Intramedullary Screw Fixation of a Proximal Fifth Metatarsal Stress Fracture in an Elite Athlete: A Case Report

Sauer, Steffen

doi:10.1055/s-0037-1599833

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…Lateral talo-1st metatarsal angle and medial cuneiform height are measures of the medial longitudinal arch, indicating that a higher arch and midfoot adduction correlate with smaller postoperative improvement in functionality. Pes cavus is a well-established risk factor for proximal fifth metatarsal fractures due to persistent overloading of the lateral column [ 30 – 32 ]. Our study shows that patients with higher arches do not recover functionality as well as patients with flatter longitudinal arches, perhaps due to increased stresses on the lateral column during the recovery period and postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

et al. 2021

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Background Zones 2 and 3 fifth metatarsal fractures are often treated with intramedullary fixation due to an increased risk of nonunion. A previous 3-dimensional (3D) computerized tomography (CT) imaging study by our group determined that the screw should stop short of the bow of the metatarsal and be larger than the commonly used 4.5 millimeter (mm) screw. This study determines how these guidelines translate to operative outcomes, measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Radiographic variables measuring the height of the medial longitudinal arch and degree of metatarsus adductus were also obtained to determine if these measurements had any effect on outcomes. And lastly, this study aimed to determine if morphologic differences between males and females affected surgical outcomes. Methods We retrospectively identified 23 patients (14 male, 9 female) who met inclusion criteria. Eighteen patients completed PROMIS surveys. Preoperative PROMIS surveys were completed prior to surgery, rather than retroactively. Weightbearing radiographs were also obtained preoperatively to assist with surgical planning and postoperatively to assess interval healing. Correlation coefficients were calculated between PROMIS scores and repair characteristics (hardware characteristics [screw length and diameter] and radiographic measurements of specific morphometric features). T tests determined the relationship between repair characteristics, PROMIS scores, and incidence of operative complications. PROMIS scores and correlation coefficients were also stratified by gender. Results The average screw length and diameter adhered to guidelines from our previous study. Preoperatively, mean PROMIS PI = 57.26±11.03 and PROMIS PF = 42.27±15.45 after injury. Postoperatively, PROMIS PI = 44.15±7.36 and PROMIS PF = 57.22±10.93. Patients with complications had significantly worse postoperative PROMIS PF scores (p=0.0151) and PROMIS PI scores (p=0.003) compared to patients without complications. Females had non-significantly worse preoperative and postoperative PROMIS scores compared to males and had a higher complication rate (33 percent versus 21 percent, respectively). Metatarsus adductus angle was shown to exhibit a significant moderate inverse relationship with postoperative PROMIS PF scores in the overall cohort (r=−0.478; p=0.045). Metatarsus adductus angle (r=−0.606; p=0.008), lateral talo-1st metatarsal angle (r=−0.592; p=0.01), and medial cuneiform height (r=−0.529; p=0.024) demonstrated significant inverse relationships with change in PROMIS PF scores for the overall cohort. Within the male subcohort, significant relationships were found between the change in PROMIS PF and metatarsus adductus angle (r=−0.7526; p=0.005), lateral talo-1st metatarsal angle (r=−0.7539; p=0.005), and medial cuneiform height (r=−0.627; p=0.029). Conclusion Patients treated according to guidelines from our prior study achieved satisfactory patient reported and radiographic outcomes. Screws larger than 4.5mm did not lead to hardware complications, including screw failure, iatrogenic fractures, or cortical blowouts. Females had non-significantly lower preoperative and postoperative PROMIS scores and were more likely to suffer complications compared to males. Patients with complications, higher arched feet, or greater metatarsus adductus angles had worse functional outcomes. Future studies should better characterize whether patients with excessive lateral column loading benefit from an off-loading cavus orthotic or plantar-lateral plating.

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Section: Discussionmentioning

confidence: 99%

Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

et al. 2021

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Intramedullary Screw versus Locking Plate Fixation for Traumatic Displaced Proximal Fifth Metatarsal Fractures: A Systematic Review

Lo,

Tai,

Huang

et al. 2024

JCM

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Background/Objectives: Intramedullary screw fixation (IMS) and locking plate fixation (LPF) are currently recommended treatments for proximal fifth metatarsal fractures (PFMF). However, treating comminuted or small displaced avulsion PFMF with IMS poses challenges due to complications. A novel alternative fixation method, the locking compression plate for distal ulna hook plate fixation (LPF), has been introduced recently for distal ulna fractures and has shown improved clinical results. This scoping review aims to assess whether LPF yields superior outcomes, such as postoperative AOFAS scores and rate of postoperative complications, compared to IMS in PFMF treatment. Methods: This review included randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies, or case series involving patients with PFMF who underwent plate fixation or screw fixation. The primary outcome was the postoperative American Orthopedic Foot and Ankle Society (AOFAS) score. Studies were sourced from databases including PubMed, Embase, and Scopus, with the search conducted up to February 2024. The Systematic Review protocol was registered in the CRD PROSPERO database (CRD42024532593). Results: Ten studies were included, comprising 3 cohort studies, 1 case–control study, and 6 case series, with a total of 309 patients (158 with LPF and 142 with IMS). The postoperative AOFAS scores showed no significant difference between LPF and IMS in treating PFMF. However, LPF demonstrated efficient surgical procedures and enhanced functional outcomes. Complications were minimal in both groups, with no significant difference in the rate of postoperative complications. Conclusions: Although there was no significant difference in AOFAS scores between LPF and IMS, LPF demonstrated efficient surgical procedures and enhanced functional outcomes, making it a reasonable alternative method for PFMF. Effective shared decision-making (SDM) with patients becomes paramount in choosing the optimal surgical approach. In the surgical landscape, thoughtful deliberation, patient engagement, and adherence to biomechanical principles are crucial for achieving successful outcomes in the treatment of PFMF.

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Intramedullary Screw Fixation of a Proximal Fifth Metatarsal Stress Fracture in an Elite Athlete: A Case Report

Cited by 2 publications

References 7 publications

Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

Intramedullary Screw versus Locking Plate Fixation for Traumatic Displaced Proximal Fifth Metatarsal Fractures: A Systematic Review

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