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The American Journal of Sports Medicine May 2022Fractures of the proximal fifth metatarsal bone are common injuries in elite athletes and are associated with high rates of delayed union and nonunion. Structural...
BACKGROUND
Fractures of the proximal fifth metatarsal bone are common injuries in elite athletes and are associated with high rates of delayed union and nonunion. Structural features of the foot may increase fracture risk in some individuals, emphasizing the need for intervention strategies to prevent fracture. Although orthotic devices have shown promise in reducing fractures of the fifth metatarsal bone, the effect of orthosis on fifth metatarsal strains is not well understood.
PURPOSE
To quantify the effects of different foot orthotic constructs on principal tensile strains in the proximal fifth metatarsal bone during cadaveric simulations of level walking. An additional purpose was to investigate the relationships between structural features of the foot and corresponding strains on the fifth metatarsal bone during level walking.
STUDY DESIGN
Controlled laboratory study.
METHODS
A total of 10 midtibial cadaveric specimens were attached to a 6 degrees of freedom robotic gait simulator. Strain gauges were placed at the metaphyseal-diaphyseal junction (zone II) and the proximal diaphysis (zone III) during level walking simulations using 11 different foot orthotic configurations. Images of each specimen were used to measure structural features of the foot in an axially loaded position. The peak tensile strains were measured and reported relative to the sneaker-only condition for each orthotic condition and orthotic-specific association between structural features and principal strains of both zones.
RESULTS
In total, 2 of the 11 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone II. Further, 6 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone III. Increased zone II principal strain incurred during level walking in the sneaker-only condition showed a significant association with increases in the Meary's angle. Changes in zone III principal strain relative to the sneaker-only condition were significantly associated with increases in the Meary's angle and fourth-fifth intermetatarsal angle.
CONCLUSION
The use of orthotic devices reduced principal strain relative to the condition of a sneaker without any orthosis in zone II and zone III. The ability to reduce strain relative to the sneaker-only condition in zone III was indicated by increasing values of the Meary's angle and levels of the fourth-fifth intermetatarsal angle.
CLINICAL RELEVANCE
Clinicians can use characteristics of foot structure to determine the proper foot orthosis to potentially reduce stress fracture risk in high-risk individuals.
Topics: Cadaver; Fractures, Bone; Fractures, Stress; Humans; Metatarsal Bones; Orthotic Devices; Walking
PubMed: 35302902
DOI: 10.1177/03635465221079652 -
Clinics in Podiatric Medicine and... Jul 2017This article discusses tarsometatarsal arthrodesis for Lisfranc injuries. Although open reduction and internal fixation has traditionally been the treatment of choice... (Review)
Review
This article discusses tarsometatarsal arthrodesis for Lisfranc injuries. Although open reduction and internal fixation has traditionally been the treatment of choice for most Lisfranc fracture-dislocations, there is a trend toward primary fusion, especially for purely ligamentous injuries. Consideration should be made for primary fusion in select fracture-dislocation cases. Primary fusion offers a single-stage alternative with potentially more stable, predictable results overtime.
Topics: Arthrodesis; Fracture Fixation; Fractures, Bone; Humans; Joint Dislocations; Metatarsal Bones; Tarsal Joints
PubMed: 28576191
DOI: 10.1016/j.cpm.2017.02.003 -
Foot & Ankle International May 2022Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to...
BACKGROUND
Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO).
METHODS
Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires.
RESULTS
RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments.
CONCLUSION
Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation.
LEVEL OF EVIDENCE
Level II, prospective analysis of MTP-1 hemiprosthesis.
Topics: Female; Follow-Up Studies; Hallux Rigidus; Hemiarthroplasty; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Prospective Studies; Treatment Outcome
PubMed: 34962173
DOI: 10.1177/10711007211061366 -
BMC Veterinary Research Dec 2021This study aimed to measure the length of metacarpal and metatarsal bones in five Iranian sheep breeds and to correlate the length of the bones with ungula measurements....
