1
|
Kadiyala ML, Kingery MT, Hamzane M, Walls R, Ganta A, Konda SR, Egol KA. Zone 2 Fifth Metatarsal Fractures Treated Nonoperatively Have Similar Time to Healing to Those Treated Operatively. J Orthop Trauma 2024; 38:e157-e161. [PMID: 38206754 DOI: 10.1097/bot.0000000000002766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To quantify the rate of union and time to clinical and radiographic healing in Zone 2 proximal fifth metatarsal (MT) fractures and compare these outcomes between Zone 2 fractures treated operatively and nonoperatively. METHODS DESIGN Retrospective cohort study. SETTING Academic Level I Trauma Center. PATIENT SELECTION CRITERIA Patients with fifth MT fractures who presented between December 2012 and April 2022 and confirmed to have Zone 2 fractures (defined as fractures entering the proximal 4-5 MT articulation on the oblique radiographic view) were included in the study analysis in either the operative or nonoperative cohort. OUTCOME MEASURES AND COMPARISONS Nonunion, time to clinical healing by, and time to radiographic healing between operative and nonoperative treatment. RESULTS Among the 499 included patients, 475 patients (95.2%) were initially treated nonoperatively and 24 patients (4.8%) were treated operatively. Both groups were similar in demographics. There was no difference in the proportion of patients with nonunions between groups (6.1% in the nonoperative group vs. 3.8% in the operative group, P = 1.000). In addition, there was no statistically significant difference between groups with respect to the time to clinical healing (9.9 ± 8.3 weeks for the nonoperative group vs. 15.4 ± 15.0 weeks for the operative group, P = 0.117) or the time to radiographic healing (18.7 ± 12 weeks for the nonoperative group vs. 18.5 ± 16.6 weeks for the operative group, P = 0.970). CONCLUSIONS Zone 2 fifth MT base fractures were successfully treated with nonoperative management. There was no evidence in this study that operative treatment leads to significantly faster clinical or radiographic healing. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Manasa L Kadiyala
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Matthew T Kingery
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Mohamed Hamzane
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Raymond Walls
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| |
Collapse
|
2
|
Anderson RB. Experience Is the Mother of Knowledge. Foot Ankle Int 2024; 45:318-319. [PMID: 38546134 DOI: 10.1177/10711007241234933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2024]
|
3
|
Walley KC, Gong DC, Hearty TM, Holmes JR, Talusan PG, Walton DM. Positioning Pearls in Foot and Ankle Surgery: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231201833. [PMID: 37789874 PMCID: PMC10542325 DOI: 10.1177/24730114231201833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Davin C. Gong
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Thomas M. Hearty
- Department of Orthopaedic Surgery, Trinity Health IHA Ann Arbor, Ypsilanti, MI, USA
| | - James R. Holmes
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Paul G. Talusan
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Davin M. Walton
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Fifth Metatarsal Jones Fractures: Diagnosis and Treatment. J Am Acad Orthop Surg 2022; 30:e470-e479. [PMID: 34932521 DOI: 10.5435/jaaos-d-21-00542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/13/2021] [Indexed: 02/01/2023] Open
Abstract
A Jones fracture, located at the metaphyseal-diaphyseal junction of the fifth metatarsal, is at an increased risk for nonunion and continued pain. Even with excellent surgical technique and postoperative management, a delayed union and refracture can occur. These complications in athletes can have deleterious effects on performance and delay return to sport. This article reviews the classification, diagnosis, and treatment considerations for Jones fractures. Treatment options including nonsurgical management, intramedullary screw, and plate fixation will be covered. The authors preferred technique using intramedullary screw fixation will be discussed in depth. Emerging considerations including biologic augmentation, primary bone grafting, and refracture will be examined as well. Ideal rehabilitation protocols, orthoses, and shoe wear suggestions will be given to optimize patient outcomes.
