The Fifth Metatarsal Shaft Fracture Is Well Treated With Benign Neglect

2021 ◽  
pp. 193864002110568
Author(s):  
Leah J. Gonzalez ◽  
Joseph R. Johnson ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
General Population ◽  
Weight Bearing ◽  
Full Range ◽  
Persistent Pain ◽  
Ankle Motion ◽  
Treatment Type ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
Professional Dancers

Background. Spiral fifth metatarsal fractures have been studied previously in professional dancers. However, little has been reported about outcomes of these injuries in the general population. The objective of this study was to examine patient demographics of those who sustain this injury and their functional outcomes, as stratified by treatment type. Methods. A total of 186 “nonprofessional dancer” patients with a fifth metatarsal fracture who were treated by one orthopaedic surgeon at our academic medical center were identified through chart review. All patients were allowed to weight bearing as tolerated (WBAT). Time to healing, persistence of pain, range of motion, and complications were recorded. Independent samples t tests, 1-way analysis of variance, and Fisher exact tests were used for analysis. Results. Thirty-seven of the 186 patients with fifth metatarsal fractures reviewed were identified as having a spiral fifth metatarsal fracture with appropriate follow-up. The cohort was 78.4% female with a mean age of 50.3 years. Twenty-two were initially treated in a controlled ankle motion (CAM) boot, 14 in a postoperative shoe, and 1 continued in their own shoes. All patients were allowed to WBAT. All fractures healed by a mean of 3.1 months. By the end of the follow-up period, 67.6% of patients had full range of ankle motion, with 5.4% reporting feeling stiff, 27.0% reporting mild persistent pain, and 2.7% reporting significant persistent pain. Conclusion. Fifth metatarsal shaft (“Dancer’s”) fractures occur within the general population, not only among professional dancers. Without operative fixation and regardless of nonoperative treatment selected, these fractures heal reliably and do so without clinically relevant complication. Level of Evidence: Level III: Retrospective comparative study

scholarly journals Pseudoarthrosis of second metatarsal fracture

2018 ◽  
Vol 40 (2) ◽  
Author(s):  
Jessica Zanovello ◽  
Barbara Bertani ◽  
Redento Mora ◽  
Gabriella Tuvo ◽  
Mario Mosconi ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Good Clinical Outcome ◽  
Non Union ◽  
Fractures In Children ◽  
Second Metatarsal ◽  
Traumatic Fracture ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
Foot Fractures

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.

scholarly journals Clinical and Radiographic Outcomes of 3D Printed Total Talus Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Daniel Scott ◽  
John Steele ◽  
Amanda Fletcher ◽  
Selene Parekh
Keyword(s):  
Avascular Necrosis ◽  
Weight Bearing ◽  
Treatment Options ◽  
Ankle Motion ◽  
Motion Data ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
3D Printed ◽  
Vas Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Trauma Introduction/Purpose: Patients with talar avascular necrosis have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTR) has arisen as a treatment option for these patients, possibly allowing for better preservation of hind-foot motion. Patients undergoing TTR will demonstrate a statistically significant improvement in FAOS scores at one year after surgery. Methods: We retrospectively reviewed 15 patients who underwent a TTR over 2 years. Patient outcomes were reviewed including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, pre-operative and post-operative weight bearing radiographs, as well as FAOS and VAS scores, and range of motion. Data analysis performed with student T-test and multivariate regression. Results: Results: FAOS scores showed statistically significant improvements post-operatively as compared to pre-operative scores. There was a statistically significant decrease in VAS pain scores from 7.0 pre-operatively to 3.4 post operatively. There was no significant difference in pre-operative and post-operative coronal and sagittal alignment on weight bearing radiographs. All FAOS sub-score shows statistically significant improvements, with the exception of the sports/recreation sub-scale, did show a trend towards improved outcomes (p =0.19). Average follow-up was 12.8 months. Conclusion: Our hypothesis was confirmed that these patients show statistically significant improvements in AOFS and VAS scores at 1 year. Sagittal and coronal alignment was well maintained at an average of 1 year following surgery. TTR represents an exciting treatment options for patients with talar avascular necrosis, though longer-term follow-up is needed.

scholarly journals Surgical Repair of Open Achilles Tendon Injuries Using No.1 Prolene to Pull Down the Proximal Tendon: A Safe Technique

1970 ◽  
Vol 21 (2) ◽  
pp. 132-134
Author(s):  
Sayed Ahmed ◽  
Debashis Roy ◽  
S Uddin Ahmed ◽  
M Enamul Haque ◽  
Moshidur Rahman
Keyword(s):  
Suture Material ◽  
Weight Bearing ◽  
Full Range ◽  
Neutral Position ◽  
Partial Weight Bearing ◽  
Active Flexion ◽  
Safe Technique ◽  
Partial Weight ◽  
Distal Tendon

