Fifth metatarsal fractures: an update on management, complications, and outcomes

Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture. If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems. Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain. Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.

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Treatment of Zone II and III Fifth Metatarsal Fractures Using a Novel Fixation Technique

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00198 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0019

Author(s):

Stephanie K. Eble ◽

Oliver B. Hansen ◽

Martin J. O’Malley ◽

Mark C. Drakos

Keyword(s):

Postoperative Complications ◽

Return To Sport ◽

Vascular Supply ◽

X Rays ◽

Non Union ◽

Anatomic Reduction ◽

Metatarsal Fractures ◽

Zone Ii ◽

Operative Notes

Category: Sports; Lesser Toes Introduction/Purpose: Zone II and III 5th metatarsal fractures are common injuries which can be addressed surgically with percutaneous fixation following anatomic reduction. Limited vascular supply and the specific anatomy of the 5th metatarsal causes concern for non-union of these fractures. This study evaluated a novel screw designed to optimize 5th metatarsal fixation. The titanium alloy headless screw (Jones Union System, Extremity Medical, Parsippany, NJ) provides compression across the fracture site using variable angle pitch and is designed to minimize the occurrence of painful hardware. In addition, we use an intramedullary reamer to create local autologous bone grafting in conjunction with an osteoplasty of the cuboid to obtain ideal positioning. This study represents the first to evaluate clinical outcomes following fixation with this system. Methods: Patients treated for a 5th metatarsal fracture between 2018 and 2019 by two surgeons fellowship-trained in foot and ankle orthopedics were identified. Operative notes were reviewed to ensure that patients were treated with the headless compression screw. 21 patients (22 fractures) were identified. Postoperative x-rays were reviewed to evaluate osseous bridging and time to union was determined. Retrospective chart review was performed to determine time to return to sport. Postoperative complications, including non-unions, need for revision, and need for hardware removal, were also evaluated. Results: Of the 22 total fractures, 16 were Zone II fractures and 6 were Zone III fractures. Average time to clinical follow-up was 13.60 months (range, 3.91-25.07). Average age at time of surgery was 28.82 years (range, 16 to 66). 16 males and 5 females were represented with average BMI of 27.41 kg/m2. Average time to union was 6.78 weeks (range, 5.13-12.12), and average time to return to sport was 11.38 weeks (range, 5.87-15.12). No patients experienced a non-union or painful hardware, and no other postoperative complications were observed. Conclusion: Fixation of Jones fractures using the Jones Union System produced excellent postoperative outcomes. This system, designed to address the challenges of 5th metatarsal anatomy, demonstrated effectiveness with expeditious times to union and return to sport. Union rates were high, and our cohort did not experience any postoperative complications. Although follow-up in some cases is short, no patient has experienced painful hardware. Our results suggest that this system is an effective approach for fixation of Zone II and III 5th metatarsal fractures.

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An evaluation of functional outcome following surgical management of fractures of the proximal humerus with Neer’s scoring system

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175064 ◽

2017 ◽

Vol 4 (1) ◽

pp. 46

Author(s):

Yeshwanth Subash ◽

Lydia M. ◽

Kamalakumar K. ◽

Ilavarasan M. Dhamu

Keyword(s):

Functional Outcome ◽

Surgical Management ◽

Scoring System ◽

Soft Tissues ◽

Proximal Humerus ◽

Articular Surface ◽

Treatment Options ◽

Early Mobilization ◽

Functional Results ◽

Non Union

Background: Fractures of the proximal humerus are complex injuries associated with significant morbidity. Various options are available for management including non-operative treatment, depending upon the pattern of the fracture, quality of the bone and the surgeon's familiarity with the techniques. The age of the patient, physical activity and the medical fitness also largely influence the treatment options. The aim of this study was to evaluate the functional outcome following surgical management of these fractures and to compare the results with studies as available in literature.Methods: 30 patients with fractures of the proximal humerus managed by surgical means were studied from January 2012 to January 2014 and were followed up for a minimum period of two years.Results: All the fractures treated united clinically by 8 weeks and radiologically by 16 weeks. There were no cases of delayed or non-union in our series. The fractures were more common in men with a gender distribution of 1.3:1 and were also more common in the age group of 50 to 65 years (53%). As per the Neer’s scoring system, 60% patients had excellent results while 33% patients had satisfactory results. They were all pain free and successfully returned to their pre-injury work. 6% patients had an unsatisfactory result. Conclusions: Surgical management of proximal humerus fractures following the principles of articular surface reconstruction, restoration of the anatomy, stable fixation, with minimal injury to the soft tissues and early mobilization, gives good functional results.