Collapse
|
5
|
Barnds B, Heenan M, Ayres J, Tarakemeh A, Schroeppel JP, Mullen S, Vopat BG. Comparison of the rate of delayed/nonunion in fifth metatarsal fractures receiving anti-inflammatory medications. J Exp Orthop 2021; 8:115. [PMID: 34894299 PMCID: PMC8665954 DOI: 10.1186/s40634-021-00435-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/22/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose Controversy exists regarding the acute effect of non-steroidal anti-inflammatory drugs (NSAIDs) on early fracture healing. The purpose of this study was to analyze the rate of nonunion or delayed union in patients with fifth metatarsal (5th MT) fractures. We hypothesize that the use of NSAIDs would increase the rate of nonunion/delayed union in 5th MT fractures. Methods Using PearlDiver, a national insurance database was analyzed. ICD codes were used to identify patients diagnosed with 5th MT fracture from 2007-2018. Patients were grouped by initial management (nonoperative vs. open reduction and internal fixation (ORIF) or non/malunion repair within 60 days) and sub-grouped by whether they had been prescribed at least one pre-defined NSAID. Subsequent ORIF or nonunion/malunion repair operative intervention was used as a surrogate for fracture nonunion/delayed union. Results Of the 10,991 subjects with a diagnosis of 5th MT, 10,626 (96.7%) underwent initial nonoperative treatment, 1,409 of which (13.3%) received prescription NSAIDS within 60 days of diagnosis. 16/1,409 (1.14%) subjects who received anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis while 46/9,217 (0.50%; P=0.003483) subjects who did not receive anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis. In the 365 subjects who underwent early repair/ORIF (within 60 days), there was no significant difference in the rate of nonunion/delayed union. Conclusion The rate of nonunion/delayed union of 5th MT fractures was significantly higher in subjects receiving NSAIDs within 60 days of initial diagnosis in patients managed non-operatively. Level of evidence Level III
Collapse
Affiliation(s)
- Brandon Barnds
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Matt Heenan
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Jack Ayres
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Armin Tarakemeh
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - J Paul Schroeppel
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Scott Mullen
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Bryan G Vopat
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| |
Collapse
|
6
|
Bušková K, Bartoníček J, Rammelt S. Fractures of the Base of the Fifth Metatarsal Bone: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202110000-00004. [PMID: 34673663 DOI: 10.2106/jbjs.rvw.21.00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
» Fractures of the proximal fifth metatarsal (PFMT) are one of the most common foot injuries, accounting for 61% to 78% of all foot fractures, but full consensus on their classification, diagnosis, and treatment has not yet been reached. » The most commonly accepted classification is that of Lawrence and Botte, who divided the location of PFMT fractures into 3 zones with respect to their healing potential. » Avulsion fractures of the tuberosity of the base (zone 1) generally heal well, and nonoperative treatment is commonly recommended. » Internal fixation may be considered for displaced fractures that extend into the fourth-fifth intermetatarsal joint (zone 2) as well as for nondisplaced fractures in athletes or high-demand patients, with the aims of reducing the healing time and expediting return to sport or work. » Stress fractures of the proximal diaphysis (zone 3) are preferably treated operatively, particularly in the presence of signs of delayed union. With nonoperative treatment, supportive measures such as ultrasonography or external/extracorporeal shockwave therapy have been demonstrated to have limited potential for the enhancement of fracture-healing.
