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.
Introduction: While many patients benefit from nonoperative treatment of insertional Achilles tendinopathy (IAT), some elect for surgical debridement and reconstruction. The purpose of this study is to determine the relationship of patient demographic characteristics, comorbidity profiles, and radiological parameters with failure of conservative management of IAT. Methods: A retrospective chart review was performed to identify patients who received either surgical or nonsurgical treatment of IAT at an academic institution from September 2015 to June 2019 (N = 226). Demographic and comorbidity data, and the presence and magnitude of relevant radiological parameters were collected and compared between the surgically (n = 48) and nonsurgically (n = 178) treated groups. Results: No significant differences could be detected between groups regarding demographic factors or previous procedures. The surgery group was significantly more likely to have evidence of Haglund’s deformity on clinical exam (83% vs 69%, P = .005), lower SF-12 physical scores (25.5 vs 35.5, P < .001), higher VAS pain scores (6.3 vs 5.3, P = .033), any mental illness (33% vs 20%, P = .044), and depression (27% vs 12%, P = .012). Discussion: Patients who received surgery for IAT were significantly more likely to have evidence of Haglund’s deformity on clinical exam, depression, higher VAS pain scores, and lower SF-12 physical scores. Both patients and surgeons should be aware of the higher rates of failure of conservative treatment in these patients. Level of Evidence: Level III
Category: Trauma Introduction/Purpose: In 2017 over 92,000 foot and ankle injuries resulted in lost work days. The average 2017 workers compensation claim for ankle injuries was $17,028 for medical costs with an additional $12,861 of indemnity. Workplace foot injuries were similarly expensive, averaging $15,140 in medical costs and $11,428 in indemnity. These costs highlight the burden workplace foot and ankle injuries place on both workers and employers. This study analyzes the incidence, rate, and days lost from work due to foot and ankle injuries across different industries, age groups, and genders and compares these findings to other musculoskeletal injuries. These findings will help us better understand which industries are greater impacted by foot and ankle injuries and what factors may influence the occurrence and severity of these injuries. Methods: Workplace injury data was obtained using a special query from the Bureau of Labor Statistics Workplace Injuries and Illnesses Nonfatal Cases Involving Days Away From Work: Selected Characteristics database. Data included injury incidence, incidence rate per 10,000 workers, and median days missed from work due to injury. The data was grouped by injury location (all injuries, ankle injuries, and foot injuries), type of injury (fracture, sprain, amputation), and industry. Spearman correlation, one way ANOVA, and independent samples t-test were used to identify the industries, gender, and ages associated with the highest rates and highest median days missed from work for each of these groups. Regression analysis was used to analyze changes in incidence rate over time. Incidence rate data was obtained for a fifteen-year period (2003-2017), and days lost from work data was obtained for a seven-year period (2011-2017). Data analysis was performed using SPSS statistics software, version 25.0. Results: The industries of mining (43.12 foot,18.17 ankle), utilities (25.24,25.10), construction (19.76,14.55), and transportation and warehousing (15.36,16.22) had four of the five highest average median days missed from work for both foot and ankle injuries. Of these four, only transportation and warehousing (11.05,14.13) and construction (8.49,8.98) were among the five industries with the highest rates of foot and ankle injuries. There was a strong negative correlation (p<0.001) between age and rate of both foot and ankle injuries and a strong positive correlation (p<0.001) between age and median days missed from work. Males had higher rates of both foot injuries (5.36) and ankle injuries (5.02) than females (3.76,4.86). Regression analysis showed the incidence rate of ankle sprains, ankle fractures, foot sprains, and foot fractures decreased from 2003-2017. Conclusion: This study demonstrates that the incidence rate and severity of workplace foot and ankle injuries are influenced by workers’ age, gender, and the industry they work in. It shows that industries with higher days missed often did not have higher rates of injuries. Our results have the potential to be used to identify industries in need of additional safeguards to protect workers from injury and provide companies with information about the industry norm for rates of employee injuries and days missed from work for these injuries.
Category: Ankle; Trauma Introduction/Purpose: Obesity affects lower extremity fracture care through increased mechanical loading and has subsequently been associated with higher complication rates following surgical management. However, the association between BMI and need for syndesmotic fixation in the setting of malleolar ankle fractures remains to be elucidated. Therefore, the primary objective of this study was to determine the risk of increased fracture severity and need for syndesmotic fixation as related to BMI. Methods: A retrospective analysis of the NSQIP database was performed for patients undergoing surgical fixation of isolated, closed ankle fractures. Patients were grouped by fracture pattern (uni-, bi- and trimalleolar ankle fractures with or without syndesmotic injury). Demographic data was collected and compared between groups and logistic regression analyses were used to assess the relationship between BMI and ankle fracture pattern. Risk factors for postoperative complications and prolonged operative time were also compared between groups. Results: A total of 15,841 patients (mean age 48.9 years) were identified for inclusion. Analyses revealed that BMI had a positive association with the incidence of open reduction and internal fixation of the ankle syndesmosis, but there was no association between BMI and malleolar fracture pattern. Conclusion: This study demonstrates that elevated BMI is associated with an increased need for syndesmotic reduction and fixation in malleolar ankle fractures. However, the data did not find conclusive evidence to suggest that obesity was associated with ankle severity when evaluating malleolar involvement. Further literature is needed to further delineate the relationship between obesity and ankle fracture pattern.
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