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Abstract
Proximal fifth metatarsal fractures are common in the athlete and can be a source of significant, temporary disability and missed playing time. The pattern of fracture can vary, and the type of fracture leads to a significantly different prognosis and treatment. Jones fractures of the fifth metatarsal are particularly common and difficult to treat in the athlete, can have recurrence and refracture, and require expertise to heal. Intramedullary screw fixation is currently the preferred method of fixation. Most other (non-Jones fractures and os vesalianum) proximal fifth metatarsal fractures can be treated successfully without surgery.
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Affiliation(s)
- David A Porter
- Methodist Sports Medicine/TOS, Department of Orthopedics, Indiana University, Purdue University, 201 Pennsylvania Parkway, Suite 100, Carmel, IN 46280, USA; Wabash College.
| | - Jeff Klott
- Department of Orthopedics, Indiana University, 46280, USA
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2
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Bean BA, Smyth NA, Abbasi P, Parks BG, Hembree WC. Biomechanical Comparison of Hook Plate vs Headless Compression Screw Fixation of Large Fifth Metatarsal Base Avulsion Fractures. Foot Ankle Int 2021; 42:89-95. [PMID: 32981339 DOI: 10.1177/1071100720953083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures. METHODS Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles. RESULTS The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 [range 100-300] cycles vs 178.6 ± 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens. CONCLUSION A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base. CLINICAL RELEVANCE Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.
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Affiliation(s)
- Bryan A Bean
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Niall A Smyth
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Pooyan Abbasi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Brent G Parks
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Samaila EM, Ditta A, Negri S, Leigheb M, Colò G, Magnan B. Central metatarsal fractures: a review and current concepts. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:36-46. [PMID: 32555075 PMCID: PMC7944817 DOI: 10.23750/abm.v91i4-s.9724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 02/08/2023]
Abstract
Central metatarsal fractures (CMF) are common injuries. More frequently fractures are those of the fifth metatarsal, followed by CMF and therefore by the first metatarsal. Third metatarsal is injured most frequently than the others and up to 63% is associated with second or fourth metatarsal fractures and up to 28% with both. Anatomy and metatarsal kinematics merits attention due to its influence on function, injuries and treatment options. Diagnosis is based on the history of trauma and clinical examination, relating with instrumental exams. Fractures with less than 10° of angulation and 3-4 mm of translation in any plane are typically treated conservatively, while operative treatment is generally reserved for fractures out if these values. Intramedullary fixation with K-wires seem to be the most common and valid surgical treatment in simple fractures. Spiral fractures should be treated by interfragmentary screws, which positioning may result difficult due to the adjacent metatarsals. Therefore, an alternative approach is an osteosynthesis with a dorsal plate. Multiple metatarsal fractures often occur in the contiguous bones, so clinicians will also have to carefully inspect metatarsals and adjacent joints such as Lisfranc articulation. The clinical and functional outcomes are often influenced by the pattern of fractures and patient conditions and are reported in the literature up to 39% of poor results.
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Affiliation(s)
| | - Alessandro Ditta
- Department of Orthopedics and Trauma Surgery, University of Verona.
| | - Stefano Negri
- Department of Orthopedics and Trauma Surgery, University of Verona.
| | - Massimiliano Leigheb
- Orthopedics and Traumatology, A.O.U. "Maggiore d.c." University of Eastern Piedmont, Novara.
| | - Gabriele Colò
- Department of Orthopedics and Traumatology, Regional Center for Joint Arthroplasty, Alessandria.
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona.
