scholarly journals Treatment of Avulsion Fractures of the Base of the Fifth Metatarsal with Walking Boot and Hard-Soled Shoes: A Comparative Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0032
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Guilherme Honda Saito ◽  
Augusto César Monteiro ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Comparative Study ◽  
Fracture Healing ◽  
Joint Disease ◽  
Function Evaluation ◽  
Avulsion Fractures ◽  
Non Union ◽  
Fracture Consolidation ◽  
And Gender ◽  
American Orthopaedic ◽  
And Function

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Acute avulsion fractures of the base of the fifth metatarsal are common and usually treated non- surgically with satisfactory outcomes. Forms of conservative treatments are described such as elasticated bandaging, immobilization in a cast, walking boot and hard-soled-shoes. The aim of this study was to compare the clinical and functional outcomes, time to return to the previous activities, time and rate of fracture healing of the patients with avulsion fracture of the base of the fifth metatarsal treated in a hard-soled-shoes (HSS) or in a walking boot (WB). Our null hypothesis is that a less rigid immobilization without restriction of the ankle yields the same final results. Methods: A retrospective and comparative study of 72 patients with acute avulsion fractures of the base of the fifth metatarsal treated with the WB or the HSS, from March 2014 to November 2018. The average age of the patients was 41,25 (range, 11-88) and there were 56 female and 16, male. 39 were treated with the WB and 33, with the HSS. Patients with comorbities that could interfere in the rate and time of bony healing (diabetes and inflammatory joint disease), associated ankle ligament lesions and loss of follow-up were excluded. Patients were followed regularly until they were clinically asymptomatic and able to return to their previous activities (work, daily activities, sports). We retrospectively reviewed medical records containing the visual analogue scale (VAS) for pain and the american orthopaedic foot and ankle society (AOFAS) score of each visit as well as radiographic exams to evaluate time and rate of fracture healing. Results: Patients of both groups had similar VAS and AOFAS scores in 8 (p=0,34 and p=0,83) and 12 (p=0,25 and p=0,79) weeks. Age and gender distribution in the two groups were equal (p=0,23 and p=0,34, respectively). Time taken to return to the previous activities were not significant different between both groups, with the HSS group taking 8,33 weeks and the WB taking 9,73 weeks (p=0,10). The mean time for bone consolidation was significant higher in the HSS group, taking 8,64 weeks while in the WB took 7,18 weeks (p<0,001). Only 1 case of non-union was observed in the WB group and none in the HSS group. Conclusion: Our study concluded that avulsion fractures of the base of the fifth metatarsal can be treated equally with the HSS or the WB. Both types of immobilization showed to be equivalent in terms of clinical and function evaluation, return to the previous activities without difference in the rate of the fracture consolidation.

scholarly journals TL 18134 - Treatment of avulsion fractures of the base of the fifth metatarsal with hard-soled shoes and a walking boot

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 88S
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Guilherme Honda Saito ◽  
Augusto César Monteiro ◽  
Bruno Rodrigues de Miranda ◽  
...  
Keyword(s):  
Bone Healing ◽  
Joint Disease ◽  
Avulsion Fractures ◽  
Loss To Follow Up ◽  
Non Union ◽  
Ankle Ligament ◽  
Comparative Cohort Study ◽  
The Mean ◽  
And Gender ◽  
American Orthopaedic

Introduction: Conservative treatments for avulsion fractures of the base of the fifth metatarsal described are elasticated bandaging, cast, a walking boot (WB) and hard-soled shoes (HSS). The aim of this study is to compare the clinical and functional outcomes, time to return to previous activities, and time and rate of bone healing of patients with avulsion fracture of the base of the fifth metatarsal treated in an HSS or in a WB. Our hypothesis is that a less rigid immobilization yields the same results. Methods: A comparative cohort study was conducted of 72 patients with acute avulsion fractures of the base of the fifth metatarsal treated with WB or HSS, from March 2014 to November 2018. The mean age of the patients was 41,25 years. There were 56 females and 16 males. Thirty-nine patients were treated with WB and 33 with HSS. Patients with comorbidities that could interfere with bone healing (diabetes, inflammatory joint disease), associated ankle ligament lesions and loss to follow-up were excluded. Patients were followed regularly until they were asymptomatic and able to return to their previous activities (work, daily activities, sports). We retrospectively reviewed medical records containing the visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score, as well as radiographic exams to evaluate the time and rate of bone healing. Results: Both groups had similar VAS and AOFAS scores at 8 (p=0,34 and p=0,83) and 12 (p=0,25 and p=0,79) weeks. Age and gender distributions in the two groups were equal (p=0,23 and p=0,34, respectively). Time taken to return to previous activities was not significant different, with the HSS group taking 8,33 weeks and the WB taking 9,73 weeks (p=0,10). The mean time for bone healing was significant longer in the HSS group, lasting 8,64 weeks compared with 7,18 weeks in the WB group (p<0,001). One case of non-union was observed in the WB group and none in the HSS group. Conclusion: Avulsion fractures of the base of the fifth metatarsal can be treated equally with HSS or WB. Both treatments were found to be equivalent in terms of clinical and functional evaluations and return to previous activities.