BACKGROUND
This study aimed to measure the length of metacarpal and metatarsal bones in five Iranian sheep breeds and to correlate the length of the bones with ungula measurements. Thoracic and pelvic limbs of 2-year-old, previously untrimmed, pastured Afshari, Moghani, Kurdi, Makoui, and Lori-Bakhtiari ewes, (n = 20 ewes per breed) were collected after slaughter. The following lengths were recorded in the metacarpal and metatarsal bones: from the margo proximalis lateralis to the lateral (L1) and medial (D1) cartilago physialis; from the margo proximalis lateralis to the margo abaxialis of the lateral (L2) and medial (D2) caput; from the cartilago physialis lateralis to the margo abaxialis of the lateral caput (X1); from the cartilago physialis medialis to the margo distalis of the caput ridge (X2) and from the margo axialis of cartilago physialis to the margo axialis of the lateral caput (X3). Additionally, measurements of the ungula including pars dorsalis length, pars mobilis lateralis and medialis height, pars dorsalis height to the ground and to the solea cornea, thickness of the solea in the pars dorsalis, pars mobilis lateralis and medialis, solea cornea length and angulus dorsalis were recorded in the medial and lateral digits of the thoracic and pelvic limbs. Data on length of the metatarsal and metacarpal bones were analysed using mixed model equations while Pearson correlations were calculated between metacarpal and metatarsal bones and ungula measurements.
RESULTS
Lori- Bakhtiari and Moghani ewes had greater L1, L2, and D1 and D2 while X1, X2 and X3 was greater in Kurdi ewes (P < 0.05). Measurements such as L1, L2, D1 and D2 were greater in the metatarsal than in metacarpal bones (P < 0.05) and the opposite was observed for X1, X2 and X3 (P < 0.05). No asymmetry was observed between the lateral and medial measurements (P > 0.05). Low to moderate correlations were observed between bone and ungula measurements (P < 0.05).
CONCLUSION
Under the conditions of this study, differences in metacarpal and metatarsal bone measurements were observed between breeds but no asymmetry was observed between lateral and medial bones. Results indicate an association between metacarpal and metatarsal bones ungula measurements. This could provide baseline information for the development and/or improvement of current ungula health protocols in the studied sheep breeds.
Topics: Animals; Breeding; Female; Iran; Metacarpal Bones; Metatarsal Bones; Sheep
PubMed: 34872547
DOI: 10.1186/s12917-021-03076-5 -
Veterinary and Comparative Orthopaedics... Sep 2019The purpose of this study was to introduce a modified-Unger fracture classification in impala and report the findings of 58 long bone fractures classified according... (Review)
Review
OBJECTIVE
The purpose of this study was to introduce a modified-Unger fracture classification in impala and report the findings of 58 long bone fractures classified according to this system.
METHODS
This was a retrospective radiographical study evaluating 122 radiographs of 58 long bone fractures in 55 impala. The Unger fracture classification was modified and fracture illustrations for the metacarpal and metatarsal bones added. Each fracture was classified and assigned a four symbol α-numeric code using our classification. The patient signalment, skeletal maturity, fracture-associated soft tissue changes, presence of fissure lines, periosteal reaction and cause of the fracture were recorded.
RESULTS
The overall fracture distribution based on location, found tibial ( = 17) fractures to be the most common fractured long bone. When combined, the majority of fractures involved the metacarpal and metatarsal bones ( = 23). Forty five of 58 fractures occurred in the diaphyseal bone segment. In all long bones, the distribution based on complexity was simple ( = 27), wedge ( = 16) and multi-fragmentary ( = 15) fractures. Thirty one of 58 fractures were open and fissure lines were detected in 20 of 58 fractures.
CLINICAL SIGNIFICANCE
Our modified-Unger fracture classification was applicable in classifying 58 impala long bone fractures. This classification should provide the basis for further advances in veterinary and comparative ungulates, and particularly the antelopes, orthopaedics and traumatology.
Topics: Animals; Antelopes; Female; Fractures, Bone; Male; Metacarpal Bones; Metatarsal Bones; Radiography
PubMed: 31158894
DOI: 10.1055/s-0039-1691818 -
Archives of Orthopaedic and Trauma... Apr 2023Although metatarsal fractures are common, the significance of previous epidemiologic studies is limited to specific fracture entities, subpopulations, or heterogeneous...
