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Toner E, McCaughey P, Peace C, Cassidy R, Bryce L, Diamond O. Functional outcome and risk of non-union for 5th metatarsal base fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2171-2177. [PMID: 38570341 DOI: 10.1007/s00590-024-03921-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Treatment of 5th metatarsal fractures via direct discharge from virtual fracture clinic (VFC) has become common practice in the NHS. We aim to assess the functional outcome and incidence of non-union in a series of 5th metatarsal base fractures, exposed to 1-year of follow-up. METHODS 194 patients who sustained a fracture between the period February 2019 to April 2020 were included, referred via the VFC pathway. Radiographs were reviewed to classify in which zone, the fracture occurred along with union on subsequent follow-up. Telephone follow-up was used to measure patient functional outcomes (EQ-5D & FAAM survey) and satisfaction with the VFC service. RESULTS Off 194 patients, 53 (27.3%) had zone 1, 99 (51%) had zone 2, and 42 (21.6%) had zone 3 fractures. 80 were discharged directly from VFC, with 114 patients being offered at least one face to face clinic follow-up. Six (3.1%) patients had clinical and radiological evidence of non-union; 4 in zone 2, and 2 in zone 3. No zone 1 injuries were identified as a non-union. Only 2 patients had surgery, 1 of which was for symptomatic non-union. Of the 6 non-union patients, 1 had surgery, 4 did not wish to have surgery and the final non-union patient was deemed unsuitable for surgery. CONCLUSION The VFC is an effective way of managing 5th metatarsal fractures, with high patient satisfaction. Conservative management has excellent outcomes, with a low percentage of zone 2 and 3 injuries developing a symptomatic non-union. Functional outcome surveys provide further reassurance.
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Affiliation(s)
- Ethan Toner
- Department of Trauma & Orthopaedics, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - Philip McCaughey
- Department of Trauma & Orthopaedics, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Conor Peace
- Department of Trauma & Orthopaedics, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Roslyn Cassidy
- Outcomes Department, Musgrave Park Hospital, Belfast, BT9 7JB, UK
| | - Leeann Bryce
- Outcomes Department, Musgrave Park Hospital, Belfast, BT9 7JB, UK
| | - Owen Diamond
- Department of Trauma & Orthopaedics, Royal Victoria Hospital, Belfast, BT12 6BA, UK
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Hantouly AT, Attia AK, Hasan K, D'Hooghe P. Is Subtle Cavovarus a Problem for Athletes? Foot Ankle Clin 2023; 28:729-741. [PMID: 37863531 DOI: 10.1016/j.fcl.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Cavovarus or high-arched foot is a common foot deformity that occurs due to the disruption of the foot-driven equilibrium between the first metatarsal, fifth metatarsal, and the heel. This imbalance leads to an increase in the foot's normal plantar concavity. Cavovarus deformity ranges from a mild and flexible malalignment to a fixed, complex, and severe deformation. Subtle cavovarus foot, the mild form of the cavus foot, was first described by Manoli and colleagues.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ahmed Khalil Attia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Khalid Hasan
- Virginia Commonwealth University, 1200 East Broad Street, 9th Floor, Richmond, VA 23298, USA
| | - Pieter D'Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
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Warden SJ, Sventeckis AM, Surowiec RK, Fuchs RK. Enhanced Bone Size, Microarchitecture, and Strength in Female Runners with a History of Playing Multidirectional Sports. Med Sci Sports Exerc 2022; 54:2020-2030. [PMID: 35941520 PMCID: PMC9669197 DOI: 10.1249/mss.0000000000003016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Female runners have high rates of bone stress injuries (BSIs), including stress reactions and fractures. The current study explored multidirectional sports (MDS) played when younger as a potential means of building stronger bones to reduce BSI risk in these athletes. METHODS Female collegiate-level cross-country runners were recruited into groups: 1) RUN, history of training and/or competing in cross-country, recreational running/jogging, swimming, and/or cycling only, and 2) RUN + MDS, additional history of training and/or competing in soccer or basketball. High-resolution peripheral quantitative computed tomography was used to assess the distal tibia, common BSI sites (diaphysis of the tibia, fibula, and second metatarsal), and high-risk BSI sites (base of the second metatarsal, navicular, and proximal diaphysis of the fifth metatarsal). Scans of the radius were used as control sites. RESULTS At the distal tibia, RUN + MDS ( n = 18) had enhanced cortical area (+17.1%) and thickness (+15.8%), and greater trabecular bone volume fraction (+14.6%) and thickness (+8.3%) compared with RUN ( n = 14; all P < 0.005). Failure load was 19.5% higher in RUN + MDS ( P < 0.001). The fibula diaphysis in RUN + MDS had an 11.6% greater total area and a 11.1% greater failure load (all P ≤ 0.03). At the second metatarsal diaphysis, total area in RUN + MDS was 10.4% larger with greater cortical area and thickness and 18.6% greater failure load (all P < 0.05). RUN + MDS had greater trabecular thickness at the base of the second metatarsal and navicular and greater cortical area and thickness at the proximal diaphysis of the fifth metatarsal (all P ≤ 0.02). No differences were observed at the tibial diaphysis or radius. CONCLUSIONS These findings support recommendations that athletes delay specialization in running and play MDS when younger to build a more robust skeleton and potentially prevent BSIs.
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Affiliation(s)
- Stuart J. Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, AUSTRALIA
| | - Austin M. Sventeckis
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis
| | - Rachel K. Surowiec
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis
- Department of Biomedical Engineering¸ Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis
| | - Robyn K. Fuchs
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis
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Pettersen PM, Radojicic N, Grün W, Andresen TKM, Molund M. Proximal Fifth Metatarsal Fractures: A Retrospective Study of 834 Fractures With a Minimum Follow-up of 5 Years. Foot Ankle Int 2022; 43:602-608. [PMID: 35125016 DOI: 10.1177/10711007211069123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal fifth metatarsal fractures are common fractures. Treatment strategies have been debated. We wanted to investigate whether Lawrence and Botte's classification has prognostic value because of time to fracture union, and evaluate if weightbearing as tolerated (WBAT) and nonweightbearing (NWB) treatment strategy had effect on time to fracture union in nonoperatively treated fractures. METHODS Computerized database search, patients diagnosed between January 1, 2003, and December 31, 2015. RESULTS We identified 834 fractures; 510 (61.2%) zone 1, 157 (18.8%) zone 2, and 167 (20.0%) zone 3. Most (94.4%) were treated nonoperatively; time to fracture union was 7.5 (SD 7.7), 7.7 (5.6), and 9.2 (8.1) weeks for zone 1, 2, and 3, respectively, which gave a significant longer time to union for zone 3 compared to zone 1 fractures (P = .04). There was no difference in time to fracture union when comparing WBAT and NWB for all fracture zones. Failure to union, defined as crossover to surgery and/or delayed union, was found in 13 (2.7%) zone 1, 5 (3.2%) zone 2, and 6 (3.8%) zone 3 fractures. Refracture during follow-up was found in 3 (0.6%) zone 1 and 14 (8.9%) zone 3 fractures. CONCLUSION Proximal fifth metatarsal fractures have high union rates with nonoperative treatment. No difference in time to union could be found between WBAT and NWB treatment strategies for all fracture zones. We observed a significantly longer time to fracture union for zone 3 fractures compared to zone 1 fractures. Refracture occurs in a nonnegligible share of nonoperatively treated zone 3 fractures.
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Attia AK, Taha T, Kong G, Alhammoud A, Mahmoud K, Myerson M. Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:3422-3436. [PMID: 33740393 DOI: 10.1177/0363546521990020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union and refractures. Intramedullary (IM) screw fixation rather than nonoperative management has been recommended in the athletic population. PURPOSE To provide an updated summary of the return-to-play (RTP) rate and time to RTP after Jones fractures in athletes with regard to their management, whether operative or nonoperative, and to explore the union rate and time to union as well as the rate of complications such as refractures. STUDY DESIGN Meta-analysis. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through November 2019 to identify studies reporting on Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the RTP rate and time to RTP, whereas the secondary outcomes were the number of games missed, time to union, and union rate as well as the rates of nonunion, delayed union, and refractures. RESULTS Of 168 studies identified, 22 studies were eligible for meta-analysis with a total of 646 Jones fractures. The overall RTP rate was 98.4% (95% CI, 97.3%-99.4%) in 626 of 646 Jones fractures. The RTP rate with IM screw fixation only was 98.8% (95% CI, 97.8%-99.7%), with other surgical fixation methods (plate, Minifix) was 98.4% (95% CI, 95.8%-100.0%), and with nonoperative management was 71.6% (95% CI, 45.6%-97.6%). There were 3 studies directly comparing RTP rates with surgical versus nonoperative management, which showed significant superiority in favor of surgery (odds ratio, 0.033 [95% CI, 0.005-0.215]; P < .001). The RTP rate according to type of sport was 99.0% (95% CI, 97.5%-100.0%) in football, 91.1% (95% CI, 82.2%-99.4%) in basketball, and 96.6% (95% CI, 92.6%-100.0%) in soccer. The overall time to RTP was 9.6 weeks (95% CI, 8.5-10.7 weeks). The time to RTP in the surgical group (IM screw fixation) was 9.6 weeks (95% CI, 8.3-10.9 weeks), which was significantly less than that in the nonoperative group of 13.1 weeks (95% CI, 8.2-18.0 weeks). The pooled union rate in the operative group (excluding refractures) was 97.3% (95% CI, 95.1%-99.4%), whereas the pooled union rate in the nonoperative group was 71.4% (95% CI, 49.1%-93.7%). The overall time to union was 9.1 weeks (95% CI, 7.7-10.4 weeks). The time to union with IM screw fixation (8.2 weeks [95% CI, 7.5-9.0 weeks]) was shorter than that with nonoperative treatment (13.7 weeks [95% CI, 12.7-14.6 weeks]). The rate of delayed union was 2.5% (95% CI, 1.2%-3.7%), and the overall refracture rate was 10.2% (95% CI, 5.9%-14.5%). CONCLUSION The RTP rate and time to RTP after the surgical management of Jones fractures in athletes were excellent, regardless of the implant used and type of sport. IM screw fixation was superior to nonoperative management, as it led to a higher rate of RTP, shorter time to RTP, higher rate of union, shorter time to union, and improved functional outcomes. We recommend surgical fixation for all Jones fractures in athletes.
