Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti-Inflammatory Medications

2019 ◽  
Vol 35 (12) ◽  
pp. e2
Author(s):  
Brandon Barnds ◽  
Matthew Heenan ◽  
Armin Tarakemeh ◽  
John Paul Schroeppel ◽  
Bryan G. Vopat
Keyword(s):  
Delayed Union ◽  
Metatarsal Fractures ◽  
Anti Inflammatory

scholarly journals Comparison of the rate of delayed/nonunion in fifth metatarsal fractures receiving anti-inflammatory medications

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Brandon Barnds ◽  
Matt Heenan ◽  
Jack Ayres ◽  
Armin Tarakemeh ◽  
J. Paul Schroeppel ◽  
...  
Keyword(s):  
Acute Effect ◽  
Delayed Union ◽  
Nonoperative Treatment ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Fracture Nonunion ◽  
Metatarsal Fractures ◽  
Icd Codes ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Purpose Controversy exists regarding the acute effect of non-steroidal anti-inflammatory drugs (NSAIDs) on early fracture healing. The purpose of this study was to analyze the rate of nonunion or delayed union in patients with fifth metatarsal (5th MT) fractures. We hypothesize that the use of NSAIDs would increase the rate of nonunion/delayed union in 5th MT fractures. Methods Using PearlDiver, a national insurance database was analyzed. ICD codes were used to identify patients diagnosed with 5th MT fracture from 2007-2018. Patients were grouped by initial management (nonoperative vs. open reduction and internal fixation (ORIF) or non/malunion repair within 60 days) and sub-grouped by whether they had been prescribed at least one pre-defined NSAID. Subsequent ORIF or nonunion/malunion repair operative intervention was used as a surrogate for fracture nonunion/delayed union. Results Of the 10,991 subjects with a diagnosis of 5th MT, 10,626 (96.7%) underwent initial nonoperative treatment, 1,409 of which (13.3%) received prescription NSAIDS within 60 days of diagnosis. 16/1,409 (1.14%) subjects who received anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis while 46/9,217 (0.50%; P=0.003483) subjects who did not receive anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis. In the 365 subjects who underwent early repair/ORIF (within 60 days), there was no significant difference in the rate of nonunion/delayed union. Conclusion The rate of nonunion/delayed union of 5th MT fractures was significantly higher in subjects receiving NSAIDs within 60 days of initial diagnosis in patients managed non-operatively. Level of evidence Level III

scholarly journals Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti-Inflammatory Medications

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
Brandon Barnds ◽  
G. Matthew Heenan ◽  
Armin Tarakemeh ◽  
Scott M. Mullen ◽  
John Paul Schroeppel ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Delayed Union ◽  
Chi Square ◽  
Number Of Patients ◽  
Icd 10 ◽  
Metatarsal Fractures ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Chi Square Analysis ◽  
Specific Fracture

Objectives: Controversy exists regarding the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing. Our retrospective study uses a private payer database to isolate patients diagnosed with 5th metatarsal (MT) fractures and compare the rate of delayed open reduction and internal fixation (ORIF) or non/malunion repair as a surrogate for nonunion or delayed union, in those prescribed anti-inflammatories and those not prescribed anti-inflammatories. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD-10 codes. All patients included had a diagnosis of 5th MT fracture and did not receive ORIF or repair of non/malunion within 60 days of diagnosis. Two groups were then created based on the presence or absence of insurance claim records for anti-inflammatory medications within 60 days of diagnosis. The number of patients in each group who underwent ORIF or non/malunion repair after 60 days post-diagnosis was determined, and the rates were compared using a chi-square analysis. Results: 10,626 patients had a diagnosis of 5th MT fracture and did not undergo early repair/ORIF (within 60 days). 1,615 had records of insurance claims for anti-inflammatories within 60 days of diagnosis, leaving 9,011 who did not receive these medications. 18 (1.11%) patients who received an anti-inflammatory medication underwent ORIF or repair of non/malunion after 60 days post-diagnosis. 44 (0.49%; p=0.0055) subjects who did not receive an anti-inflammatory prescription underwent ORIF or repair of non/malunion at after 60 days post-diagnosis. Conclusion: The rate of delayed ORIF or non/malunion repair of 5th MT fractures, a surrogate for delayed union or nonunion in an insurance database study, was significantly higher in subjects receiving anti-inflammatories within 60 days of diagnosis. This study isolates a specific fracture and finds a negative correlation between NSAIDs and fracture healing. Further, this provides valuable information to help guide future higher level studies.

scholarly journals Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti- Inflammatory Medications

