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Journal of Biomechanical Engineering May 2023Metatarsal fractures represent the most common traumatic foot injury; however, metatarsal fracture thresholds remain poorly characterized, which affects performance...
Metatarsal fractures represent the most common traumatic foot injury; however, metatarsal fracture thresholds remain poorly characterized, which affects performance targets for protective footwear. This experimental study investigated impact energies, forces, and deformations to characterize metatarsal fracture risk for simulated in situ workplace impact loading. A drop tower setup conforming to ASTM specifications for testing impact resistance of metatarsal protective footwear applied a target impact load (22-55 J) to 10 cadaveric feet. Prior to impact, each foot was axially loaded through the tibia with a specimen-specific bodyweight load to replicate a natural weight-bearing stance. Successive iterations of impact tests were performed until a fracture was observed with X-ray imaging. Descriptive statistics were computed for force, deformation, and impact energy. Correlational analysis was conducted on donor age, BMI, deformation, force, and impact energy. A survival analysis was used to generate injury risk curves (IRC) using impact energy and force. All 10 specimens fractured with the second metatarsal being the most common fracture location. The mean peak energy, force, and deformation during fracture were 46.6 J, 4640 N, 28.9 mm, respectively. Survival analyses revealed a 50% fracture probability was associated with 35.8 J and 3562 N of impact. Foot deformation was not significantly correlated (p = 0.47) with impact force, thus deformation is not recommended to predict metatarsal fracture risk. The results from this study can be used to improve test standards for metatarsal protection, provide performance targets for protective footwear developers, and demonstrate a methodological framework for future metatarsal fracture research.
Topics: Humans; Metatarsal Bones; Foot; Fractures, Bone; Foot Injuries; Ankle Injuries; Workplace
PubMed: 36628995
DOI: 10.1115/1.4056652 -
The Journal of Foot and Ankle Surgery :... 2018Fractures of the metatarsals account for 35% of all foot fractures. Conservative management of fractures proximal to the metaphyseal-diaphyseal junction of the fifth... (Comparative Study)
Comparative Study Meta-Analysis
Fractures of the metatarsals account for 35% of all foot fractures. Conservative management of fractures proximal to the metaphyseal-diaphyseal junction of the fifth metatarsal bone (pseudo-Jones) is protected weightbearing. The methods of protected weightbearing include a short-leg cast and splint (boot cast, Jones bandage, and elastic bandage). However, no consensus has yet been reached regarding which method is most suitable. We conducted a systematic review and meta-analysis to compare the outcomes of a short-leg cast and splint for pseudo-Jones metatarsal fractures. We searched the PubMed and Scopus databases up to October 29, 2016. Five of 104 studies (3 comparative studies and 2 randomized controlled trials; n = 246 patients) were eligible. Of the studies, 3, 5, and 4 were included in pooling of early (within 1 month) and last follow-up foot function scale scores and fracture nonunion, respectively. The unstandardized mean difference of early (within 1 month) and last follow-up foot scores for the short leg cast were -14.58 (95% confidence interval [CI] -24.12 to -5.04) and -3.89 (95% CI -6.30 to -1.49), significantly lower than the scores for the splint (bandage or boot support) for pseudo-Jones fracture of the fifth metatarsal bone. The risk of nonunion of the fifth metatarsal bone fracture of the patients who were treated with short leg cast method was insignificantly greater at 1.57 times (95% CI 0.29 to 8.49) that compared with the splint. The treatment of fracture of the pseudo-Jones fifth metatarsal bone with a splint (boot or bandage) resulted in foot function scale scores better than those with short leg cast treatment and a lower nonunion rate.
Topics: Casts, Surgical; Fracture Fixation; Fractures, Bone; Humans; Metatarsal Bones; Splints; Treatment Outcome
PubMed: 30149851
DOI: 10.1053/j.jfas.2018.03.018 -
Foot and Ankle Clinics Jun 2018Many different surgeries have been proposed for hallux valgus treatment, osteotomies being the currently recommended ones. Because of high recurrence rates, distal,... (Review)
Review
Many different surgeries have been proposed for hallux valgus treatment, osteotomies being the currently recommended ones. Because of high recurrence rates, distal, diaphyseal and proximal osteotomies have been used to improve alignment and sesamoid reduction. The center of rotation of angulation (CORA) concept applies to any deformity and helps to completely realign 2 bone segments. When used with proximal osteotomies, bone displacement and angulation is performed obtaining complete deformity correction. The proximal oblique sliding closing wedge (POSCOW) osteotomy follows the CORA concept and permits preoperative planning. Future directions must include the correction of the pronation deformity of the metatarsal.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Rotation
PubMed: 29729799
DOI: 10.1016/j.fcl.2018.01.005 -
Foot & Ankle Specialist Aug 2021Injury to the Lisfranc interosseous ligament is currently managed with a screw. However, this can potentially further disrupt the ligament. The objective of this study...
