In China, the stable type of fifth metatarsal base fracture is usually treated by rehabilitation methods after the limbs have been fixed for approximately 4 weeks. A 37-year-old female agreed to undergo rehabilitation treatment, without surgery or long-term fixation, from the second day of the fracture onward. Fourteen days after the fracture, the patient was able to bear 100% of her body weight and stand for 20 min in a normal posture with supportive elbow crutches. She was able to return to work with double elbow crutches on the 25th day. On the 30th day after the fracture, the patient was able to walk 300 m outdoors without any walking aids, and with no any discomfort. Two months after the fracture, the patient went jogging and was participating in all of her normal daily activities.
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Affiliation(s)
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1
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Fernández-Rojas E, Araya-Bonilla V, Barra-Dinamarca E, Pastor-Villablanca J, Mortada-Mahmoud A, Alvarado-Livacic C, Vilá-Rico J. New Classification System for Proximal Fifth Metatarsal Fractures: Intraobserver and Interobserver Reliability Assessment. Foot Ankle Int 2025; 46:246-254. [PMID: 39745182 DOI: 10.1177/10711007241303756] [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: 02/09/2025]
Abstract
BACKGROUND The most commonly used classification for proximal fifth metatarsal fractures has not shown good reproducibility. The aim of this study was to evaluate the intraobserver and interobserver agreement of a new classification system for such fractures. METHODS The study involved the development of a novel classification system that categorized these fractures into 2 main types and 2 subtypes. This cross-sectional study included a total of 52 cases that were retrospectively collected to assess the reliability of this system. These cases were then evaluated by 3 independent foot and ankle surgeons who classified the fractures based on the newly established classification system. After 10 months, the same evaluators classified the fractures again. The level of agreement among the evaluators, both internally and externally, was assessed using the kappa coefficient, following the criteria established by Landis and Koch. This framework categorizes agreement levels as slight (0.00-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), or almost perfect (0.81-1.00). RESULTS Fifty-two fractures were detected, and 312 evaluations were carried out. The interobserver agreement was substantial when assessing the 2 main types, with a κ value of 0.73, and remained substantial even when considering the subtypes, with a κ value of 0.67. Similarly, the intraobserver agreement demonstrated substantial outcomes when evaluating the 2 main types, with a κ value 0.79. It maintained its significance when including the subtypes, with a κ value 0.77. CONCLUSION Lawrence and Botte's classification identifies 3 primary zones and exhibits moderate interobserver agreement. In contrast, the newly proposed system focuses on only 2 main zones and shows better interobserver agreement. The present study introduces a more precise and reproducible framework that reveals consistency among various observers, including the same observer. This framework may be beneficial for biomedical research as it enhances the ability to compare results across different studies.
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Affiliation(s)
- Enrique Fernández-Rojas
- Foot and Ankle Group, Traumatology and Orthopedics Unit, Las Higueras Hospital, Talcahuano, Chile
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Víctor Araya-Bonilla
- Foot and Ankle Group, Traumatology and Orthopedics Unit, Las Higueras Hospital, Talcahuano, Chile
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Emilio Barra-Dinamarca
- Foot and Ankle Group, Traumatology and Orthopedics Unit, Las Higueras Hospital, Talcahuano, Chile
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | | | - Ahmed Mortada-Mahmoud
- Trauma and Orthopaedic Department, Minia University Hospital, Corniche El Nil, Minia, Egypt
| | - Cristóbal Alvarado-Livacic
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
- Unidad de Apoyo a Investigación Biomédica, Hospital Las Higueras, Talcahuano, Chile
| | - Jesús Vilá-Rico
- University Hospital October 12, Madrid, Spain
- Surgical Department, Complutense University of Madrid, Madrid, Spain
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2
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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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3
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Sarpong NO, Swindell HW, Trupia EP, Vosseller JT. Republication of "Metatarsal Fractures". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231193428. [PMID: 37566699 PMCID: PMC10408340 DOI: 10.1177/24730114231193428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hasani W Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Evan P Trupia
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - J Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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4