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Affiliation(s)
| | - Tarek Taha
- Weill Cornell Medical College, Doha, Qatar
| | - Geraldine Kong
- Orthopedic Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Karim Mahmoud
- Department of Orthopaedics, Emory University Hospital, Atlanta, Georgia, USA
| | - Mark Myerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Zhang S, Yang K, Wang Q, Hou J, Zang H, Luo S, Zhang T, Zhang X. Treatment of Fractures of Metatarsal Shaft Using a Cemented K-wire Frame. J Foot Ankle Surg 2021; 60:42-46. [PMID: 33218864 DOI: 10.1053/j.jfas.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/17/2019] [Accepted: 05/11/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this retrospective study was to report on percutaneous reduction and fixation for the treatment of fractures of metatarsal shaft. Between March 2015 and October 2017, 29 patients (37 fractures of metatarsal shaft) were treated using a cemented Kirschner wire (K-wire) frame. The accuracy of reduction of the fragments was assessed as anatomic (0 to 8 points), good (9 to 11 points), fair (12 to 15 points), or poor (>15 points). The Maryland foot score was used to assess pain and functional outcomes. All fractures were reduced using percutaneous techniques. Anatomic reduction was achieved in 31 metatarsal fractures (84%), and good reduction was achieved in 6 (16%). The average bone healing time was 7 weeks (range, 4 to 16). Pin tract infection was noted in 2 metatarsal bones, which healed with pin site care. The mean cost of the cemented K-wire frame was US$335 (range, $283 to $385) per patient. Based on the Maryland foot score, there were 26 excellent results (90%) and 3 good results (10%). The cemented K-wire frame is a useful external fixator and can be an alternative for treating fractures of metatarsal shaft, especially when open surgeries are a major concern owing to severely damaged soft-tissue envelope. The system is cheap and easy to apply and provides rigid fixation, resulting in good function of the foot.
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Affiliation(s)
- Shenghua Zhang
- Professor, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Kun Yang
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Qi Wang
- Professor, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Jiguang Hou
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Hongwei Zang
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Shi Luo
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Tao Zhang
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Xu Zhang
- Professor, Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Operative treatment of acute shaft and neck lesser metatarsals fractures: a systematic review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1263-1271. [PMID: 33484346 DOI: 10.1007/s00590-020-02869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Metatarsal fractures are relatively common injuries that they might lead to significant disability and chronic pain if suboptimally treated. Operative treatment is reserved for the displaced fractures. The primary aim of the herein study is to present the union time and rate, as well as the functional outcome of the surgically treated isolated lesser metatarsal shaft and neck fractures. The secondary aim is to present the related complications of each fixation method. METHODS The electronic databases of Pubmed, Scopus, Embase and Cochrane libraries were searched from January 1990 to December 2020. PRISMA guidelines were used for data collection. We retrieved five articles including in total 154 patients, which were compatible to our inclusion criteria and they were used for this systematic review. RESULTS A total of 75 patients were treated with percutaneous antegrade pinning resulting in AOFAS score: 96.4 ± 4.8 and time to heal 7.4 ± 1 weeks, 34 patients underwent ante/retrograde pinning resulting in AOFAS score: 95.2 ± 4.75 and time to heal 6.5 ± 1 weeks, and 45 patients underwent open reduction and internal fixation with plate and screws resulting in a time to union 10.9 ± 0.5 weeks. CONCLUSION Our results demonstrate that K wire intramedullary nailing regardless of the specific technique (antegrade, retrograde, ante/retrograde) is associated with better outcomes compared to open reduction and internal fixation as it permits faster weight bearing and quicker rehabilitation. K-wire fixation is related to statistically significant shorter time for the fracture to heal, by approximately three weeks compared to open reduction and internal fixation. Future research should focus on studies directly comparing the different intramedullary K-wiring techniques and also K-wiring versus plate fixation.
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Baumbach SF, Urresti-Gundlach M, Böcker W, Vosseller JT, Polzer H. Results of Functional Treatment of Epi-Metaphyseal Fractures of the Base of the Fifth Metatarsal. Foot Ankle Int 2020; 41:666-673. [PMID: 32100555 PMCID: PMC7294529 DOI: 10.1177/1071100720907391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the fifth metatarsal base (5th MT) are common foot injuries, but their treatment remains a subject of debate. The aim was to assess the midterm outcome of functionally treated epi-metaphyseal fractures (Lawrence and Botte types I and II) of the 5th MT. METHODS This study was a longitudinal retrospective database study with prospective follow-up. Included were all patients with an acute, isolated fracture to the 5th MT base (types I and II). All patients were treated functionally: weightbearing as tolerated without immobilization. Fracture types and fracture characteristics (displacement <2 mm/>2 mm, articular involvement, number of fragments) were assessed retrospectively. Patient-reported outcome measures (PROMs) including the visual analog scale for foot and ankle (VAS FA) and the quality-of-life score (QoL) SF-12 were collected prospectively at 2- and 5-year follow-up. Out of 95 patients, 43 patients (45%) were included with a median follow-up of 5.7 (1.5) years. RESULTS For both the VAS FA and SF-12, excellent scores were observed. For 30 patients (77%), longitudinal 2- and 5-year follow-up was available. No significant longitudinal changes could be observed for the VAS FA and SF-12. For both time points, neither fracture type nor characteristics significantly influenced any outcome parameter assessed. CONCLUSION Functional treatment by full weightbearing and free range of motion led to excellent 5-year results for both type I and II fractures. Neither fracture location nor characteristics had a significant influence on the 5-year PROMs. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Sebastian F. Baumbach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Marcel Urresti-Gundlach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - J. Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA,Hans Polzer, MD, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, Munich, 80336, Germany.
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Plantar Loads of Habitual Forefoot Strikers during Running on Different Overground Surfaces. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10072271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study is to investigate plantar loads characteristics of habitual forefoot strike runners while running on different surfaces. Twenty-six runners (age: 28.2 ± 6.8 y, height: 172.9 ± 4.1 cm, weight: 67.7 ± 9.6 kg, BMI (body mass index): 22.6 ± 2.8 kg/m2, running age: 5.0 ± 4.2 y, running distance per week: 14.6 ± 11.7 km) with habitual forefoot strike participated in the study. Runners were instructed to run at 3.3 ± 0.2 m/s on three surfaces: grass, synthetic rubber and concrete. An in-shoe pressure measurement system was used to collect and analyze plantar loads data. Running on the synthetic rubber surface produced a lower plantar pressure in the lateral forefoot (256.73 kPa vs. 281.35 kPa, p = 0.006) than running on concrete. Compared with the concrete surface, lower pressure–time integrals were shown at the central forefoot (46.71 kPa⋅s vs. 50.73 kPa⋅s, p = 0.001) and lateral forefoot (36.13 kPa⋅s vs. 39.36 kPa⋅s, p = 0.004) when running on the synthetic rubber surface. The different surfaces influence plantar loads of habitual forefoot strikers and runners should choose appropriate overground surface to reduce the risk of lower extremity musculoskeletal injuries.