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Chaturvedi A, Mann L, Cain U, Chaturvedi A, Klionsky NB. Acute Fractures and Dislocations of the Ankle and Foot in Children. Radiographics 2020; 40:754-774. [PMID: 32243231 DOI: 10.1148/rg.2020190154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Distinct biologic and mechanical attributes of the pediatric skeleton translate into fracture patterns, complications, and treatment dilemmas that differ from those of adults. In children, increasing participation in competitive sports activities has led to an increased incidence of acute injuries that affect the foot and ankle. These injuries represent approximately 13% of all pediatric osseous injuries. Important posttraumatic complications include premature physeal arrest, three-dimensional deformities and consequent articular incongruity, compartment syndrome, and infection. The authors describe normal developmental phenomena and injury mechanisms of the ankle and foot and associated imaging findings; mimics and complications of acute fractures; and dislocations that affect the pediatric ankle and foot. Treatment strategies, whether conservative or surgical, are aimed at restoring articular congruency and functional alignment and, for pediatric patients specifically, protecting the physis. The different types of ankle and foot fractures are described, and the American College of Radiology guidelines used to determine appropriate imaging recommendations for patients who meet the Ottawa ankle and foot rules are discussed. The systems used to classify clinically important fractures, including the Salter-Harris, Dias-Tachdjian, Rapariz, and Hawkins systems, are described, with illustrations that reinforce key concepts. These classification systems aid in diagnosis and treatment planning, facilitate communication, and help standardize documentation and research. This information is intended to supplement radiologists' understanding of developmental phenomena, anatomic variants, fracture patterns, and associated complications that affect the pediatric foot and ankle. In addition, the role of imaging in ensuring appropriate treatment, follow-up, and patient and parent counseling is highlighted. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Apeksha Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Laura Mann
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Usa Cain
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Abhishek Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Nina B Klionsky
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
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Gill LE, Klingele KE. Management of foot and ankle injuries in pediatric and adolescent athletes: a narrative review. Orthop Res Rev 2019; 10:19-30. [PMID: 30774457 PMCID: PMC6209353 DOI: 10.2147/orr.s129990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In this review, we focus on the treatment of injuries to the foot and ankle in the adolescent athlete. While many injuries in the adolescent foot and ankle are similar to or overlap with their counterparts in the adult population, the anatomy of the adolescent ankle, especially the presence of growth plates, results in different injury patterns in many cases and calls for specific management approaches. We discuss the unique anatomy of the pediatric patient as well as the diagnostic evaluation and treatment of common injuries in the young athlete.
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Affiliation(s)
- Laura E Gill
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA,
| | - Kevin E Klingele
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA,
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The peroneus brevis tendon at its insertion site on fifth metatarsal bone. Foot Ankle Surg 2016; 22:41-5. [PMID: 26869499 DOI: 10.1016/j.fas.2015.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/27/2015] [Accepted: 04/20/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The differences at the attachment site of peroneus brevis (PB) to the fifth metatarsal bone is important in terms of the forces exerted on the bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of fifth metatarsal bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site. METHODS The length and the width of PB tendons at their mid- and end-points were measured and classified according to the insertion types. Besides, the length and the width of the base of fifth metatarsal bone were assessed. The slips extending from the PB tendons and their relationship with PT were also evaluated. The data was compared statistically with each other and between the right and left sides. RESULTS The length of PB tendon was measured 79.57±15.40mm on the right side; 81.48±14.31mm on the left. The width of PB tendon at the mid-point was 4.46±0.80mm on the right side; 4.42±0.94mm on the left. The width of the tendon at its insertion point was measured 14.85±3.40mm and 15.16±3.42mm on the right and left sides respectively. PB was divided into three types according to its attachment to base of fifth metatarsal bone (5thMB). Type I, Type II and Type III were observed at the rates of 59.5%, 28.6% and 11.5% respectively. It was observed that the slips to the bone were extending more commonly from PB than from PT and that the large majority of them were single having their insertions on the base of the proximal phalanx of the fifth toe. CONCLUSIONS Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot.
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Wong PKW, Hanna TN, Shuaib W, Sanders SM, Khosa F. What’s in a name? Lower extremity fracture eponyms (Part 2). Int J Emerg Med 2015. [PMID: 26223985 PMCID: PMC4512960 DOI: 10.1186/s12245-015-0076-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eponymous extremity fractures are commonly encountered in the emergency setting. Correct eponym usage allows rapid, succinct communication of complex injuries. We review both common and less frequently encountered extremity fracture eponyms, focusing on imaging features to identify and differentiate these injuries. We focus on plain radiographic findings, with supporting computed tomography (CT) images. For each injury, important radiologic descriptors are discussed which may need to be communicated to clinicians. Aspects of management and follow-up imaging recommendations are included. This is a two-part review: Part 1 focuses on fracture eponyms of the upper extremity, while Part 2 encompasses fracture eponyms of the lower extremity.
