What is the standard of care for lesser metatarsal neck fractures with joint dislocation?

• A. Open reduction and internal fixation (ORIF)
• B. Closed reduction and casting
• C. External fixation
• D. Percutaneous pinning

Answer: (A)

When a lesser metatarsal neck fracture is accompanied by dislocation of the metatarsophalangeal joint, the injury is unstable and involves the joint surface. The goal is to restore anatomic alignment of the articular surface and the metatarsal neck, and to maintain that alignment through healing. Open reduction provides direct visualization to precisely reconstruct the articular geometry, correct any fragment displacement or rotation, and then fix it with screws (and sometimes a plate) to create stable, rigid fixation. This stability supports early motion and minimizes the risk of secondary displacement, malunion, or persistent joint incongruity that can lead to pain and transfer lesions.

Nonoperative approaches like closed reduction with casting often cannot maintain reduction once the joint is dislocated, and less rigid methods such as percutaneous pinning or external fixation usually don’t provide the same durable stabilization needed for an intra-articular, unstable injury. Hence, open reduction and internal fixation is the standard of care for this scenario.