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Garofolini A, Taylor S. The effect of running on foot muscles and bones: A systematic review. Hum Mov Sci 2019; 64:75-88. [PMID: 30682645 DOI: 10.1016/j.humov.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/12/2022]
Abstract
Despite the widespread evidence of running as a health-preserving exercise, little is known concerning its effect on the foot musculature and bones. While running may influence anatomical foot adaptation, it remains unclear to what extent these adaptations occur. The aim of this paper is to provide a systematic review of the studies that investigated the effects of running and the adaptations that occur in foot muscles and bones. The search was performed following the PRISMA guidelines. Relevant keywords were used for the search through PubMed/MEDLINE, Scopus and SPORTDiscus. The methodological quality of intervention studies was assessed using the Downs and Black checklist. For cross-sectional studies, the Newcastle-Ottawa scale was used. Sixteen studies were found meeting the inclusion criteria. In general, the included studies were deemed to be of moderate methodological quality. Although results of relevant literature are limited and somewhat contradictory, the outcome suggests that running may increase foot muscle volume, muscle cross-sectional area and bone density, but this seems to depend on training volume and experience. Future studies conducted in this area should aim for a standard way of reporting foot muscle/bone characteristics. Also, herein, suggestions for future research are provided.
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Affiliation(s)
| | - Simon Taylor
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia
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11
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Yan R, Qu J, Cao L, Liu H, Chen J, Gao Y, Peng Y. [Effectiveness of mini locking plate combined with Kirschner wire in treatment of comminuted Jones fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:587-590. [PMID: 29806347 DOI: 10.7507/1002-1892.201711104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the effectiveness of mini locking plate combined with Kirschner wire in treatment of comminuted Jones fracture. Methods Between January 2011 and October 2016, 25 cases with comminuted Jones fracture were treated with mini locking plate combined with Kirschner wire. There were 9 males and 16 females with an average age of 31.4 years (range, 16-66 years). The fractures located on the left side in 11 cases and on the right side in 14 cases. The causes of injury included spraining in 21 cases, falling down in 3 cases, and bruise in 1 case. The bone fragment of all cases was more than 3 pieces. The fracture line was mostly Y-shape or T-shape. Twelve of them were combined with other fractures. The time from injury to operation was 1-9 days (mean, 5 days). The mini locking plate and Kirschner wire were removed at 9-12 months postoperatively. At 12 months postoperatively, the pain was evaluated by the visual analogue scale (VAS) score, and the function by the American Orthopaedic Foot & Ankle Society (AOFAS) score. Results All incisions healed by first intention. All cases were followed up 12-36 months with an average of 21.7 months. Fracture union was observed in all patients without complications such as nonunion, delayed union, and malunion. The fracture union time was 8-12 weeks (mean, 9.4 weeks). At 12 months postoperatively, the VAS score was 1.15±0.87; the AOFAS score was 89.45±6.24, and the results were excellent in 14 cases, good in 9 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 92%. Conclusion The procedure of mini locking plate combined with Kirschner wire for comminuted Jones fracture has such advantages as convenient operation, more rigid fixation, high rate of fracture healing, and good functional recovery in foot.
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Affiliation(s)
- Rongliang Yan
- Department of Foot and Ankle Surgery, the Second Hospital of Tangshan City, Tangshan Hebei, 063000,
| | - Jiafu Qu
- Department of Foot and Ankle Surgery, the Second Hospital of Tangshan City, Tangshan Hebei, 063000, P.R.China
| | - Lihai Cao
- Department of Foot and Ankle Surgery, the Second Hospital of Tangshan City, Tangshan Hebei, 063000, P.R.China
| | - Hongda Liu
- Department of Foot and Ankle Surgery, the Second Hospital of Tangshan City, Tangshan Hebei, 063000, P.R.China
| | - Jianghua Chen
- Department of Foot and Ankle Surgery, the Second Hospital of Tangshan City, Tangshan Hebei, 063000, P.R.China
| | - Yan Gao
- Department of Foot and Ankle Surgery, the Second Hospital of Tangshan City, Tangshan Hebei, 063000, P.R.China
| | - Yi Peng
- Department of Foot and Ankle Surgery, the Second Hospital of Tangshan City, Tangshan Hebei, 063000, P.R.China
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Kim JB, Song IS, Park BS, Ahn CH, Kim CU. Comparison of the Outcomes Between Headless Cannulated Screw Fixation and Fixation Using a Locking Compression Distal Ulna Hook Plate in Fracture of Fifth Metatarsal Base. J Foot Ankle Surg 2018; 56:713-717. [PMID: 28479162 DOI: 10.1053/j.jfas.2017.01.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to evaluate and compare the clinical and radiologic results of internal fixation with a headless cannulated screw versus a locking compression distal ulna hook plate for fractures at the base of the fifth metatarsal bone, zone 1. From April 2012 to April 2015, 30 cases (29 patients) were retrospectively evaluated. The mean follow-up period was 13 months. The patients were divided into 2 groups stratified by the fixation method: screw (group A, n = 15) or plate (group B, n = 15). We measured the displacement to diastasis of the fracture on the foot oblique radiographs taken pre- and postoperatively in each group, recorded the time to bony union, and measured the difference in the reduction distance in each group. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society midfoot score at 12 months postoperatively. In group A, the mean interval to union was 54.2 ± 9.3 days, the mean displacement to diastasis had improved to 0.3 ± 0.4 mm postoperatively (p < .001), and the mean reduction distance was 2.9 ± 1.0 mm postoperatively. In group B, the mean interval to union was 41.5 ± 7.0 days, the mean displacement to diastasis had improved to 0.06 ± 0.2 mm postoperatively (p < .001), and the mean reduction distance was 4.1 ± 1.6 mm. The American Orthopaedic Foot and Ankle Society midfoot scale score was 97.7 ± 3.4 in group A and 98.2 ± 3.2 in group B. The interval to union was significantly different between the 2 groups (p = .01). No complications were recorded. Our findings have shown that the plate is a reasonable and alternative method for the surgical treatment of fifth metatarsal base fractures.
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Affiliation(s)
- Jun-Beom Kim
- Orthopedist, Department of Orthopaedic Surgery, Sun General Hospital, Daejeon, Republic of Korea.
| | - In-Soo Song
- Orthopedist, Department of Orthopaedic Surgery, Sun General Hospital, Daejeon, Republic of Korea
| | - Byeong-Seop Park
- Orthopedist, Department of Orthopaedic Surgery, Sun General Hospital, Daejeon, Republic of Korea
| | - Chi-Hoon Ahn
- Orthopedist, Department of Orthopaedic Surgery, Sun General Hospital, Daejeon, Republic of Korea
| | - Cheol-U Kim
- Orthopedist, Department of Orthopaedic Surgery, Sun General Hospital, Daejeon, Republic of Korea
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13
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Biz C, Zamperetti M, Gasparella A, Dalmau-Pastor M, Corradin M, de Guttry G, Ruggieri P. Early radiographic and clinical outcomes of minimally displaced proximal fifth metatarsal fractures: cast vs functional bandage. Muscles Ligaments Tendons J 2018; 7:532-540. [PMID: 29387648 DOI: 10.11138/mltj/2017.7.3.532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The purpose of this non-randomized retrospective study was to investigate outcomes of minimally displaced, proximal 5MTB fractures, treated by a below-knee walking cast or a functional elasticated bandage with a support of a flat hard-soled shoe. Methods A consecutive patient series was divided into two groups: the cast group (CG) and the functional group (FG). The subjects were radiologically and clinically evaluated according to Mehlhorn and Lawrence-Botte classification, and AOFAS Midfoot score, respectively. Results 154 patients were followed up for a median of 15 months (range 12-24). There was no significant difference (p > 0.05) among the outcomes of each fracture pattern regarding the treatment choice. However, an earlier return to sports was noted in the FG, while Type-3 fractures achieved the worst results. Conclusion Type-1 and 2 minimally displaced 5MTB proximal fractures can be successfully treated conservatively without weight-bearing restriction and without benefit of a cast with respect to a functional elasticated bandage. Level of clinical evidence level III retrospective comparative study.
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Affiliation(s)
- Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Marco Zamperetti
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Alberto Gasparella
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Barcelona, Spain.,Faculty of Health Sciences at Manresa, University of Vic Central, University of Catalonia, Manresa, Spain.,GRECMIP: Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Merignac, France
| | - Marco Corradin
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Giacomo de Guttry
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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Carver TJ, Schrock JB, Kraeutler MJ, McCarty EC. The Evolving Treatment Patterns of NCAA Division I Football Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016. Sports Health 2018; 10:234-243. [PMID: 29298161 PMCID: PMC5958450 DOI: 10.1177/1941738117745488] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Previous studies have analyzed the treatment patterns used to manage injuries
in National Collegiate Athletic Association (NCAA) Division I football
players. Hypothesis: Treatment patterns used to manage injuries in NCAA Division I football
players will have changed over the study period. Study Design: Descriptive epidemiology study. Level of Evidence: Level 5. Methods: The head orthopaedic team physicians for all 128 NCAA Division I football
teams were asked to complete a survey containing questions regarding
experience as team physician, medical coverage of the team, reimbursement
issues, and treatment preferences for some of the most common injuries
occurring in football players. Responses from the current survey were
compared with responses from the same survey sent to NCAA Division I team
physicians in 2008. Results: Responses were received from 111 (111/119, 93%) NCAA Division I orthopaedic
team physicians in 2008 and 115 (115/128, 90%) orthopaedic team physicians
between April 2016 and April 2017. The proportion of team physicians who
prefer a patellar tendon autograft for primary anterior cruciate ligament
reconstruction (ACLR) increased from 67% in 2008 to 83% in 2016
(P < 0.001). The proportion of team physicians who
perform anterior shoulder stabilization arthroscopically increased from 69%
in 2008 to 93% in 2016 (P < 0.0001). Of team physicians
who perform surgery for grade III posterior cruciate ligament (PCL)
injuries, the proportion who use the arthroscopic single-bundle technique
increased from 49% in 2008 to 83% in 2016 (P < 0.0001).
