Journal of Orthopedics and Joint Surgery

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VOLUME 3 , ISSUE 2 ( July-December, 2021 ) > List of Articles

Original Article

Management of Compound Metatarsal Fractures under Tamil Nadu Accident and Emergency Care Initiative

Vetrivel Chezian Sengodan, Arun Subramanian

Keywords : Government of Tamil Nadu chief minister's comprehensive health insurance scheme, Kirschner wire, Metatarsal fractures, Tamil Nadu accident and emergency care initiative

Citation Information : Sengodan VC, Subramanian A. Management of Compound Metatarsal Fractures under Tamil Nadu Accident and Emergency Care Initiative. 2021; 3 (2):70-75.

DOI: 10.5005/jp-journals-10079-1047

License: CC BY-NC 4.0

Published Online: 22-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Introduction: Metatarsal fractures are common among foot injuries. This study aimed to evaluate and analyze the functional outcomes of compound metatarsal fractures using the anterograde retrograde fixation technique under the Tamil Nadu Accident and Emergency Care Initiative. Materials and methods: This is a prospective study done on patients admitted with compound metatarsal fractures in emergency orthopedic unit, Government Coimbatore Medical Hospital under Tamil Nadu Accident and Emergency Care Initiative between January 2020 and December 2020. The displaced compound metatarsal fractures are treated with limited internal fixation using Kirschner's wires within the golden period of 6 hours and they were covered under Government of Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme–Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (TNCMCHIS-AB-PMJAY). Anterograde retrograde technique was used for the fixation of compound metatarsal fractures. Results: The American Orthopaedic Foot and Ankle Society score was used to assess the functional outcome of compound metatarsal fractures. Good results were observed in 32 patients and excellent results were observed in 5 patients. Fair results were seen in three patients. Conclusion: The compound undisplaced metatarsal fractures can be treated conservatively. The displaced metatarsal fractures need limited internal fixation with Kirschner's wires. The Tamil Nadu accident and emergency care initiative provide early treatment and early discharge of the patients. The health department is no more an expenditure department for the government since it generates money from TNCMCHIS–AB-PMJAY which is very useful for the patients from below poverty line.

  1. Mereddy PK, Molloy A, Hennessy MS. Osteochondral fracture of the fourth metatarsal head treated by open reduction and internal fixation. J Foot Ankle Surg 2007;46(4):320–322. DOI: 10.1053/j.jfas.2007.02.003.
  2. Ozer H, Ozner A. The transverse dorsal approach to displaced multi-metatarsal fractures. J Foot Ankle Surg 2006;45(3):190–191. DOI: 10.1053/j.jfas.2006.02.009.
  3. Peled E, Norman D, Melamed E. Metatarsal fracture reduction and fixation by Kirschner wires: technical tip. Surg Sci 2012;3(06):344–346. DOI: 10.4236/ss.2012.36067.
  4. Donahue MP, Manoli A. Technical tip: transverse percutaneous pinning of metatarsal neck fractures. Foot Ankle Int 2004;25(6): 438–439. DOI: 10.1177/107110070402500615.
  5. Early JS. Fractures and dislocations of the midfoot and forefoot. In: Fractures in adults, ed. Bucholz RW, Heckman JD, Court-Brown DM 6th ed., Philadelphia: Lippincott Williams and Wilkins; 2006. pp. 2370–2383.
  6. Rammelt S, Heineck J, Zwipp H. Metatarsal fractures. Injury 2004;35(suppl 2):SB77–SB86. DOI: 10.1016/j.injury.2004.07.016.
  7. Aguado HJ, Herranz PG, Rapariz JM. Metaizeau's technique for displaced metatarsal neck fractures. J Pediatr Orthop 2004;12-B:350–353.
  8. Sengodan VC, Sivagnanam M, Kandasamy K. Impact of Tamil Nadu accident and emergency care initiative (TAEI) programme on orthopaedic emergency fixation: lesson from Coimbatore for low income countries. Int J Orthop Sci 2019;6(1):480–486. DOI: 10.22271/ortho.2020.v6.i1i.1911.
  9. Kim HN, Park YJ, Kim GL, et al. Closed antegrade intramedullary pinning for reduction and fixation of metatarsal fractures. J Foot Ankle Surg 2012;51(4):445–449. DOI: 10.1053/j.jfas.2012. 04.009.
  10. Zarei M, Bagheri N, Nili A, et al. Closed antegrade/retrograde intramedullary fixation of central metatarsal fractures: surgical technique and clinical outcomes. Injury 2020;51(4):1125–1129. DOI: 10.1016/j.injury.2020.03.001.
  11. Baumfeld D, Macedo BD, Nery C, et al. Anterograde percutaneous treatment of lesser metatarsal fractures: technical description and clinical results. Revista Brasileira de Ortopedia (English Edition) 2012;47(6):760–764. DOI: 10.1016/S2255-4971(15)30035-5.
  12. Goyal NB, Patil AV, Nishandar VV. Multiple metatarsal fracture fixation by k-wire: retrograde technique. Global J Res Analy 2018;7(8): 2277–8160.
  13. Kaushik S, Verma RK, Gupta SP, et al. Evaluation of efficacy of different modalities in treatment of fracture metatarsal. Asian J Pharmaceut Clin Res 2021;14(5):974–2441.
  14. Goel NK, Khurana A, Narula V, et al. Closed transverse pinning for reduction and fixation of metatarsal neck fractures: surgical technique. Indian J Orthop 2020;55(3):758–762. DOI: 10.1007/s43465-020-00170-y.
  15. Gade SS, Bhor P, Vatkar AJ, et al. VAC (cacuum assisted closure) therapy with K wire fixation as management protocol in complex compound foot fractures with soft tissue defects. Int J Orthop Sci 2019;5(3):205–208. DOI: 10.22271/ortho.2019.v5.i3d. 1532.
  16. Bhat SA, Kangoo KA, Zahoor A, et al. Outcome after fluoroscopic guided closed reduction and percutaneous kirschner wire fixation of lisfranc joint injuries: a nationwide randomized controlled trial. Surgery Curr Res 2015;5(1):220.
  17. Shereff MJ. Fractures of the forefoot. Instr Course Lect 1990;39: 133–140.
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