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He W, Zhou H, Zhang Y, Yu T, Xia J, Zhao Y, Yang Y, Li B. Classification of avulsion fractures of the fifth metatarsal base using three-dimensional CT mapping and anatomical assessment: a retrospective case series study. J Foot Ankle Res 2022; 15:65. [PMID: 36045449 PMCID: PMC9429432 DOI: 10.1186/s13047-022-00571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background To clarify the injury mechanism of the avulsion fracture of the fifth metatarsal combining 3-dimensional (3D) fracture mapping with anatomical measurements. Methods Two hundred twenty-two patients with the avulsion fractures of the fifth metatarsal base, who were admitted to our hospital from August 2015 to August 2020. The computed tomography (CT) scans were used to generate the 3-D images of all mapped fracture lines for the avulsion fractures of the fifth metatarsal base were compiled in an overall 3D image. The fifth metatarsal base of 8 unpaired lower limbs of adult Asian frozen cadaveric specimens were also dissected to observe and measure the specific locations of the attachment points of the peroneus brevis, lateral band of the plantar fascia, and peroneus tertius to the fifth metatarsal base. Results Based on the type of fracture line produced and the specific locations of the attachment points of the tendons or fascia, the avulsion fractures of the fifth metatarsal base can be classified into three types: type I predominantly involves the action of the lateral band of the plantar fascia; type II predominantly involves the action of the peroneus brevis; type IIIA involves the joint action of the peroneus brevis and lateral band of the plantar fascia with one fracture line, and type IIIB involves the joint action of the peroneus brevis and lateral band of the plantar fascia with two fracture lines. Conclusion The lateral band of the plantar fascia and peroneus brevis play a major role, either separately or together, in avulsion fractures of the fifth metatarsal base. With this knowledge, we propose a novel classification based on the injury mechanism, which can serve as a reference for clinical treatment and diagnosis. Level of evidence Level III, retrospective case series.
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Affiliation(s)
- Wenbao He
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yingqi Zhang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Tao Yu
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jiang Xia
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Youguang Zhao
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
| | - Bing Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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5
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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: 8] [Impact Index Per Article: 2.7] [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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6
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Jiao L, Xi J, Lin A. Early Active Rehabilitation Treatment for a Patient with a Stable Type of Fifth Metatarsal Base Fracture: a Case Report. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2021; 4:1000068. [PMID: 34540147 PMCID: PMC8438790 DOI: 10.2340/20030711-1000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/16/2022]
Abstract
In China, the stable type of fifth metatarsal base fracture is usually treated by rehabilitation methods after the limbs have been fixed for approximately 4 weeks. A 37-year-old woman fractured her fifth metatarsal base, with a stable fracture type. From the second day of the fracture onward, she agreed to participate in rehabilitative treatment that did not involve surgery or long-term fixation. Fourteen days after the fracture, the patient was able to bear 100% of her body weight and stand for 20 min in a normal posture with supportive elbow crutches. She was able to return to work with double elbow crutches after 25 days. On the 30th day after the fracture, the patient was able to walk 300 m outdoors without any walking aids and with no discomfort. Two months after the fracture, the patient went jogging and was participating in all of her normal daily activities. This case shows that, for stable type fractures of the fifth metatarsal base, rehabilitation starting on the second day after the fracture can help accelerate the patient’s return to normal physical activities.
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LAY ABSTRACT
- Long Jiao
- Department of Rehabilitation, Kunshan Rehabilitation Hospital, Kunshan, China
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- Juan Xi
- Department of Nursing, Jen Ching Memorial Hospital, Kunshan, China
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- Aicui Lin
- Department of Science and Technology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Şahin E. A new radiographic classification of fifth distal metacarpal fractures.
Ir J Med Sci 2021;
191:1355-1360. [PMID:
34195920 PMCID:
PMC8244675 DOI:
10.1007/s11845-021-02684-2]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND
The fifth metacarpal fractures are the most common in all of hand fractures. To our knowledge, the classification of the fifth distal metacarpal bone fractures has not been studied.
AIMS
The aim of this study was to describe a new classification system based on x-ray and to evaluate its reliability and reproducibility.
MATERIAL AND METHODS
A total of 166 fifth distal metacarpal fractures were identified for classification and recorded. Two orthopedic surgeons reviewed and categorized them according to a newly designed classification. twice 1 month apart. Reliabilities of intra- and inter-observer were calculated with Spearman's rho correlation coefficient.
RESULTS
Mean values of inter and intra-observer reliability were excellent (p = 0.85) and substantial (p = 0.70), respectively. In 166 patients (163 males and 3 females), concerning the percentage of the distribution of fracture types, the most common type was Type I accounted for 81 (48.8%) followed by Type II 70 (42.2%), Type III 11 (6.6%), and Type IV 4 (2.4%). Type Ia was the most prevalent among all groups.