INTRODUCTION
Although metatarsal fractures are common, the significance of previous epidemiologic studies is limited to specific fracture entities, subpopulations, or heterogeneous fracture aetiologies. The aim of the study was to assess the epidemiology of isolated metatarsal fractures in an adult population at a level-1 trauma centre.
MATERIALS AND METHODS
Radiological and clinical databases were searched for a five-year period. Eligible were all patients with acute isolated metatarsal fractures over the age of 18 years with radiographs in two planes available. Stress fractures, injuries affecting Lisfranc joint stability, and concomitant injuries to other regions than the metatarsals were excluded. Data collection included general demographics, mechanism of injury, season of the trauma and fracture details.
RESULTS
Out of 3259 patients, 642 patients met the inclusion criteria and were included for the analysis. The patients' mean age was 44.5 ± 18.9 years, 50.6% were female. 83.3% suffered an isolated, 16.7% multiple metatarsal fractures. Single metatarsal fractures occurred predominantly at the fifth metatarsal bone (81.3%), their frequency decreased with increasing age, with a seasonal peak during the summer. Patients suffering multiple metatarsal fractures were significantly older (51.6 ± 21.2 vs. 43.0 ± 18.1 years; p < 0.001) and the injury resulted significantly more often from a high-energy trauma (6.7% vs. 23.4%; p < 0.001). Multiple metatarsal fractures occurred evenly throughout all metatarsals but revealed a focus on female population with no seasonal differences.
CONCLUSION
Single metatarsal fractures predominantly occurred at the fifth metatarsal bone and showed a seasonal, gender and age dependency. Multiple metatarsal fractures were homogeneously distributed between the different metatarsals with distinct age-dependent gender differences.
LEVEL OF EVIDENCE
Level III.
Topics: Adult; Humans; Female; Middle Aged; Male; Metatarsal Bones; Retrospective Studies; Fractures, Bone; Fractures, Stress; Radiography; Foot Injuries; Metatarsus
PubMed: 35235028
DOI: 10.1007/s00402-022-04396-3 -
Journal of the American Podiatric... Jul 2021Fifth metatarsal base fractures are the most commonly seen fractures of the foot. Ankle sprains occur with inversion and plantarflexion mechanisms, similar to most fifth...
BACKGROUND
Fifth metatarsal base fractures are the most commonly seen fractures of the foot. Ankle sprains occur with inversion and plantarflexion mechanisms, similar to most fifth metatarsal base fractures. We sought to investigate the possible ankle injuries that accompany fifth metatarsal base fractures.
METHODS
A hospital's digital database was searched for the International Classification of Diseases, Tenth Revision codes for metatarsal bone fractures (codes S92.30 and S92.35) between January 2015 and January 2018. Thirty-nine patients with fifth metatarsal base fracture who underwent ankle magnetic resonance imaging (MRI) within 14 days of injury were included in the study. The MRI findings were evaluated, and comparisons were performed according to fracture zone, sex, and age.
RESULTS
The most common MRI finding was talocrural joint effusion, which was observed in 28 patients (71.8%). Bone marrow edema was observed in 16 patients (41.0%). Chondral injury at the medial dome of talus was observed in three patients (7.7%). Grade 1 ligament sprain was observed in six patients (15.4%): two in the lateral ligament and four in the deltoid ligament.
CONCLUSIONS
Although most fifth metatarsal base fractures and ankle sprains occur as a result of a common mechanism, physical examination findings and patients' complaints are very important. Routine MRI should be unnecessary for most patients. If a patient with a fifth metatarsal base fracture has complaints about the ankle joint, one should be aware of bone marrow edema, which was observed in 41.0% of the study population.
Topics: Ankle Fractures; Ankle Injuries; Ankle Joint; Foot Injuries; Fractures, Bone; Humans; Metatarsal Bones
PubMed: 32915953
DOI: 10.7547/19-032 -
Journal of Foot and Ankle Research Feb 2023In people with diabetes (DM) and peripheral neuropathy (PN), loss of bone mineral density (BMD) in the tarsals and metatarsals contribute to foot complications; however,...
