Functional outcome of fifth metatarsal fractures

IntroductionFifth metatarsal fractures are common and the outcome has been reported; however, prospective studies reporting the functional outcome using validated questionnaires are lacking in the literature. The aims of this study were to determine whether fifth metatarsal fractures remain symptomatic in the medium term and whether the fracture type influences outcome.MethodsOver the course of a year, 117 patients (62 avulsion fractures, 26 Jones fractures, 29 shaft fractures) were followed up (1 month, 4 months, 12 months), with functional outcome assessed using the Foot Function Index (FFI)- and Short Form 36 (SF36)-validated questionnaires.ResultsThe FFI reduced (function improved) over the course of the year from 22.0 (8.4–38.5) at 1 month to 0.0 (0.0–4.2) at 4 months, to 0.0 (0.0–1.3) at 1 year. There was no significant difference in the FFI scores with regard to gender or fracture type.Pain scores were also observed to decline over the year, with no significant differences between fracture types. However, while the severity of pain was low, the numbers of people reporting pain were relatively high. At 1 month, >80% of patients reported ongoing pain (83% avulsion, 88% Jones and 83% shaft), reducing to 38% at 4 months and 28% at 1 year. At final follow-up, 25% with an avulsion fracture, 28% with a Jones fracture and 33% with a shaft fracture reported pain.ConclusionsWhile 25–33% of patients continue to experience pain at 1 year, <10% experience any limitation of their activities. At the final follow-up at 1 year, there were no significant differences in functional outcome by fracture type, gender or patient age. Patients should be advised about the likelihood of ongoing low-level symptoms, even after a year from injury in this previously presumed innocuous injury.     

Avulsion fractures of the fifth metatarsal base: a prospective outcome study

BACKGROUND: This prospective study was done to evaluate functional outcomes after acute avulsion fractures of the fifth metatarsal base. METHODS: Fifty-two patients who sustained an avulsion fracture of the fifth metatarsal base and presented to the outpatient clinic of our hospital system were treated according to a standardized protocol. A total of 49 patients (50 fractures) were available for 1-year followup. There were eight men and 41 women with an average age of 41.9 (range 17 to 81) years. The lower extremity was placed in a hard-soled shoe, and patients were allowed to bear weight as tolerated. Baseline data collection consisted of demographic information, and radiographic, and functional evaluation. Patients were seen at regularly scheduled visits for 6 months and then contacted at 1 year to obtain followup information. A Short Musculoskeletal Function Assessment (SMFA) questionnaire was obtained at 6 months and 1 year. Analyses were performed to determine differences in outcome based on demographics and injury information. A p value of less than 0.05 was considered significant. RESULTS: An average of 22 days were lost from work, with 23 patients (46.9%) taking up to 10 days, 18 (36.7%) taking 10 days or longer off work, and eight patients (16.4%) losing no days of work. Based on self-reports, 10 patients (20.4%) had returned to pre-injury functional status by 3 months, 42 patients (85.7%) by 6 months, and all 49 patients by 1 year. At six and 12 months, no differences in SFMA were found based on gender, fracture type, or amount of fracture displacement. CONCLUSIONS: Fracture of the fifth metatarsal base often is a source of lost work productivity. Although patients can be expected to return to their preinjury level of function, recovery may take 6 months or longer.     

第五跖骨基底部撕脱骨折的手术选择

背景：第五跖骨基底部撕脱骨折是临床常见骨折,以保守治疗为主,在一些情况下需行手术治疗,目前对其手术适应证和具体手术方法尚存争议。目的：探讨第五跖骨基底部撕脱骨折的手术治疗效果与手术适应证。方法：2004年6月至2011年4月手术治疗34例第五跖骨基底部撕脱骨折患者,男18例,女16例;左侧14例,右侧20例;其中6例行克氏针张力带固定,6例行可吸收钉固定,18例行空心钉固定,3例为陈旧骨折不愈合行锁定接骨板固定,1例行骑缝钉固定。均为Dameron分型1区骨折,手术适应证为明显移位超过2imm或累及骰骨第5跖骨关节面超过30％,受伤机制均为扭伤。结果：24例患者获得随访,随访时间为8-78个月,平均27个月,伤口均一期愈合,愈合时间为2．7-3．3个月,平均3个月。根据美国足踝协会中前足功能评分为87-100分,平均（93．0±5．3）分;VAS疼痛评分为0-2分,平均（0．6±0．8）分。结论：第五跖骨基底部撕脱骨折根据骨折情况采取适合的手术治疗可取得良好的治疗效果,但需严格掌握手术适应证。     

Three-wire fixation technique for displaced fifth metatarsal base fractures

Fractures of the tuberosity of the fifth metatarsal are the most common type of fifth metatarsal fractures. This particular fracture usually produces low morbidity and low rates of nonunion when treated nonoperatively. However, on occasion, significant displacement, comminution, or significant intra-articular involvement may warrant operative intervention. Multiple techniques have been described for the operative care of this fracture. We present a somewhat simplified fixation method for displaced fifth metatarsal fractures in a small set of patients who were all followed up to final healing of the fracture.     