The proportion of team physicians who use Toradol injections prior to a game
to help with nagging injuries decreased from 62% in 2008 to 26% in 2016
(P < 0.0001). Conclusion: Orthopaedic physicians changed their injury treatment preferences for NCAA
Division I football players over the study period. In particular, physicians
have changed their preferred techniques for ACLR, anterior shoulder
stabilization, and PCL reconstruction. Physicians have also become more
conservative with pregame Toradol injections. Clinical Relevance: These opinions may help guide treatment decisions and lead to better care of
all athletes.
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Affiliation(s)
- Trevor J Carver
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - John B Schrock
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Kraeutler
- Department of Orthopaedics, Seton-Hall Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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15
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Dineen HA, Murphy TD, Mangat S, Lukosius EZ, Lin FC, Pettett BJ, Peoples SJ, Hurwitz SR. Functional Outcomes for Nonoperatively Treated Proximal Fifth Metatarsal Fractures. Orthopedics 2017; 40:e1030-e1035. [PMID: 29058755 DOI: 10.3928/01477447-20171012-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 09/05/2017] [Indexed: 02/03/2023]
Abstract
Fractures of the proximal fifth metatarsal are relatively common and can be treated with a variety of treatment modalities. The goals of the current study were to answer the following questions: (1) Is there a difference in functional outcomes with different nonoperative treatment modalities for avulsion and Jones fractures? (2) What is the long-term functional impairment? This study included 53 patients who were treated for proximal fifth metatarsal fracture at 1 university health care system between 2004 and 2013. Treatment methods included shoe modification, cast, and boot. Patients completed a telephone questionnaire that included selected questions from the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). Treatment groups were stratified as shoe modification or immobilization, and the results of the MODEMS survey were compared. At most recent follow-up, no significant difference was found between the 2 patient groups (P=.062) for self-reported effects of the injury on work and quality of life. No significant difference was found for frequency of use of pain medication (P=.157), patient satisfaction with current symptoms (P=.633), ambulatory status (P=.281), or pain level with strenuous activity (P=.772). Obese patients were more likely to have severe pain with strenuous activity (P=.015). Most (87%) patients were able to ambulate without the need for assistive devices. Of the study patients, 79% could wear dress shoes, excluding high heels, comfortably. The findings showed that patients who were treated with a variety of nonoperative methods for closed proximal fifth metatarsal fracture had acceptable functional outcomes, regardless of treatment method. [Orthopedics. 2017; 40(6):e1030-e1035.].
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16
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Effects of footwear and stride length on metatarsal strains and failure in running. Clin Biomech (Bristol, Avon) 2017; 49:8-15. [PMID: 28826012 DOI: 10.1016/j.clinbiomech.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/13/2017] [Accepted: 08/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The metatarsal bones of the foot are particularly susceptible to stress fracture owing to the high strains they experience during the stance phase of running. Shoe cushioning and stride length reduction represent two potential interventions to decrease metatarsal strain and thus stress fracture risk. METHODS Fourteen male recreational runners ran overground at a 5-km pace while motion capture and plantar pressure data were collected during four experimental conditions: traditional shoe at preferred and 90% preferred stride length, and minimalist shoe at preferred and 90% preferred stride length. Combined musculoskeletal - finite element modeling based on motion analysis and computed tomography data were used to quantify metatarsal strains and the probability of failure was determined using stress-life predictions. FINDINGS No significant interactions between footwear and stride length were observed. Running in minimalist shoes increased strains for all metatarsals by 28.7% (SD 6.4%; p<0.001) and probability of failure for metatarsals 2-4 by 17.3% (SD 14.3%; p≤0.005). Running at 90% preferred stride length decreased strains for metatarsal 4 by 4.2% (SD 2.0%; p≤0.007), and no differences in probability of failure were observed. INTERPRETATIONS Significant increases in metatarsal strains and the probability of failure were observed for recreational runners acutely transitioning to minimalist shoes. Running with a 10% reduction in stride length did not appear to be a beneficial technique for reducing the risk of metatarsal stress fracture, however the increased number of loading cycles for a given distance was not detrimental either.
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17
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Matsuda S, Fukubayashi T, Hirose N. Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study. SPORTS MEDICINE-OPEN 2017; 3:27. [PMID: 28785961 PMCID: PMC5545985 DOI: 10.1186/s40798-017-0095-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/25/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is a large amount of information regarding risk factors for fifth metatarsal stress fractures; however, there are few studies involving large numbers of subjects. This study aimed to compare the static foot alignment and distribution of foot pressure of athletes with and without a history of fifth metatarsal stress fractures. METHODS The study participants comprised 335 collegiate male soccer players. Twenty-nine with a history of fifth metatarsal stress fractures were in the fracture group and 306 were in the control group (with subgroups as follows: 30 in the fracture foot group and 28 in the non-fracture group). We measured the foot length, arch height, weight-bearing leg-heel alignment, non-weight-bearing leg-heel alignment, forefoot angle relative to the rearfoot, forefoot angle relative to the horizontal axis, and foot pressure. RESULTS The non-weight-bearing leg-heel alignment was significantly smaller and the forefoot angle relative to the rearfoot was significantly greater in the fracture foot group than in the control foot group (P = 0.049 and P = 0.038, respectively). With regard to plantar pressure, there were no significant differences among the groups. Midfield players had significantly higher rates of fifth metatarsal stress fracture in their histories, whereas defenders had significantly lower rates (chi-square = 13.2, P < 0.05). There were no significant differences in the frequency of fifth metatarsal stress fractures according to the type of foot (kicking foot vs. pivoting foot) or the severity of ankle sprain. CONCLUSIONS Playing the midfield position and having an everted rearfoot and inverted forefoot alignment were associated with fifth metatarsal stress fractures. This information may be helpful for preventing fifth metatarsal stress fracture recurrence. More detailed load evaluations and a prospective study are needed in the future.
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Affiliation(s)
- Sho Matsuda
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa Saitama, 359-1192, Japan.
| | | | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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18
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Bowes J, Buckley R. Fifth metatarsal fractures and current treatment. World J Orthop 2016; 7:793-800. [PMID: 28032031 PMCID: PMC5155254 DOI: 10.5312/wjo.v7.i12.793] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/13/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literature on management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.
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19
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Azevedo RR, da Rocha ES, Franco PS, Carpes FP. Plantar pressure asymmetry and risk of stress injuries in the foot of young soccer players. Phys Ther Sport 2016; 24:39-43. [PMID: 27863793 DOI: 10.1016/j.ptsp.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/08/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asymmetries in the magnitude of plantar pressure are considered a risk factor for stress fracture of the fifth metatarsal in soccer athletes. OBJECTIVE To investigate the presence of plantar pressure asymmetries among young soccer athletes. DESIGN Observational. SETTING Laboratory. PARTICIPANTS Thirty young adolescents divided into a soccer player group (n = 15) or a matched control group (n = 15). MAIN OUTCOME MEASURES Mean plantar pressure was determined for seven different regions of the foot. Data were compared between the preferred and non-preferred foot, and between the groups, during barefoot standing on a pressure mat system. RESULTS Higher pressure was found in the hallux, 5th metatarsal and medial rearfoot of the non-preferred foot in the young soccer players. These asymmetries were not observed in the control group. Magnitudes of plantar pressure did not differ between the groups. CONCLUSION Young soccer players present asymmetries in plantar pressure in the hallux, 5th metatarsal and medial rearfoot, with higher pressure observed in the non-preferred foot.
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Affiliation(s)
- Renato R Azevedo
- Applied Neuromechanics Research Group, Faculty of Health Sciences, Federal University of Pampa, Uruguaiana, RS, Brazil; Graduate Program in Physical Education, Physical Education and Sports Centre, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Emmanuel S da Rocha
- Applied Neuromechanics Research Group, Faculty of Health Sciences, Federal University of Pampa, Uruguaiana, RS, Brazil; Graduate Program in Physical Education, Physical Education and Sports Centre, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Pedro S Franco
- Applied Neuromechanics Research Group, Faculty of Health Sciences, Federal University of Pampa, Uruguaiana, RS, Brazil; Graduate Program in Physical Education, Physical Education and Sports Centre, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Faculty of Health Sciences, Federal University of Pampa, Uruguaiana, RS, Brazil; Graduate Program in Physical Education, Physical Education and Sports Centre, Federal University of Santa Maria, Santa Maria, RS, Brazil.
