A Rare Case of First Metatarsal Extrusion: Results of Treatment After 12 Months

• Published in: The Journal of foot and ankle surgery 2020-05, Vol.59 (3), p.629-631
• Main Authors: Basile, Attilio, Liuni, Federico Maria, Guidi, Marco, Perugia, Dario, Zoccali, Carmine, Baldi, Jacopo
• Format: Article
• Language: English
• Subjects: Amputation, Traumatic - diagnostic imaging; Amputation, Traumatic - etiology; Amputation, Traumatic - surgery; extrusion; first metatarsal; foot trauma; Fracture Fixation, Internal; Humans; infection; Male; Metatarsal Bones - injuries; reimplantation; Replantation; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2018.12.045

We present the case of a 21-year-old male with 12 months’ follow-up after reimplantation of a completely extruded first metatarsal. The patient had a motorcycle accident involving his right foot and ankle, with multiple lesser metatarsal fractures, lateral malleolus fracture, and a total first metatarsal extrusion (without fracture) through a large dorso-medial forefoot wound. The extruded bone was recovered at the site of the motor vehicle accident and was transported to the hospital with the patient. Before the reimplantation surgery was undertaken, the first metatarsal was immersed in a chlorhexidine solution for 20 minutes and then washed in an antibiotic solution. Metatarsal fixation was performed with Kirschner wires; the lateral malleolus fracture was fixed with plate and screws. An external fixator was then applied. Throughout the 12-month follow-up period, there was no evidence of infection. At the present time, this case suggests that, after antiseptic cleansing and prompt surgery, extruded first metatarsal reimplantation is possible with a reasonable degree of clinical success.