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Table of Contents
CASE REPORT
Year : 2013  |  Volume : 1  |  Issue : 2  |  Page : 114-115

Jess fixator : an alternative for treating 1st metatarsal head fracture


1 Assistant Professor, Department of Orthopaedics, SBKS Medical Institute & Research Centre & Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, India
2 PG student, Department of Orthopaedics, SBKS Medical Institute & Research Centre & Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, India
3 Professor & Head, Department of Orthopaedics, SBKS Medical Institute & Research Centre & Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, India

Date of Web Publication21-Aug-2018

Correspondence Address:
Yogesh Bapuji Patil
PG student, Department of Orthopaedics, SBKS Medical Institute & Research Centre & Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.239493

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  Abstract 


First Metatarsal head bears the major part of the transmitted forces in foot in weight bearing and gait. Hence managing first metatarsal head fracture needs a sound approach to achieve a good post injury functional life especially in a young active individual. JESS Fixator working on principle of ligamentotaxis has been used in fractures at various other sites. Same principle can also be used for intra articular fractures of first metatarsal head as described in the presenting case of a young male labourer. Thus it is an innovative method to address such vital fractures as well.

Keywords: JESS Fixator, 1st’ metatarsal, ligamentotaxis, intra articular fractures


How to cite this article:
Shah SN, Patil YB, Joshi H, Golwala PP. Jess fixator : an alternative for treating 1st metatarsal head fracture. J Integr Health Sci 2013;1:114-5

How to cite this URL:
Shah SN, Patil YB, Joshi H, Golwala PP. Jess fixator : an alternative for treating 1st metatarsal head fracture. J Integr Health Sci [serial online] 2013 [cited 2022 Aug 12];1:114-5. Available from: https://www.jihs.in/text.asp?2013/1/2/114/239493




  Introduction Top


Foot serves a major role in the basic function of weight bearing and gait. First Metatarsal head bears the major part of the transmitted forces in these functions. Hence managing these fractures need a sound approach to achieve a good post injury functional life especially in a young active individual. Moreover, Intra articular fractures add to its complexity and hence its anatomical reduction contributes equally to the gravity of the condition. Dislocations are uncommon in the first metatarsophalangeal joint [1],[2]

JESS Fixator working on principle of ligamentotaxis has been used mainly for distal end radius fractures and neglected CTEV. Certain centers have also used the same principle for treating proximal and distal end humerus and upper end tibia fractures [3],[4]. However there have been no reports on using the same for treating metatarsal fractures in literature.


  Case Report Top


A 22 year male presented with a history of collision of a two wheeler with another two wheeler two days back following which patient had pain and swelling in right foot and inability to bear weight. Patient was labourer by profession. On examination patient had swelling and tenderness over head of first metatarsal.

Radiography revealed a comminuted, intra-articular fracture of first metatarsal head resulting in loss of the column height.[Figure 1]
Figure 1: Pre-op intra-articular fracture of first metatarsal head

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Hence two problems of the fracture: loss of length of the bone and intra-articular comminution were addressed intra operatively by JESS Fixator and joysticking by K-wire intra operatively. Initially, length was regained by distracting the fracture site by JESS Fixator. Distracting also helped to achieve acceptable reduction by ligamentotaxis. The minor fragments were addressed by joysticking by a thick 2 mm k-wire thereby achieving the required anatomical reduction. Thereafter the reduction was stabilized by a transverse k-wire transfixing with second metatarsal head.[Figure 2]
Figure 2: Post-op x-ray - distracting the fracture site by JESS Fixator and holding reduction with k-wire

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Post operatively patient was kept strictly at rest without weight bearing for 6 weeks.[Figure 3] Percutaneous K-wire was removed at 4 weeks and JESS Fixator was removed at 6 weeks post operatively. Patient was able to return to his pre injury occupation within 2 months of injury and was followed till 1 year post injury.
Figure 3: 1 month follow-up

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Figure 4: Final follow- up at 1 year

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  Discussion Top


First metatarsal head bears the major brunt of stress of weight bearing and hence its fracture needs special attention. Despite this very few cases have been reported in literature regarding these fractures. This could be due to rarity of occurrence of isolated 1st’ metatarsal head fractures and a neglected attitude of the orthopedic surgeons towards metatarsal fractures.

Comminution and intra articular fractures further compound the fracture complexity thus requiring anatomical reduction. Plating has been described in literature but has an abode of complications in form of infection, inability to address all fragments, soft tissue complications, etc with open reduction.

JESS fixators have been used previously in lower limbs mainly for neglected CTEV cases and at some centres for treating upper end tibia fracture. However it is not conventionally used for 1st’ metatarsal head fractures.

Anatomical reduction and height restoration as achieved in the above case by ligamentotaxis by JESS Fixator and joysticking by K wiring offers an alternative procedure circumventing the above mentioned complications, thereby allowing earlier discharge of the patient from hospital and return to occupation.



 
  References Top

1.
Jahss, M. H. Traumatic dislocation of the first metatarsophalangeal joint. Foot Ankle 1(1):15- 21, 1980.  Back to cited text no. 1
    
2.
Sage, R. Type I dorsal dislocation of the first metatarsophalangeal joint: a case report. 1. Am. Podiatr. Med. Assoc. 75(4):215-217, 1985  Back to cited text no. 2
    
3.
Anil Kumar Gupta, Manu Gupta, Gyanendra Sengar, and Rajendra Nath, Functional outcome of closed fractures of proximal humerus managed by Joshi’s external stabilizing system. Indian J Orthop. 2012 Mar-Apr; 46(2): 216–220.  Back to cited text no. 3
    
4.
Zahid M , Sherwani MKA, SiddiquiYS, Abhas M, Asif N, Sabir AB. The role of the JESS Fexator in the management of tibial plateau fractures which are associated with sever soft tissy injuries. Journal of Clinical and Diagnostic Research , 2010 December; 4: 3356-3361.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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