Collapse
Affiliation(s)
- Kamila Bušková
- Department of Orthopaedics, First Faculty of Medicine Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Jan Bartoníček
- Department of Orthopaedics, First Faculty of Medicine Charles University and Military University Hospital Prague, Prague, Czech Republic
- Department of Anatomy, First Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Stefan Rammelt
- University Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| |
Collapse
|
7
|
Goodloe JB, Cregar WM, Caughman A, Bailey EP, Barfield WR, Gross CE. Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211037647. [PMID: 34552993 PMCID: PMC8450619 DOI: 10.1177/23259671211037647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/03/2021] [Indexed: 12/28/2022] Open
Abstract
Background As a result of the high physical demand in sport, elite athletes are particularly prone to fifth metatarsal fractures. These injuries are typically managed surgically to avoid high rates of delayed union and allow for quicker return to play (RTP). Purpose To review studies showing clinical and radiographic outcomes, RTP rates, and complication rates after different surgical treatment modalities for fifth metatarsal fractures exclusively in elite-level athletes. Study Design Systematic review; Level of evidence, 4. Methods A systematic search was conducted within the PubMed, Scopus, and Cochrane databases from January 2000 to January 2020. Inclusion criteria consisted of clinical outcome studies after operative management of fifth metatarsal fractures in elite athletes. Exclusion criteria consisted of nonoperative management, high school or recreational-level athletic participation, nonclinical studies, expert opinions, and case series with <5 patients. Results A total of 12 studies met inclusion and exclusion criteria, comprising 280 fifth metatarsal fractures treated surgically. Intramedullary screw fixation was the most common fixation construct (47.9%), and some form of intraoperative adjunctive treatment (calcaneal autograft, iliac crest bone graft, bone marrow aspirate concentrate, demineralized bone matrix) was used in 67% of cases. Radiographic union was achieved in 96.7% of fractures regardless of surgical construct used. The overall mean time to union was 9.19 weeks, with RTP at a mean of 11.15 weeks. The overall reported complication rate was 22.5%, with varying severity of complications. Refracture rates were comparable between the different surgical constructs used, and the overall refracture rate was 8.6%. Conclusion Elite athletes appeared to have a high rate of union and reliably returned to the same level of competition after surgical management of fifth metatarsal fractures, irrespective of surgical construct used. Despite this, the overall complication rate was >20%. Specific recommendations for optimal surgical management could not be made based on the heterogeneity of the included studies.
Collapse
Affiliation(s)
- J Brett Goodloe
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William M Cregar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander Caughman
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan P Bailey
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William R Barfield
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher E Gross
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
8
|
Albloushi M, Alshanqiti A, Qasem M, Abitbol A, Gregory T. Jones type fifth metatarsal fracture fixation in athletes: A review and current concept. World J Orthop 2021; 12:640-650. [PMID: 34631448 PMCID: PMC8472442 DOI: 10.5312/wjo.v12.i9.640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels. These fractures may occur due to several mechanisms, but inversions and twisting injuries are considered some of the leading causes in sports. However, while Jones fracture incidences are frequent in the sporting world, there is still a lack of consensus on how such fractures should be effectively managed. There are numerous treatment options for patients with fifth metatarsal Jones fractures. The role of nonoperative treatment remains controversial, with concerns about delayed union and nonunion. Surgical stabilization of metatarsal Jones fractures is therefore often recommended for athletes, as it is often associated with a low number of complications and a higher rate of union than nonoperative management. This review will focus on literature regarding the prevalence of Jones type fifth metatarsal fracture, alongside the efficacy of both conservative and surgical treatment within this population.
Collapse
Affiliation(s)
- Mohammad Albloushi
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Amer Alshanqiti
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Mohammad Qasem
- Al-Razi Hospital, Ministry of Health, State of Kuwait, Kuwait City 00965, Kuwait
| | - Andreas Abitbol
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Thomas Gregory
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| |
Collapse
|
9
|
Baumfeld T, Fernandes Rezende R, Nery C, Batista JP, Baumfeld D. Fifth Metatarsal Fractures in Professional Soccer Players: Case Series. Foot Ankle Spec 2021; 14:213-218. [PMID: 32172591 DOI: 10.1177/1938640020911223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Fifth metatarsal fractures occur mainly in young athletes, with an estimated incidence of 1.8 per 1000 individuals per year. This study aims to evaluate the functional outcome of professional soccer players undergoing surgical treatment of fifth metatarsal base fractures. METHODS We appraised 34 soccer players operated on from July 2001 to June 2016. All individuals were assessed by the American Orthopedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) before and after surgery, with a mean 23-month follow-up. The need for grafting, fracture healing, Torg classification, and return to sports were also evaluated. RESULTS There were 10 attackers, 7 offensive-defensive midfielders, 6 side defenders, 5 central defensive midfielders, 3 defenders, 2 goalkeepers, and 1 defensive midfielder, at an average age of 19 years. Preoperative and postoperative AOFAS averaged 42 and 99 points, respectively, whereas VAS scores were 6 and 0. The longer the time to get operated on, the greater was the need for grafting (P = .011). In our study, all fractures have consolidated. Return to sports occurred, on average, 73 days after surgical treatment, and it was not influenced by the time to get operated on, fracture healing, Torg classification, and grafting. CONCLUSION Surgical treatment of the fifth metatarsal base fracture in professional soccer players presents good clinical results. Getting back to activities after surgery is not influenced by surgery time, fracture healing, Torg classification, and grafting.Levels of Evidence: Level IV: Therapeutic studies, Case series.
