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Keller M, Saltrick B, Gull L, Reade B. Fifth Metatarsal Fractures. Clin Podiatr Med Surg 2024; 41:391-405. [PMID: 38789160 DOI: 10.1016/j.cpm.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Fifth metatarsal features are the most common fractures in the foot. They have a long history that has resulted in many classification systems and little consensus on appropriate treatment. Although there is some agreement among experts, there are also many questions yet to be answered. There is a general consensus that dancer's fractures and zone 1 fractures can generally be treated nonoperatively. There is much more debate about zone 2 and 3 fractures and appropriate treatment guidelines. The authors review the current literature and give the recommendation for treatment based on their experience in a community-based private practice.
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Affiliation(s)
| | | | - Logan Gull
- Health Alliance Hospital, Kingston, NY, USA
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2
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Wininger AE, Klavas DM, Gardner SS, Ahuero JS, Harris JD, Varner KE. Plantar Plating for Medial Naviculocuneiform Arthrodesis in Progressive Collapsing Foot Deformity. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221088517. [PMID: 35386584 PMCID: PMC8978315 DOI: 10.1177/24730114221088517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Medial column procedures are commonly used to treat progressive collapsing foot deformity (PCFD) reconstruction. The aim of this research is to present the clinical results of plantar plating for medial naviculocuneiform (NC) arthrodesis when NC joint pathology contributes to medial arch collapse. The authors hypothesized that lag screws with a plantar neutralization plate would result in a satisfactory NC joint fusion rate. Methods: A single-surgeon, retrospective case series was performed on patients with flexible PCFD who underwent NC arthrodesis using lag screws and a contoured neutralization plate applied plantarly across the medial NC joint as part of PCFD reconstruction. Thirteen patients (11 females, 2 males; mean age 53.1 [34-62] years) between 2016 and 2019 were identified for inclusion. Mean follow-up was 25.2 ± 12.7 months. Preoperative and postoperative anteroposterior talo–first metatarsal angle, lateral talo–first metatarsal angle, talonavicular coverage angle, and calcaneal pitch were measured. Union was evaluated radiologically. AOFAS midfoot scores were recorded at final follow-up. Results: All parameters demonstrated a significant improvement. Fusion was confirmed in 11 of 13 patients (85%) at a mean 5.7 ± 2.1 months. One patient required a revision of their NC fusion because of symptomatic nonunion. There were no cases of symptomatic plantar hardware. Conclusion: The results of this small cohort series suggest that lag screw with plantar plate NC arthrodesis yielded generally improved short-term radiographic and clinical outcomes in PCFD patients with medial arch collapse through the NC joint. Level of Evidence: Level IV, retrospective case series.
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Affiliation(s)
| | - Derek M. Klavas
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | | | - Jason S. Ahuero
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | - Joshua D. Harris
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | - Kevin E. Varner
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
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Lam K, Bui R, Morris R, Panchbhavi V. Biomechanical Analysis of Conventional Partially Threaded Screws Versus Headless Compression Screws in Proximal Fifth Metatarsal (Jones) Fracture Fixation. Foot Ankle Spec 2021; 14:509-514. [PMID: 32506962 DOI: 10.1177/1938640020931668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Intramedullary screw fixation of Jones fractures using partially threaded screws is a common method of fixation for these injuries, but refracture continues to be a problem. Various other fixation strategies, such as headless compression screws, plantar plating, and tension-band wiring. have been developed to mitigate these issues. Biomechanical studies with regard to these other fixation strategies are limited. Herein, we investigate the compression strength and angular stiffness of Jones fractures fixed with Herbert-style headless compression screws. METHODS Jones fractures were created in 10 fresh-frozen pairs of cadaveric fifth metatarsals. A bone from each pair was instrumented with either a conventional, partially threaded screw 5.0 or 6.5 mm in diameter, or a headless compression screw 5.0 or 7.0 mm in diameter. Sizes were determined via sequential tapping until a snug fit was obtained. Each metatarsal was stressed via cantilever bending over 1000 cycles. We monitored compression and displacement throughout. RESULTS Headless compression screws achieved a significantly higher amount of stiffness than conventional, partially threaded screws (P = 0.005). There was no statistically significant difference with respect to compression. CONCLUSION In a cadaveric model, headless compression screws achieved a greater amount of fracture stiffness versus conventional, partially threaded screws.Levels of Evidence: Therapeutic, Level V: Biomechanical.
