Distal Fixation

Since 1995, I have been using an oblique fixation through the metatarsal head, which does not decrease the lowering and ensures good longitudinal compression. This is useful because the two fragments have a large area in contact in a distal frontal plane. The location of the screw allows the DMAA and the axial rotation corrections. The setting of the K-wire has to be accurate; it is described on Fig. 08b2.

One point of distal fixation is not sufficient to allow early weight bearing, so a proximal screw is added, ensuring the fixation. Double fixation ensures such a strong osteosynthesis that functional recovery is immediate; this is one of the main advantages of this procedure.

Fig. 08b1. M1 scarf distal fixation 1) the screw location.

1. The introduction of the K-wire has to be in a correct location: 1 cm proximally from the head cartilage, near of the lateral border (b, c) and in a sagittal direction (b).

2. Oblique distal screwing in order to ensure the distal compression of the fragment and also to avoid elevation of the head.

3. The distal surfaces in contact (d) are in a correct longitudinal compression thanks to the distal screw obliquity (vector h).

4. 5, 6. The sagittal direction and the medial location of the screw in the metatarsal head fix both the head axial rotation and the DMAA correction.

Fig. 08b1. M1 scarf distal fixation 1) the screw location.

1. The introduction of the K-wire has to be in a correct location: 1 cm proximally from the head cartilage, near of the lateral border (b, c) and in a sagittal direction (b).

2. Oblique distal screwing in order to ensure the distal compression of the fragment and also to avoid elevation of the head.

3. The distal surfaces in contact (d) are in a correct longitudinal compression thanks to the distal screw obliquity (vector h).

4. 5, 6. The sagittal direction and the medial location of the screw in the metatarsal head fix both the head axial rotation and the DMAA correction.

Fig. 08b2. Ml scarf distal fixation 2) setting the screw.

1, 2. Setting a thin diameter K-wire in a forward and backward motion until positioned at level of head cartilage.

3. Direct measure of screw length on a graduated ruler (which has the same length than the K-wire).We have to remove 5 mm to have the screw tip distal 3 mm from the cartilage and its head countersunk in the dorsal fragment.

4, 5, 6. Setting the special scarf drill and the screw around the same K-wire (now the FRS screw avoids the use of a drill with countersink).

Fig. 08b3. Problems with scarf distal fixation.

1. Without oblique screwing, the distal end of the screw may result in plantar problems.

2. Not enough obliquity leads to lack of longitudinal compression of the fragments.

3. Too much obliquity generates problems with the screw head.

4. 5. In spite of a correct location, the screw head must be deeply introduced in the dorsal fragment in order to avoid problems when a woman wears shoes.

Fig. 08b3. Problems with scarf distal fixation.

1. Without oblique screwing, the distal end of the screw may result in plantar problems.

2. Not enough obliquity leads to lack of longitudinal compression of the fragments.

3. Too much obliquity generates problems with the screw head.

4. 5. In spite of a correct location, the screw head must be deeply introduced in the dorsal fragment in order to avoid problems when a woman wears shoes.

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