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The Journal of the American Academy of... Feb 2022A Jones fracture, located at the metaphyseal-diaphyseal junction of the fifth metatarsal, is at an increased risk for nonunion and continued pain. Even with excellent... (Review)
Review
A Jones fracture, located at the metaphyseal-diaphyseal junction of the fifth metatarsal, is at an increased risk for nonunion and continued pain. Even with excellent surgical technique and postoperative management, a delayed union and refracture can occur. These complications in athletes can have deleterious effects on performance and delay return to sport. This article reviews the classification, diagnosis, and treatment considerations for Jones fractures. Treatment options including nonsurgical management, intramedullary screw, and plate fixation will be covered. The authors preferred technique using intramedullary screw fixation will be discussed in depth. Emerging considerations including biologic augmentation, primary bone grafting, and refracture will be examined as well. Ideal rehabilitation protocols, orthoses, and shoe wear suggestions will be given to optimize patient outcomes.
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones
PubMed: 34932521
DOI: 10.5435/JAAOS-D-21-00542 -
Clinics in Podiatric Medicine and... Jul 2024Metatarsal fractures are some of the most common fractures reported in the human body. Recent advances in surgical techniques and fixation have helped facilitate healing... (Review)
Review
Metatarsal fractures are some of the most common fractures reported in the human body. Recent advances in surgical techniques and fixation have helped facilitate healing and improved outcomes for our patients. The treatment goals of metatarsal fractures are to maintain the metatarsal parabola, sagittal position of the metatarsal heads, and a congruent metatarsophalangeal joint. Most of these injuries can be treated nonoperatively, but displaced fractures require surgical intervention to preserve normal gait biomechanics.
Topics: Humans; Metatarsal Bones; Fractures, Bone; Fracture Fixation, Internal; Fracture Healing; Male
PubMed: 38789159
DOI: 10.1016/j.cpm.2024.01.001 -
The Journal of Orthopaedic and Sports... Jul 2021Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using...
BACKGROUND
Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using noninvasive approaches that are designed to achieve a speedy but safe return to running.
CLINICAL QUESTION
What is the optimal load to manage low-risk tibial and metatarsal BSIs and safely return to running?
KEY RESULTS
Optimal load can be guided by knowledge of the BSI healing process and is symptom driven. At all stages, the optimal load does not produce symptoms during, after, or the day following loading.
CLINICAL APPLICATION
A period of initial load reduction, via partial or non-weight bearing, is typically needed to alleviate presenting symptoms. Analgesics or nonsteroidal anti-inflammatory drugs may be used in the short term (sooner than 7 days), but only for resting pain and night pain. Healing supplements (eg, low-intensity pulsed ultrasound and/or recombinant parathyroid hormone therapy) may be attempted to influence tissue healing. Athletes can maintain cardiopulmonary fitness via cross-training, while simultaneously addressing musculoskeletal fitness. A return-to-run program can be initiated once an athlete is pain free during daily activities for 5 consecutive days. Progress is directed by symptom provocation and initially focuses on increasing running volume before speed. Optimal loading should be continued following return to running and may include jump training and/or gait retraining to reduce subsequent BSI risk. The optimal loading approach to managing low-risk tibial and metatarsal BSIs is clinically successful, but requires further scientific validation. .
Topics: Athletic Injuries; Clinical Reasoning; Fractures, Stress; Humans; Metatarsal Bones; Return to Sport; Running; Tibia
PubMed: 33962529
DOI: 10.2519/jospt.2021.9982 -
Deutsches Arzteblatt International Sep 2021Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons. Approximately 30% of metatarsal fractures...
BACKGROUND
Metatarsal fractures are among the most common foot and ankle injuries, with an annual incidence of 6.7 per 100 000 persons. Approximately 30% of metatarsal fractures affect the base of the fifth metatarsal bone. Nevertheless, no evidence-based treatment recommendations are available to date.
METHODS
The three fracture localizations according to Lawrence and Botte (zone I, proximal to the intermetatarsal joint between the fourth and fifth metatarsal bones; zone II, in the area of the joint; zone III, at the distal end of the joint) are analyzed on the basis of a systematic literature search. Studies were included that compared the treatment of two types of fracture in the same manner, or that compared two different treatments for a single type of fracture.