Collapse
Affiliation(s)
- Tiago Baumfeld
- Universidade Federal de Minas Gerais (UFMG), MG, Brasil (TB, DB).,Hospital Felício Rocho, Belo Horizonte, MG, Brasil (RFR).,Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brasil (CN).,Centro Artroscópico Jorge Batista AS (CAJB AS), Buenos Aires, CABA, Argentina (JPB)
| | - Ricardo Fernandes Rezende
- Universidade Federal de Minas Gerais (UFMG), MG, Brasil (TB, DB).,Hospital Felício Rocho, Belo Horizonte, MG, Brasil (RFR).,Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brasil (CN).,Centro Artroscópico Jorge Batista AS (CAJB AS), Buenos Aires, CABA, Argentina (JPB)
| | - Caio Nery
- Universidade Federal de Minas Gerais (UFMG), MG, Brasil (TB, DB).,Hospital Felício Rocho, Belo Horizonte, MG, Brasil (RFR).,Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brasil (CN).,Centro Artroscópico Jorge Batista AS (CAJB AS), Buenos Aires, CABA, Argentina (JPB)
| | - Jorge P Batista
- Universidade Federal de Minas Gerais (UFMG), MG, Brasil (TB, DB).,Hospital Felício Rocho, Belo Horizonte, MG, Brasil (RFR).,Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brasil (CN).,Centro Artroscópico Jorge Batista AS (CAJB AS), Buenos Aires, CABA, Argentina (JPB)
| | - Daniel Baumfeld
- Universidade Federal de Minas Gerais (UFMG), MG, Brasil (TB, DB).,Hospital Felício Rocho, Belo Horizonte, MG, Brasil (RFR).,Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brasil (CN).,Centro Artroscópico Jorge Batista AS (CAJB AS), Buenos Aires, CABA, Argentina (JPB)
| |
Collapse
|
10
|
Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures. J Orthop Surg Res 2021; 16:209. [PMID: 33752730 PMCID: PMC7986515 DOI: 10.1186/s13018-021-02331-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zones 2 and 3 fifth metatarsal fractures are often treated with intramedullary fixation due to an increased risk of nonunion. A previous 3-dimensional (3D) computerized tomography (CT) imaging study by our group determined that the screw should stop short of the bow of the metatarsal and be larger than the commonly used 4.5 millimeter (mm) screw. This study determines how these guidelines translate to operative outcomes, measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Radiographic variables measuring the height of the medial longitudinal arch and degree of metatarsus adductus were also obtained to determine if these measurements had any effect on outcomes. And lastly, this study aimed to determine if morphologic differences between males and females affected surgical outcomes. METHODS We retrospectively identified 23 patients (14 male, 9 female) who met inclusion criteria. Eighteen patients completed PROMIS surveys. Preoperative PROMIS surveys were completed prior to surgery, rather than retroactively. Weightbearing radiographs were also obtained preoperatively to assist with surgical planning and postoperatively to assess interval healing. Correlation coefficients were calculated between PROMIS scores and repair characteristics (hardware characteristics [screw length and diameter] and radiographic measurements of specific morphometric features). T tests determined the relationship between repair characteristics, PROMIS scores, and incidence of operative complications. PROMIS scores and correlation coefficients were also stratified by gender. RESULTS The average screw length and diameter adhered to guidelines from our previous study. Preoperatively, mean PROMIS PI = 57.26±11.03 and PROMIS PF = 42.27±15.45 after injury. Postoperatively, PROMIS PI = 44.15±7.36 and PROMIS PF = 57.22±10.93. Patients with complications had significantly worse postoperative PROMIS PF scores (p=0.0151) and PROMIS PI scores (p=0.003) compared to patients without complications. Females had non-significantly worse preoperative and postoperative PROMIS scores compared to males and had a higher complication rate (33 percent versus 21 percent, respectively). Metatarsus adductus angle was shown to exhibit a significant moderate inverse relationship with postoperative PROMIS PF scores in the overall cohort (r=-0.478; p=0.045). Metatarsus adductus angle (r=-0.606; p=0.008), lateral talo-1st metatarsal angle (r=-0.592; p=0.01), and medial cuneiform height (r=-0.529; p=0.024) demonstrated significant inverse relationships with change in PROMIS PF scores for the overall cohort. Within the male subcohort, significant relationships were found between the change in PROMIS PF and metatarsus adductus angle (r=-0.7526; p=0.005), lateral talo-1st metatarsal angle (r=-0.7539; p=0.005), and medial cuneiform height (r=-0.627; p=0.029). CONCLUSION Patients treated according to guidelines from our prior study achieved satisfactory patient reported and radiographic outcomes. Screws larger than 4.5mm did not lead to hardware complications, including screw failure, iatrogenic fractures, or cortical blowouts. Females had non-significantly lower preoperative and postoperative PROMIS scores and were more likely to suffer complications compared to males. Patients with complications, higher arched feet, or greater metatarsus adductus angles had worse functional outcomes. Future studies should better characterize whether patients with excessive lateral column loading benefit from an off-loading cavus orthotic or plantar-lateral plating.