The outcome of conservative treatment of fifth metatarsal diaphyseal fractures

IntroductionThe fifth metatarsal diaphyseal fracture is a common fracture. However, clear consensus about the treatment is lacking. Unlike the avulsion fracture or Jones’ fracture, literature available on the treatment and long-term outcome of the diaphyseal fracture is scarce.The purpose of this study is to demonstrate a substantial number of conservatively treated patients with persistent pain and to evaluate metatarsal shortening and displacement within this group.MethodsIn this retrospective study, 106 patients who had experienced a fifth metatarsal diaphyseal fracture were included and evaluated. The minimum follow-up period was three months. FAAM, AOFAS and NRS scores were used as outcome measurements for function and pain. Length and displacement were analysed on plain X-rays.ResultsAt least 11% of the patients who received conservative treatment for their fifth metatarsal diaphyseal fracture had persistent pain at least 3 months after initiation of conservative treatment. No relationship has been found between the length of the fifth metatarsal and the FAAM (r( Petrisor et al., 2006) 2 = 0,051), AOFAS (r( Petrisor et al., 2006) 2 = 0,009) and NRS (r( Petrisor et al., 2006) 2 = 0,001). Furthermore, there was no association between patients with a shorter fifth metatarsal and FAAM, AOFAS, NRS, displacement and BMI.Discussion and conclusionThe finding of persistent pain in at least 11% of all patients at long-term follow-up confirms our hypothesis on long-term symptoms. However, the results suggest that these persistent symptoms are not related to metatarsal shortening or displacement.     

The outcome of proximal fifth metatarsal fractures: redefining treatment strategies

Background

To optimize the treatment strategy and reduce treatment costs of proximal fifth metatarsal fractures, clinical and patient-reported outcome, and its determinants were addressed.

Methods

A retrospective adult cohort study including 152 proximal fifth metatarsal fractures: 121 nonoperatively and 31 operatively treated. In the operative group, 21 were zone 1 and 10 zone 2 fractures. Median follow-up was 37.5 (IQR 20.8–52.3) months with a minimal follow-up of 6 months. Twenty-three demographic, fracture, and treatment characteristics were assessed as well as the healthcare costs. Outcome was assessed using the patient files, anterior-posterior and oblique X-rays, foot function index (FFI), visual analog score (VAS), and SF-36 questionnaires.

Results

The median FFI, physical SF-36, and VAS scores did not significantly differ between nonoperatively and operatively treated patients. The FFI and physical SF-36 were predominantly affected by a history of mobility impairment and pre-existent cardiovascular diseases, whereas mental SF-36 correlated significantly with higher ASA-score. Overall complication rate was 5.9% (4.1 vs. 12.9%; p?=?0.065, nonoperative vs. operative, respectively). Nonunion was recorded in only one (nonoperatively) treated patient. The total healthcare costs for operative treatment were 4.2 times higher compared to nonoperative treatment (€1960 vs. €463 per patient, respectively).

Conclusion

Overall, the clinical and patient-reported outcome was good. The foot function and quality of life were mainly affected by comorbidity, rather than fracture and treatment-related variables. Although nonoperatively treated patients indicated decreased mental quality of life, our study indicates that proximal fifth metatarsal fractures can safely be treated nonoperatively without the risk of nonunion, with fewer complications and lower healthcare costs.

Level of evidence

3.

     

Strength analysis of intraosseous wire fixation for avulsion fractures of the fifth metatarsal base

The objective of this study was to gather pilot data of the pullout strength of intraosseous wire for fixation of fifth metatarsal avulsion fractures and to compare intraosseous wire fixation with tension-band wiring. Osteotomies consistent with fifth metatarsal avulsion fractures were created in 5 matched pairs of cadaver limbs. One limb of each pair underwent fixation with intraosseous wiring and the other with tension band wiring. Metatarsals were then loaded to failure, defined as the maximum force achieved before the slope of the load curve moved from a positive to a negative value. Tension-band wiring showed a mean strength of 164.5 +/- 103.7 N compared with a mean strength of 113.7 +/- 46.6 N for intraosseous wiring. No significant difference in strength was shown between methods of fixation. Although the power of this data is small (.143), the data indicate that intraosseous wiring shows similar pullout strength when compared with tension-band wiring for fixation of fifth metatarsal avulsion fractures.     

第5跖骨基底部骨折手术治疗的短期疗效分析

2006年7月-2009年6月,我科对26例第5跖骨基底部骨折患者行切开复位、微型掌骨钢板固定和空心螺钉固定,短期疗效满意,报道如下。     

Treatment of fractures of the fifth metatarsal bone

Fractures of the fifth metatarsal are fairly frequent. Articles and texts offer conflicting advice concerning treatment and prognosis of these fractures. By proper classification of these fractures and understanding of the mechanism of injury, a criterion can be established for the prognosis and treatment.     