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Avulsion fractures in the foot: telltale radiographic signs to avoid mismanagement. Clin Imaging 2014; 39:374-9. [PMID: 25482353 DOI: 10.1016/j.clinimag.2014.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/12/2014] [Accepted: 11/15/2014] [Indexed: 11/22/2022]
Abstract
Due to similar clinical presentations, avulsion fractures are frequently missed on initial exam and categorically treated as "sprain" not otherwise specified. However, delays in appropriate diagnosis and treatment can result in further injury and long-term disability. This article will review multiple foot avulsion fractures, their respective mechanisms of injury, the clinical and radiographic presentations, and the most appropriate courses of treatment.
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DeVries JG, Taefi E, Bussewitz BW, Hyer CF, Lee TH. The fifth metatarsal base: anatomic evaluation regarding fracture mechanism and treatment algorithms. J Foot Ankle Surg 2014; 54:94-8. [PMID: 25441854 DOI: 10.1053/j.jfas.2014.08.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Indexed: 02/03/2023]
Abstract
Fractures occurring within the 1.5-cm proximal portion of the fifth metatarsal are commonly considered avulsion fractures. The exact mechanisms of such fractures are controversial. The present study focused on determining the likely mechanism of fracture according to the exact anatomy to allow for more successful treatment. The research sample included 10 frozen cadaveric specimens. The lateral band of the plantar fascia, peroneus brevis, and articular surface were identified and separated from their attachments, thereby splitting the fifth metatarsal base into zones A, B, and C. In zone A, the attachment of the plantar fascia was 6.6 ± 2.2 mm from the inferior aspect, 9.5 ± 2.9 mm from the proximal aspect, and 11.5 ± 0.9 mm from the lateral aspect. In zone B, the attachment of the peroneus brevis was 12.0 ± 2.2 mm from the inferior aspect, 10.2 ± 2.2 mm from the proximal aspect, and 11.5 ± 0.9 mm from the lateral aspect. Zone C was measured from the border of zone B and encompassed the articulation of the fifth metatarsal to the cuboid. We propose that fractures occurring in the most proximal end of the fifth metatarsal, zone A, are caused by a lateral band of plantar fascia and might be able to be treated conservatively by immobilization with weightbearing. We also propose that fractures occurring in zones B and C result from traumatic tension on peroneus brevis and might need to be treated with strict immobilization and non-weightbearing or open reduction internal fixation.
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Affiliation(s)
- J George DeVries
- Attending Physician, BayCare Clinic, Orthopedic and Sports Medicine, Manitowoc, WI.
| | | | | | - Christopher F Hyer
- Fellowship Director, Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Westerville, OH
| | - Thomas H Lee
- Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH
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Boutefnouchet T, Budair B, Backshayesh P, Ali SA. Metatarsal fractures: A review and current concepts. TRAUMA-ENGLAND 2014. [DOI: 10.1177/1460408614525738] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Metatarsal fractures represent a significant proportion of foot injuries. Various patterns of metatarsal injuries exist and the resultant impact on function and quality of life is not negligible. This in fact reflected the attention given to these fractures in the medical literature. Conventionally, a complete clinical and radiological assessment is needed in order to guide management and tailor treatment options to the clinical and functional needs of the individual metatarsal fracture. This article provides a thorough review of all metatarsal fractures; it examines the latest literature especially in relation to management of distinct types of metatarsal fractures. Special attention is given to the first metatarsal due to its important implication in stable functionality of the first ray and foot. In relation to the higher incidence of fifth metatarsal fractures this article provides a broader review of their management.
