Surgical results of 5th metatarsal stress fracture using modified tension band wiring

Lee, Kyung Tai; Park, Young Uk; Young, Ki Won; Kim, Jin Su; Kim, Jun Beom

doi:10.1007/s00167-011-1406-3

Cited by 42 publications

(37 citation statements)

References 20 publications

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“…Finally, two different fracture locations were analyzed in combination. Although several authors reported the proximal diaphyseal fifth metatarasal fracture is more difficult to obtain satisfactory outcomes than Jones fracture [1,22], the largest study in comparison between two fracture locations revealed no difference in clinical and radiographic outcomes [9]. We also consider that the treatment of Jones fracture is challenging as well as proximal diaphyseal fifth metatarsal fracture.…”

Section: Discussionmentioning

confidence: 72%

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

Tsukada

Ikeda

Seki³

et al. 2012

BMC Sports Sci Med Rehabil

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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.

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Section: Discussionmentioning

confidence: 72%

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

Tsukada

Ikeda

Seki³

et al. 2012

BMC Sports Sci Med Rehabil

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“…There are strong ligaments between the base of the fifth metatarsal and the cuboid and base of the forth metatarsal, which make this part of the fifth metatarsal relatively fixed (5, 12, 13). On the other hand, the diaphysis of the fifth metatarsal is relatively mobile.…”

Section: Resultsmentioning

confidence: 99%

“…By six to eight weeks post-operatively, full weight-bearing walking is allowed and normal activities can be resumed. Some authors suggest extension of the initial period of cast immobilization and non-weight bearing to six weeks in case of stress fractures of the proximal diaphysis (12). Return to sports should only be allowed when there is radiological evidence of union and the patient is clinically asymptomatic (26).…”

Section: Resultsmentioning

confidence: 99%

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Cheung¹,

Lui²

2016

Arch Trauma Res

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ContextFractures of proximal fifth metatarsal are one of the most common fractures of the foot.Evidence AcquisitionA search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.ResultsThe vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.ConclusionsLawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

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“…SeSti, F. Oliva, R. iunduSi is recommended for fractures displaced more than 2 mm or that involve more than 30% of the cuboidal joint (15,16). Case series of fractures at the border between metaphyseal and diaphyseal proximal metatarsus, treated by modified Tension Band Wiring procedure has been described (17).…”

Section: Discussionmentioning

confidence: 99%

Fifth metatarsal tuberosity avulsion fractures: a new surgical technique without metal implant

Sesti

Oliva

Iundusi

2019

Muscle Ligaments and Tendons J

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Background: Lawrence and Botte classified in the 1993 the fractures of 5MTB in a Zone 1 (tuberosity avulsion fracture), Zone 2 (Jones fracture), and Zone 3 (stress diaphyseal fractures). Despite good outcomes with non-operative treatment, displacement, intra-articular involvement, comminution or painful non-union of Zone 1 fracture have been reported to benefit with early open reduction and fixation. We considered a Zone 1 fracture (tuberosity avulsion) with displacement of the segment from the metatarsal metaphysis > 2 mm. Surgical technique: We describe a surgical procedure for the tuberosity avulsion fractures (Zone 1 of Lawrence and Botte classification or type I-B of Mehlhorn classification) using FiberWire or Vycril sutures. Conclusions: This technique, without using metal implant, provides a theoretically lower rate of infections, could be useful in patients referring metal allergy or hypersensitivity to metal implants and it is not necessary the fluoroscopic guidance.

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Surgical results of 5th metatarsal stress fracture using modified tension band wiring

Abstract: Case series with no comparison group, retrospective case series, Level IV.

Cited by 42 publications

References 20 publications

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

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

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Fifth metatarsal tuberosity avulsion fractures: a new surgical technique without metal implant

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