-
The New England Journal of Medicine Jan 2022
Topics: Adult; Foot Joints; Fracture Dislocation; Humans; Ligaments, Articular; Male; Metatarsal Bones; Radiography; Tarsal Bones
PubMed: 35029849
DOI: 10.1056/NEJMicm2034535 -
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; Male; Arthrodesis; Bone Plates; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Metatarsal Bones; Open Fracture Reduction
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 -
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 -
Unfallchirurgie (Heidelberg, Germany) Nov 2023Bone stress injuries are chronic overload reactions of the bone, which are characterized by the load-dependent occurrence of locally perceived pain and tenderness on... (Review)
Review
Bone stress injuries are chronic overload reactions of the bone, which are characterized by the load-dependent occurrence of locally perceived pain and tenderness on palpation at the site of the injury. Structurally normal bone becomes fatigued as a result of repetitive submaximal loading and/or inadequate regeneration. Certain stress fractures of the femoral neck (tension side), patella, anterior tibial cortex, medial malleolus, talus, tarsal navicular bone, proximal fifth metatarsal, and sesamoid bones of the great toe tend to develop complications (complete fractures, delayed union, pseudarthrosis, dislocation, arthrosis). These injuries are classified as high-risk stress fractures. Aggressive diagnostics and treatment are recommended when a high-risk stress fracture is suspected. Treatment is frequently different from low-risk stress fractures, including prolonged non-weight-bearing immobilization. In rare cases, surgery is indicated when conservative treatment fails, when a complete or non-healing fracture develops, or in cases of dislocation. The outcomes of both conservative and operative treatment are described as less successful compared with low-risk stress injuries.
Topics: Humans; Fractures, Stress; Metatarsal Bones; Tibia; Talus; Joint Dislocations; Athletes
PubMed: 37341736
DOI: 10.1007/s00113-023-01339-4 -
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