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20
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Shimasaki Y, Nagao M, Miyamori T, Aoba Y, Fukushi N, Saita Y, Ikeda H, Kim SG, Nozawa M, Kaneko K, Yoshimura M. Evaluating the Risk of a Fifth Metatarsal Stress Fracture by Measuring the Serum 25-Hydroxyvitamin D Levels. Foot Ankle Int 2016; 37:307-11. [PMID: 26596794 DOI: 10.1177/1071100715617042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The fifth metatarsal bone is a common site of stress fractures in soccer athletes. Although several endocrine risk factors for stress fractures have been proposed, the endocrine risks for fifth metatarsal (5-MT) stress fractures have not been evaluated. METHODS To evaluate the endocrine risks of fifth metatarsal stress fractures, we conducted a cumulative case-control study. The present study included 37 athletes, of which 18 had a history of a zone 2 or zone 3 fifth metatarsal stress fracture and 19 controls. We analyzed serum 25-hydroxyvitamin D (25-OHD), serum parathyroid hormone (PTH), as well as biochemical markers of bone turnover by univariate or multivariate analyses. RESULTS Logistic regression analyses adjusted for multiple confounders revealed that insufficient serum 25-OHD levels less than 30 ng/mL (odds ratio [OR], 23.3), higher serum PTH levels (OR, 1.01), or higher serum bone-specific isoform of alkaline phosphatase levels (OR, 1.10) rather than serum tartrate-resistant acid phosphatase 5b were associated with statistically significantly increased odds of 5-MT stress fractures. A postestimation calculation demonstrated that 25-OHD levels of 10 and 20 ng/mL were associated with 5.1 and 2.9 times greater odds for 5-MT stress fractures, respectively. CONCLUSION 25-OHD insufficiency was associated with an increased incidence of 5-MT stress fractures. This insight may be useful for intervening to prevent 5-MT stress fractures. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Yu Shimasaki
- School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Masashi Nagao
- Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takayuki Miyamori
- Department of Nursing and Rehabilitation Science, School of Physical Therapy at Odawara, International University of Health and Sports Science, Kanagawa, Japan
| | - Yukihiro Aoba
- School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Norifumi Fukushi
- Institute of Physical Education, Keio University, Kanagawa, Japan
| | - Yoshitomo Saita
- Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Hiroshi Ikeda
- Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Sung-Gon Kim
- Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Masahiko Nozawa
- Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Masafumi Yoshimura
- School of Health and Sports Science, Juntendo University, Chiba, Japan Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
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21
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Kane JM, Sandrowski K, Saffel H, Albanese A, Raikin SM, Pedowitz DI. The Epidemiology of Fifth Metatarsal Fracture. Foot Ankle Spec 2015; 8:354-9. [PMID: 25666689 DOI: 10.1177/1938640015569768] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A paucity of data exists studying the epidemiology of fifth metatarsal fractures. While a number of studies exist focusing on specific fracture patterns and patient populations, a large comprehensive epidemiologic study on the general public does not. OBJECTIVE We reviewed 1275 fifth metatarsal fractures treated at a multicenter orthopaedic practice attempting to classify mechanism of injury and patient demographics as they pertain to specific fracture patterns. METHODS Patient demographics were recorded and fractures categorized by location and mechanism of injury. Demographics and mechanism of injury were assessed to determine their predictive value for the type of fracture. Statistical analysis was used to predict whether demographics and mechanism of injury were statistically significant for types of fractures and whether gender and age were positive predictive values for fifth metatarsal fractures. RESULTS Twisting injuries were a statistically significant predictor of zone 1 injuries. A significant correlation between gender and fracture location was seen with women sustaining 75% of zone 1 injuries and 84% of dancer's fractures. A positive predictive value existed for age and gender with respect to the incidence of fractures. Males accounted for more fractures among younger patients and females accounting for the majority of fractures among older patients. CONCLUSION Mechanism of injury is a predictor for fracture location. Gender and age have a role in fracture incidence. In younger patient populations, males account for the majority of fifth metatarsal fractures. In older patient populations, females account for the majority of fifth metatarsal fractures. LEVEL OF EVIDENCE Prognostic study, Level II: Retrospective Study.
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Affiliation(s)
- Justin M Kane
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (JMK, KS)Joan C. Edwards Marshall School of Medicine, Huntington, West Virginia (HS)Jefferson Medical College, Philadelphia, Pennsylvania (AA)Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (SMR, DIP)
| | - Kristin Sandrowski
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (JMK, KS)Joan C. Edwards Marshall School of Medicine, Huntington, West Virginia (HS)Jefferson Medical College, Philadelphia, Pennsylvania (AA)Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (SMR, DIP)
| | - Heather Saffel
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (JMK, KS)Joan C. Edwards Marshall School of Medicine, Huntington, West Virginia (HS)Jefferson Medical College, Philadelphia, Pennsylvania (AA)Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (SMR, DIP)
| | - Anthony Albanese
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (JMK, KS)Joan C. Edwards Marshall School of Medicine, Huntington, West Virginia (HS)Jefferson Medical College, Philadelphia, Pennsylvania (AA)Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (SMR, DIP)
| | - Steven M Raikin
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (JMK, KS)Joan C. Edwards Marshall School of Medicine, Huntington, West Virginia (HS)Jefferson Medical College, Philadelphia, Pennsylvania (AA)Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (SMR, DIP)
| | - David I Pedowitz
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (JMK, KS)Joan C. Edwards Marshall School of Medicine, Huntington, West Virginia (HS)Jefferson Medical College, Philadelphia, Pennsylvania (AA)Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (SMR, DIP)
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22
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Iselin LD, Ramawat S, Hanratty B, Klammer G, Stavrou P. When Planning Screw Fracture Fixation Why the 5.5 mm Screw is the Goldilocks Screw. An Observational Computer Tomographic Study of Fifth Metatarsal Bone Anatomy in a Sample of Patients. Medicine (Baltimore) 2015; 94:e756. [PMID: 25950685 PMCID: PMC4602519 DOI: 10.1097/md.0000000000000756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We wanted to verify our clinical experience that the 5.5 mm screw was ideal in the majority of fifth metatarsal fracture fixation. The size of a screw is important for the successful surgical treatment of these fractures in order to obtain the maximal stability while reducing the risk for iatrogenic fracture.A sample of patients undergoing computer tomographic imaging of the foot for investigation other than fifth metatarsal pathology were recruited. The parameters of the fifth metatarsal bone anatomy were measured.These parameters of the 5.5 mm screw were correlated with this data. The upper parameter (the diameter of the threads) was 5.5 and the lower parameter (the diameter of the shank) was 4.0 mm.Twenty seven patients were recruited.The proximal third internal diameter ranged from 3.6 to 7.0 mm with a mean of 5.0 mm. 93% of the metatarsals could easily accommodate the 5.5 mm screw. Two of the metatarsals had an internal diameter of < 4 mm (7%).It is our belief that the 5.5 mm screw may be used safely in the majority of patients with fifth metatarsal fractures.
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Affiliation(s)
- Lukas D Iselin
- From the University Hospital Basel, Department of Traumatology, Basel, Switzerland (LDI); Adelaide Orthosports Clinic, Adelaide, SA, Australia (LDI, SR, BH, PS); Departement of Orthopaedics & Trauma, Luzerner Kantonsspitäler, Luzern, Switzerland (GK)
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Abstract
Metatarsal fractures are those most frequently encountered in the foot. More than half of these are of the 5th metatarsal. The incidence is increasing, along with the activity levels of the general population. Fractures of the 5th metatarsal require careful evaluation and classification to ensure selection of the optimum treatment plan. Distal fractures rarely require fixation, even when displacement is wide. Cases of established nonunion or refracture require fixation.
