Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis

Leumann, André; Pagenstert, Geert; Fuhr, Peter; Hintermann, Beat; Valderrábano, Víctor

doi:10.1007/s00402-008-0709-4

Cited by 16 publications

(16 citation statements)

References 23 publications

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“…5 The described incidence is about 1.8 per 1000 person years. 6 , 7 Aim of the operative fracture treatment is the reduction of nonunion and mal-union rate and a quick return to daily activities or sports in athletes. 8 A recent systematic literature review by Roche on treatment and return to sport following basal fifth metatarsal fractures reveals that acute fractures treated nonoperatively had a lower union rate compared with fractures treated with a intramedullary screw.…”

Section: Discussionmentioning

confidence: 99%

When Planning Screw Fracture Fixation Why the 5.5 mm Screw is the Goldilocks Screw. An Observational Computer Tomographic Study of Fifth Metatarsal Bone Anatomy in a Sample of Patients

et al. 2015

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We wanted to verify our clinical experience that the 5.5 mm screw was ideal in the majority of fifth metatarsal fracture fixation. The size of a screw is important for the successful surgical treatment of these fractures in order to obtain the maximal stability while reducing the risk for iatrogenic fracture.A sample of patients undergoing computer tomographic imaging of the foot for investigation other than fifth metatarsal pathology were recruited. The parameters of the fifth metatarsal bone anatomy were measured.These parameters of the 5.5 mm screw were correlated with this data. The upper parameter (the diameter of the threads) was 5.5 and the lower parameter (the diameter of the shank) was 4.0 mm.Twenty seven patients were recruited.The proximal third internal diameter ranged from 3.6 to 7.0 mm with a mean of 5.0 mm. 93% of the metatarsals could easily accommodate the 5.5 mm screw. Two of the metatarsals had an internal diameter of < 4 mm (7%).It is our belief that the 5.5 mm screw may be used safely in the majority of patients with fifth metatarsal fractures.

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Section: Discussionmentioning

confidence: 99%

When Planning Screw Fracture Fixation Why the 5.5 mm Screw is the Goldilocks Screw. An Observational Computer Tomographic Study of Fifth Metatarsal Bone Anatomy in a Sample of Patients

et al. 2015

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“…[6][7][8]10,13,14,19,[22][23][24]26 Of the 11 published studies reviewed, there were 27 radiographs showing the position of the screw in the fifth MT. [6][7][8]10,13,14,19,[22][23][24]26 Of those 27 radiographs, 78% (21/27) had a screw head that was not fully within the cortex of the fifth MT. Patients with continued pain after fracture union may benefit from appropriate imaging aimed down the lateral tarsometatarsal joints to evaluate for potentially symptomatic hardware or CT imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Review of the literature demonstrated (1) a high propensity of radiographs without oblique views clearly showing the tarsometatarsal joints and (2) radiographs that demonstrated screw heads outside the cortex of the fifth MT. 6–8,10,13,14,19,22–24,26 Of the 11 published studies reviewed, there were 27 radiographs showing the position of the screw in the fifth MT. 6–8,10,13,14,19,22–24,26 Of those 27 radiographs, 78% (21/27) had a screw head that was not fully within the cortex of the fifth MT.…”

Section: Discussionmentioning

confidence: 99%

“…17 Several studies have demonstrated good outcomes following screw fixation for zone 2 fractures in athletes, with high rates of return to play at 8-9 weeks postoperatively. 4,14,22,23 However, surgical fixation for these fractures is not without risk, with delayed union or nonunion, refracture, prominent screw head, and sural nerve injury being among the most common complications. 3,4,10,11,15,30 The fifth MT has a distal latero-plantar curvature and narrow intramedullary canal (4.1±0.9 mm).…”

