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The Orthopedic Clinics of North America Oct 2020Jones fractures in both elite and recreational athletes are best treated with surgical fixation, given superior results as compared to nonoperative management. While... (Review)
Review
Jones fractures in both elite and recreational athletes are best treated with surgical fixation, given superior results as compared to nonoperative management. While screw specifics remain controversial, intramedullary screw fixation is established as the standard surgical technique. Plate fixation also has shown excellent outcomes. Complications of refracture, nonunion, and delayed union require careful evaluation for contributions of early return to play, implant characteristics, and anatomic/metabolic abnormality. Revision fixation with autograft and biologic augmentation is supported in the literature, with ongoing inquiry to optimizing specific implants and adjuvants.
Topics: Athletes; Fracture Fixation, Intramedullary; Fractures, Bone; Humans; Metatarsal Bones
PubMed: 32950224
DOI: 10.1016/j.ocl.2020.06.010 -
Journal of Pediatric Orthopedics Jan 2021Apert syndrome is a rare condition characterized by a craniosynostosis associated with complex bilateral malformations of the hands and feet. Although correction of...
BACKGROUND
Apert syndrome is a rare condition characterized by a craniosynostosis associated with complex bilateral malformations of the hands and feet. Although correction of syndactyly of the extremities is largely described, just a few authors have focused their attention on the gradual subluxation of the second metatarsal head during child growth, with hyper pressure, hyperkeratosis on the plantar surface and acute pain leading to walking impairment. The aim of this study is to describe our experience with the Helal metatarsal osteotomy technique on this group of patients. An oblique osteotomy performed dorsal to plantar, proximal to distal on the subluxed metatarsal bone is carried out. No internal bone fixation is needed, but a fundamental hypercorrective bandage is placed under the plantar surface. Immediate full weight-bearing, 24 hours after surgery, is highly recommended.
METHODS
Seventeen feet of 12 patients were treated between 2003 and 2018. Corrective osteotomy was performed on a single bone in 13 patients, on 2 bones in 3 patients, and on 3 bones on 1 patient. The mean follow-up was 5 years, with a physical examination once a year.
RESULTS
No complication such as infection or delayed wound healing was registered. X-rays taken 3 weeks after surgery showed complete bone consolidation and a correction of the previous plantarflexed position of the metatarsal with consistent reduction of pressure and pain for every patient who was able to wear normal shoes again after surgery.
CONCLUSION
The Helal metatarsal osteotomy is a safe, reproducible, and feasible technique that should be considered in cases of painful metatarsal head plantar subluxation in Apert feet.
LEVEL OF EVIDENCE
Level IV.
Topics: Acrocephalosyndactylia; Adolescent; Child Development; Child, Preschool; Female; Foot Deformities, Congenital; Humans; Male; Metatarsal Bones; Mobility Limitation; Osteotomy; Postoperative Complications; Radiography; Plastic Surgery Procedures; Treatment Outcome
PubMed: 32804867
DOI: 10.1097/BPO.0000000000001662 -
Foot and Ankle Clinics Dec 2020The reported incidence of Lisfranc injuries is 9.2/100.000 person-years; two-thirds of the injuries are nondisplaced. Tarsometatarsal injuries range from minor sprains... (Review)
Review
The reported incidence of Lisfranc injuries is 9.2/100.000 person-years; two-thirds of the injuries are nondisplaced. Tarsometatarsal injuries range from minor sprains and isolated ligamentous injuries to grossly unstable and multiligamentous lesions. High-energy injuries are usually linked with mechanical energy dissipation through the soft tissues. Operative treatment options include open reduction and internal fixation, open reduction with hybrid internal and external fixation, closed reduction with percutaneous internal or external fixation, and primary arthrodesis. Treatment goals are to obtain a painless, plantigrade, and stable foot. Anatomic reduction is a key factor for improved outcomes and decreased rates of post-traumatic arthritis.
Topics: Arthrodesis; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Metatarsal Bones; Open Fracture Reduction
PubMed: 33543726
DOI: 10.1016/j.fcl.2020.08.010 -
American Family Physician Feb 2024Foot fractures account for about one-third of lower extremity fractures in adults. They are typically caused by a crush injury or an axial or twisting force on the foot....
Foot fractures account for about one-third of lower extremity fractures in adults. They are typically caused by a crush injury or an axial or twisting force on the foot. Patients usually present with bony point tenderness and swelling of the affected area. Weight-bearing varies based on the extent of the fracture and the patient's pain tolerance. When a foot or toe fracture is suspected, anteroposterior, lateral, and oblique radiography with weight-bearing should be obtained. The Ottawa foot and ankle rules can help determine the need for radiography after an acute ankle inversion injury. Many foot fractures can be managed with a short leg cast or boot or a hard-soled shoe. Weight-bearing and duration of immobilization are based on the stability of the fracture and the patient's pain level. Most toe fractures can be managed nonsurgically with a hard-soled shoe for two to six weeks. Close attention should be paid to the great toe because of its role in weight-bearing, and physicians should follow specific guidelines for orthopedic referral. Meta-tarsal shaft fractures are managed with a boot or hard-soled shoe for three to six weeks. The proximal aspect of the fifth metatarsal has varied rates of healing due to poor blood supply, and management is based on the fracture zone. Lis-franc fractures are often overlooked; radiography with weight-bearing should be obtained, and physicians should look for widening of the tarsometatarsal joint. Other tarsal bone fractures can be managed with a short leg cast or boot for four to six weeks when nonsurgical treatment is indicated. Common foot fracture complications include arthritis, infection, malunion or nonunion, and compartment syndrome.