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0010
Author(s):  
Brandon Barnds ◽  
G. Matthew Heenan ◽  
Armin Tarakemeh ◽  
J. Paul Schroeppel ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Delayed Union ◽  
Chi Square ◽  
Number Of Patients ◽  
Icd 10 ◽  
Metatarsal Fractures ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Chi Square Analysis ◽  
Specific Fracture

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Controversy exists regarding the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing. Our retrospective study uses a private payer database to isolate patients diagnosed with 5th metatarsal (MT) fractures and compare the rate of delayed open reduction and internal fixation (ORIF) or non/malunion repair as a surrogate for nonunion or delayed union, in those prescribed anti-inflammatories and those not prescribed anti-inflammatories. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD-10 codes. All patients included had a diagnosis of 5th MT fracture and did not receive ORIF or repair of non/malunion within 60 days of diagnosis. Two groups were then created based on the presence or absence of insurance claim records for anti-inflammatory medications within 60 days of diagnosis. The number of patients in each group who underwent ORIF or non/malunion repair after 60 days post- diagnosis was determined, and the rates were compared using a chi-square analysis. Results: 10,626 patients had a diagnosis of 5th MT fracture and did not undergo early repair/ORIF (within 60 days). 1,615 had records of insurance claims for anti-inflammatories within 60 days of diagnosis, leaving 9,011 who did not receive these medications. 18 (1.11%) patients who received an anti-inflammatory medication underwent ORIF or repair of non/malunion after 60 days post-diagnosis. 44 (0.49%; p=0.0055) subjects who did not receive an anti-inflammatory prescription underwent ORIF or repair of non/malunion after 60 days post-diagnosis. Conclusion: The rate of delayed ORIF or non/malunion repair of 5th MT fractures, a surrogate for delayed union or nonunion in an insurance database study, was significantly higher in subjects receiving anti-inflammatories within 60 days of diagnosis. This study isolates a specific fracture and finds a negative correlation between NSAIDs and fracture healing. Further, this provides valuable information to help guide future higher level studies.

scholarly journals Predictors of Malreduction in Zone II and III 5th Metatarsal Fractures Fixed with an Intramedullary Screw: A Retrospective Analysis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0028
Author(s):  
Ankit Khurana ◽  
Charles C. Pitts ◽  
Bradley Alexander ◽  
Akshar Patel ◽  
Charles R. Sutherland ◽  
...  
Keyword(s):  
Delayed Union ◽  
Fracture Site ◽  
Entry Point ◽  
Entry Length ◽  
Increased Risk ◽  
Screw Length ◽  
Metatarsal Fractures ◽  
Screw Diameter ◽  
Zone Ii ◽  
Intramedullary Screw

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Percutaneous fixation of 5th metatarsal fractures may lead to malreduction due to improper implant selection and placement. Our aim was to test the effects of screw entry, length, and diameter on malreduction, delayed union, non-union, or refracture. Methods: We retrospectively reviewed zone II and proximal zone III 5th metatarsal fractures managed with intramedullary screw fixation. Comparisons were made between plantar cortex distraction/lateral cortex distraction and ratios of screw length, diameter, and entry point using multiple regression analysis. A further analysis was carried out between time to union and distraction in the lateral and plantar cortices. Results: Plantar and lateral gap were both correlated with entry point ratio on lateral and AP view respectively (p<0.001 for both views). We did not see an association between plantar and lateral gap with screw diameter ratio (p=0.393 for AP and p=0.981 for lateral) or screw length ratio (p=0.966 for AP and p=0.740 for Lateral). Ratio of postop/preop apex height on AP and lateral showed correlation to presence of lateral and plantar fracture gap respectively (p<0.0001). Presence of a plantar gap did have a slight influence on time to union (p=0.044). Most fractures showed radiographic union at 12 weeks (38/44 that were followed until union). There were no refractures or nonunions as per available records. Conclusion: Our study shows that screw length and diameter did not lead to significant plantar or lateral fracture site distraction. However, entry point had a significant effect on plantar and lateral gap on post-operative x-ray. Patients with a plantar gap did have an increased risk of delayed union. Entry point should be given more significance rather than screw diameter and length in managing zone 2/3 fifth metatarsal base fractures. This is contradictory to existing radiologic studies. [Table: see text]

Extracorporeal Shock Wave Treatment of Non- or Delayed Union of Proximal Metatarsal Fractures

2011 ◽  
Vol 32 (8) ◽  
pp. 746-754 ◽  
Author(s):  
Richard G. Alvarez ◽  
Brandon Cincere ◽  
Chandra Channappa ◽  
Richard Langerman ◽  
Robert Schulte ◽  
...  
Keyword(s):  
Shock Wave ◽  
Delayed Union ◽  
Wave Treatment ◽  
Shock Wave Treatment ◽  
Extracorporeal Shock Wave ◽  
Metatarsal Fractures ◽  
Extracorporeal Shock Wave Treatment

Do Nonsteroidal Anti-Inflammatory or COX-2 Inhibitor Drugs Increase the Nonunion or Delayed Union Rates After Fracture Surgery?