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Direct Ink Writing of Highly Conductive MXene Frames for Tunable Electromagnetic Interference Shielding and Electromagnetic Wave-Induced Thermochromism

Nano-Micro Letters ◽

10.1007/s40820-021-00665-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Xinyu Wu ◽

Tingxiang Tu ◽

Yang Dai ◽

Pingping Tang ◽

Yu Zhang ◽

...

Keyword(s):

Electromagnetic Wave ◽

Electromagnetic Interference ◽

High Performance ◽

Normal Operation ◽

List Type ◽

Emi Shielding ◽

Electromagnetic Interference Shielding ◽

Direct Ink Writing ◽

Aluminum Ions ◽

Wave Induced

Highlights 3D printing of MXene frames with tunable electromagnetic interference shielding efficiency is demonstrated. Highly conductive MXene frames are reinforced by cross-linking with aluminum ions. Electromagnetic wave is visualized by electromagnetic-thermochromic MXene patterns. Abstract The highly integrated and miniaturized next-generation electronic products call for high-performance electromagnetic interference (EMI) shielding materials to assure the normal operation of their closely assembled components. However, the most current techniques are not adequate for the fabrication of shielding materials with programmable structure and controllable shielding efficiency. Herein, we demonstrate the direct ink writing of robust and highly conductive Ti3C2Tx MXene frames with customizable structures by using MXene/AlOOH inks for tunable EMI shielding and electromagnetic wave-induced thermochromism applications. The as-printed frames are reinforced by immersing in AlCl3/HCl solution to remove the electrically insulating AlOOH nanoparticles, as well as cross-link the MXene sheets and fuse the filament interfaces with aluminum ions. After freeze-drying, the resultant robust and porous MXene frames exhibit tunable EMI shielding efficiencies in the range of 25–80 dB with the highest electrical conductivity of 5323 S m−1. Furthermore, an electromagnetic wave-induced thermochromic MXene pattern is assembled by coating and curing with thermochromic polydimethylsiloxane on a printed MXene pattern, and its color can be changed from blue to red under the high-intensity electromagnetic irradiation. This work demonstrates a direct ink printing of customizable EMI frames and patterns for tuning EMI shielding efficiency and visualizing electromagnetic waves.

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RADT-23. IMPACT OF REIRRADIATION UTILIZING STEREOTACTIC RADIOSURGERY ON RECURRENT GLIOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.776 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii186-ii186

Author(s):

O’Dell Patrick ◽

H Nickols ◽

R LaRocca ◽

K Sinicrope ◽

D Sun ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Median Survival ◽

High Performance ◽

Performance Status ◽

Treatment Options ◽

Methylation Status ◽

Initial Therapy ◽

Recurrent Glioblastoma ◽

Control Group ◽

The Impact

Abstract BACKGROUND Patients who have recurrent glioblastoma have limited treatment options. We conducted a retrospective review of patients with recurrent glioblastoma treated with standard initial radiation and temozolomide with tumor treating fields to investigate whether reirradiation using radiosurgery would be associated with improved outcomes. METHODS We reviewed the records of 54 consecutively treated patients with recurrent glioblastoma with ECOG 0 or 1 at recurrence and conducted Kaplan-Meier analysis with Log-rank testing to determine significance between groups. RESULTS We identified 24 patients who were treated without radiation therapy (control) while 30 patients underwent re-irradiation using radiosurgery (ReSRS) with a median total dose of 25Gy in five fractions. All patients had completed standard initial therapy, and there was no difference in the time to recurrence between the two groups (10 months for control, 15 months for ReSRS, [P = 0.17, HR for progression 0.65 (95% CI 0.38-1.13)]. A larger proportion of patients in the control arm (54%) had subtotal or gross total resection of the recurrence compared with the ReSRS group (44%, P < 0.05). The majority of patients had recurrence confirmed with biopsy (18/22 in control group, 25/31 in the ReSRS group). MGMT methylation status did not differ between control vs ReSRS (29% vs. 27%). ReSRS was associated with improved median survival from the time of first recurrence of 11.6 months versus 3.8 months in the control arm [P< 0.0001, HR for death 0.33 (95% CI 0.18-0.6)]. CONCLUSIONS In a group of patients with high performance status diagnosed with recurrent glioblastoma, reirradiation with stereotactic radiosurgery was associated with nearly one year median survival after recurrence. Additional analyses are warranted to determine the impact of concurrent systemic therapies with irradiation and underlying tumor or patient factors to predict outcomes.