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Affiliation(s)
- Matthew Solan
- Surrey Foot and Ankle Clinic, Mount Alvernia Hospital, Harvey Road, Guildford, Surrey GU1 3LX, UK; Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 5XX, UK.
| | - Mark Davies
- London Foot and Ankle Centre, Hospital of St John and St Elizabeth, 80 Grove End Road, London NW8 9NH, UK
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24
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Lui TH. Lateral foot pain following open reduction and internal fixation of the fracture of the fifth metatarsal tubercle: treated by arthroscopic arthrolysis and endoscopic tenolysis. BMJ Case Rep 2014; 2014:bcr-2014-204116. [PMID: 24744074 DOI: 10.1136/bcr-2014-204116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of fracture of the tuberosity of the fifth metatarsal which was managed by tension band wiring and bone grafting. It was complicated by symptomatic fibrosis of the operated site involving the cubometatarsal joint, peroneus brevis tendon, peroneus tertius tendon and the long extensor tendon to the fifth toe. This was successfully managed by arthroscopic lysis of the involved joint and tendons.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, Hong Kong
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25
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Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review. Knee Surg Sports Traumatol Arthrosc 2013; 21:1307-15. [PMID: 22956165 DOI: 10.1007/s00167-012-2138-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/09/2012] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study is to better inform the sports surgeon of current evidence for the treatment of Jones fractures of the base of the 5th metatarsal. The study aimed to establish what the outcomes were for different treatments modalities. By doing this, the clinician will be better prepared to institute a logical, evidence-based approach to the treatment of their patients with this injury. METHODS A thorough literature search was performed from 1980 to present day. Studies were included based on set criteria and analysed for their validity, and their results were scrutinised. Jones fractures were segregated into acute fractures, delayed unions and non-unions. RESULTS Twenty-six studies were included, of which 22 were level 4 evidence, with only 1 randomised controlled trial. Functional outcome data were limited to return to sports in most studies with few studies using established scoring systems. Return to sports following intra-medullary screw fixation for acute fractures ranged from 4 to 18 weeks. Acute fractures treated non-operatively had a union rate of 76 % (pooled), whereas in fractures treated with a screw it was 96 % (pooled). Delayed unions treated non-operatively had a union rate of 44 and 97 % treated operatively. Non-unions treated with screw fixation healed in 97 % of cases. CONCLUSIONS Although supported by mostly level 4 evidence, intra-medullary screw fixation is more likely to lead to successful union of all types of Jones fractures compared to non-operative treatments. Early return to play in athletes prior to full radiological union is not advised in case of re-fracture.
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Abstract
The purpose of this foot and ankle update is to educate the reader on important foot and ankle topics including current controversies, physical examination, diagnostics, and management. Quick-view lists are used to give easy access to the most significant knowledge points for providing patient care for these entities. These topics were chosen either because they are very common or because of the high morbidity involved should there be a misdiagnosis or mismanagement.
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Affiliation(s)
- Ahmed Saleh
- PGY-3, Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Beirer M, Harrasser N, Schmidutz F, Kanz KG, Biberthaler P, Kirchhoff C. [Therapeutic approach to fractures of the proximal fifth metatarsal bone]. MMW Fortschr Med 2013; 155:53-4. [PMID: 23573748 DOI: 10.1007/s15006-013-0111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marc Beirer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München.
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Polzer H, Polzer S, Mutschler W, Prall WC. Acute fractures to the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury 2012; 43:1626-32. [PMID: 22465516 DOI: 10.1016/j.injury.2012.03.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/18/2012] [Accepted: 03/04/2012] [Indexed: 02/02/2023]
Abstract
Fractures to the proximal fifth metatarsal bone are among the most frequent injuries to the foot. Various classifications intend to distinguish different fracture entities in regard to prognosis and treatment. The most commonly used classification by Lawrence and Botte delineates three fracture zones and gives treatment recommendations based on retrospective case series. Aim of our study was to critically review the literature and reevaluate the classification and treatment recommendations based on the highest level of evidence available. We performed a systematic literature search in Medline, Embase and Cochrane library and identified six prospective trials either comparing the same treatment for different fracture entities or different treatment strategies for the same fracture entity. The studies reveal that all "tuberosity avulsion fractures" (Zone 1, according to Lawrence and Botte) heal well using functional treatment. Even multifragmentary, displaced and intraarticular fractures in Zone 1 give comparable good results. Treatment with a short leg cast leads to a significant delay in return to preinjury level when compared to functional treatment. "Jones' fractures" (Zone 2) also demonstrate good to excellent results and complete bone healing when treated functionally. In contrast, "diaphyseal stress fractures" (Zone 3) at the distal limit of the fourth-fifth intermetatarsal articulation and just distally feature a significantly higher rate of treatment failure when treated non-operatively in a non-weight bearing short leg cast. Early intramedullary screw fixation leads to a significantly shorter time to bone healing and return to sport. In conclusion, acute fractures to the proximal fifth metatarsal bone should be classified into two entities only: First, metaphyseal fractures not extending beyond the distal end of the fourth-fifth intermetatarsal articulation, as these fractures, regardless the number of fragments, displacement and intraarticular involvement, should be treated functionally. Second, meta-diaphyseal fractures located at the distal end of the fourth-fifth intermetatarsal articulation or just distally, as these fractures require early intramedullary screw fixation.
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Affiliation(s)
- Hans Polzer
- Munich University Hospital, Department of Trauma Surgery - Campus Innenstadt, Ludwig-Maximilians-University, Nussbaumstr. 20, 80336 Munich, Germany.
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Fansa AM, Smyth NA, Murawski CD, Kennedy JG. The lateral dorsal cutaneous branch of the sural nerve: clinical importance of the surgical approach to proximal fifth metatarsal fracture fixation. Am J Sports Med 2012; 40:1895-8. [PMID: 22679294 DOI: 10.1177/0363546512448320] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fractures of the proximal fifth metatarsal are one of the most common forefoot injuries encountered by orthopaedic surgeons in sports medicine. The percutaneous surgical approach to Jones fracture fixation and corresponding anatomy has received little attention in the literature to date. PURPOSE To describe in detail the location of the lateral dorsal cutaneous nerve (LDCN) and its branches relative to the base of the fifth metatarsal and to the standard lateral approach. STUDY DESIGN Descriptive laboratory study. METHODS Ten fresh-frozen cadaveric foot specimens were used for this study. Specimens were dissected at the lateral aspect of the foot over the proximal fifth metatarsal, and the LDCN and its branches were identified. The distance of the LDCN to the superior border of the peroneus brevis tendon (PBT) was measured relative to standard reference points in all specimens, and the presence of an anastomotic branch was noted. A set of vertical and horizontal reference lines were also constructed to determine whether the LDCN or its branches would be compromised by a standard lateral approach. RESULTS The LDCN was superficial (ie, lateral) and inferior to the superior border of the PBT in all specimens and at all reference points. A bifurcation of the LDCN was present in 8 specimens, located an average of 18 mm posterior and 11 mm dorsal to the base of the fifth metatarsal. The dorsolateral branch and dorsomedial branch of the LDCN each intersected with the base of the fifth metatarsal horizontal line and vertical line, respectively, indicating potential compromise of the nerve with a standard lateral surgical approach. CONCLUSION The standard lateral approach to the base of the fifth metatarsal carries a higher risk for surgical injury to the LDCN. A "high and inside" approach that remains superior to the superior border of the PBT is anatomically safe and may decrease the chance of intraoperative nerve injury and irritation postoperatively.
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Affiliation(s)
- Ashraf M Fansa
- Hospital for Special Surgery, 523 East 72nd Street, Suite 514, New York, NY 10021, USA.
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Interventions for treating proximal fifth metatarsal fractures in adults: a meta-analysis of the current evidence-base. Foot Ankle Surg 2011; 17:300-7. [PMID: 22017907 DOI: 10.1016/j.fas.2010.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/13/2010] [Accepted: 12/23/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study assessed the clinical and radiological outcomes of different non-surgical interventions, surgical versus non-surgical interventions, and different surgical interventions used in the management of proximal fifth metatarsal fractures. METHODS A systematic review of published and unpublished literature was undertaken. RESULTS Six studies, assessing 330 patients and 333 fractures of the proximal fifth metatarsal were reviewed. Four studies assessed outcomes following tuberosity fractures, whilst 2 studies recruited patients following proximal diaphyseal or Jones fractures. The findings suggested that bandage is superior to below knee cast immobilisation for patient-reported functional and pain scores, with no difference in fracture union or re-fracture, and a shorter duration to return to work. There was no significant difference in complication rates or functional outcomes for patients managed in a plaster slipper compared to a bandage post-injury. When comparing surgical and non-surgical management, intramedullary screw fixation results in a shorter time to fracture union, reduced complication rates and earlier return to pre-injury activities compared to non-surgical cast immobilisation. However, the evidence-base is limited in it size and presented with a number of methodological limitations. CONCLUSIONS Further well-conducted randomised controlled trials are required to determine the optimal management strategy for the different types of proximal fifth metatarsal fractures.