Topics: Adult; Humans; Fractures, Bone; Metatarsal Bones; Foot Injuries; Lower Extremity; Knee Injuries; Pain
PubMed: 38393796
DOI: No ID Found -
British Journal of Sports Medicine Feb 2015High-resolution ultrasound is emerging as an important imaging modality in fracture assessment due to its availability, ease of use and multiplanar capabilities. Its... (Review)
Review
High-resolution ultrasound is emerging as an important imaging modality in fracture assessment due to its availability, ease of use and multiplanar capabilities. Its usefulness includes injury assessment for the presence of a fracture when obtaining radiographs is not immediately available, detecting occult fractures not revealed on radiographs, and diagnosing bone stress injury before radiographic changes. Sonographic evaluation of bone, however, has limitations and should always be coupled with radiographs and possibly advanced imaging modalities such as CT and MR when clinically indicated.
Topics: Ankle Fractures; Athletic Injuries; Clavicle; Diagnosis, Differential; Fibula; Finger Injuries; Foot Injuries; Fractures, Bone; Fractures, Stress; Humans; Incidental Findings; Metatarsal Bones; Patella; Sports Medicine; Tibial Fractures; Ulna Fractures; Ultrasonography
PubMed: 25540189
DOI: 10.1136/bjsports-2014-094217 -
Acta Bio-medica : Atenei Parmensis May 2020Central metatarsal fractures (CMF) are common injuries. More frequently fractures are those of the fifth metatarsal, followed by CMF and therefore by the first... (Review)
Review
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.
Topics: Fracture Fixation; Fractures, Bone; Humans; Metatarsal Bones; Treatment Outcome
PubMed: 32555075
DOI: 10.23750/abm.v91i4-S.9724 -
The Journal of the American Academy of... Jun 2021Stress fractures of the fifth metatarsal (zones 2 and 3) remain a challenging clinical problem. It has been well established that nonsurgical treatment has unacceptably... (Review)
Review
Stress fractures of the fifth metatarsal (zones 2 and 3) remain a challenging clinical problem. It has been well established that nonsurgical treatment has unacceptably high nonunion and refracture rates. Surgical fixation remains the treatment of choice in the athletic cohort, and intramedullary screw fixation with a solid screw has been established as the most predictable means of achieving a successful outcome. Recently, the use of a plantar plate has also been advocated as has been shown in some studies to be more biomechanically advantageous. The use of bone grafting at the primary surgery and morphology and screw type are also important decisions to be made when treating these patients. This review will discuss our management of both primary fractures and refractures of the fifth metatarsal in athletes.
Topics: Athletes; Athletic Injuries; Fracture Fixation, Internal; Fractures, Bone; Fractures, Stress; Humans; Metatarsal Bones
PubMed: 33826553
DOI: 10.5435/JAAOS-D-20-01060 -
Foot and Ankle Surgery : Official... Jun 2020The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the...
INTRODUCTION
The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy which can address first metatarsal rotation when necessary.
METHODS
The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial based wedge parallel to the plantar limb of the osteotomy in order to make the distal fragment free to correct rotation.
RESULTS
The more recent concern about hallux valgus surgery is the very interesting concept that this deformity really occurs in three different planes, and we may have mistreated the rotation component with our current techniques. Many authors have revisited many common techniques in order to adapt them to correct metatarsal pronation. To our best knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address the rotation of the first metatarsal.
CONCLUSION
We can conclude that the rotational biplanar Chevron osteotomy can be an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 31155287
DOI: 10.1016/j.fas.2019.05.011 -
Foot and Ankle Clinics Dec 2020Fractures of the proximal fifth metatarsal are common injuries with a unique history. Treatment of these fractures is controversial partly because of confusion regarding... (Review)
Review
Fractures of the proximal fifth metatarsal are common injuries with a unique history. Treatment of these fractures is controversial partly because of confusion regarding fracture subtype nomenclature. Today "Jones fracture" refers to proximal fifth metatarsal fracture in zones 2 or 3. Zone 2 fractures are acute injuries, and their optimal treatment is unclear. Zone 3 fractures commonly occur in the presence of a chronic stress reaction. Because of poor healing potential, zone 3 fractures typically require operative treatment. Zone 1 fractures have excellent healing potential and may be treated nonoperatively with a weightbearing as tolerated protocol.
Topics: Foot; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Weight-Bearing
PubMed: 33543727
DOI: 10.1016/j.fcl.2020.08.012 -
The Journal of Foot and Ankle Surgery :... 2017Iselin's disease was first described in 1912. It is a condition affecting the tuberosity of the base of the fifth metatarsal. It has been described as a traction... (Review)
Review
Iselin's disease was first described in 1912. It is a condition affecting the tuberosity of the base of the fifth metatarsal. It has been described as a traction apophysitis predominately affecting adolescents, in particular those who partake in regular sporting activity. The condition is rarely reported and likely to remain undiagnosed, possibly mistaken for a fracture. The present report reviewed the available published data to highlight this condition as a differential diagnosis in patients with fifth metatarsal pain. Investigations, treatments and outcomes into this condition are described, to support the management and diagnosis of this condition.
Topics: Adolescent; Athletic Injuries; Diagnosis, Differential; Female; Fractures, Bone; Humans; Metatarsal Bones; Osteochondritis; Radiography; Risk Assessment; Severity of Illness Index; Young Adult
PubMed: 28842092
DOI: 10.1053/j.jfas.2017.04.030