Section: Introductionmentioning

confidence: 99%

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Avoiding Fifth Metatarsal Intramedullary Screw Head Cuboid Impingement: A Weightbearing Computed Tomography Anatomic Study

et al. 2022

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Background: Multiple case reports of fifth metatarsal (MT) intramedullary fixation highlight symptomatic hardware with screw head impingement on the cuboid. We developed a fifth MT intramedullary screw trajectory model using weightbearing computed tomography data. The goal was to assess for cuboid impingement with simulated intramedullary screw position, Methods: For 20 weightbearing foot computed tomographs (CTs), an automated tool was used to simulate fifth MT screw fixation in the ideal trajectory down the shaft and with a 7-mm screw head. (1) The closest distance from the simulated ideal trajectory to the cuboid in 3 dimensions was measured. A measurement less than 3.5 mm (the radius of the screw head) indicated screw head impingement on the cuboid if not countersunk into the metatarsal. (2) In 3 dimensions, a simulated screw head was then advanced from the proximal tip of the metatarsal distally into the metatarsal until it was entirely avoiding the cuboid. Results: In this model, 95% (19/20) of the patients would have cuboid impingement if the screw was not countersunk. The average ideal pin start distance was 0.15 mm (SD 2.4 mm) inside the cuboid. In this cohort, the screw head would have to be countersunk an average of 8.1 mm (SD 2.7 mm) relative to the proximal tip of the metatarsal to avoid cuboid impingement. For all cases, the simulated fluoroscopic oblique view was a reliable indicator of cuboid impingement, demonstrating visible overlapping of the screw with the cuboid. The overlap resolved on the oblique foot view once the screw was sufficiently countersunk, confirmed on 3-dimensional imaging. Conclusion: The ideal guidewire placement for fifth MT intramedullary fixation is directly against the cuboid. Approximately 95% of patients would have cuboid impingement if the screw is not countersunk. The oblique fluoroscopic view of the foot is a reliable assessment of screw head impingement on the cuboid. Level of Evidence: Level III, retrospective study.

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“…Many have thought most athletes with Jones fractures have a subtle or significant varus hindfoot or lateral foot overload 3,21 due to a subtle varus heel, metatarsus adductus, 50 or plantarflexed first ray. 36 However, our study did not show significant varus in the involved foot.…”

Section: Cavovarus Footmentioning

confidence: 99%

Fifth Metatarsal Jones Fractures in the Athlete

Porter

2017

Foot Ankle Int.

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Fifth metatarsal fractures in the athlete are common 14 and can be a source of significant, temporary disability and missed playing time. 1,4,11,14,17,34 Operative intervention with intramedullary screw fixation has become the standard for treatment of the "Jones" fifth metatarsal fracture in the competitive athlete 15,18,48 (it is common in the nonathlete as well). 22,26,43 Although some have advocated plate fixation 10,20 and even external fixation, 44 this author prefers intramedullary fixation. 34,35 Considerable attention has focused on optimizing screw biomechanics,* biological augmentation for healing, 27 and mechanical corrections for reducing recurrence. 36 Recent studies have focused on treatment of nonunions 9,11 and recurrent fractures, 11,19,23 as well as etiologies of fractures. 31,36,41,50 The occurrence in the popular elite athlete has led to more public knowledge and interest in the fifth metatarsal Jones fracture. 12 Despite this awareness in the elite athlete, 17,29 the Jones fracture is common at all levels of sports and training. All physicians and health care professionals involved in treatment of the active patient have experienced the satisfaction of full healing at 6 weeks, as well as the dilemma of delayed union and refracture. We focus this review on all aspects of the Jones fracture, including all 3 types of Jones fractures (Torg types I, II, and III) 45 (Figure 1) and its etiology, operative and nonoperative treatment, rehabilitation, return-to-play criterion, prevention, refracture, nonunion, augmentation, and orthobiologics. We do not address other fractures of the fifth metatarsal, such as avulsions of the fifth metatarsal base, apophyseal nonunions, and oblique fifth metatarsal shaft fractures (dancer's fracture) (Figure 2). 5 Historical Background Sir Robert Jones, a surgeon himself, initially described this metaphyseal-diaphyseal fifth metatarsal base fracture in 4 patients of which one was his own foot that occurred "whilst dancing." 13 Early studies by Shereff et al 40 and Smith et al 42

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Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis

Cited by 16 publications

References 23 publications

When Planning Screw Fracture Fixation Why the 5.5 mm Screw is the Goldilocks Screw. An Observational Computer Tomographic Study of Fifth Metatarsal Bone Anatomy in a Sample of Patients

When Planning Screw Fracture Fixation Why the 5.5 mm Screw is the Goldilocks Screw. An Observational Computer Tomographic Study of Fifth Metatarsal Bone Anatomy in a Sample of Patients

Avoiding Fifth Metatarsal Intramedullary Screw Head Cuboid Impingement: A Weightbearing Computed Tomography Anatomic Study

Fifth Metatarsal Jones Fractures in the Athlete

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