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Murawski CD, Kennedy JG. Percutaneous internal fixation of proximal fifth metatarsal jones fractures (Zones II and III) with Charlotte Carolina screw and bone marrow aspirate concentrate: an outcome study in athletes. Am J Sports Med 2011; 39:1295-301. [PMID: 21212308 DOI: 10.1177/0363546510393306] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internal fixation is a popular first-line treatment method for proximal fifth metatarsal Jones fractures in athletes; however, nonunions and screw breakage can occur, in part because of nonspecific fixation hardware and poor blood supply. PURPOSE To report the results from 26 patients who underwent percutaneous internal fixation with a specialized screw system of a proximal fifth metatarsal Jones fracture (zones II and III) and bone marrow aspirate concentrate. STUDY DESIGN Case series; Level of evidence, 4. METHODS Percutaneous internal fixation for a proximal fifth metatarsal Jones fracture (zones II and III) was performed on 26 athletic patients (mean age, 27.47 years; range, 18-47). All patients were competing at some level of sport and were assessed preoperatively and postoperatively using the Foot and Ankle Outcome Score and SF-12 outcome scores. The mean follow-up time was 20.62 months (range, 12-28). Of the 26 fractures, 17 were traditional zone II Jones fractures, and the remaining 9 were zone III proximal diaphyseal fractures. RESULTS The mean Foot and Ankle Outcome Score significantly increased, from 51.15 points preoperatively (range, 14-69) to 90.91 at final follow-up (range, 71-100; P < .01). The mean physical component of the SF-12 score significantly improved, from 25.69 points preoperatively (range, 6-39) to 54.62 at final follow-up (range, 32-62; P < .01). The mean mental component of the SF-12 score also significantly improved, from 28.20 points preoperatively (range, 14-45) to 58.41 at final follow-up (range, 36-67; P < .01). The mean time to fracture healing on standard radiographs was 5 weeks after surgery (range, 4-24). Two patients did not return to their previous levels of sporting activity. One patient experienced a delayed union, and 1 healed but later refractured. CONCLUSION Percutaneous internal fixation of proximal fifth metatarsal Jones fractures, with a Charlotte Carolina screw and bone marrow aspirate concentrate, provides more predictable results while permitting athletes a return to sport at their previous levels of competition, with few complications.
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Miller T, Kaeding CC, Flanigan D. The classification systems of stress fractures: a systematic review. PHYSICIAN SPORTSMED 2011; 39:93-100. [PMID: 21378491 DOI: 10.3810/psm.2011.02.1866] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Stress fractures of the upper and lower extremity are troublesome overuse injuries in athletes and nonathletes alike. These injuries have a broad spectrum of severity and prognosis. We performed a systematic search of the literature, which revealed multiple classification systems; however, we did not uncover a general system that offered both validated radiographic and clinical parameters. METHODS A literature search was conducted using Ovid/Medline, Embase, and the Cochrane Library, with publication dates ranging from 1960 to December 2009. Inclusion criteria included all studies and review articles regarding stress or fatigue fractures and their classification. RESULTS Forty-three studies and/or articles were identified for this review. Of these articles, 27 classification systems were referenced. Sixteen of the systems were applicable to any injury location, and 1 applied to specific bones (femoral neck, tibia, tarsal navicular, pars interarticularis, and fifth metatarsal). Four classification systems were referenced more often than others. Of the classification systems, 11 were based on radiographs alone, while the other 16 used a variety of radiographic modalities, including radiographs, bone scans, computed tomography, ultrasound, and magnetic resonance imaging. CONCLUSION There are many different stress fracture classification systems in the literature. These systems employ various imaging modalities, but few include clinical parameters. Many are site specific. Of those that are widely applicable, no general classification system has been shown to be reproducible, easily accessible, safe, inexpensive, and clinically relevant. A gold standard classification system for describing stress fractures has yet to be determined.
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Affiliation(s)
- Timothy Miller
- Department of Orthopaedics, Sports Medicine Center, The Ohio State University, Columbus, OH, USA
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Abstract
Running has many beneficial effects, including cardiovascular and skeletal health. Poor training technique and a variety of risk factors may predispose runners to lower-limb overuse injuries affecting muscle, tendon, and bone. Injuries to the bone include stress reactions to full-fledged stress fractures. This article is designed to provide an understanding of the general concepts involving bone strain, risk factor assessment, and evaluation and treatment strategies for the runner with a stress fracture. The second half of the article presents more detail regarding each specific fracture seen in runners. The ultimate goal of this article is to provide the basics regarding stress fractures in runners from pathophysiology and general guidelines of evaluation and treatment and provide a quick reference regarding the details of each specific fracture encountered in clinical practice.
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Affiliation(s)
- Mark A Harrast
- Seattle Marathon, 1530 Westlake Avenue North, Seattle, WA 98019, USA.
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Abstract
This article provides an update and overview of Lisfranc injury and Jones fracture in the athletic population. Sports-related Lisfranc sprains or fractures are subtle injuries that can be easily missed. Now, there is greater understanding of midfoot sprains that represent a spectrum of injury to the Lisfranc ligament complex. Most types of fifth metatarsal fractures have a favorable prognosis and can be treated conservatively. The treatment options for Jones fractures in athletes have been much debated. This article discusses issues related to anatomy, mechanism of injury, clinical presentation, imaging, and diagnosis, which are necessary to appropriately treat these injuries.
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Affiliation(s)
- Bora Rhim
- Department of Podiatric Medicine, Surgery, and Biomechanics, College of Podiatric Medicine, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766-1854, USA.
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Abstract
The emergency provider (EP) must be aware of the anatomy of the leg, ankle, and foot. The varied presentation of common injuries must be recognized as well as the unique presentations of uncommon injuries. The astute EP must rely on a focused history and a precise examination to avoid the pitfalls and missed injuries from an over-reliance on radiographic studies. In some cases, emergent orthopedic consultation is required. Potential complications associated with these injuries must be anticipated and avoided if possible.
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36
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Persistent foot pain after a skateboarderʼs fall. JAAPA 2010; 23:63-4. [DOI: 10.1097/01720610-201005000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Pediatric Foot Fractures. Tech Orthop 2009. [DOI: 10.1097/bto.0b013e3181b634cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Orendurff MS, Rohr ES, Segal AD, Medley JW, Green JR, Kadel NJ. Biomechanical analysis of stresses to the fifth metatarsal bone during sports maneuvers: implications for fifth metatarsal fractures. PHYSICIAN SPORTSMED 2009; 37:87-92. [PMID: 20048514 DOI: 10.3810/psm.2009.06.1714] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fifth metatarsal stress fractures are an increasing problem in elite and recreational athletic populations. One possible mechanism of injury is the many bending moments applied to the fifth metatarsal during dynamic sports maneuvers involving rapid changes in direction and speed. A potentially important bending moment is loading of the base versus the head of the fifth metatarsal, which tends to cause a bending moment along the bone. To determine which maneuver applies the greatest pressure differential between the base and head of the fifth metatarsal, 10 college-aged male athletes performed running straight, jump take-off, jump landing, cutting right, cutting left, and accelerating while plantar pressures were recorded using a Pedar insole system (Novel Electronics, Inc., St. Paul, MN). Peak pressure at the fifth metatarsal base was subtracted from the peak pressure at the fifth metatarsal head to obtain the fifth metatarsal pressure differential-a corollary to the bending moment. The greatest fifth metatarsal pressure differential was observed during acceleration maneuvers (20 + or - 13.1 N/cm(2); P < 0.0001) followed by running straight (11.6 + or - 8 N/cm(2); P < 0.0008). The other maneuvers had low pressure differentials: jump take-off (4.2 + or - 10.6 N/cm(2)), jump landing (3.7 + or - 9.2 N/cm(2)), cutting left (2.3 + or - 4.2 N/cm(2)), and cutting right (-2.1 + or - 10 N/cm(2)). It appears that acceleration maneuvers may apply the largest bending moments to the fifth metatarsal and could lead to stress fractures. Because fifth metatarsal stress fractures are associated with rapid increases in training volume, reducing the number of acceleration events may be effective in altering the balance between bone resorption and bone formation and reducing stress fracture risk. Careful planning of training programs allowing for adequate rest between intense bouts of exercise involving many acceleration maneuvers may be the best preventative measure.
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Affiliation(s)
- Michael S Orendurff
- Movement Science Laboratory, Texas Scottish Rite Hospital for Children, 2222 Welborne St., Dallas, TX 75219-3993, USA.
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39
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Carmont MR, Blundell CM, Straus B, Turgeon DR. Surgical Management of Proximal Fourth Metatarsal Stress Fracture Nonunion: Debridement and Locking Plate Stabilization. OPER TECHN SPORT MED 2009. [DOI: 10.1053/j.otsm.2009.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Thomas JL, Blitch EL, Chaney DM, Dinucci KA, Eickmeier K, Rubin LG, Stapp MD, Vanore JV. Diagnosis and treatment of forefoot disorders. Section 5. Trauma. J Foot Ankle Surg 2009; 48:264-72. [PMID: 19232982 DOI: 10.1053/j.jfas.2008.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
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- University of Florida, Department of Orthopaedics and Rehabilitation, Jacksonville, 32209, USA.
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41
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Thomas JL, Blitch EL, Chaney DM, Dinucci KA, Eickmeier K, Rubin LG, Stapp MD, Vanore JV. Diagnosis and treatment of forefoot disorders. Section 2. Central metatarsalgia. J Foot Ankle Surg 2009; 48:239-50. [PMID: 19232979 DOI: 10.1053/j.jfas.2008.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
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- University of Florida, Department of Orthopaedics and Rehabilitation, Jacksonville, 32209, USA.
