Internal Fixation of Fifth Metatarsal Metaphyseal–Diaphyseal Stress Fractures With an Intramedullary Screw

The fifth metatarsal metaphyseal–diaphyseal stress fracture is a notoriously difficult fracture with a history of delayed healing and prolonged treatment times. The prominent location of the metatarsal head at the lateral foot reduces the utility of typical screw fixation. The advent of cannulated systems has improved the technical ease of intramedullary insertion, but requires a larger screw head which produces an even greater source of mechanical irritation at the lateral foot. A solution to this challenge is presented with the Acutrak screw (Acumed, LLC, Hillsboro, OR), a titanium alloy, cannulated, headless, tapered, variable-pitched, fully threaded compression screw. The headless design of the Acutrak screw and its proximal insertion portal eliminate the potential for mechanical irritation at the lateral border of the foot. The tapered, fully threaded design provides excellent intramedullary contact along the entire length of the screw with the benefit of immediate stability. The variable pitch, with a faster leading pitch, provides significant compression across the fracture site. The surgical technique uses a portal proximal to the metatarsal base and is dependent on radiographic assistance for intramedullary positioning. The device and technique allow for a predictable and rapid return to athletic activity.