RESULTS
Nine studies compared different treatments of zone I fractures. Two of these were randomized controlled trials (RCTs); in one RCT, patients given functional therapy returned to work much sooner than those treated with immobilization (11 vs. 28 days; p = 0.001), with otherwise similar outcomes. The non-randomized studies revealed a faster return to full function (33 vs. 46 days; p<0.05) with early functional therapy, and similar outcomes for immobilization and surgery. One RCT that compared functional therapy with immobilization for zone II fractures revealed no statistically significant difference. Five studies compared fractures in zones I and II that were treated in the same manner, revealing similar outcomes. One RCT compared surgery and immobilization for zone III fractures: surgery led to statistically significant improvement of the outcome in all of the measured parameters.
CONCLUSION
Fractures in zones I and II should be treated with early functional therapy. There seems to be no reason to consider zone I and II fractures as two separate entities, as the outcomes in the two groups are similar. In contrast, fractures in zone III should primarily be treated surgically.
Topics: Ankle Injuries; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Randomized Controlled Trials as Topic
PubMed: 34789369
DOI: 10.3238/arztebl.m2021.0231 -
Clinics in Podiatric Medicine and... Jul 2024Fifth metatarsal features are the most common fractures in the foot. They have a long history that has resulted in many classification systems and little consensus on... (Review)
Review
Fifth metatarsal features are the most common fractures in the foot. They have a long history that has resulted in many classification systems and little consensus on appropriate treatment. Although there is some agreement among experts, there are also many questions yet to be answered. There is a general consensus that dancer's fractures and zone 1 fractures can generally be treated nonoperatively. There is much more debate about zone 2 and 3 fractures and appropriate treatment guidelines. The authors review the current literature and give the recommendation for treatment based on their experience in a community-based private practice.
Topics: Humans; Metatarsal Bones; Fractures, Bone; Fracture Fixation, Internal; Foot Injuries
PubMed: 38789160
DOI: 10.1016/j.cpm.2024.01.002 -
Injury Apr 2015Lisfranc injuries are commonly asked about in FRCS Orthopaedic trauma vivas. The term "Lisfranc injury" strictly refers to an injury where one or more of the metatarsals... (Review)
Review
Lisfranc injuries are commonly asked about in FRCS Orthopaedic trauma vivas. The term "Lisfranc injury" strictly refers to an injury where one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot centred on the 2nd tarsometatarsal joint. The injury is named after Jacques Lisfranc de St. Martin (1790-1847), a French surgeon and gynaecologist who first described the injury in 1815. 'Lisfranc injury' encompasses a broad spectrum of injuries, which can be purely ligamentous or involve the osseous and articular structures. They are often difficult to diagnose and treat, but if not detected and appropriately managed they can cause long-term disability. This review outlines the anatomy, epidemiology, classification, investigation and current evidence on management of this injury.
Topics: Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Ligaments, Articular; Metatarsal Bones; Practice Guidelines as Topic; Tarsal Joints; Treatment Outcome
PubMed: 25543185
DOI: 10.1016/j.injury.2014.11.026 -
Foot & Ankle Specialist Apr 2017Lisfranc injury fixation or arthrodesis typically involves the reduction and fixation of several tarsometatarsal joints with either screws or a plate and screw...
UNLABELLED
Lisfranc injury fixation or arthrodesis typically involves the reduction and fixation of several tarsometatarsal joints with either screws or a plate and screw constructs. A successful fixation or arthrodesis of the Lisfranc joint requires proper screw placement from the medial cuneiform to the base of the second metatarsal. This is typically done free-hand; however, we describe use of an anterior cruciate ligament guide to help maintain reduction and assist with drill trajectory for more accurate screw or suture button construct placement.
LEVELS OF EVIDENCE
Level V.