Herbert钉治疗第5跖骨基底部骨折

<正>2010年10月~2013年10月,我科采用Herbert钉治疗32例第5跖骨基底部骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组32例,男19例,女13例,年龄22~58岁,均为第5跖骨基底部闭合骨折。1.2治疗方法以第5跖骨基底部粗隆处为中心,纵向切开2~3 cm,直视下     

Biomechanical principles of tension band wiring applied to fractures of the distal fibula and fifth metatarsal base

Application of the tension band principle to provide dynamic compression across sites of the ankle and foot is discussed. Two cases are presented that demonstrate the basic principles of tension band fixation. A biomechanical explanation of fracture failure in long bones is also provided.     

Demographics and outcome of metatarsal fractures

Introduction  

Although metatarsal fractures are amongst the most common injuries of the foot, this is the first study on outcome after metatarsal fractures.     

Fractures of the base of the fifth metatarsal: the Jones fracture

The Jones fracture continues to be a problem fracture for the orthopedic surgeon and sports medicine physician. This injury seems to occur in athletes as well as nonathletes. The underlying inherent poor blood supply of the proximal metaphyseal diaphyseal region makes the fifth metatarsal a difficult bone to unite. Many techniques have been advocated for the treatment of this troublesome fracture, including non-weight-bearing short leg casting, orthotic management, open reduction and internal fixation, corticocancellous onlay bone grafting, and electric stimulation. The author believes that in young athletic patients, using meticulous surgical technique, reliable open reduction and internal fixation yields excellent results. In nonathletic or less demanding patients, the patient should participate in the discussion and choice of the treatment techniques. If delayed union or non-union occurs, drilling with the use of internal fixation usually produces a union.     

Relative stability of tension band versus two-cortex screw fixation for treating fifth metatarsal base avulsion fractures.

This study assesses the strength of fixating avulsion fractures of the fifth metatarsal base with a 4.0-mm partially threaded cancellous screw crossing two cortices as compared to tension banding. Our data showed statistically significant fixation strength improvement over tension banding for avulsion fractures (p < 0.02) in both polystyrene foam models and fresh, nonpreserved frozen cadaveric samples. In cadavers, the screw fixations were able to withstand more than three times the load sustained by the tension band fixations. The study utilized the Instron 8500 tensiometer to apply physiologic loads to test the constructs until failure. The displacement and load data at failure show the limitations of both fixations. By increasing the load resistance while maintaining compression, the bicortical cancellous screw fixation created greater stability at the avulsion fracture of the fifth metatarsal base as compared to tension band stabilization.     

纸板加压垫与短腿石膏托治疗第5跖骨基底骨折病例对照研究

目的：探讨纸板加压垫治疗第5跖骨基底骨折的疗效、安全性及优势,建立纸板加压垫疗法治疗第5跖骨基底骨折的诊疗规范.方法：自2010年6月至2013年3月,采用纸板加压垫或短腿石膏外固定治疗新鲜第5跖骨基底骨折患者59例.随机纳入到纸板组或石膏组,纸板组29例,男9例,女20例,平均年龄（51.79±11.40）岁,平均病程（11.59±6.58）h.石膏组30例,男9例,女21例,平均年龄（52.13±17.34）岁,平均病程（11.03±7.06）h.根据骨折线分型：纸板组A型骨折14例,B型骨折15例;石膏组A型骨折16例,B型骨折14例.根据骨折移位分级：纸板组Ⅰ度移位16例,Ⅱ度移位13例;石膏组Ⅰ度移位20例,Ⅱ度移位10例.根据骨折分型采取相应的手法进行整复,纸板组给予纸板加压垫治疗,石膏组给予短腿石膏外固定,固定时间均为4～6周.于固定后第2、4、6、8周,3、6个月进行随访,采用足部功能评分量表评价患足功能,其中第2、4、6、8周时拍摄患足正斜位X线片,对X线骨折线和骨折边缘情况进行评分比较.结果：所有患者完成随访,治疗后8周,骨折均达临床愈合,没有压疮、骨折不愈合、骨折端移位等不良事件发生.治疗后4～8周,纸板组X线评分高于石膏组,但组间差异无统计学意义.重复测量分析结果显示,不同时间点间及各时间点两组间具有交互作用,差异有统计学意义（P＜0.001）.治疗后各时间点,纸板组足部功能评分均高于石膏组,其中在治疗后2、4、6周,组间差异具有统计学意义（P＜0.01）.治疗后6个月,纸板组优良率93.10％,优于石膏组的86.67％,但差异无统计学意义（P=-0.483）.结论：纸板加压垫的方法治疗第5跖骨基底骨折,具有操作简单、固定可靠、取材方便、费用经济、疗效满意等优点,是一种简便验廉的治疗方法.