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The Peroneus Brevis and Plantar Fascia Insertions Are Related to Proximal Fifth Metatarsal Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000198 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Ali Hosseini ◽

Pim Van Dijk ◽

Sofie Breuking ◽

Bryan Vopat ◽

Daniel Guss ◽

...

Keyword(s):

Surface Area ◽

Fracture Mechanism ◽

Soft Tissues ◽

Plantar Fascia ◽

Dorsal Side ◽

Fracture Zones ◽

Surface Areas ◽

Metatarsal Bones ◽

Metatarsal Fractures ◽

Peroneus Brevis

Category: Midfoot/Forefoot Introduction/Purpose: Proximal fifth metatarsal fractures (PFMF) are among the most common fractures in the foot and can be categorized into three fracture zones [1]. To investigate the fracture mechanism of PFMF in different zones, a better understanding of the anatomy of the bone and its surrounding soft tissues is required. Both the plantar fascia (PF) and the peroneus brevis (PB) tendon insertions are at the base of the fifth metatarsal, and may contribute to the pathophysiology of PFMF. However, the role of the PB and PF insertions in the pathogenesis of PFMF remains unclear. The purpose of this study was to accurately define the footprint of the PB and PF insertions of the base of the 5th metatarsal in relation to the different zones of PFMF. Methods: 21 cadaveric fifth metatarsal bones were harvested from cadaveric feet. All bones were freed of any remaining soft tissue adherence, except for the PB and the PF insertions. Three reference screws with a diameter of 1 mm were placed and secured on each bone with 2 screws distally and 1 screw proximally for registration. All bones were CT scanned to create a 3D bone reconstruction. Next, the insertions of the PB and PF and the reference screws of each bone were digitized and then mapped to its corresponding 3D bone model. In order to describe the three different fracture zones of the 5th metatarsal, an established coordinate system was made for each bone to simulate separate fracture zones (Figure a) based on Lawrence guideline [1]. The shape, location and surface areas of both insertions and their relation to the different fractures zones were determined (Figure b). Results: The insertion of the PB was oval shaped and located on the dorsal side of the base, with a mean surface area of 88.1 ± 46.4 mm2. The PF was oval shaped and situated around the tip of tuberosity, with a mean surface area of 150.7±53.5 mm2. The PB insertion was present in zone 1 fractures in 100% (21/21) of the 5th metatarsal models and 29% (6/21) of the models for zone 2 fractures. The PF insertion was involved in 100% (21/21) of the 5th metatarsal models for zone 1 fractures and 43% (9/21) of the models for zone 2 fractures. Conclusion: Results of this study demonstrate that the insertion of both the PB and PF are involved in all zone 1 PFMF and a significant percentage of zone 2 PFMF. The location of tendon insertions affect the forces exerted on the bone, which may indicate a relation of the insertions of both the PB and the PF with the fracture mechanism of many zone 1 and 2 PFMF. Moreover, in the treatment of these fractures, care should be taken to maintain or restore the anatomy of these insertions to maximize functional outcomes.

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Sleep disordered breathing at the extremes of age: the elderly

Breathe ◽

10.1183/20734735.003216 ◽

2016 ◽

Vol 12 (1) ◽

pp. 50-60 ◽

Cited By ~ 20

Author(s):

Alison McMillan ◽

Mary J. Morrell

Keyword(s):

Risk Factors ◽

Older People ◽

Sleep Disordered Breathing ◽

Treatment Options ◽

Current Evidence ◽

List Type ◽

Pressure Therapy ◽

Age Related ◽

The Impact ◽

Disordered Breathing

Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

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Management of fracture of neck talus and clinical evaluation of results

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162195 ◽

2016 ◽

Vol 2 (3) ◽

pp. 80

Author(s):

Satish Raghunath Gawali ◽

Gajanan Madhav Kathar ◽

Pramod Vilas Niravane ◽

Mansoor Iqbal Bhosage

Keyword(s):