From July 1998 to October 2004 forty-seven patients with open tendo-Achilles injuries were treated pull down the proximal tendon with no.1 prolene. In this surgical method no.1 prolene was threaded through the proximal tendon and the same suture material passed through the distal tendon and its bilateral ends were tightened over the rubber button either under the heel or by the sides of the heel. Box sutures apposed cut ends of the tendon. The ankle was placed in the cast in near neutral position. At six weeks the cast was removed and active flexion program was started. Partial weight bearing was allowed at seven weeks and full bearing was allowed at ten weeks after surgery. The average follow up period is 1.8 years. All the patients exhibited full range of motion at the final follow-up. doi: 10.3329/taj.v21i2.3792 TAJ 2008; 21(2): 132-134

scholarly journals An Uncemented Spreading Stem for the Fixation in the Metaphyseal Femur: A Preliminary Report

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Daniel Burger ◽  
Matthias Pumberger ◽  
Bruno Fuchs
Keyword(s):  
Weight Bearing ◽  
Full Range ◽  
Implant Design ◽  
Full Weight Bearing ◽  
Tumour Resection ◽  
Rigid Fixation ◽  
Femoral Bone ◽  
Bone Resection ◽  
Uncemented Fixation

Surgical treatment to restore full range of motion and full weight bearing after extensive femoral bone resection in patients with primary or metastatic femoral tumours is individually challenging. Especially when the remaining distal or proximal bone is very short, a rigid fixation of an implant is difficult to achieve due to the reverse funnel shape of the metaphysis. Herein, we present a novel implant design using a spreading mechanism in the distal part of the prosthesis for rigid, uncemented fixation in the remaining femoral bone after extensive tumour resection of the femur. We present the outcome of 5 female patients who underwent implantation of this spreading stem after extensive proximal or distal femoral bone resection. There was no radiological or clinical loosening or implant-related revision surgery in our follow-up (mean 21.46 months, range 3.5–46 months). This uncemented spreading stem may therefore represent an alternative option for fixation of a prosthetic device in the remaining metaphyseal femur.

scholarly journals Plate Fixation of Metatarsal Shaft and Neck fractures has high union rates and low rates of hardware removal

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
David Beck ◽  
Steven Raikin ◽  
Tony Bryant ◽  
David Pedowitz
Keyword(s):  
Medical Records ◽  
Sagittal Plane ◽  
Plate Fixation ◽  
Statistical Significance ◽  
Weight Bearing ◽  
Hardware Removal ◽  
Full Weight Bearing ◽  
X Rays ◽  
Metatarsal Fractures

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Despite large numbers of traumatic 1st,2nd,3 rd, and 4th (1-4 MT) metatarsal shaft and neck fractures, there have be very few outcome studies related to their treatment. K- wire fixation of metatarsal fractures has been shown to lead to poor outcomes when residual displacement and angulation occurs. In order to maintain anatomic alignment, some surgeons use plates for fixation of metatarsal fractures. To the best of our knowledge, this is the first study to report the healing rates, fracture angulation and need for hardware removal of operatively treated 1-4 MT shaft and neck fractures with plate fixation. Methods: In this retrospective cohort study, we reviewed the medical records of all metatarsal fractures at our institution from October 1, 2006 – December 31, 2014 to identify all 1-4 MT shaft and neck fractures. All tarsometatarsal joint factures, isolated 5th metatarsal fractures, fractures treated at outside facilities, skeletally immature patients and fractures treated non operatively were excluded. Final available x-rays with a minimum of one year follow-up from the date of surgery were reviewed. Medical records and x-rays were reviewed for evidence of union, sagittal and coronal fracture angulation (degrees), time to full weight bearing, plate size, fracture location (neck vs shaft) and number of screws on each side of the fracture. Patients were also called to see if the plates were bothersome, if the plates had been removed, or if they desired to have the plate removed. Multiple linear regression analysis was used to make calculations of statistical significance. Results: 45 patients with 75 metatarsal fractures treated with plate fixation were included. All fractures went to union and full weight bearing. Average time to union and full weight bearing was 10.9 and 7.5 weeks respectively. The average coronal and sagittal plane angulation was 3.9 degrees and 2.2 degrees. No demographic variable showed statistical significance with regards to sagittal and coronal angulation. Fractures located in the neck were found to have higher coronal plane angulation malunion compared to fractures in the shaft (P=0.019). No variable was related to final sagittal plane angulation. 28/45 patients responded to our telephone interview with an average follow-up of 4.4 years. 10 stated the plate bothered them. No plates had been removed and 27/28 patients did not want the plate removed. Conclusion: Metatarsal fractures fixed with plates show high rates of union and low final fracture angulation. Patients did not report symptomatic hardware and did not desire to have plates removed. No patient included in this study underwent hardware removal.