CONCLUSION
This study represented a unique classification system for fractures of the distal part of the fifth metacarpal bone. Categorization in radiographs might provide ideas regarding the prognosis and clinical outcomes of fracture patterns. Therefore, this study could guide future investigations to determine the first-line treatment of fifth distal metacarpal fracture patterns using this classification and help form a common language among surgeons concerning their treatment options.
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Affiliation(s)
- Ertuğrul Şahin
- Kemalpaşa State Hospital, Sekiz Eylul Mahallesi, Kırovası küme boulevard, 8/1 street, 35730, Kemalpaşa, Izmir, Turkey.
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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: 1.4] [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
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- Marcel Urresti-Gundlach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
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- Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
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- J. Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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- 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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9
Khan S, Axelrod D, Paul R, Catapano M, Stephen D, Henry P, Wasserstein D. Acute Fifth Metatarsal Tuberosity Fractures: A Systematic Review of Nonoperative Treatment.
PM R 2020;
13:405-411. [PMID:
32472589 DOI:
10.1002/pmrj.12427]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/09/2020] [Accepted: 05/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE
Acute metatarsal fractures are a common lower extremity injury. Although surgery may be recommended in specific cases, most are treated nonoperatively. Treatment protocols vary significantly among practitioners, with no consensus on the most efficacious approach. This systematic review aims to identify the effect of treatment protocols on union rate and functional outcome after an acute fifth metatarsal tuberosity fracture.
LITERATURE SURVEY
Multiple databases, including CINAHL, EMBASE, MEDLINE, and the Cochrane CEntral Register of Controlled Trials (CENTRAL) were searched from database inception to March 4, 2018 to identify clinical studies addressing nonoperative management of metatarsal fractures reporting nonunion, pain, and/or length of recovery.
METHODOLOGY
Two reviewers independently completed title, abstract, and full-text screening. Data abstraction was completed in duplicate. Outcome measures and complications were descriptively analyzed.
SYNTHESIS
A total of 1941 studies were eligible for screening. Seven studies (four randomized controlled trials and three prospective cohort studies) satisfied inclusion criteria. This resulted in a total of 388 patient with acute fifth metatarsal tuberosity fractures in 12 different treatment arms, with the most common treatment including plaster casting (7). The mean age was 42 years (27 to 56 years), and the overall nonunion rate was low (1.1%). Four unique functional scores were reported across all studies, and all showed good to excellent short-term results. The overall qualities of studies were moderate, with particular limitations in randomization and concealment allocation.
CONCLUSION
Most acute fifth metatarsal tuberosity fractures heal well, with good-to-excellent functional outcomes with nonoperative treatment, regardless of technique. We recommend a conservative rehabilitation framework, including 2 to 3 weeks of immobilization in a walking cast, followed by gradual increase in activity and strengthening until clinical union is achieved.
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Affiliation(s)
- Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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- Daniel Axelrod
- Department of Orthopedic Surgery, McMaster University, Toronto, ON, Canada
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- Ryan Paul
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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- Michael Catapano
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
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- David Stephen
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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- Patrick Henry
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Orthopaedic Rehabilitation Institute, Toronto, ON, Canada
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- David Wasserstein
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Orthopaedic Rehabilitation Institute, Toronto, ON, Canada
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Hörterer H, Baumbach SF, Gregersen J, Kriegelstein S, Gottschalk O, Szeimies U, Walther M. Treatment of Bone Marrow Edema of the Foot and Ankle With the Prostacyclin Analog Iloprost.
Foot Ankle Int 2018;
39:1183-1191. [PMID:
29862844 DOI:
10.1177/1071100718778557]
[Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND
Bone marrow edema (BME) of the foot and ankle is challenging to treat. One approach is intravenous Iloprost treatment, which is a vasoactive prostacyclin analog. The aim of this study was to evaluate the early and intermediate outcome of intravenous Iloprost therapy on BME of the foot and ankle and to analyze the influence of its etiology and Association Research Circulation Osseous (ARCO) stage on the outcome.
