Open reduction of metatarsal fractures is associated with a safer risk profile than percutaneous fixation.

BACKGROUND: Despite open reduction internal fixation (ORIF) and percutaneous fixation being commonly used for the treatment of metatarsal fractures, the relative complication profiles are unclear. PURPOSE: To compare short- and medium-term complications between ORIF and percutaneous fixation of metatarsal fractures using a large multi-center database. STUDY DESIGN: We used the TriNetX research network to identify two patient cohorts with metatarsal fractures: those who underwent ORIF, and those that underwent percutaneous fixation. METHODS: Two propensity-matched cohorts of 846 patients each who underwent percutaneous fixation or internal fixation between 2010 and 2024. We compared complication rates at 30 days, 90 days, and 1 year by calculating rates, odds ratios, and p-values. RESULTS: At 30 and 90-days, ORIF was associated with lower rates of ED visits and inpatient admission, with no differences in revision procedures at 1 year. Subgroup analysis by fracture location demonstrated that ORIF of 1st metatarsal fractures was associated with higher short-term complication rates than central metatarsal fractures, while patients who underwent ORIF of a 5th metatarsal fracture had lower rates of early adverse events and revision surgery within 1 year. CONCLUSIONS: Despite greater surgical exposure, open reduction internal fixation was associated with fewer short-term ED presentations and inpatient admissions. These findings challenge assumptions about the relative safety of percutaneous fixation and suggest that open techniques for metatarsal fracture fixation may offer a favorable risk profile, especially when considering hospital utilization. Further prospective trials are warranted to validate these results and explore whether patient- or injury-specific factors meaningfully impact complication risk.

Duke Scholars

Author Conor Neumann O'Neill Orthopaedic Surgery