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Affiliation(s)
- Tarek Boutefnouchet
- Trauma and Orthopaedics Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, UK
| | - Basil Budair
- Trauma and Orthopaedics Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, UK
| | - Peyman Backshayesh
- Trauma and Orthopaedics Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, UK
| | - Seyed A Ali
- Trauma and Orthopaedics Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, UK
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DANESI VALENTINA, CRISTOFOLINI LUCA, JUSZCZYK MATEUSZMARIA, ERANI PAOLO, VICECONTI MARCO. MECHANICAL PROPERTIES OF THE HUMAN METATARSAL BONES. J MECH MED BIOL 2012. [DOI: 10.1142/s0219519412005034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite the incidence of metatarsal fractures and the associated risk of significant disability, little is known about the biomechanical properties (strength and stiffness) of metatarsal bones. In most cases a single metatarsal bone (first, second and fifth) has been investigated. An extensive investigation of the biomechanical properties of the metatarsal bones is essential in the understanding and prevention of metatarsal injuries. Entire sets of metatarsal bones from four feet were tested. The first foot was used to fine-tune the testing set-ups. To measure the stiffness, each metatarsal bone was subjected to non-destructive four-point-bending in the sagittal and transverse planes, axial compression and torsion. Strain was measured at two locations. To measure the strength, each metatarsal bone was tested to failure in torsion. Significant differences (p < 0.0001) existed among the stiffness of the five metatarsal bones: (i) in torsion the first metatarsal bone was 2–3 times stiffer than the others; (ii) in four-point-bending and axial compression this difference was less pronounced than in torsion; (iii) differences were smaller among the other metatarsal bones; (iv) the second metatarsal bone was less stiff than the third and fourth in bending. The second, third and fourth metatarsal bones were stiffer in the sagittal than in the transverse plane (p < 0.0001). Conversely, there was no significant difference between the two planes of bending for the first and fifth bones. During destructive testing, all metatarsal bones exhibited a linear elastic behavior and brittle failure. The torsional strength at failure ranged between 1.9 Nm and 6.9 Nm. The first metatarsal bone was stronger than all the others. Stiffness in different loading conditions and failure were measured and compared for all metatarsal bones. These data corroborate previous biomechanical studies concerning the role and load sharing of the different metatarsal bones.
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Affiliation(s)
- VALENTINA DANESI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
- Facoltà di Ingegneria, Università di Bologna, Italy
| | - LUCA CRISTOFOLINI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
- Facoltà di Ingegneria, Università di Bologna, Italy
| | - MATEUSZ MARIA JUSZCZYK
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
- Facoltà di Ingegneria, Università di Bologna, Italy
| | - PAOLO ERANI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - MARCO VICECONTI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Foot and ankle fractures at the supination line. Foot (Edinb) 2011; 21:124-8. [PMID: 21185168 DOI: 10.1016/j.foot.2010.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 11/17/2010] [Accepted: 11/30/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND The supination line is a fictive line along the foot and ankle, on which over twenty fracture types and approximately ten different ligamentous sprain-injuries have been identified. OBJECTIVE The current study was conducted to evaluate the incidence of different types of supination line injuries visible at the initial radiographs at the Emergency Department and to determine the type and percentage of misdiagnosed injuries. METHOD Retrospective study of consecutive patients who visited the Emergency Department, between January 1 and June 30, 2009, after sustaining an injury of the foot or ankle and had a radiograph taken within 24 h of the incident. RESULTS In the 6-month study period 1284 patients were included. In these cases the trauma mechanism was a sprain in 780 patients (60.7%). Of these patients 310 suffered from a fracture (40%). There were 36 (4.6%) false-positive cases and in 91 (11.7%) cases the initial diagnosis was false-negative. The number with a missed fracture expressed as a percentage of all patients with a fracture was 29.4% (91/310). CONCLUSION Detection of injuries along the supination line remains difficult. This study might aid in decreasing the number of misdiagnosed injuries, which is of value as these might negatively affect outcome.
