Staged treatment using external fixation for comminuted fracture of first metatarsal: a case report

In high-energy midfoot fractures with severe soft-tissue damage, immediate osteosynthesis is often challenging owing to the lack of subcutaneous tissue and forefoot swelling. We herein report a case of comminuted first-metatarsal fracture with marked shortening and poor skin condition, managed using a staged approach with external fixation. A 52-year-old man presented with left forefoot pain after a tiller-related mishap. Computed tomography revealed a comminuted first-metatarsal fracture with shortening. Owing to poor condition of the skin, a staged treatment was adopted. In the first stage, an external fixator was applied to correct the metatarsal shortening; in the second stage, a fusion plate was placed between the first metatarsal and medial cuneiform. The external fixator was removed after 4 weeks. The patient achieved bone union with satisfactory functional outcomes. External fixation allows for delayed definitive fixation until tissue physiology improves, thereby enhancing the stability of internal fixation.