scholarly journals CLINICAL APPLICATION OF BONE MORPHOGENETIC PROTEIN ON FRACTURE HEALING PROCESS

2019 ◽  
Vol 6 (2) ◽  
pp. 48
Author(s):  
Riko Febrian Kunta Adjie
Keyword(s):  
Fracture Healing ◽  
Clinical Application ◽  
Bone Morphogenetic Proteins ◽  
Bone Healing ◽  
Healing Process ◽  
Delayed Union ◽  
Non Union ◽  
Morphogenetic Protein ◽  
Number Of Patients ◽  
And Function

Delayed union or non-union often occurs in bone healing fracture process. The clinical application of Bone Morphogenetic Proteins (BMPs) has helped an increasing number of patients achieve bone regeneration in clinical area lacking simple solutions for difficult bone healing situations. Many researches has proved that BMPs improved fracture healing regeneration. In this review article, introduction and current clinical issues are summarized on efficacy and function of BMPs. Currently, rhBMP-2 and rhBMP-7 have shown clinical significance but other subfamily members of BMPs still lacked of evidence.

A COMPARATIVE STUDY OF STUDENTS’ PREFERENCES FOR LEARNING ENVIRONMENT ON THE BASIS OF SCHOOL TYPES.

2017 ◽  
Vol 4 (36) ◽  
Author(s):  
Megha D’souza ◽  
Shefali Pandya
Keyword(s):  
Learning Environment ◽  
Comparative Study ◽  
Growth And Development ◽  
T Test ◽  
Dominance Test ◽  
Environment Scale ◽  
And Gender ◽  
Descriptive Method

Education is a potent force in developing a child into skilled, effective, productive and law-abiding citizen. It is therefore imperative that the environment for the education of the child is conducive and congenial for his growth and development. The aim of the study was to compare students’ preferences for learning environment on the basis of School Types. The study adopted the descriptive method of the Casual – Comparative type. The sample comprised of 574 standard VIII English medium students from schools. The tools used for the study were Preferred Learning Environment Scale by Fraser (1996) and Hemisphericity Dominance Test by Venkataraman. ANOVA and ‘t’ test was used to compare students’ preference for learning environment on the basis of hemisphericity and gender respectively. The findings are discussed in detail in the paper.

scholarly journals Timing of Bisphosphonate Initiation After Fracture: What Does the Data Really Say?

2020 ◽  
Vol 11 ◽  
pp. 215145932098036
Author(s):  
David W. Barton ◽  
C. Taylor Smith ◽  
Amit S. Piple ◽  
Sterling A. Moskal ◽  
Jonathan J. Carmouche
Keyword(s):  
Fracture Healing ◽  
Clinical Studies ◽  
Osteoporosis Treatment ◽  
The Body ◽  
Non Union ◽  
Increased Risk ◽  
Level I ◽  
Timing Of Initiation ◽  
The Impact ◽  
Published Research

Introduction: Osteoporosis is often not clinically recognized until after a fracture occurs. Individuals who have 1 fracture are at increased risk of future fractures. Prompt initiation of osteoporosis treatment following fracture is critical to reducing the rate of future fractures. Antiresorptives are the most widely used class of medications for the prevention and treatment of osteoporosis. Many providers are hesitant to initiate antiresorptives in the acute post-fracture period. Concerns include interference with bone remodeling necessary for successful fracture healing, which would cause increased rates of non-union, malunion, and refracture. While such concerns should not extend to anabolic medications, physicians may also hesitate to initiate anabolic osteoporosis therapies due to high cost and/or lack of familiarity. This article aims to briefly review the available data and present a digestible narrative summary to familiarize practicing orthopaedic surgeons with the essential details of the published research on this topic. Results: The results of 20 clinical studies and key pre-clinical studies related to the effect of anti-resorptive medications for osteoporosis on fracture healing are summarized in the body of this narrative review. Discussion & Conclusions: While few level I studies have examined the impact of timing of initiation of osteoporosis medications in the acute post-fracture period, the few that have been published do not support these concerns. Specifically, data from level I clinical trials indicate that initiating bisphosphonates as early as 2 weeks post-fracture does not increase rates of non-union or malunion. By reviewing the available data, we hope to give clinicians the confidence to initiate osteoporosis treatment promptly post-fracture.

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