Conservative versus surgical treatment of metacarpal and metatarsal fractures in dogs

2000 ◽  
Vol 13 (03) ◽  
pp. 123-127 ◽  
Author(s):  
R. Howe-Smith ◽  
A. Kapatkin ◽  
F. Shofer
Keyword(s):  
Retrospective Study ◽  
Weight Bearing ◽  
Scientific Validity ◽  
Multiple Fractures ◽  
Articular Fractures ◽  
Metatarsal Bones ◽  
Metatarsal Fractures ◽  
Working Dogs ◽  
Surgical Fixation

SummaryThe purpose of this retrospective study was to compare the outcome of metacarpal and metatarsal fractures treated conservatively versus surgically. Internal fixation of these fractures is recommended if there are: more than two metacarpal or metatarsal fractures in the same leg; two fractures of weight bearing bones; articular fractures; fractures with significant displacement; open fractures; and if the fractures occur in large breed, athletic, show, or working dogs. All 25 dogs fit the published criteria for surgical fixation to achieve a good outcome. Treatment (surgical versus conservative) was assigned based on owners’ decisions only. Follow-up was nine-68 months. Anything less than perfect in the categories used to evaluate outcome was considered a failure. Outcome was not statistically affected by surgery or conservative treatment, and no other factors significantly affected outcome. The present recommendations used in determining if surgery is necessary for these fractures were extrapolated from human literature and may have no scientific validity in our patients.Open reduction and fixation was compared with closed reduction and coaptation for the treatment of multiple fractures of the metacarpal and metatarsal bones in 25 dogs.

Treatment of Proximal Fifth Metatarsal Fractures and Refractures With Plantar Plating in Elite Athletes

2018 ◽  
Vol 39 (12) ◽  
pp. 1410-1415 ◽  
Author(s):  
Derek T. Bernstein ◽  
Ronald J. Mitchell ◽  
Patrick C. McCulloch ◽  
Joshua D. Harris ◽  
Kevin E. Varner
Keyword(s):  
Elite Athletes ◽  
Demographic Data ◽  
Case Series ◽  
Radiographic Evaluation ◽  
Autogenous Bone ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures

Background: Fractures of the proximal fifth metatarsal are relatively common foot injuries in elite athletes. Acute fixation with intramedullary screws is the most common operative treatment. However, the rate of nonunion and refracture after this procedure remains a concern. The purpose of this study was to determine rates of clinical and radiographic fracture healing, return to sport, and patient-reported clinical outcomes of elite athletes with proximal fifth metatarsal fracture or refracture treated with plantar plating. Methods: An institutional review board–approved retrospective single-surgeon case series investigation assessed athletes (competing at college, Olympic, or professional levels) with proximal fifth metatarsal fracture or refracture, treated with open reduction internal fixation and calcaneal autogenous bone grafting using a plantar plate with a minimum 2-year follow-up. Demographic data, radiographic evaluation, and the time until return to unrestricted sporting competition were collected and analyzed. Means with standard deviations were calculated for continuous data, and frequencies of categorical data were calculated in percentages. Results: Four refractures and 4 primary fractures were treated in 8 male athletes with a mean age of 21.9 ± 1.9 years at a mean follow-up of 3.2 ± 0.4 years. Two patients experienced temporary neuropraxia of the sural nerve that resolved within 6 weeks. There were no incisional complications, delayed unions or nonunions, refractures, hardware loosening, or complaints of hardware prominence. Clinically asymptomatic radiographic union was observed in 100% of the athletes at 6.5 ± 1.1 weeks and full release given at 12.3 ± 1.9 weeks. All athletes returned to sport at the same level of competition. Conclusion: With minimum 2-year follow-up, plantar plating of proximal fifth metatarsal fractures was an effective and safe technique that was used in both primary and revision settings. Level of Evidence: Level IV, case series.

scholarly journals Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

2021 ◽  
Vol 10 (6) ◽  
pp. 1314
Author(s):  
Rebeca Lorca ◽  
Isaac Pascual ◽  
Andrea Aparicio ◽  
Alejandro Junco-Vicente ◽  
Rut Alvarez-Velasco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Young Women ◽  
Artery Dissection ◽  
Men And Women ◽  
High Prevalence

Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. Methods: A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014–31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). Results: Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. Conclusion: Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04–98.04), 95.64% (95% CI 92.87–97.35), and 94.5% (95% CI 91.12–97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.

scholarly journals Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142097570
Author(s):  
Mossub Qatu ◽  
George Borrelli ◽  
Christopher Traynor ◽  
Joseph Weistroffer ◽  
James Jastifer
Keyword(s):  
Articular Cartilage ◽  
Digital Imaging ◽  
Articular Surface ◽  
Implant Design ◽  
Joint Surface ◽  
Fracture Classification ◽  
Articular Damage ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
The Mean

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

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