Topics: Arthrodesis; Bone Plates; Bone Screws; Female; Fluoroscopy; Follow-Up Studies; Foot Injuries; Fracture Fixation, Internal; Fracture Healing; Humans; Injury Severity Score; Male; Metatarsal Bones; Risk Assessment; Suture Techniques; Treatment Outcome
PubMed: 28333559
DOI: 10.1177/1938640016677812 -
Clinics in Podiatric Medicine and... Jul 2024Lisfranc injuries were thought to primarily occur during high-energy events, leading to a preference for fusion treatment; however, recent data have shifted this... (Review)
Review
Lisfranc injuries were thought to primarily occur during high-energy events, leading to a preference for fusion treatment; however, recent data have shifted this perspective by highlighting a greater occurrence of low-energy injuries and reshaping the focus on open reduction internal fixation. This multifaceted process is guided by various factors, including the nature of the injury, specific anatomic considerations, and the involved joints. Our overarching goal remains to achieve anatomic reduction, with flexibility in hardware fixation methods. In cases of comminution, bridge plating may be warranted, potentially followed by arthrodesis in the future.
Topics: Humans; Fracture Fixation, Internal; Arthrodesis; Foot Injuries; Fractures, Bone; Open Fracture Reduction; Metatarsal Bones; Male; Bone Plates
PubMed: 38789161
DOI: 10.1016/j.cpm.2024.01.014 -
Journal of Orthopaedic Trauma Aug 2019Lisfranc injuries remain a frequently missed pathology and may present as an isolated injury or as a component of a polytrauma case. Weight-bearing films or advanced...
Lisfranc injuries remain a frequently missed pathology and may present as an isolated injury or as a component of a polytrauma case. Weight-bearing films or advanced imaging such as CT may be imperative in identifying or further classifying the injury. Common indications for fusion after lisfranc injury include primarily ligamentous injuries, delayed/chronic presentations, or post-traumatic arthritis, although primary fusion in the setting of acute fracture may be considered as an alternative to open reduction internal fixation techniques. The primary goals of surgery are to provide stability to the midfoot and restoration of the anatomical arch/cascade. The purpose of this video is to demonstrate a technique for tarsometatarsal joint fusion in the setting of acute lisfranc injury. This technique may be used for both ligamentous as well as bony varieties.
Topics: Arthrodesis; Bone Screws; Female; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Open Fracture Reduction; Tomography, X-Ray Computed; Young Adult
PubMed: 31290835
DOI: 10.1097/BOT.0000000000001542 -
Operative Orthopadie Und Traumatologie Jun 2018Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with... (Review)
Review
OBJECTIVE
Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with subluxation of the metatarsophalangeal joint. A minimally invasive osteotomy of the fifth metatarsal without internal fixation using burrs is an increasingly used alternative for symptomatic tailor's bunion deformity. Similar to open surgery procedures the type of osteotomy complies with the underlying pathology. Minimally invasive surgical (MIS) procedures allow comprehensive treatment of various types of tailor's bunion deformities.
INDICATIONS
Symptomatic tailor's bunion deformity, failed conservative treatment, a closed epiphyseal gap.
CONTRAINDICATIONS
Osteoporotic bone, poor patient compliance.
SURGICAL TECHNIQUE
The technique comprises percutaneous resection of the lateral exostosis of the fifth metatarsal head with a straight burr and an osteotomy of the fifth metatarsal, either distally, diaphyseal or proximally with a conical burr due to the shape of the deformity, usually without internal fixation.
POSTOPERATIVE MANAGEMENT
Redressive wrapping, partial pain-adapted weight bearing. Non-steroidal anti-inflammatory drugs for 3-5 days, lymphatic drainage, intermittent cooling. Radiographic assessment on postoperative day 1; radiographic follow-up 6 weeks postoperatively. Thromboembolic prophylaxis.
RESULTS
The clinical outcome is comparable to standard surgical procedures with the advantages of MIS. Based on our results and the current literature, the minimally invasive distal metatarsal osteotomy without fixation is becoming a reliable treatment for tailor's bunion.
Topics: Bunion, Tailor's; Hallux Valgus; Humans; Metatarsal Bones; Minimally Invasive Surgical Procedures; Osteotomy; Treatment Outcome
PubMed: 29704103
DOI: 10.1007/s00064-018-0542-z