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hyojune Kim ◽  
Do-Hoon Kim ◽  
Dong Min Kim ◽  
Erica Kholinne ◽  
Eui-Sup Lee ◽  
...  
Keyword(s):  
Delayed Union ◽  
Cox 2 ◽  
Anti Inflammatory ◽  
Fracture Surgery

The use of low-intensity pulsed ultrasound in treating delayed union of fifth metatarsal fractures

The Foot ◽  
2018 ◽  
Vol 35 ◽  
pp. 52-55 ◽  
Author(s):  
Kar Hao Teoh ◽  
Robert Whitham ◽  
Jenny F. Wong ◽  
Kartik Hariharan
Keyword(s):  
Delayed Union ◽  
Pulsed Ultrasound ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity ◽  
Metatarsal Fractures

Predictors of Malreduction in Zone II and III Fifth Metatarsal Fractures Fixed With an Intramedullary Screw

2020 ◽  
Vol 41 (12) ◽  
pp. 1537-1545
Author(s):  
Ankit Khurana ◽  
Bradley Alexander ◽  
Charles Pitts ◽  
Ashish Brahmbhatt ◽  
Benjamin Cage ◽  
...  
Keyword(s):  
Delayed Union ◽  
Fracture Site ◽  
Diameter Ratio ◽  
Entry Point ◽  
Screw Length ◽  
Metatarsal Fractures ◽  
Screw Diameter ◽  
Zone Ii ◽  
Intramedullary Screw ◽  
Lateral Gaps

Background: Proper implant selection and placement is crucial during fixation of zone II and III fifth metatarsal fractures to avoid postoperative complications. This study examined the effects of screw parameters and placement on malreduction, delayed union, nonunion, and refracture rate. Methods: A retrospective review of zone II and proximal zone III fifth metatarsal fractures managed with intramedullary screw fixation was conducted. Comparisons were made between cortex distraction (gap) and ratios of screw length, diameter, and entry point. Further analysis was carried out between time to union and distraction in the lateral and plantar cortices. Results: The plantar and lateral gaps were both associated with the mean entry point ratio on the lateral and anteroposterior (AP) views ( P < .001 for both views). No association between the plantar and lateral gaps and the screw diameter ratio ( P = .393 for AP and P = .981 for lateral) or the screw length ratio ( P = .966 for AP and P = .740 for lateral) was identified. The ratio of postoperative to preoperative apex height on AP and lateral views was correlated with the presence of lateral and plantar fracture gaps ( P < .001). The presence of a plantar gap was associated with increased time to union ( P = .022). A majority of fractures showed radiographic union at 12 weeks (38/43). Only 5 of 38 patients had delayed union. There were no refractures or nonunions as per available records. Conclusion: Plantar or lateral fracture site distraction (gap) was not influenced by screw diameter ratio or screw length ratio. The entry point ratio had a significant effect on plantar and lateral gaps on postoperative radiographs, with lateral and inferior placement leading to fracture site distraction. Patients with a plantar gap did have an increased risk of delayed union. The results of this study emphasize the significance of the entry point when managing zone II and III fifth metatarsal base fractures. Level of Evidence: Level IV, case series.

Clarifying proximal diaphyseal fifth metatarsal fractures. The acute fracture versus the stress fracture

1999 ◽  
Vol 89 (8) ◽  
pp. 398-404 ◽  
Author(s):  
KB Landorf
Keyword(s):  
Stress Fracture ◽  
Treatment Plan ◽  
Delayed Union ◽  
Diaphyseal Fracture ◽  
Mechanism Of Injury ◽  
Acute Fracture ◽  
Metatarsal Fractures ◽  
Similar Location ◽  
Type Of Fracture ◽  
Classification And Treatment

This article discusses the classification and treatment of proximal diaphyseal fifth metatarsal fractures. There are two types of proximal diaphyseal fracture of the fifth metatarsal: the acute proximal diaphyseal fracture and the proximal diaphyseal stress fracture. Confusion between the two types of fractures is probably due to their similar location and the historical practice of referring to all fractures in this location as Jones fractures. Both fractures are prone to delayed union and require long periods of nonweightbearing immobilization or internal fixation for healing. However, because the mechanism of injury is different for each fracture, the treatment plan may need to be tailored to the particular type of fracture.

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