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Mansour R, Jibri Z, Kamath S, Mukherjee K, Ostlere S. Persistent ankle pain following a sprain: a review of imaging. Emerg Radiol 2011; 18:211-25. [DOI: 10.1007/s10140-011-0945-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 02/21/2011] [Indexed: 12/26/2022]
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Abstract
INTRODUCTION Although metatarsal fractures are amongst the most common injuries of the foot, this is the first study on outcome after metatarsal fractures. METHOD All consecutive patients with metatarsal fractures treated between January 2006 and September 2008 were re-evaluated. Patients aged 16 to 75 were sent a questionnaire consisting of the American Orthopaedic Foot Ankle Society midfoot score and a Visual Analogue Scale (VAS) for patient satisfaction. RESULTS Four-hundred metatarsal fractures were identified in 322 patients. The fifth metatarsal was involved in more than 50% of patients. Most fractures were caused by an inversion injury or fall from height (75%). Out of 247 patients between 16 and 75 years, a total of 166 patients (67.2%) returned the questionnaire with a median follow-up of 33 months. All patients were treated conservatively. The median AOFAS score was 100 points (P(25)-P(75), 87-100), the median VAS was 9 points (P(25)-P(75), 8-10). The AOFAS and VAS scores correlated negatively with the body mass index (BMI) (R (s) = -0.409 and -0.305; p < 0.001). Patients with diabetes reported lower VAS (p = 0.010) and AOFAS scores (p = 0.020). Females reported a lower AOFAS score (p = 0.034). An increase in dislocation (>2 mm) resulted in a decrease in VAS score (p = 0.017). Multivariable analysis indicated that the VAS score was significantly affected by BMI and dislocation >2 mm (p = 0.013). The AOFAS score was affected by BMI (p = 0.011). CONCLUSION This is the first investigation using two validated outcome scoring systems to determine functional outcome in metatarsal fractures. Overall outcome in metatarsal fractures is high, as almost all fractures healed without complaints at 33 months. Outcome is dependent on BMI, diabetes, gender, and dislocation at the fracture site.
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Zwitser EW, Breederveld RS. Fractures of the fifth metatarsal; diagnosis and treatment. Injury 2010; 41:555-62. [PMID: 19570536 DOI: 10.1016/j.injury.2009.05.035] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 05/24/2009] [Accepted: 05/26/2009] [Indexed: 02/07/2023]
Abstract
Of all foot fractures the fifth metatarsal fracture is the most common. A complete clinical and radiological assessment is required to select the best treatment option. Nondisplaced tuberosity avulsion fractures can be treated non-operatively. Surgical treatment is indicated when the fracture is displaced more than 2mm or when more than 30% of the cubometatarsal joint is involved. Non or minimally displaced shaft fractures can be treated non-operatively. If the dislocation is more than 3-4mm or the angulation is more than 10 degrees, percutaneous K-wires, plate or screw fixation is indicated. The Jones fracture is known for prolonged healing time and non-union. The indication for surgical treatment of Jones' fractures depends on activity level and Torg classification: type I fractures are treated non-operatively. Type II fractures can be treated non-operatively or operatively, depending on patient activity level. Type III fractures have more complications and should be treated operatively. Several operation techniques have been described.
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Affiliation(s)
- E W Zwitser
- Department of Trauma Surgery, Rode Kruis Ziekenhuis, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.
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Gu YD, Ren XJ, Li JS, Lake MJ, Zhang QY, Zeng YJ. Computer simulation of stress distribution in the metatarsals at different inversion landing angles using the finite element method. INTERNATIONAL ORTHOPAEDICS 2009; 34:669-76. [PMID: 19685241 DOI: 10.1007/s00264-009-0856-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 07/01/2009] [Accepted: 07/28/2009] [Indexed: 11/25/2022]
Abstract
Metatarsal fracture is one of the most common foot injuries, particularly in athletes and soldiers, and is often associated with landing in inversion. An improved understanding of deformation of the metatarsals under inversion landing conditions is essential in the diagnosis and prevention of metatarsal injuries. In this work, a detailed three-dimensional (3D) finite element foot model was developed to investigate the effect of inversion positions on stress distribution and concentration within the metatarsals. The predicted plantar pressure distribution showed good agreement with data from controlled biomechanical tests. The deformation and stresses of the metatarsals during landing at different inversion angles (normal landing, 10 degree inversion and 20 degree inversion angles) were comparatively studied. The results showed that in the lateral metatarsals stress increased while in the medial metatarsals stress decreased with the angle of inversion. The peak stress point was found to be near the proximal part of the fifth metatarsal, which corresponds with reported clinical observations of metatarsal injuries.