Injury to the Lisfranc interosseous ligament is currently managed with a screw. However, this can potentially further disrupt the ligament. The objective of this study was to observe the proximity of the screw or disruption it can cause at the ligament attachment sites. Twenty-three feet were studied. A 40-mm, 4.0, partially threaded, cannulated screw was inserted from the base of the second metatarsal into the medial cuneiform. The relationship of the ligament attachment sites to the screw hole were measured. The screw hole contacted at least 1 of the ligament attachment sites in 20 of the 23 feet. The screw hole fully penetrated it in 7 feet, partially disrupted it in 4 feet, and had less than or equal to 1 mm of contact in 9 feet. There was no contact with either of the attachment sites in 3 feet, with an average distance of 1.5 mm separating them. Conclusion. Our results show the proximity of the ligament to the screw and the disruption that can result from its insertion. This is clinically relevant as some amount ligamentous disruption is likely to occur with insertion of the "Lisfranc screw," which may interfere with its healing process. Level V: Expert opinion includes case reports and technique tips.
Topics: Bone Screws; Cadaver; Humans; Ligaments, Articular; Metatarsal Bones; Tarsal Bones
PubMed: 32299231
DOI: 10.1177/1938640020913447 -
European Journal of Medical Research Dec 2021Metatarsal fractures are common skeletal injuries of the lower extremity in adults. The majority involves the proximal fifth metatarsal bone. In the current literature,...
BACKGROUND
Metatarsal fractures are common skeletal injuries of the lower extremity in adults. The majority involves the proximal fifth metatarsal bone. In the current literature, there still exists controversy regarding treatment recommendations for the different fracture entities.
METHODS
All patients suffering from single fractures to the proximal fifth metatarsal bone between 2003 and 2015 were enrolled in this retrospective analysis. Only patients with a minimum follow-up of 12 months were included. The fractures were classified according to Lawrence and Botte (L&B). Data were collected via patient registry, radiographs and a standardized questionnaire (Foot and Ankle Outcome Score = FOAS). For outcome analysis, the nonparametric Mann-Whitney U test was performed and Spearman's rank correlation coefficient calculated.
RESULTS
In total, the functional outcomes of 103 patients suffering from fractures to the proximal fifth metatarsal bone were analyzed. L&B type I fractures (n = 13) had a FAOS score of 91 ± 23, L&B type II (n = 67) presented a score of 91 ± 15 and L&B type III (n = 23) a score of 93 ± 11. Surgically treated patients with an L&B type II fracture had no statistically significant better functional outcome in comparison to conservative management (p = 0.89). Operatively treated L&B type III fractures tended to have a better functional score (p = 0.16). The follow-up time was 58 (min: 15; max: 164) months.
CONCLUSIONS
Overall, the functional outcome following fractures to the proximal fifth metatarsal bone is satisfactory. Conservatively treated L&B type II fractures showed an equivalent functional outcome compared to surgical management. Patients with an L&B type III fracture mainly were treated surgically, but difference in FAOS score did not reach level of significance.
Topics: Bone Screws; Female; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Metatarsal Bones; Middle Aged; Radiography; Retrospective Studies; Time Factors; Weight-Bearing
PubMed: 34930495
DOI: 10.1186/s40001-021-00623-6 -
Operative Orthopadie Und Traumatologie Dec 2021Open reduction and internal fixation of grossly dislocated fifth metatarsal shaft and neck fractures aims at restoration of the anatomical structure of the forefoot. The...
OBJECTIVE
Open reduction and internal fixation of grossly dislocated fifth metatarsal shaft and neck fractures aims at restoration of the anatomical structure of the forefoot. The goal is to restore length, axis, rotation and joint position, while observing the metatarsal index (Maestro curve).