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Chuckpaiwong B, Queen RM, Easley ME, Nunley JA. Distinguishing Jones and proximal diaphyseal fractures of the fifth metatarsal. Clin Orthop Relat Res 2008; 466:1966-70. [PMID: 18363075 PMCID: PMC2584274 DOI: 10.1007/s11999-008-0222-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 03/05/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Jones and proximal diaphyseal fractures of the fifth metatarsal are in close anatomic proximity and often are difficult to differentiate. We determined whether it is necessary to differentiate between these two diagnoses. Retrospectively, the two diagnoses were identified radiographically using an accepted classification scheme. Initial management is nonoperative; however, intramedullary screw fixation is performed for competitive athletes, or others with displaced fractures, or delayed union or nonunion. Outcomes were analyzed using Student's t tests, whereas nominal data were analyzed using chi square tests. Thirty-two Jones fractures and 29 proximal diaphyseal fractures were identified. All fractures healed between 4.8 and 9.8 months with a 78% to 82% patient satisfaction rate. Regardless of treatment, the clinical outcomes were not different between the two fracture locations. Shorter return to sport time was observed in operatively treated patients. Operatively treated patients with fracture site sclerosis or medullary canal obliteration on radiographs had lower satisfaction and higher complication rates than patients without these changes. Based on our findings, we do not find a reason to distinguish between fractures of the fifth metatarsal in these two locations. We suggest referring to fifth metatarsal base fractures (excluding avulsions) as Jones fractures. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Bavornrit Chuckpaiwong
- Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC USA ,Michael W. Krzyzewski Human Performance Lab, Duke University Medical Center, 102 Finch Yeager Building, DUMC 3435, Durham, NC 27710 USA
| | - Robin M. Queen
- Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC USA ,Michael W. Krzyzewski Human Performance Lab, Duke University Medical Center, 102 Finch Yeager Building, DUMC 3435, Durham, NC 27710 USA
| | - Mark E. Easley
- Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC USA
| | - James A. Nunley
- Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC USA
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Raikin SM, Slenker N, Ratigan B. The association of a varus hindfoot and fracture of the fifth metatarsal metaphyseal-diaphyseal junction: the Jones fracture. Am J Sports Med 2008; 36:1367-72. [PMID: 18443278 DOI: 10.1177/0363546508314401] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fractures to the fifth metatarsal metaphyseal-diaphyseal junction (Jones fracture) have high nonunion rates. Surgical intramedullary screw fixations have excellent results but a high refracture rate. This has been associated with inadequate screw size and too early return to activity. HYPOTHESIS Varus hindfoot alignment overloads the lateral column of the foot and acts as a predisposing factor to the development of and failure of treatment of Jones fractures. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty-one primary Jones fractures (20 patients) treated surgically with a 4.5-mm cannulated screw were retrospectively reviewed. Detailed clinical and radiographic data and outcomes were recorded, including measurements of hindfoot alignment. RESULTS A 100% union rate with return to prior activity level and no refractures were found at a mean follow-up of 49 months. Clinical varus was present in 16 feet, whereas radiographic measurements revealed 18 of 21 hindfeet to be in varus. The mean calcaneal pitch angle was 28.5 degrees , and the mean Meary angle was 13 degrees convex upward. Patients with varus alignment were fitted postoperatively with lateral hindfoot and forefoot posted orthotic inserts to correct alignment. CONCLUSION The majority of patients sustaining Jones fractures have evidence of varus hindfoot alignment. This may be a predisposing factor to developing the fracture or refracture after fixation. Postoperative varus unloading (lateral hindfoot and forefoot posting) orthotic insert appears to be helpful in preventing reinjury or refracture of Jones fractures.
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Affiliation(s)
- Steven M Raikin
- Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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44
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Singer G, Cichocki M, Schalamon J, Eberl R, Höllwarth ME. A study of metatarsal fractures in children. J Bone Joint Surg Am 2008; 90:772-6. [PMID: 18381315 DOI: 10.2106/jbjs.g.00547] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metatarsal fractures are common in children. The aim of the present study was to analyze a consecutive series of metatarsal fractures in children and to describe the epidemiology of the fractures, the location of the fractures, and the mechanism of injury. METHODS A consecutive series of 125 patients with metatarsal fractures who presented to one pediatric surgery department over a twenty-two-month period was evaluated with use of a questionnaire to define the mechanism of injury. All patients were followed until the fracture was healed. The specific location of the fractures and the mechanism of injury were identified. RESULTS One hundred and twenty-five children (seventy-five boys and fifty girls; average age, 8.6 years [range, one to seventeen years]) presented with 166 metatarsal fractures. Major differences were found between children who were five years of age or less and those who were more than five years of age. In patients who were five years of age or less, the predominant location of the accident that had caused the fracture was inside the house and the primary mechanism was a fall from a height. In patients who were more than five years of age, most accidents occurred at sports facilities and were caused by a fall on a level surface. The most frequently fractured metatarsal in younger children was the first, whereas the most frequently fractured metatarsal in older children was the fifth. CONCLUSIONS The mechanism of injury and clinical presentation of metatarsal fractures in children are age-dependent, with patients five years of age or less and those more than five years of age having different mechanisms of injury and different types of metatarsal fractures.
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Affiliation(s)
- Georg Singer
- Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.
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45
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Chuckpaiwong B, Cook C, Pietrobon R, Nunley JA. Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations. Br J Sports Med 2007; 41:510-4. [PMID: 17339282 PMCID: PMC2465429 DOI: 10.1136/bjsm.2006.033571] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND Stress fractures of the second metatarsal are common injuries in athletes and military recruits. There are two distinct areas in the second metatarsal where stress fractures develop: one proximal (at the base) and the other non-proximal (distal). Diagnosis can be difficult, and there is a difference in prognosis and treatment of the two types of stress fracture. Therefore differentiation of fracture location is warranted. Differences in risk factors and clinical outcomes between proximal and non-proximal stress fractures have not been studied. OBJECTIVE To determine whether different risk factors and/or clinical outcomes associated with proximal and non-proximal stress fractures of the second metatarsal exist. METHODS Patients diagnosed with proximal stress fractures of the second metatarsal were included in the study. Retrospectively, an age-matched control group with a non-proximal stress fracture was selected for comparison. Statistical analysis involved bivariate comparisons of demographic variables and clinical measurement between the two groups. RESULTS Patients with proximal stress fractures were more likely to be chronically affected, usually exhibited an Achilles contracture, showed differences in length of first compared with second metatarsal, were more likely to experience multiple stress fractures, and exhibited low bone mass. In addition, a high degree of training slightly increased the risk of a non-proximal fracture, whereas low training volume was associated with a proximal stress fracture. CONCLUSION The signs, symptoms and clinical findings associated with proximal metatarsal stress fractures are different from those of non-proximal stress fractures.
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Affiliation(s)
- Bavornrit Chuckpaiwong
- Department of Surgery, Division of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
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Niva MH, Sormaala MJ, Kiuru MJ, Haataja R, Ahovuo JA, Pihlajamaki HK. Bone stress injuries of the ankle and foot: an 86-month magnetic resonance imaging-based study of physically active young adults. Am J Sports Med 2007; 35:643-9. [PMID: 17099238 DOI: 10.1177/0363546506295701] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No comprehensive studies of bone stress injuries in the ankle and foot based on magnetic resonance imaging findings have been published. PURPOSE Using magnetic resonance imaging findings to assess incidence, location, and type of bone stress injuries of the ankle and foot in military conscripts with ankle and/or foot pain. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients with ankle or foot pain, negative findings on plain radiography, and magnetic resonance images obtained of the ankle or foot were included in this 86-month study. Magnetic resonance images with bone stress injury findings were re-evaluated regarding location and injury type. Based on the number of conscripts within the hospital catchment area, the person-based incidence of bone stress injuries was calculated. RESULTS One hundred thirty-one conscripts displayed 378 bone stress injuries in 142 ankles and feet imaged, the incidence being 126 per 100 000 person-years. This incidence represents the stress injuries not diagnosable with radiographs and requiring magnetic resonance images. Of injuries, 57.7% occurred in the tarsal and 35.7% in the metatarsal bones. Multiple bone stress injuries in 1 foot were found in 63% of the cases. The calcaneus and fifth metatarsal bone were usually affected alone. Injuries to the other bones of the foot were usually associated with at least 1 other stress injury. The talus and calcaneus were the most commonly affected single bones. High-grade bone stress injury (grade IV-V) with a fracture line on magnetic resonance images occurred in 12% (talus, calcaneus), and low-grade injury (grade I-III) presented only as edema in 88% of the cases. CONCLUSION Multiple, various-stage bone stress injuries of the ankle and foot may occur simultaneously in physically active young adults. When considering injuries that were missed by plain radiographs but detected by magnetic resonance imaging, the bones most often affected were the tarsal bones, of which the talus and calcaneus were the most prominent single bones and most common locations for higher grade (IV-V) bone stress injuries. With use of magnetic resonance imaging, early detection and grading of bone stress injuries are available, which enable early and appropriate injury management.
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Affiliation(s)
- Maria H Niva
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland.
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