Return to sport following toe phalanx fractures: A systematic review

Outcomes of open or closed treatment of foot fractures: A database study comparing patients with and without diabetes

Treatment of ankle and foot fractures in patients with diabetes mellitus (DM) is challenging, and complications may arise. Although much data exists on complication rates in tibial, fibular, and malleolar fractures, there exists a comparable lack of data on complication rates in fractures of the tarsal, metatarsal, and phalanx bones of the foot. Therefore, we aimed to compare post-procedural outcomes after such fractures in diabetic vs non-diabetic patients. A commercially available de-identified database was searched using ICD-10 codes for the open or closed surgical treatment in patients with fractures of the calcaneus, cuboid, navicular, talus, cuneiforms, metatarsals, and phalanges from 2010 to 2023. Patients with at least 1 year of post-procedural follow-up were included. We then separated patients into two groups: those with diabetes (108,603, 26.4 %) and those without diabetes (302,464, 73.6 %). Post-procedural complications assessed including those related to hardware when surgical treatment was pursued (reoperation, non-union, malunion, delayed union, wound disruption, surgical site infection) and health complications after fracture treatment (AKI, DVT, MI, pneumonia, sepsis) were assessed at 1 year and odds ratios were used to compare rates of these complications in diabetics vs non-diabetics for each bone. Rates of complications after fracture treatment were found to be significantly higher in all bones for diabetic patients compared to non-diabetic patients.

Extracorporeal Shock Wave Therapy Combined With Platelet-Rich Plasma Injection to Treat the Nonunion of a Stress Fracture of the Proximal Phalanx of the Great Toe: A Case Report

A 15-year-old female short-distance track and field athlete started to experience pain in her left great toe while competing. One month after the onset of symptoms, she was diagnosed with a stress fracture of the proximal phalanx of the great toe. Despite three months of conservative treatment, no bone healing was observed, resulting in a nonunion. To promote healing of the fractured area, a treatment method involving the combination of extracorporeal shock wave therapy (ESWT) with platelet-rich plasma (PRP) injection was pursued. Complete bone healing was achieved six weeks after the start of the treatment, enabling the patient to fully return to her sport. Based on our findings, the combined use of ESWT and PRP injections, both beneficial for bone healing, is a potentially effective treatment for nonunion of the stress fracture of the proximal phalanx of the great toe.

Surgical Treatment for Non-union of the Great Toe Proximal Phalanx Stress Fracture in an Adolescent Jumping Athlete

Stress fractures of the proximal phalanx of the great toe are primarily attributed to repetitive shear forces, with the vertical ground reaction forces exerting several times the body weight. In the initial stages of injury, conservative management anticipates bone healing within approximately five weeks, followed by a gradual return to sports activities over an additional five weeks. Athletes presenting with pain in this region warrant a thorough evaluation for stress fractures to initiate timely conservative care. In instances of delayed healing or non-union, surgical intervention is indicated. However, literature on the management and optimal timing of surgery, particularly in adolescent athletes, remains sparse. This case report, complemented by a literature review, offers insights into management based on the patient's clinical course.