Mid-term follow-up after surgical treatment of fifth metatarsal base fractures in professional soccer players

Abstract

Objective: Fifth metatarsal fractures occur mainly in young athletes, with an estimated incidence of 1.8 per 1,000 people a year. The objective of this study was to evaluate the functional outcome of professional soccer players subjected to surgical treatment of fifth metatarsal base fractures. Methods: A total of 34 soccer players who underwent surgery from July 2001 to June 2016 were evaluated. All participants were evaluated by the American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue scale (VAS) score before and after surgery, with a mean follow-up of 23 months. The need for grafting relative to time to surgery, time to fracture consolidation and Torg classification and graft use relative to return to sport were valuated. Results: There were 10 forwards, 7 offensive midfielders, 6 fullbacks, 5 center midfielders, 3 defenders, 2 goalkeepers and 1 defensive midfielder, with a mean age of 19 years. The mean pre- and postoperative AOFAS was 42 and 99 points whereas the mean VAS score was 6 and 0, respectively. The longer the time to surgery, the greater was the need for grafting (p=0.011). The time to return to sport was not influenced by the time to surgery, time to consolidation, Torg classification or graft use. Conclusion: The surgical treatment of fifth metatarsal base fractures in professional soccer players showed good clinical results. The return to activities after surgery is not influenced by the time to surgery, time to consolidation, Torg classification or grafting. Level of Evidence IV; Therapeutic Studies; Case Series.

Fracture of the Fifth METATARSAL.BIBLIOGRAPHIC Review

“…However, it should be taken into account that an efficient rehabilitation, without compromising the whole process of consolidation and recovery of the patient, reduces the risk of presenting refractures and the presence of pseudarthrosis. Among the studies reviewed, it was evidenced that the following variables were not influential factors for a favorable recovery: surgical time, healing time, Torg classification and if they use a graft during the surgical procedure (12)(13)(14).…”

Fractures of the Base of the Fifth Metatarsal Bone

“…There is evidence from numerous studies that minimally invasive intramedullary screw fixation allows early postoperative weight-bearing, with union rates ranging from 89% to 100% and no need for bone-grafting 3,5,49,50,99,133,137,157-159 . The main disadvantages of intramedullary screws are a demanding insertion technique, the risk of irritation of the sural nerve, and symptomatic prominence of the screw head 3,5,49,122,130,133,158,160-163 .…”

“…Plate fixation has been successfully employed for Torg type-II and III fractures 176,178 . In cases of delayed healing or nonunion (Torg type-II and III fractures), several authors have combined internal fixation with the application of bone marrow aspirate concentrate (BMAC) to the fracture site 134,141,161,172,179 or cancellous bone-grafting from the calcaneus, the tibia, or the iliac crest 6,40,56,141,162,175,178-182 . Popovic et al found less refractures (0 versus 27%) in professional football players with Torg type-I and II fractures when 4.5-mm screw fixation was supplemented by local bone-grafting 40 .…”

“…Bone grafts may be applied as sliding (local) grafts from the fifth metatarsal 2,4,6 or as corticocancellous grafts that have been harvested from the iliac crest, the calcaneus, or the tibia 40,141,162,175,179,181,182 .…”

“…Several authors recorded excellent results after use of a single screw 3,5,40,71,122,131,137,157-159,174 , use of a screw in combination with BMAC 134,161,172 , and use of a screw in combination with cancellous bone-grafting or a solid bone graft 40,141,162,175,179,181,182 . Reported union rates after operative treatment of zone-3 fractures and nonunions have ranged between 86% and 100% 5,49,50,133,158,172,175 .…”