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Affiliation(s)
- Kenrick Lam
- Department of Orthopaedic Surgery and Rehabilitation (KL, RM, VP).,School of Medicine (RB), The University of Texas Medical Branch, Galveston, Texas
| | - Roger Bui
- Department of Orthopaedic Surgery and Rehabilitation (KL, RM, VP).,School of Medicine (RB), The University of Texas Medical Branch, Galveston, Texas
| | - Randal Morris
- Department of Orthopaedic Surgery and Rehabilitation (KL, RM, VP).,School of Medicine (RB), The University of Texas Medical Branch, Galveston, Texas
| | - Vinod Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation (KL, RM, VP).,School of Medicine (RB), The University of Texas Medical Branch, Galveston, Texas
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Goodloe JB, Cregar WM, Caughman A, Bailey EP, Barfield WR, Gross CE. Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211037647. [PMID: 34552993 PMCID: PMC8450619 DOI: 10.1177/23259671211037647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/03/2021] [Indexed: 12/28/2022] Open
Abstract
Background As a result of the high physical demand in sport, elite athletes are particularly prone to fifth metatarsal fractures. These injuries are typically managed surgically to avoid high rates of delayed union and allow for quicker return to play (RTP). Purpose To review studies showing clinical and radiographic outcomes, RTP rates, and complication rates after different surgical treatment modalities for fifth metatarsal fractures exclusively in elite-level athletes. Study Design Systematic review; Level of evidence, 4. Methods A systematic search was conducted within the PubMed, Scopus, and Cochrane databases from January 2000 to January 2020. Inclusion criteria consisted of clinical outcome studies after operative management of fifth metatarsal fractures in elite athletes. Exclusion criteria consisted of nonoperative management, high school or recreational-level athletic participation, nonclinical studies, expert opinions, and case series with <5 patients. Results A total of 12 studies met inclusion and exclusion criteria, comprising 280 fifth metatarsal fractures treated surgically. Intramedullary screw fixation was the most common fixation construct (47.9%), and some form of intraoperative adjunctive treatment (calcaneal autograft, iliac crest bone graft, bone marrow aspirate concentrate, demineralized bone matrix) was used in 67% of cases. Radiographic union was achieved in 96.7% of fractures regardless of surgical construct used. The overall mean time to union was 9.19 weeks, with RTP at a mean of 11.15 weeks. The overall reported complication rate was 22.5%, with varying severity of complications. Refracture rates were comparable between the different surgical constructs used, and the overall refracture rate was 8.6%. Conclusion Elite athletes appeared to have a high rate of union and reliably returned to the same level of competition after surgical management of fifth metatarsal fractures, irrespective of surgical construct used. Despite this, the overall complication rate was >20%. Specific recommendations for optimal surgical management could not be made based on the heterogeneity of the included studies.
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Affiliation(s)
- J Brett Goodloe
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William M Cregar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander Caughman
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan P Bailey
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William R Barfield
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher E Gross
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
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Albloushi M, Alshanqiti A, Qasem M, Abitbol A, Gregory T. Jones type fifth metatarsal fracture fixation in athletes: A review and current concept. World J Orthop 2021; 12:640-650. [PMID: 34631448 PMCID: PMC8472442 DOI: 10.5312/wjo.v12.i9.640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels. These fractures may occur due to several mechanisms, but inversions and twisting injuries are considered some of the leading causes in sports. However, while Jones fracture incidences are frequent in the sporting world, there is still a lack of consensus on how such fractures should be effectively managed. There are numerous treatment options for patients with fifth metatarsal Jones fractures. The role of nonoperative treatment remains controversial, with concerns about delayed union and nonunion. Surgical stabilization of metatarsal Jones fractures is therefore often recommended for athletes, as it is often associated with a low number of complications and a higher rate of union than nonoperative management. This review will focus on literature regarding the prevalence of Jones type fifth metatarsal fracture, alongside the efficacy of both conservative and surgical treatment within this population.
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Affiliation(s)
- Mohammad Albloushi
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Amer Alshanqiti
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Mohammad Qasem
- Al-Razi Hospital, Ministry of Health, State of Kuwait, Kuwait City 00965, Kuwait
| | - Andreas Abitbol
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
| | - Thomas Gregory
- Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne-Paris-Nord, Sorbonne Paris Cité +33, France
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Abstract
Proximal fifth metatarsal fractures are common in the athlete and can be a source of significant, temporary disability and missed playing time. The pattern of fracture can vary, and the type of fracture leads to a significantly different prognosis and treatment. Jones fractures of the fifth metatarsal are particularly common and difficult to treat in the athlete, can have recurrence and refracture, and require expertise to heal. Intramedullary screw fixation is currently the preferred method of fixation. Most other (non-Jones fractures and os vesalianum) proximal fifth metatarsal fractures can be treated successfully without surgery.
