Conservative Treatment of the Fifth Metatarsal Bone Fractures in Professional Football Players Using Platelet-Rich Plasma

Abstract

Injuries of the metatarsal bones in football are relatively rare and in most cases are localized in the fifth metatarsal. The gold standard of the diagnosis of fractures in this area can be X-rays, which in most cases allows verifying the diagnosis. The treatment tactics depend on the localization of the fracture according to Lawrence and Botte’s classification: 3 zones of localization are distinguished. Fractures located in zones 2 and 3 belong to a high-risk group due to delayed consolidation and nonunion and therefore athletes are most often treated with osteosynthesis using intramedullary screws. The minimal recovery time for this type of treatment is at least 8 weeks. This report describes 7 cases of the fifth metatarsal bone fractures, located in zones 2 and 3 in professional football players who were treated with an immobilization boot, cryotherapy, nutritional supplements of calcium and vitamin D, and local injections of platelet-rich plasma, which contains numerous growth factors. The deadline for returning to regular training activities was 43 to 50 days, and there was no relapse of damage within 6 months of follow-up. Levels of Evidence: Level of evidence 4: case report study

Injectable orthobiologics in professional football (soccer) players: a systematic review

“…Rehabilitation was the most common concomitant intervention, 17-19 , 21-23 , 25-27 followed by bracing or immobilization, 17 , 18 , 20 , 22 , 25 pain medication, 24 and vitamin supplementation. 17 Three of the included studies evaluated PRP injections in treating muscle injuries, 21 , 23 , 27 3 in ligament injuries, 20 , 22 , 25 1 in degenerative knee cartilage injuries, 24 1 in fifth metatarsal fractures, 17 1 in chronic patellar tendinopathy, 19 1 in a plantar fascia rupture, 26 and 1 in a capsular hip defect. 18 A 3 PRP injection protocol was implemented in 6 studies, 17-20 , 24 , 27 a 2-injection protocol in 3 studies, 22 , 23 , 26 and a single injection protocol in 2 studies.…”

“…21 , 24 "Study size" and "mean follow-up" scored the lowest because 10 of 11 studies had < 50 patients, 17-20 , 22-27 and the follow-up was < 36 months. [17][18][19][20][21][22][23][24][25][26] Furthermore, 6 were retrospective cohort studies or case reports. 17 , 18 , 20 , 23 , 25 , 26 Injection technique was adequately described in 2 studies 19 , 21 and fairly reported in 7, 18 , 20 , 22-25 , 27 while concomitant rehabilitation was described if any in all but 2 studies.…”

“…A retrospective case series of 7 PF players with fifth metatarsal fractures showed an RTS-T ranging between 43 and 54 days after injury and no relapse with structural damage within 6 months of follow-up after 3 PRP injections with a 7 to 10 days interval. 17 On the other hand, Charousset et al 19 prospective case series in 28 professional and semiprofessional athletes, including 3 PF players (10.71%), revealed VISA-P , VAS, and Lysholm score significant improvement ( P < .001) and a 75% RTS-R to the preinjury level in chronic patellar tendinopathy.…”

Bone Stress Injuries at the Ankle and Foot

“…Fractures located in zones 2 and 3 belong to the high-risk group due to poor vascular supply and therefore have a high risk of delayed consolidation and nonunion. 74 Torg proposed another widely used classification of proximal fifth metatarsal fractures. 75 Torg type I fractures are considered acute fractures with sharp margins and a narrow fracture line.…”

“…Fractures located in zones 2 and 3 belong to the high-risk group due to poor vascular supply and therefore have a high risk of delayed consolidation and nonunion. 74…”