Lateral Approach to the Base of the Fifth MetatarsalThe lateral approach to the base of the fifth metatarsal bone gives easy, safe access to that part of the bone. Its uses include the following:
Basal osteotomy of the fifth metatarsal bone in cases of bunionette. This procedure is indicated if the intermetatarsal angle between the fourth and fifth metatarsal bones is abnormal.
Open reduction and internal fixation of fractures or nonunions of the base of the fifth metatarsal bone. Transverse fractures are much more likely to result in nonunion than avulsion fractures.
Position of the Patient
Place the patient supine on the operating table. Fix a support to the opposite side of the operating table to support the contralateral iliac wing. Next, place a sandbag under the buttock and tilt the table away from you (see Fig. 7-1). This will ensure internal rotation of the leg and bring the lateral side of the foot into the operative field. After exsanguination, place a tourniquet on the middle of the thigh. Alternatively, use a soft rubber bandage to exsanguinate the foot, then wrap the leg tightly just above the ankle (see Fig. 12-31).
Landmarks and Incisions
The styloid process of the base of the fifth metatarsal bone is easily palpable along the lateral aspect of the foot. Place your fingers over the styloid process, moving them proximally and superiorly to palpate the tendon of the peroneus brevis muscle.
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