Collapse
|
11
|
Abstract
Fractures of the proximal fifth metatarsal are common injuries with a unique history. Treatment of these fractures is controversial partly because of confusion regarding fracture subtype nomenclature. Today "Jones fracture" refers to proximal fifth metatarsal fracture in zones 2 or 3. Zone 2 fractures are acute injuries, and their optimal treatment is unclear. Zone 3 fractures commonly occur in the presence of a chronic stress reaction. Because of poor healing potential, zone 3 fractures typically require operative treatment. Zone 1 fractures have excellent healing potential and may be treated nonoperatively with a weightbearing as tolerated protocol.
Collapse
Affiliation(s)
- Michelle M Coleman
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA
| | - Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA.
| |
Collapse
|
12
|
Pugliese M, De Meo D, Sinno E, Pambianco V, Cavallo AU, Persiani P, Villani C. Can body mass index influence the fracture zone in the fifth metatarsal base? A retrospective review. J Foot Ankle Res 2020; 13:9. [PMID: 32087744 PMCID: PMC7036254 DOI: 10.1186/s13047-020-0374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- M Pugliese
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 3, 00155, Rome, Italy. .,Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy.
| | - D De Meo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 3, 00155, Rome, Italy.,Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - E Sinno
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 3, 00155, Rome, Italy.,Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - V Pambianco
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 3, 00155, Rome, Italy.,Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - A U Cavallo
- Division of Diagnostic and Interventional Radiology, University Hospital Policlinico "Tor Vergata", Rome, Italy
| | - P Persiani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 3, 00155, Rome, Italy.,Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - C Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 3, 00155, Rome, Italy.,Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| |
Collapse
|
13
|
D'Hooghe P, Caravelli S, Massimi S, Calder J, Dzendrowskyj P, Zaffagnini S. A novel method for internal fixation of basal fifth metatarsal fracture in athletes: a cadaveric study of the F.E.R.I. technique (Fifth metatarsal, Extra-portal, Rigid, Innovative). J Exp Orthop 2019; 6:45. [PMID: 31713049 PMCID: PMC6848546 DOI: 10.1186/s40634-019-0213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose One of the main problems of Kirschner wire fixation of fifth metatarsal base fractures (in combination with a tension band wiring technique) seems to be hardware intolerance and several studies in athletes also report failure after isolated fixation with a screw only. These reports prompted us to look at new materials and a novel technique through fixation with an intramedullary screw combined with a high-resistance suture via the presented F.E.R.I. (Fifth metatarsal, Extra-portal, Rigid, Innovative) technique. Methods This cadaveric study describes F.E.R.I. technique. On a cadaver, through two mini portals, a full reduction and solid internal fixation with an intramedullary screw and suture cerclage with Fiberwire of a fifth metatarsal base fracture is achieved. In this article, the cadaveric study and proposed surgical technique are explained and illustrated step by step. Results The presented internal fixation F.E.R.I. technique is indicated in acute proximal fractures, stress fractures or non-union of metatarsal 5 (Zone 2–3 by Lawrence and Botte) and it resulted feasible and stable during manual stress test. The authors intend to study this technique in the clinical setting in the near future. Conclusions Fifth metatarsal base fractures gain specific interest when occurring in athletes. In this group of patients, internal fixation is often required to obtain a satisfactory outcome and time to return to play. The aim of the presented cadaveric study is to illustrate an innovative concept of internal fixation, named F.E.R.I.
