Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

Abstract

BackgroundDelayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure.MethodsThe authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity.ResultsAll patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient.ConclusionsThere were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

Can low-intensity pulsed ultrasound (LIPUS) accelerate bone healing after intramedullary screw fixation for proximal fifth metatarsal stress fractures? A retrospective study

“…Early return to sports is a risk factor for the delayed bone union after intramedullary screw fixation in fifth metatarsal stress fractures [11]. In our rehabilitation protocol, return to sports was permitted after the complete radiographic bone union was achieved, as in other studies examining intramedullary screw fixation for proximal fifth metatarsal stress fractures [8][9][10]. Therefore, the time to radiographic bone union was not influenced by a return to sports in our study.…”

“…Many athletes desire an early return to sports, but the appropriate time for a safe return to sports is still unclear. In stress fractures, return to sports after a bone union is generally advocated [6,7], and many studies on proximal fifth metatarsal stress fractures have adopted this criterion [8][9][10]. Early return to sports following intramedullary screw fixation for proximal fifth metatarsal stress fractures does not increase the risk of nonunion, but lengthens the time to bone union [11].…”

Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review

“…Ipsilateral calcaneal autograft was the most common source of bone graft, 3 , 8 , 17 , 27 , 28 , 51 followed by iliac crest bone autograft, proximal tibial autograft, and distal tibial autograft. 18 , 21 , 22 , 32 , 45 Various techniques for bone grafting were used, from minimally invasive subperiosteal injections to open inlay procedures. Only 2 of the included studies 34 , 43 did not use any form of adjunctive bone grafting, accounting for 26 athletes.…”

A Novel Method for Internal Fixation of Fifth Metatarsal Tuberosity Avulsion Fractures

“…[5] An isolated intramedullary screw had poor resistance to dorsal exion forces; it resulted in a high risk of implant breakage or micromotion of the fracture site, and caused pain due to stimulation of the surrounding soft tissues. [23] To improve the compression at the fracture site, researchers are inclined to use a thicker screw, even though it can disintegrate the fracture fragment. We used 2.4 mm diameter screws to effectively prevent iatrogenic fracture fragmentation.…”