joint instability (Lisfranc injury) comminution resulting in instability, angulation, and shortening of the medial and/or lateral columns of the foot impairing stance and gait and malunion resulting in plantar prominence and sequelae including toe ulceration and metatarsalgia. 2 Metatarsal fractures are typically caused by a direct blow or repetitive stress. Metatarsal and phalangeal fractures and dislocations account for 35% of all foot fractures and 3% to 7% of all fractures.
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