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Affiliation(s)
- David A Porter
- Methodist Sports Medicine/TOS, Department of Orthopedics, Indiana University, Purdue University, 201 Pennsylvania Parkway, Suite 100, Carmel, IN 46280, USA; Wabash College.
| | - Jeff Klott
- Department of Orthopedics, Indiana University, 46280, USA
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Young KW, Kim JS, Lee HS, Jegal H, Park YU, Lee KT. Operative Results of Plantar Plating for Fifth Metatarsal Stress Fracture. Foot Ankle Int 2020; 41:419-427. [PMID: 31904259 DOI: 10.1177/1071100719895273] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating. METHODS Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months. RESULTS The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks. CONCLUSION With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Ki Won Young
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jin Su Kim
- Department of Orthopedic Surgery, CM General Hospital, Seoul, Korea
| | - Hong Sup Lee
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hyuk Jegal
- Foot and Ankle Service, Bonbone Orthopedic Hospital, Seoul, Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Kyung Tai Lee
- Foot and Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Korea
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Roberts L, Bernasconi A, Netto CDC, Elliott A, Hamilton W, O'Malley M. Cuboid Edema Syndrome Following Fixation of Proximal Fifth Metatarsal Fractures in Professional Athletes. Foot Ankle Spec 2019; 12:373-379. [PMID: 31248285 DOI: 10.1177/1938640019857798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stress fractures of the proximal fifth metatarsal are common injuries in elite athletes. Fixation using an intramedullary screw represents the most popular surgery performed for treating these injuries, with excellent results in most cases. However, multiple reports in the literature highlight the possibility of painful hardware, usually related to the presence of the screw head, following intramedullary fixation In this case report, we outline 4 cases of professional athletes who developed lateral-based foot symptoms following complete healing of their surgically treated proximal fifth metatarsal fractures and were found to have significant cuboid edema on magnetic resonance images. We also outline recommendations regarding specific surgical technique considerations aiming to minimize this possible complication. Level of Evidence: Level V: Case report.
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Affiliation(s)
- Lauren Roberts
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, London, Stanmore, Middlesex, UK
- Orthopaedics and Traumatology Unit, Department of Public Health, "Federico II" University of Naples, Napoli, Italy
| | - Cesar de Cesar Netto
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Andrew Elliott
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - William Hamilton
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
| | - Martin O'Malley
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York
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Bernstein DT, Mitchell RJ, McCulloch PC, Harris JD, Varner KE. Treatment of Proximal Fifth Metatarsal Fractures and Refractures With Plantar Plating in Elite Athletes. Foot Ankle Int 2018; 39:1410-1415. [PMID: 30079768 DOI: 10.1177/1071100718791835] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Fractures of the proximal fifth metatarsal are relatively common foot injuries in elite athletes. Acute fixation with intramedullary screws is the most common operative treatment. However, the rate of nonunion and refracture after this procedure remains a concern. The purpose of this study was to determine rates of clinical and radiographic fracture healing, return to sport, and patient-reported clinical outcomes of elite athletes with proximal fifth metatarsal fracture or refracture treated with plantar plating. METHODS: An institutional review board-approved retrospective single-surgeon case series investigation assessed athletes (competing at college, Olympic, or professional levels) with proximal fifth metatarsal fracture or refracture, treated with open reduction internal fixation and calcaneal autogenous bone grafting using a plantar plate with a minimum 2-year follow-up. Demographic data, radiographic evaluation, and the time until return to unrestricted sporting competition were collected and analyzed. Means with standard deviations were calculated for continuous data, and frequencies of categorical data were calculated in percentages. RESULTS: Four refractures and 4 primary fractures were treated in 8 male athletes with a mean age of 21.9 ± 1.9 years at a mean follow-up of 3.2 ± 0.4 years. Two patients experienced temporary neuropraxia of the sural nerve that resolved within 6 weeks. There were no incisional complications, delayed unions or nonunions, refractures, hardware loosening, or complaints of hardware prominence. Clinically asymptomatic radiographic union was observed in 100% of the athletes at 6.5 ± 1.1 weeks and full release given at 12.3 ± 1.9 weeks. All athletes returned to sport at the same level of competition. CONCLUSION: With minimum 2-year follow-up, plantar plating of proximal fifth metatarsal fractures was an effective and safe technique that was used in both primary and revision settings. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
- Derek T Bernstein
- 1 Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | - Ronald J Mitchell
- 1 Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | | | - Joshua D Harris
- 1 Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | - Kevin E Varner
- 1 Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
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