Fourth Metatarsal Base Stress Fractures in Athletes

Rongstad, Kurt M.; Tueting, Jonathan L.; Rongstad, Meriel; Garrels, Katie; Meis, Ryan C.

doi:10.1177/1071100713475613

Cited by 24 publications

(12 citation statements)

References 13 publications

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“…Initial treatment of choice for most stress fractures of the second metatarsal is nonoperative [ 6 , 8 - 10 ], as they are considered to be low-risk and typically heal well with conservative treatment. Management includes activity restriction, stiff-soled shoes [ 9 ], rest, ice, compression, elevation, and in some cases immobilization.…”

Section: Discussionmentioning

confidence: 99%

Is Use of Bone Cement for Treatment of Second Metatarsal Stress Fractures Safe? A Case Report

McKissack

Montgomery

et al. 2018

Cureus

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Metatarsal stress fractures are common injuries of the foot and can be a source of chronic pain without appropriate management. Conservative management is first line, but surgery may be indicated in athletes, cases of nonunion, and fractures of the fifth metatarsal. We report a case of a 34-year-old female who presented to clinic for intractable pain of the left foot secondary to a stress fracture of the left second metatarsal, which had been previously treated with injectable acrylic bone cement. Calcium sulfate hydroxyapatite cement has a multitude of applications in orthopedic surgery, but to our knowledge no studies have documented its use in the treatment of metatarsal stress fractures. Our findings suggest that injectable calcium sulfate hydroxyapatite cement is not a suitable stand-alone treatment in fractures of the second metatarsal.

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Section: Discussionmentioning

confidence: 99%

Is Use of Bone Cement for Treatment of Second Metatarsal Stress Fractures Safe? A Case Report

McKissack

Montgomery

et al. 2018

Cureus

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“…While low-risk stress fractures have a good chance to heal with conservative treatment, high-risk fractures are prone to delayed unions or non-unions more often [ 7 ]. An operative regimen with open reduction and internal fixation (ORIF) has been described by a few authors in current literature [ 26 , 27 ]. Rongstad et al showed the benefits of operative treatment of fourth metatarsal stress fractures in a retrospective study on 14 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Rongstad et al showed the benefits of operative treatment of fourth metatarsal stress fractures in a retrospective study on 14 patients. 11 of the 14 patients chose operative treatment (ORIF) and returned to sports at an average of 12 weeks post surgery and would choose surgery for this kind of fracture again [ 27 ]. Nevertheless, an operative regimen is discussed controversially in current literature [ 10 , 28 ] and a conservative regimen is preferred in most of the cases [ 1 , 18 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Visualization of stress fractures of the foot using PET-MRI: a feasibility study

et al. 2015

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BackgroundDiagnosis and treatment of stress fractures still remains to be a clinical and radiological challenge. Therapeutic options vary from conservative treatment to surgical treatment without a clear treatment concept. Recently the combination of PET and MRI has been introduced, aiming a superior diagnostic accuracy in clinical practice. Therefore the aim of our study was to analyse whether PET-MRI would be a feasible technique to recognize stress fractures of the foot and to analyse if our conservative treatment plan leads to a good clinical outcome.MethodsTherefore, 20 patients with suspected stress fractures of the foot and ankle underwent plain radiography and 18F-Fluoride PET-MRI. Two blinded readers assessed in consensus both imaging techniques for the presence of stress fracture, stress reaction or osteoarthritis. Patients with stress fractures or stress reactions in the foot and ankle area underwent our conservative treatment plan, with immobilization in a VACO®ped cast for 6 weeks under partial weight bearing on forearm crutches. The benefit of our conservative therapeutic concept was evaluated by the patients on the basis of VAS and FAOS scoring systems before and after treatment.Results8 out of 20 patients underwent conservative treatment after diagnosis of either a stress fracture or a stress reaction of the foot and ankle area. PET-MRI identified four stress fractures and seven stress reactions. In all cases, no pathological findings were present on plain X-ray. FAOS and VAS significantly improved according to the patients’ records.ConclusionsPET-MRI seems to be a useful modality to diagnose stress fractures and stress reactions of the foot and ankle area, especially when conventional modalities, such as plain radiographs fail. Conservative management is a promising therapeutic option for the treatment of stress fractures. To rule out the benefits compared to a surgical treatment plan, further studies are needed.

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“…However, for athletes in whom return to sporting pursuits is a priority, internal fixation with an intramedullary screw may accelerate time to return to sport compared to non-operative management [6]. Some have promulgated a role for extracorporeal shock wave therapy or electromagnetic field therapy in nonoperative management, although their exact benefit is unproven [14].…”

Section: Metatarsalmentioning

confidence: 98%

“…The 2nd and 3rd metatarsals are most commonly involved, although 4th and 5th metatarsal fractures remain clinically significant given their greater potential for non-union [6].…”

Section: Metatarsalmentioning

confidence: 99%

Stress fractures of the foot and ankle

Welck,

Hayes,

Pastides

et al. 2017

Injury

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Fourth Metatarsal Base Stress Fractures in Athletes

Abstract: Level IV, retrospective case series.

Cited by 24 publications

References 13 publications

Is Use of Bone Cement for Treatment of Second Metatarsal Stress Fractures Safe? A Case Report

Is Use of Bone Cement for Treatment of Second Metatarsal Stress Fractures Safe? A Case Report

Visualization of stress fractures of the foot using PET-MRI: a feasibility study

Stress fractures of the foot and ankle

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