METHODS
This was a retrospective study with prospective follow-up. All patients treated by intravenous Iloprost for BME of the foot and ankle (ARCO I-III) at a single orthopedic reference center were included. Demographics, medical history, and MRIs were assessed prior to treatment (t0). MRIs were used to assess the BMEs' etiology (idiopathic/ischemic/metabolic, mechanical/degenerative, traumatic) and severity (ARCO). Complications as well as changes in pain, treatment, and MRI were evaluated after 3 months (t1). The following patient-rated outcome measures (PROMs) were assessed prospectively (t2): 12-Item Short Form Health Survey (SF-12), Visual Analog Scale Foot and Ankle (VAS FA), and the Foot Function Index (FFI) (also at t0). The descriptive outcomes and the influence of the etiology and ARCO on the outcome parameters were evaluated. Out of 70 eligible patients, 42 patients (60%; 47 ± 15 years; 30% female) with a mean follow-up of 28 ± 19 months were included.
RESULTS
Twelve patients reported minor complications during Iloprost therapy. At t1, pain decreased significantly in 56%, and the amount of BME decreased in 83% of patients. Both parameters correlated moderately (r = -0.463, P = .015). The PROMs at t2 revealed moderate results. The overall FFI improved from 59 ± 21 to 30 ± 22 ( P < .001), the overall VAS FA was 68 ± 20, the SF-12 Physical Component Summary 42 ± 12 and Mental Component Summary 50 ± 9. Subgroup analysis revealed no significant influence of the etiology or ARCO stage on any outcome measure.
CONCLUSION
Iloprost therapy for BME of the foot and ankle resulted in a 60% pain and 80% edema decrease after 3 months. After 2 years, patient-rated outcome measures showed residual impairment. Neither the etiology nor ARCO stage significantly influenced the outcome.
LEVEL OF EVIDENCE
Level III, comparative study.
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Affiliation(s)
- Hubert Hörterer
- 1 Schön Klinik München Harlaching, Center for Foot and Ankle Surgery, Munich, Germany.,2 Paracelsus Medical Private University, Salzburg, Austria
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- Sebastian Felix Baumbach
- 3 University Hospital Munich, Department of General, Trauma, and Reconstructive Surgery, Munich, Germany
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- Johanne Gregersen
- 1 Schön Klinik München Harlaching, Center for Foot and Ankle Surgery, Munich, Germany.,2 Paracelsus Medical Private University, Salzburg, Austria.,5 Department of Orthopedics and Orthopedic Surgery, Julius-Maximilians-University, Würzburg, Germany
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- Stefanie Kriegelstein
- 1 Schön Klinik München Harlaching, Center for Foot and Ankle Surgery, Munich, Germany.,2 Paracelsus Medical Private University, Salzburg, Austria
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- Oliver Gottschalk
- 1 Schön Klinik München Harlaching, Center for Foot and Ankle Surgery, Munich, Germany.,2 Paracelsus Medical Private University, Salzburg, Austria
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- Markus Walther
- 1 Schön Klinik München Harlaching, Center for Foot and Ankle Surgery, Munich, Germany.,2 Paracelsus Medical Private University, Salzburg, Austria.,5 Department of Orthopedics and Orthopedic Surgery, Julius-Maximilians-University, Würzburg, Germany
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11
Russell BS, Hoiriis KT, Hosek RS. Walking Gait Before and After Chiropractic Care Following Fifth Metatarsal Fractures: A Single Case Kinetic and Kinematic Study.
J Chiropr Med 2018;
17:106-116. [PMID:
30166967 DOI:
10.1016/j.jcm.2018.02.002]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/11/2017] [Accepted: 02/28/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives
The purpose of this report is to describe the kinetic and kinematic analysis of walking gait following healed left proximal fifth metatarsal fractures.
Clinical Features
A 62-year-old female presented at a chiropractic clinic with concerns that recent metatarsal fractures had not fully resolved and reported abnormal gait due to pain and several weeks use of a "walking boot." The patient's walking gait was evaluated with a force-sensor treadmill and an inertial measurement unit motion capture system. Recordings were made before, at midpoint, and post-chiropractic care (11 visits total). Data were analyzed for spatio-temporal gait parameters, vertical ground reaction forces, and ranges of motion of the hip, knee, and ankle.
Intervention and Outcome
Pre-care, the patient's self-rated disability in walking was 50 out of 80 on a Lower Extremity Functional Scale, which improved to 80 out of 80, post-care. Her self-selected preferred walking speed increased, as did step length, cadence, and single support time. Increased symmetry was seen in timing of peak ground reaction forces, stance phase percentages of loading and pre-swing, and ranges of motion for hip and knee flexion and extension.
Conclusions
The patient recovered completely, and the post-injury kinematic and kinetic data allowed for quantification of gait patterns and changes in the clinical environment.