BACKGROUND
In people with diabetes (DM) and peripheral neuropathy (PN), loss of bone mineral density (BMD) in the tarsals and metatarsals contribute to foot complications; however, changes in BMD of the calcaneal bone is most commonly reported. This study reports rate of change in BMD of all the individual bones in the foot, in participants with DM and PN. Our aim was to investigate whether the rate of BMD change is similar across all the bones of the foot.
METHODS
Participants with DM and PN (n = 60) were included in this longitudinal cohort study. Rate of BMD change of individual bones was monitored using computed tomography at baseline and 6 months, 18 months, and 3-4 years from baseline. Personal factors (age, sex, medication use, step count, sedentary time, and PN severity) were assessed. A random coefficient model estimated rate of change of BMD in all bones and Pearson correlation tested relationships between personal factor variables and rate of BMD change.
RESULTS
Mean and calcaneal BMD decreased over the study period (p < 0.05). Individual tarsal and metatarsal bones present a range of rate of BMD change (-0.3 to -0.9%/year) but were not significantly different than calcaneal BMD change. Only age showed significant correlation with BMD and rate of BMD change.
CONCLUSION
The rate of BMD change did not significantly differ across different foot bones at the group level in people with DM and PN without foot deformity. Asymmetric BMD loss between individual bones of the foot and aging may be indicators of pathologic changes and require further investigation.
TRIAL REGISTRATION
Metatarsal Phalangeal Joint Deformity Progression-R01. Registered 25 November 2015, https://clinicaltrials.gov/ct2/show/NCT02616263.
Topics: Adult; Humans; Metatarsal Bones; Longitudinal Studies; Bone Density; Diabetes Mellitus; Peripheral Nervous System Diseases; Metatarsus
PubMed: 36782282
DOI: 10.1186/s13047-023-00606-2 -
Orthopaedics & Traumatology, Surgery &... Oct 2021Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in...
Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in short osteotomy, translation and diaphyseal bone-suture. We report the first 25 operated feet, with mean AOFAS score 58.4 preoperatively and 94.9 postoperatively at a mean 25 months' follow-up. These results were comparable to reported data, whatever the deformity.
Topics: Bunion, Tailor's; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Prostheses and Implants; Treatment Outcome
PubMed: 33992833
DOI: 10.1016/j.otsr.2021.102960 -
Veterinary and Comparative Orthopaedics... Nov 2021The aim of this study was to create a feline reference database for the length, width and slenderness (length to width ratio) of metacarpal and metatarsal bones,...
OBJECTIVE
The aim of this study was to create a feline reference database for the length, width and slenderness (length to width ratio) of metacarpal and metatarsal bones, radius and tibia.
STUDY DESIGN
Radiographs of the radius, tibia, metacarpus and metatarsus were performed in domestic short hair cat cadavers ( = 40). Length and width of the aforementioned bones were measured in mature domestic shorthair cats and bone slenderness (length/width) and index ratios calculated.
RESULTS
A significant skeletal sex dimorphism exists in cats, with bones of the metacarpus, metatarsus, radius and tibia generally longer and wider in male cats compared with female cats, with differences frequently significant. The most significant difference was identified for the width of Mc5 ( = 0.0008) and the length and width of Mt5 ( = 0.0005). Index ratios for length and width of radius to metacarpal bones, and tibia to metatarsal bones, were not significantly different between male and female cats, except for Mc5. The index ratio for Mc5 was significantly higher in male cats ( = 0.002).
CONCLUSION
The present study provides insights into the normal length and width of distal forelimb and hind limb bones as well as bone index ratios in mature domestic shorthair cats. Using this information, it is now possible to quantitatively assess the relationship between these bones in domestic cats using radiography. This will assist not only with the diagnosis and categorization of skeletal abnormalities but can also guide surgical interventions of metacarpal and metatarsal bone fractures.
Topics: Animals; Cadaver; Cat Diseases; Cats; Extremities; Female; Male; Metacarpal Bones; Metatarsal Bones; Metatarsus
PubMed: 34488232
DOI: 10.1055/s-0041-1735289