A combined intramedullary–extramedullary fixation strategy for distal central metatarsal fractures: Clinical outcomes in two cases

Central metatarsal fractures are common injuries encountered in foot and ankle trauma.Management depends on multiple factors, including fracture pattern, position, age, bone quality, and body mass index (BMI).While these injuries are often managed conservatively, outcomes vary according to individual risk factors.Operative treatment typically involves retrograde percutaneous pinning or small plate fixation.Oblique central metatarsal fractures may accommodate small-diameter screws; however, transverse fractures near the metatarsal neck remain challenging due to limited bone stock for secure hardware placement.Percutaneous Kirshner wire (K-wire) fixation offers temporary stabilization but may not adequately resist pistoning or rotational forces, particularly in distal metatarsal neck fractures.This report presents a novel technique employing extramedullary fixation to supplement intramedullary K-wire stabilization in two such cases.Both patients underwent open reduction and internal fixation using this hybrid method.At follow-up, both demonstrated complete radiographic union and a return to pre-injury activity without complications.These findings suggest that extramedullary fixation may serve as a low-profile and effective option for managing difficult distal metatarsal fractures when traditional fixation methods are limited.