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Affiliation(s)
- Y D Gu
- School of Engineering, Liverpool John Moores University, Liverpool L3 3AF, UK
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Abstract
Using radiographs culled over a 33-month period, the treatment, complications, revision, and rehabilitation of complicated Jones fractures and stress fractures involving the proximal diaphysis are examined. Although the non-operative approach remains viable, the exigencies and desires of the athletic and leg-based working population require sooner-rather-than-later return to play or work. Fortunately, these needs can be matched by the available and functioning orthopedic practice of intramedullary screw fixation. This practice is coupled with prevention, reliable orthopedic techniques, the orthopedist's surgical skills, and devices necessary for successful surgery. Recent attention directed toward handling complications promise better, quicker, and more reliable recovery for the patient.
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Johnson PT, Fayad LM, Fishman EK. Sixteen-slice CT with volumetric analysis of foot fractures. Emerg Radiol 2006; 12:171-6. [PMID: 16568280 DOI: 10.1007/s10140-006-0469-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022]
Abstract
Computed tomography (CT) imaging of the foot demands excellent resolution for the delineation of complex fractures and joint alignment after trauma. The quality of current multislice volumetric acquisition results in exceptional multiplanar and 3-D reconstructions, precluding the requirement for an additional acquisition in a second plane. This pictoral essay depicts fractures of various bones of the foot, with reference to recent investigative studies demonstrating the value of CT in the evaluation of foot fractures.
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Affiliation(s)
- Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiologic Sciences, Johns Hopkins School of Medicine, 601 N. Caroline Street Room 3251, Baltimore, MD 21287, USA
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Theodorou DJ, Theodorou SJ, Kakitsubata Y, Botte MJ, Resnick D. Fractures of proximal portion of fifth metatarsal bone: anatomic and imaging evidence of a pathogenesis of avulsion of the plantar aponeurosis and the short peroneal muscle tendon. Radiology 2003; 226:857-65. [PMID: 12616022 DOI: 10.1148/radiol.2263020284] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the normal anatomy of the structures supporting the proximal portion of the fifth metatarsal bone and investigate the pathogenesis of fractures in this region. MATERIALS AND METHODS In two cadaveric feet, the region of the lateral component of the plantar aponeurosis (PAL), short peroneal muscle (SPM) tendon, and third peroneal muscle (TPM) tendon was dissected. These two foot specimens and four nondissected foot specimens were studied at magnetic resonance (MR) imaging. Two of the six specimens were studied at computed tomography (CT). Sectioning the nondissected foot specimens enabled anatomic correlation. In two additional specimens, simulation of the presumed mechanism of fifth metatarsal bone fracture was attempted. The radiographic, CT, and MR images obtained in 13 patients with fractures of the proximal portion of the fifth metatarsal bone were evaluated. RESULTS Anatomic, CT, and MR imaging studies revealed broad insertion of the PAL into the plantar aspect of the proximal portion of the fifth metatarsal bone in all specimens. The SPM tendon was consistently attached more distally and to the lateral side of the tuberosity, blending with the PAL fibers. The TPM tendon was inconsistently identified inserting anteriorly to the SPM tendon. No fracture was created in the specimens subjected to attempted injury. Frequent attachment of the PAL and the SPM tendon to the avulsed fragment was confirmed in clinical cases. CONCLUSION The pathogenesis of fractures of the proximal portion of the fifth metatarsal bone appears to be related to avulsion injury of PAL and SPM tendon fibers.
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Affiliation(s)
- Daphne J Theodorou
- Department of Radiology, School of Medicine, University of California, San Diego Medical Center, CA, USA.
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Hall FM. Additional foot radiographs. AJR Am J Roentgenol 2001; 176:811. [PMID: 11222233 DOI: 10.2214/ajr.176.3.1760811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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