An Isolated Chronic Osteochondral Fracture of the Third Metatarsal Head Treated With Bioabsorbable Pins

An osteochondral fracture of the metatarsal head is generally the result of direct trauma and is associated with additional proximal fractures of the medially adjacent metatarsals. An isolated osteochondral fracture of the metatarsal head is extremely rare, with only 10 published case reports. Open reduction and internal fixation was performed in 6 of 10 cases and in 2 of 4 chronic cases, each with different implants previously. The mechanism of injury was considered to be shear force in 5 of the reported cases. It is difficult to achieve and maintain reduction in these cases, and the best method for treatment of this type of fracture is unclear. We report a case of an isolated chronic osteochondral fracture of the third metatarsal head in a 14-year-old boy. The boy reported pain in his third metatarsophalangeal joint on dismounting from a bicycle 2 months prior to presentation. He could play soccer at first; however, the pain worsened after running long distances. Therefore, he was referred to our department. Magnetic resonance imaging revealed an osteochondral fracture of the metatarsal head without Freiberg’s disease. We achieved a good result 12 months postoperatively by using open reduction and internal fixation with 2 bioabsorbable thread pins.

Levels of Evidence: Therapeutic, Level IV: Case study