Repair of metatarsal neck fracture using retrograde nail: a case report

Metatarsal fractures are among the most frequent foot injuries, representing up to 35% of all foot fractures and a significant cause of forefoot pain and disability. While most nondisplaced fractures are managed conservatively, displaced or unstable fractures often require surgical fixation to restore alignment and maintain forefoot biomechanics. Various fixation methods have been described, including open reduction and internal fixation with plates and screws, Kirschner wire stabilization, and intramedullary fixation. Retrograde intramedullary nailing has recently gained attention as a minimally invasive technique offering stable fixation while minimizing soft-tissue disruption. We present the case of a 21-year-old Lebanese male who sustained displaced fractures of the 2nd till 5th metatarsal necks following a fall after accidental electrocution. Operative fixation was performed using retrograde percutaneous cannulated screws inserted through small dorsal incisions under fluoroscopic guidance. Postoperatively, the patient was managed with antibiotics, analgesia, and protected partial weight-bearing. Follow-up radiographs demonstrated progressive callus formation and maintained alignment, with complete clinical and radiological union by 6 weeks. The patient achieved pain-free full weight-bearing without complications. Retrograde intramedullary fixation provides several biomechanical and clinical advantages over conventional techniques, including load-sharing stability, resistance to torsional and bending forces, and preservation of periosteal blood supply. This approach facilitates early mobilization and reduces soft-tissue morbidity compared to open techniques. While literature remains limited, existing studies and biomechanical data support its use in appropriately selected metatarsal fractures, particularly those involving the shaft and neck. Retrograde intramedullary nailing represents a safe, effective, and minimally invasive option for the fixation of displaced metatarsal neck fractures. It offers stable fixation with favorable functional and radiological outcomes while minimizing soft-tissue complications. Further prospective studies and larger clinical series are warranted to better define its indications, long-term outcomes, and potential role in comparison with traditional fixation methods.