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Affiliation(s)
- Brent S Russell
- Dr Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
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- Kathryn T Hoiriis
- Dr Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
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- Ronald S Hosek
- Dr Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
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12
Affiliation(s)
- Nana O. Sarpong
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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- Hasani W. Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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- Evan P. Trupia
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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- J. Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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13
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: 1.1] [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
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- Marco Zamperetti
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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- Alberto Gasparella
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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- 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
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- Marco Corradin
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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- Giacomo de Guttry
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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- Pietro Ruggieri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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14
Baumbach SF, Prall WC, Kramer M, Braunstein M, Böcker W, Polzer H. Functional treatment for fractures to the base of the 5th metatarsal - influence of fracture location and fracture characteristics.
BMC Musculoskelet Disord 2017;
18:534. [PMID:
29246170 PMCID:
PMC5732483 DOI:
10.1186/s12891-017-1893-6]
[Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/04/2017] [Indexed: 01/29/2023] Open
Abstract
Background
Fractures to the base of the fifth metatarsal are common, but their treatment remains controversial. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures. Of special interest were the influence of (1) the fracture location (L&B type I vs. II) and (2) the fracture characteristics (displacement, intra-articular involvement, communition) on the subjective outcome.
Methods
Retrospective registry study with a prospective follow-up. Patients with an acute, isolated, epi-metaphyseal fracture to the fifth metatarsal bone (L&B type I and II) treated by full weightbearing with a minimum follow-up of 6 months were included. Fracture location (L&B type I and II) and characteristics (displacement <2 mm or >2 mm, intra-articular involvement, and number of fragments) were assessed. Outcome parameters were return to work, return to sports, VAS-FA, and SF-12. The influence of the fracture (1) location and (2) -characteristics on these parameters was tested.
Results
Thirty-nine patients (40 ± 15 years, 56% female) were enrolled with a mean follow-up of 22 ± 10 months. L&B type I fractures occurred in 59%, type II in 41%. Thirty-one percent of all fractures were dislocated, 74% intra-articular, and 41% multi-fragmentary. Patients returned to work after 17 ± 12 days, to sports after 53 ± 22 days. The VAS-FA score at the final follow-up was 96 ± 4, SF-12 PCS score 57 ± 5 and MCS score 51 ± 8. No complications were reported, no patient required surgery. None of the assessed outcome parameters differed significantly between (1) the different fracture locations (L&B type I vs. II) or (2) the different fracture characteristics (displacement, intra-articular involvement, and number of fragments).
Conclusions
(1) Both, L&B I and II fractures featured excellent results with immediate full weightbearing. Consequently, L&B type I and II fractures should be summarized as epi-metaphyseal fractures. (2) Fracture displacement, articular involvement, and number of fragments did not influence the outcome. Therefore, functional treatment should be recommended for all epi-metaphyseal fractures.
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Affiliation(s)
- Sebastian Felix Baumbach
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
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- Wolf Christian Prall
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
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- Michael Kramer
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
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- Mareen Braunstein
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
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- Wolfgang Böcker
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany
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- Hans Polzer
- Department of Trauma Surgery, Munich University Hospital, LMU, Nussbaumstr. 20, 80336, Munich, Germany.
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15
Xie L, Guo X, Zhang SJ, Fang ZH. Locking compression plate distal ulna hook plate fixation versus intramedullary screw fixation for displaced avulsion fifth Metatarsal Base fractures: a comparative retrospective cohort study.
BMC Musculoskelet Disord 2017;
18:405. [PMID:
28950848 PMCID:
PMC5615762 DOI:
10.1186/s12891-017-1766-z]
[Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/21/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND
Intramedullary screw (IMS) fixation was wildly used in fifth metatarsal base fractures (FMBFs) and the results were satisfactory. However, in the comminuted osteoporosis or small displaced avulsion FMBFs, anatomical reduction and stable fixation could not be achieved with IMS. The Locking Compression Plate (LCP) distal ulna hook plate fixation was a novel alternative fixation method. The aim of this retrospective cohort study was to determine if LCP distal ulna hook plate fixation resulted in improved outcomes compared to the traditional IMS fixation in displaced avulsion FMBFs.
METHODS
Of 43 patients with displaced avulsion FMBFs, 18 patients were treated with LCP distal ulna hook plate fixation and 25 were treated with IMS fixation. The patients were evaluated clinically and radiographically and followed up to 12 months. The surgery time, time for hospital stay, time for weight-bearing, time for bony union, time for return to daily life, pain relief, functional outcome and complications after treatment with LCP distal ulna hook plate fixation or IMS fixation were compared. The functional outcome was assessed by the AOFAS (American Orthopedic Foot and Ankle Society) mid-foot score at 3, 6, 9, and 12 months after surgery. Meanwhile, pain scores were obtained at 3, 6, 9, and 12 months after surgery.
