Surgical Management of Proximal Fourth Metatarsal Stress Fracture Nonunion: Debridement and Locking Plate Stabilization

Although fractures of the proximal fourth metatarsal are rare, when they occur they may be associated with prolonged healing and increased rates of nonunion. We report a case of fourth metatarsal nonunion and describe the technique of debridement of the nonunion site and locking plate stabilization. This technique allows fracture stabilization and optimizes periosteal vascularization of the fracture site, thus promoting healing. We recommend this technique for the debridement and stabilization of marginal proximal metatarsal fractures with established nonunion.