INDICATIONS
Grossly dislocated and/or open shaft/neck fractures of the fifth metatarsal; combined fractures of the forefoot involving the fifth metatarsal.
CONTRAINDICATIONS
Lack of consent to surgery. Overall critical (life-threatening) general condition preventing surgery to the extremities. Contaminated or infected soft tissues.
SURGICAL TECHNIQUE
Depending on the planned method of fixation, open reduction is usually conducted via a lateral approach centrally above the easily palpable metatarsal V shaft. The incision lies above the glabrous skin of the sole. For markedly shortened and multifragment subcapital and shaft fractures of the fifth metatarsal, open reduction and plate fixation is the method of choice. Interlocking plates with a screw diameter of 2.0-2.4 mm are preferred to avoid later soft tissue irritation. Anatomic reconstruction is carried out under longitudinal traction at the fifth toe using small reduction clamps and, if necessary, temporary K‑wire fixation. If the fragments are large enough, one or more interfragmentary lag screws can be used for fracture compression. A straight or condylar plate is used for internal fixation. Long spiral fifth metatarsal shaft fractures may alternatively be fixed with screws. In the case of transverse or subcapital fractures, percutaneous antegrade or retrograde medullary wiring with two Kirschner wires should be considered.
POSTOPERATIVE MANAGEMENT
Following surgical treatment, rest and elevation of the injured leg, and local cooling are indicated. Subsequently, mobilization with partial weight bearing (20 kg) in foot orthosis or cast shoe for 6 weeks.
RESULTS
Even grossly displaced fractures of the fifth metatarsal shaft have a good to excellent prognosis following surgical treatment with high union rates and rare complications. Undisplaced and mildly displaced fractures can be successfully managed nonoperatively with 6 weeks of weight bearing as tolerated in a stable orthosis or cast shoes.
Topics: Bone Plates; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Treatment Outcome
PubMed: 34811573
DOI: 10.1007/s00064-021-00750-7 -
Archives of Orthopaedic and Trauma... Apr 2023Although intramedullary screw fixation likely leads to successful union of Jones fractures compared to that of nonoperative treatments, bony union disorder after...
INTRODUCTION
Although intramedullary screw fixation likely leads to successful union of Jones fractures compared to that of nonoperative treatments, bony union disorder after surgical treatment remains to be elucidated.
METHODS
Intramedullary screw fixation was performed for the surgical treatment of proximal fifth metatarsal stress fractures in this series. Between January 2008 and December 2019, the feet of 222 patients were investigated regarding the effective factors for postoperative bony union between the normal union group and the bony union disorder group according to the patients' physical status, radiological assessment, and screw size. The mean postoperative follow-up period was 11.1 months. Bone union disorder was defined as delayed union, nonunion, or a re-fracture recognized through a radiographic image.
RESULTS
The prevalence rate of union disorders occurred in 14% (31/222) of the patients. The risk of bone union disorder significantly increased when using a small-diameter screw (odds ratio 4.81, 95% confidence interval [CI] 1.62-14.2, p = 0.004) and non-bone graft procedures (odds ratio 3.13, 95% CI 1.22-8.02, p = 0.02). Screw length, preoperative Torg's classification, or patients' physical status did not affect postoperative bony union.
CONCLUSIONS
Approximately 14.0% of the patients in our study had postoperative bone union disorder. Small-diameter screws and non-bone graft procedures increased the risk of bone union disorder in the intramedullary screw fixation technique of fifth metatarsal bone stress fractures.
LEVEL OF EVIDENCE
Level 4, case series.
Topics: Humans; Metatarsal Bones; Fractures, Stress; Fracture Fixation, Internal; Bone Screws; Bone Diseases
PubMed: 35235029
DOI: 10.1007/s00402-022-04398-1 -
Evolution & Development Nov 2019In many vertebrate animals that run or leap, the metatarsals and/or metacarpals of the distal limb are fused into a single larger element, likely to resist fracture due...
