Os Vesalianum Pedis in a Young Adult: A Case Report and Literature Review

Os vesalianum pedis is a rare accessory foot ossicle. It is usually asymptomatic, however, it can be an infrequent cause of lateral foot pain. We present the case of a 19-year-old healthy male with lateral foot pain after an inversion-type injury. Initial X-rays were mistaken for fracture of the fifth metatarsal, however, a high index of suspicion for the presence of the os vesalianum led us to perform imaging of the contralateral foot; a mirror image with contralateral os vesalianum was revealed. The patient was treated conservatively and had an excellent outcome. In the context of trauma, os vesalianum must be differentiated from other causes of lateral foot pain, such as Iselin’s disease, avulsion fracture of the fifth metatarsal, Jones fracture, and others. Os vesalianum pedis is characterized as a rounded ossicle, with smooth edges, surrounded by cortical bone. Prompt diagnosis is essential as it changes the management. 

Bilateral jones fractures in a high school football player

OBJECTIVE

To present a case of a high school football player with bilateral Jones fractures who was treated both conservatively and with acute intramedullary compression screw fixation.

BACKGROUND

Jones fractures tend to heal slowly, have a propensity for reinjury, and a significant number progress to delayed union or nonunion. Because of the time constraints imposed by athletic seasons, there is a need to avoid lengthy periods of immobilization.

DIFFERENTIAL DIAGNOSIS

Tuberosity fracture, metatarsal stress fracture.

TREATMENT

Treatment options include either conservative care or acute intramedullary compression screw fixation. Jones fractures are difficult to treat and can cause prolonged disability.

UNIQUENESS

The athlete was treated conservatively for a delayed union of an old stress fracture. X-rays revealed a sclerotic fracture line with partial union after 6 weeks. The athlete underwent open reduction and internal fixation using an intramedullary screw to obtain compression fixation and a graft to aid healing. Several months later, x-rays showed excellent resolution. One year later, he suffered a similar fracture of the other foot. Because of his history and his desire to return to play, he underwent open reduction and internal fixation using an intramedullary compression screw and was allowed to return to competition by the end of the sixth week postsurgery.

CONCLUSIONS

Treatment of Jones fracture should be individualized, based on the athlete's needs, the history and clinical presentation, and the initial radiographic appearance of the injury. The literature indicates that a rapid return to activity can be realized using rigid internal fixation and may be the treatment of choice in athletes.

Rate of bony union after Jones fracture fixation in the general population

Nonunion rates in the conservative treatment of Jones fractures can be high, therefore surgical intervention is often recommended. Most current studies in the literature look at a younger athletic population to assess bony union rates. Little has been published on healing rates in the general population. A retrospective chart review was performed of all patients undergoing surgical fixation of Jones fractures by three surgeons from 2015 to 2022. A total of 195 patients were collected. Radiographs were evaluated to determine time to fracture union, type of fixation construct, and risk factors for development of the fracture such as pes cavus and forefoot adduction. The bony union rate was 92.8 % with a nonunion rate of 7.2 % (14/195), a delayed union rate of 10.3 % (20/195), and a refracture rate of 4.1 % (8/195). The overall time to union was 14 weeks, with a median of 11 weeks in patients less than 30 years of age and 14 weeks in those greater than 30 years of age. Pes cavus was present in 42.1 % of patients and forefoot adduction in 32.8 %. Patients with increased age (p < 0.001) and type II diabetes (p = 0.04) were found to have statistically significant longer times to union. Metatarsus adductus was a significant predictor of nonunion status (p = 0.015). The primary aim of this study was to evaluate the healing rates of Jones fractures after fixation in the general population.

Percutaneous Intramedullary Application of Stem Cells for Fifth Metatarsal Fractures Treated With a Cannulated Screw

Non-union and refracture of fifth metatarsal fractures are common and devastating complications in the athletic population. Stem cell application at the fracture site, for biologic enhancement, is utilized to address this challenge. We present a simple technique to approach both the endosteum and the periosteum percutaneously, under a local anesthetic, in cases of cannulated screw intramedullary fixation.