Collapse
Affiliation(s)
- Pieter D'Hooghe
- Department of Orthopaedic Surgery and Sports Medicine, Aspetar Hospital, Doha, Qatar
| | - Silvio Caravelli
- 2nd Clinic of Ortopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Simone Massimi
- 2nd Clinic of Ortopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - James Calder
- Department of Orthopaedic Surgery, Fortius Clinic, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - Peter Dzendrowskyj
- Department of Orthopaedic Surgery and Sports Medicine, Aspetar Hospital, Doha, Qatar
| | - Stefano Zaffagnini
- 2nd Clinic of Ortopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
14
|
Lau BC, Moore LK, Thuillier DU. Evaluation and Management of Lateral Ankle Pain Following Injury. JBJS Rev 2019; 6:e7. [PMID: 30153244 DOI: 10.2106/jbjs.rvw.17.00143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Brian C Lau
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Laura K Moore
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Daniel U Thuillier
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| |
Collapse
|
15
|
Roberts L, Bernasconi A, Netto CDC, Elliott A, Hamilton W, O'Malley M. Cuboid Edema Syndrome Following Fixation of Proximal Fifth Metatarsal Fractures in Professional Athletes. Foot Ankle Spec 2019; 12:373-379. [PMID: 31248285 DOI: 10.1177/1938640019857798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stress fractures of the proximal fifth metatarsal are common injuries in elite athletes. Fixation using an intramedullary screw represents the most popular surgery performed for treating these injuries, with excellent results in most cases. However, multiple reports in the literature highlight the possibility of painful hardware, usually related to the presence of the screw head, following intramedullary fixation In this case report, we outline 4 cases of professional athletes who developed lateral-based foot symptoms following complete healing of their surgically treated proximal fifth metatarsal fractures and were found to have significant cuboid edema on magnetic resonance images. We also outline recommendations regarding specific surgical technique considerations aiming to minimize this possible complication. Level of Evidence: Level V: Case report.
Collapse
Affiliation(s)
- Lauren Roberts
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, London, Stanmore, Middlesex, UK
- Orthopaedics and Traumatology Unit, Department of Public Health, "Federico II" University of Naples, Napoli, Italy
| | - Cesar de Cesar Netto
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Andrew Elliott
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - William Hamilton
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Martin O'Malley
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| |
Collapse
|
16
|
Chow CL, Lui TH. Endoscopic Management of Nonunion of the Tuberosity of the Fifth Metatarsal. Arthrosc Tech 2019; 8:e105-e109. [PMID: 30899660 PMCID: PMC6410346 DOI: 10.1016/j.eats.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/11/2018] [Indexed: 02/03/2023] Open
Abstract
Tuberosity avulsion fractures of the fifth metatarsal are common and the lateral band of the plantar aponeurosis as the structure more likely to cause these fractures. Most tuberosity avulsion fractures heal by 8 weeks with conservative treatment. Symptomatic nonunion can occasionally occur. Internal fixation with or without bone graft is the treatment of choice for painful nonunion if conservative treatment fails. The purpose of this Technical Note is to describe the details of endoscopic management of nonunion of the tuberosity of the fifth metatarsal without diastasis. This includes endoscopic release of the nonunion site, debridement of the fibrous tissue, microfracture of the sclerotic bone surfaces, and percutaneous screw fixation.
Collapse
Affiliation(s)
| | - Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(H.K.), F.R.C.S.(Edin.), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd, Sheung Shui, NT, Hong Kong SAR, China.
| |
Collapse
|