In many vertebrate animals that run or leap, the metatarsals and/or metacarpals of the distal limb are fused into a single larger element, likely to resist fracture due to high ground-reaction forces during locomotion. Although metapodial fusion evolved independently in modern birds, ungulates, and jerboas, the developmental basis has only been explored in chickens, which diverged from the mammalian lineage approximately 300 million years ago. Here, we use a bipedal rodent, the lesser Egyptian jerboa (Jaculus jaculus), to understand the cellular processes of metatarsal fusion in a mammal, and we revisit the developing chicken to assess similarities and differences in the localization of osteoblast and osteoclast activities. In both species, adjacent metatarsals align along flat surfaces, osteoblasts cross the periosteal membrane to unite the three elements in a single circumference, and osteoclasts resorb bone at the interfaces leaving a single marrow cavity. However, the pattern of osteoclast activity differs in each species; osteoclasts are highly localized to resorb bone at the interfaces of neighboring jerboa metatarsals and are distributed throughout the endosteum of chicken metatarsals. Each species, therefore, provides an opportunity to understand mechanisms that pattern osteoblast and osteoclast activities to alter bone shape during development and evolution.
Topics: Animals; Cell Differentiation; Chickens; Metatarsal Bones; Osteoblasts; Osteoclasts; Rodentia; Species Specificity
PubMed: 31631508
DOI: 10.1111/ede.12320 -
The Journal of Foot and Ankle Surgery :... 2023Brachymetatarsia is a condition in which a metatarsal bone does not grow out to full length. This is caused by premature physeal closure. The proximal phalanx associated...
Brachymetatarsia is a condition in which a metatarsal bone does not grow out to full length. This is caused by premature physeal closure. The proximal phalanx associated with the shortened metatarsal helps achieve the natural parabola of the foot. A hypoplastic proximal phalanx is a common finding in patients with brachymetatarsia. The goal of this study was to determine the length of the proximal phalanx in the setting of brachymetatarsia, and how much the shortening is attributed to the clinically smaller toe. We performed a retrospective study to evaluate the length of the proximal phalanx in the shortened ray. After the metatarsal was brought out to the desired length of correction, the proximal phalanx was measured on radiographs. Ninety-seven feet with congenital brachymetatarsia were reviewed in a cohort of 66 patients who underwent surgical correction between January 2005 and February 2020 at a single institution. The group was comprised of 61 females and 5 males, with a mean age of 27.5 years. The average length of the proximal phalanx associated with the affected metatarsal was noted to be 18.9 ± 3.83 mm for males and 15.6 ± 4.02 mm for females. Our results indicate the shortened proximal phalanx is 5 mm shorter when compared to normal population and is a contributing factor to the shortened clinical appearance of the digit in brachymetatarsia. Treating surgeons should be aware of this to better educate patients on the influence of the digit on the overall shortening seen in cases of brachymetatarsia.
Topics: Male; Female; Humans; Adult; Retrospective Studies; Osteogenesis, Distraction; Foot Deformities, Congenital; Osteotomy; Metatarsal Bones; Lower Extremity
PubMed: 35853807
DOI: 10.1053/j.jfas.2022.06.001 -
The Journal of Foot and Ankle Surgery :... 2021Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity,...
Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity, such as the metatarsal length discrepancy, the abnormal metatarsal head height, cavus, flat foot, and rheumatoid conditions. However, it is unclear which variable is most involved in the cause of callosity in hallux valgus deformity. To clarify the factors associated with the callosity with hallux valgus deformity, we conducted multiple image assessments based on weightbearing radiography and computed tomography. A retrospective review was performed based on the collection of clinical records from all patients with hallux valgus treated from 2010 to 2019 in our institution. We measured the hallux valgus angle, intermetatarsal angles, calcaneal pitch angles, talo-first metatarsal angles, metatarsal length, metatarsal head height, first metatarsal pronation angles, and sesamoid position with weightbearing radiography and computed tomography. We analyzed the relation between callosity formation and imaging assessments using univariate and multivariate logistic regression models. Fifty feet were retrospectively evaluated, and multiple logistic analyses by the stepwise method revealed that the first metatarsal-lateral-sesamoid distance was the only radiographical variable associated with callosity formation among all the tested variables (p < .001). As the grade of the callosity became more severe, the lateral shift of the lateral sesamoid increased. The position of the sesamoid bone appears to have a critical role in the assessment and choice of treatment protocols and further research needs to be conducted on the relationship with the position of sesamoid bone to elucidate the mechanism of callus formation.
Topics: Callosities; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Retrospective Studies; Tomography, X-Ray Computed; Weight-Bearing
PubMed: 34158227
DOI: 10.1053/j.jfas.2021.05.007