RESULTS
The two cohorts had similar baseline characteristics. Surgery time was less in LCP distal ulna hook plate fixation cohort compare to IMS fixation cohort (p < 0.0001). Time for partial weight-bearing (p < 0.0001) and full weight-bearing (p < 0.0001) also demonstrated significant improvements in patients with LCP distal ulna hook plate fixation compared to IMS fixation. Patients in the LCP distal ulna hook plate fixation cohort had significantly increased AOFAS at 9 months (p < 0.0001) and 12 months (p < 0.0001) after surgery compared to the IMS fixation cohort.
CONCLUSION
In this retrospective cohort study, LCP distal ulna hook plate fixation as an alternative fixation method was better therapy for the displaced avulsion FMBFs compared to IMS fixation. LCP distal ulna hook plate fixation had a short surgery time and improved functional performance.
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Affiliation(s)
- Lin Xie
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China
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- Xin Guo
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China
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- Shu-Jun Zhang
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China
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- Zhen-Hua Fang
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China.
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16
Kiener AJ, Hanna TN, Shuaib W, Datir A, Khosa F. Osseous injuries of the foot: an imaging review. Part 1: the forefoot.
Arch Emerg Med 2017;
34:112-118. [DOI:
10.1136/emermed-2015-204807]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 12/16/2015] [Accepted: 01/17/2016] [Indexed: 11/03/2022]
17
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: 32] [Impact Index Per Article: 3.6] [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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18
Abstract
This review describes the normal healing process for bone, ligaments, and tendons, including primary and secondary healing as well as bone-to-bone fusion. It depicts the important mediators and cell types involved in the inflammatory, reparative, and remodeling stages of each healing process. It also describes the main challenges for clinicians when trying to repair bone, ligaments, and tendons with a specific emphasis on Charcot neuropathy, fifth metatarsal fractures, arthrodesis, and tendon sheath and adhesions. Current treatment options and research areas are also reviewed.
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Affiliation(s)
- Jessica A Cottrell
- Department of Biological Sciences, Seton Hall University, 400 South Orange Avenue, South Orange, NJ 07101, USA.
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- Jessica Cardenas Turner
- Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Martin Luther King Boulevard, Newark, NJ 07102, USA
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- Treena Livingston Arinzeh
- Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Martin Luther King Boulevard, Newark, NJ 07102, USA
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- J Patrick O'Connor
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Medical Sciences Building, Room E-659, 185 South Orange Avenue, Newark, NJ 07103, USA
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19
Lee TH, Lee JH, Chay SW, Jang KS, Kim HJ. Comparison of clinical and radiologic outcomes between non-operative and operative treatment in 5th metatarsal base fractures (Zone 1).
Injury 2016;
47:1789-93. [PMID:
27282690 DOI:
10.1016/j.injury.2016.05.016]
[Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/09/2016] [Accepted: 05/13/2016] [Indexed: 02/02/2023]
Abstract
The treatment of Zone 1 fractures of the 5th metatarsal base with >2mm of displacement remains controversial. We prospectively analyzed 29 patients with 5th metatarsal base fractures (Zone 1) during 2009-2014. Radiography was performed to assess the degree of fracture gap and metatarsal length. Patients with gaps of 2mm or less were treated conservatively using a short leg cast or splint (Group A), while patients with fracture gap >2mm were randomly assigned to one of two groups. Group B patients were managed with open reduction and internal fixation (ORIF), and Group C patients were placed in a short leg cast only. Visual analog scale (VAS) score and American orthopedic foot and ankle society (AOFAS) score were obtained at the initial consult and at the last follow-up after treatment; change of the 5th metatarsal length was also measured at the initial consult and after complete bony union. Our study demonstrated that radiographic union of all cases was observed with a significant decrease in VAS and AOFAS scores, regardless of the initial fracture gap and type of management. Additionally, there was no difference seen in final VAS scores for patients with longer metatarsals when compared to those in whom the metatarsals were unchanged or shortened.
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Affiliation(s)
- Tae Hoon Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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- Ji Ho Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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- Suh Woo Chay
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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- Kyu Sun Jang
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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- Hak Jun Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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