Soft Tissues ◽

Late Complications ◽

Successful Outcome ◽

Excessive Pressure ◽

Lower Extremity Injuries ◽

Non Union ◽

Type Iv ◽

Subtalar Arthritis ◽

Neck Fracture ◽

Extremity Injuries

Background: Fracture of neck of talus is rare and serious injury with significant complication rate. The talus is involved in about 2% of all lower extremity injuries and about 5-7% of foot injuries. Talus neck fixation is associated with serious complications such as stiffness at ankle and subtler joint, AVN of body of talus, ankle arthritis and later on subtalar arthritis. The objective was to study and evaluate the operative treatment for talus neck fracture.Methods: All adult patients with talus neck fracture admitted in government medical college and hospital, Latur, Maharashtra, India from January 2006 to December 2015 were involved. There were 15 patients with 10 males and 05 females. Fractures were classified as per Hawkins classification and were treated with closed/open reduction and internal fixation with CC screws.Results: All patients were followed prospectively post operatively and clinical and radiological evaluation was done. Results were analyzed. We noted skin complications in 02 patients and rate of consolidation was 60-70%. The final follow-up examination included determination of the AHS score (ankle–hind foot scale) from the American orthopaedic foot and ankle society (AOFAS), range of motion evaluation and radiological analysis.Conclusions: Displaced talar neck fractures are a therapeutic challenge which has significant early and late complications. Despite of all excellent management, non-union rate in type III, and type IV Hawkins fracture is 85%; and AVN of body of talus is 90-95% due to inherent complications of cut off of blood supply which comes from talar neck. Types II, III, IV were associated with talar body dislocation which caused excessive pressure on soft tissues having significant soft tissue complications. Early anatomical reduction and stable fixation is of vital importance to achieve successful outcome.

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Exploring the feasibility of lossy compression for PDE simulations

The International Journal of High Performance Computing Applications ◽

10.1177/1094342018762036 ◽

2018 ◽

Vol 33 (2) ◽

pp. 397-410 ◽

Cited By ~ 8

Author(s):

Jon Calhoun ◽

Franck Cappello ◽

Luke N Olson ◽

Marc Snir ◽

William D Gropp

Keyword(s):

Energy Cost ◽

High Performance ◽

Truncation Error ◽

Computational Cost ◽

Lossy Compression ◽

Data Movement ◽

Hardware Failure ◽

Traditional Approaches ◽

Application Codes ◽

Performance Computing

Checkpoint restart plays an important role in high-performance computing (HPC) applications, allowing simulation runtime to extend beyond a single job allocation and facilitating recovery from hardware failure. Yet, as machines grow in size and in complexity, traditional approaches to checkpoint restart are becoming prohibitive. Current methods store a subset of the application’s state and exploit the memory hierarchy in the machine. However, as the energy cost of data movement continues to dominate, further reductions in checkpoint size are needed. Lossy compression, which can significantly reduce checkpoint sizes, offers a potential to reduce computational cost in checkpoint restart. This article investigates the use of numerical properties of partial differential equation (PDE) simulations, such as bounds on the truncation error, to evaluate the feasibility of using lossy compression in checkpointing PDE simulations. Restart from a checkpoint with lossy compression is considered for a fail-stop error in two time-dependent HPC application codes: PlasComCM and Nek5000. Results show that error in application variables due to a restart from a lossy compressed checkpoint can be masked by the numerical error in the discretization, leading to increased efficiency in checkpoint restart without influencing overall accuracy in the simulation.

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Classification and Treatment Options for BCG-Failure

Advances in Clinical Medicine ◽

10.12677/acm.2021.119623 ◽

2021 ◽

Vol 11 (09) ◽

pp. 4255-4262

Author(s):

璇姚

Keyword(s):

Treatment Options ◽

Bcg Failure ◽

Classification And Treatment

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Orthopaedic surgery

Oxford Assess and Progress: Clinical Surgery ◽

10.1093/oso/9780199696420.003.0022 ◽

2014 ◽

Author(s):

Sebastian Dawson-Bowling

Keyword(s):

Fracture Healing ◽

Orthopaedic Surgery ◽

Soft Tissues ◽

Orthopaedic Practice ◽

Non Union ◽

Valuable Adjunct ◽

The Common ◽

Musculoskeletal Function ◽

Comprehensive History ◽

Primary Modality

Sound knowledge of anatomy and understanding of musculoskeletal function underpins good orthopaedic practice. Bones and joints may be affected by genetic and degenerative conditions, by infection, primary and secondary neoplasia, by endocrine and metabolic anomalies, and by trauma. As in other areas of surgery, a comprehensive history and thorough examination are essential in leading the clinician to a correct diagnosis. Appropriate imaging complements clinical acuity. The plain X-ray remains the primary modality of investigation for visualizing bony injuries and pathology, but MRI is a valuable adjunct for investigating soft tissues and joints. Principles of fracture healing, reduction and fixation, and knowledge of consequences of complications which delay healing, or cause non-union, are integral to the practice of orthopaedic surgery. This chapter will help you to revise basic tenets of orthopaedic practice and the common injuries and conditions encountered by the orthopaedic surgeon.

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