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. 2020 May 5;44(7):1409–1416. doi: 10.1007/s00264-020-04581-2

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© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — Intramedullary screw fixation technique. Intramedullary screw fixation is schematically outlined on a left fifth metatarsal using a 4.5-mm solid fracture specific screw (Jones fracture screw, Arthrex Inc., Naples, FL). In the first step (1), the fifth metatarsal bone was distally fixed in a padded machine vise. The bone and the peroneus brevis muscle were kept moist during preparation. (2) Then a complete Jones fracture at the meta-diaphyseal junction at the distal aspect of the 4^th–5^th intermetatarsal articular facet (green line) was created by the use of an oscillating saw. A small forceps fixed and held the proximal fragment in place. In the next step, preparation for intramedullary screw fixation started by marking the entry point for the screw. (3) In a proximal dorsal view, the entry point is located “high and inside”, lateral to the cubometatarsal articular surface [5]. Anatomic studies described the ideal starting point 10.5-mm dorsal to the palpable inferior margin of the proximal tuberosity, and just medial to the peroneus brevis insertion. In a craniocaudal orientation the entry point is approximately 5.3-mm medial to the palpable lateral aspect of the tuberosity. [34] (4) A 2.0-mm guide wire is drilled into the metatarsal aiming for the straight part of the intramedullary canal. Afterwards, cannulated drilling with a 3.5-mm drill was performed followed by taping, starting with a 4.5-mm tap. The threads should tightly engage with the endosteal bone of the intramedullary canal. If the tap felt undersized, the next size was used (i.e., 6.0 for JFXS and 6.5 for HCS preparation). During taping, the appropriate screw size and length were measured by tactile feedback and by visual inspection superimposing the screw over the metatarsal. Screw length was determined as approximately 70% of the total length of the fifth metatarsal. Screw threads must cross the fracture line. (5) Finally, the guide wire was removed for solid screw (JFXS) insertion and the appropriate screw was inserted by hand. (6) Optimal screw size implantation was verified via X-ray control. Schematic view from medial.