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

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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Facial Esthetics Classification and Gingival Pigmentation Index of Treatment Needs

RGUHS Journal of Dental Sciences ◽

10.26715/rjds.11_1_2 ◽

2019 ◽

Vol 11 (1) ◽

pp. 77-88

Author(s):

Puzhankara Lakshmi ◽

Menon Sai Megha ◽

Suresh Reshma

Keyword(s):

Indian Population ◽

Treatment Plan ◽

Specific Treatment ◽

Treatment Modalities ◽

Treatment Needs ◽

Complete Coverage ◽

Facial Esthetics ◽

Comprehensive Classification ◽

Precise Assessment ◽

Classification And Treatment

Background : The Indian population shows an extensive range of gingival pigmentation. A detailed description of the gingival pigmentation pattern would provide data for the formulation of an efficient plan for depigmentation. This article gives a novel comprehensive classification to aid in the precise assessment of the pattern and distribution of gingival pigmentation and decision regarding the methods for depigmentation. Methods : Previously existing, established indices and classifications for degree of pigmentation, facial complexion, smile line, lip colour and their modifications were used to differentiate various categories of Esthetics: Esthetic, Unaesthetic-mild, Unaesthetic-severe. Treatment needs were formulated based on the category of Esthetics. Results : The various categories of esthetics include E (Esthetic), M (Unaesthetic-Mild), N (UnaestheticSevere) and specific treatment modalities have been assigned based on the treatment needs. Discussion : The treatment for gingival pigmentation should be based on overall facial esthetics. The classification given in this article takes into consideration the components of facial esthetics: Facial Pigmentation, Degree and distribution of gingival pigmentation, smile line and lip colour. The treatment plan proposed considers the need for the treatment and the possible treatment for each category of esthetics. Conclusion : The classification proposed in this article attempts a complete coverage of combinations of facial esthetic components and the Treatment Index encompasses all the possible treatment modalities for each combination. Although a learning curve might exist, once mastered, the classification and treatment index would serve as a baseline for determining treatment needs in patients with gingival pigmentation.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00284 ◽

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]

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

Foot & Ankle International ◽

10.3113/fai.2011.0746 ◽

2011 ◽

Vol 32 (8) ◽

pp. 746-754 ◽

Cited By ~ 22

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

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

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.11.010 ◽

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

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The Management of Unstable Cervical Spine Injuries

Clinical Medicine Insights Trauma and Intensive Medicine ◽

10.4137/cmtim.s12263 ◽

2014 ◽

Vol 5 ◽

pp. CMTIM.S12263

Author(s):

Venu M. Nemani ◽

Han Jo Kim

Keyword(s):

Cervical Spine ◽

Medical Condition ◽

Treatment Plan ◽

Neurological Status ◽

Patient Specific ◽

X Rays ◽

Mechanism Of Injury ◽

Imaging Studies ◽

Cervical Spine Injuries ◽

Spine Injuries

Injuries to the cervical spine can cause potentially devastating morbidity and even mortality. In this review we discuss the anatomy and biomechanics of the cervical spine. The evaluation and treatment of cervical spine injuries begins with the prompt immobilization of suspected injuries in the field. Once an assessment of the patient's neurological status is made, imaging studies are obtained, which can include X-rays, CT, and MRI. Careful scrutiny of the imaging studies for bony and/or ligamentous injury allows the physician to determine the mechanism of injury, which guides treatment. The ultimate treatment plan can consist of non-operative or operative management, and depends on patient specific factors (medical condition and neurological status), the mechanism of injury, and the resultant degree of instability. With prompt diagnosis and appropriate management, the morbidity of these injuries can be minimized.

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An unusual transverse sacral fracture treated with early decompression

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.5.6.546 ◽

2006 ◽

Vol 5 (6) ◽

pp. 546-549 ◽

Cited By ~ 4

Author(s):

Luis A. Robles ◽

Edgar Plantillas

Keyword(s):

Sacral Fracture ◽

Early Surgery ◽

Mechanism Of Injury ◽

Quick Recovery ◽

Personal Watercraft ◽

Laminar Fracture ◽

Type Of Fracture

✓The authors describe the case of a patient who sustained a transverse sacral fracture (TSF) associated with a depressed laminar fracture in a personal watercraft accident. The patient underwent early surgery, which allowed a quick recovery. To the best of the authors’ knowledge, the mechanism of injury and type of fracture have not been previously described or classified in cases of TSF.

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Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing

SICOT-J ◽

10.1051/sicotj/2020031 ◽

2020 ◽

Vol 6 ◽

pp. 34

Author(s):

Alexandru Ulici ◽

Elena Odagiu ◽

Oana Haram ◽

Adelina Ionescu ◽

Gabriel Alin Sterian ◽

...

Keyword(s):

Postoperative Complications ◽

Intramedullary Nailing ◽

Femoral Shaft ◽

Delayed Union ◽

Elastic Stable Intramedullary Nailing ◽

Mechanism Of Injury ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Elastic Intramedullary Nailing

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

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Optimal Treatment and Management of Proximal Fifth Metatarsal Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00061 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0006

Author(s):

Reinout Heijboer ◽

Sofie Breuking ◽

Noortje Hagemeijer ◽

Daniel Guss ◽

Christopher DiGiovanni

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Propensity Score ◽

Conservative Treatment ◽

Propensity Score Matching ◽

Avulsion Fracture ◽

Diaphyseal Fracture ◽

Factors Associated ◽

Metatarsal Fractures ◽

Diaphyseal Fractures

Category: Midfoot/Forefoot Introduction/Purpose: Proximal fifth metatarsal fractures (PFMF) are among the most common fractures of the foot, and may be subdivided into tuberosity avulsion fracture, Jones fracture, and proximal diaphyseal fracture. However, for Jones fractures and proximal diaphyseal fractures optimal treatment is still debated in literature. The Torg criteria are used in deciding to treat surgically or conservative, whereby Torg type I and II indicates conservative treatment, and type III indicates surgical treatment. Yet failure rates of both management options vary and derive from small study groups. The aim of this study was to compare failure rates after surgical- and conservative treatment of Jones fractures and proximal diaphyseal fractures, to evaluate the incidence of treatment failure, and to assess factors associated with healing difficulties of PFMF. Methods: A total of 1,133 adult patients that were diagnosed and treated for PFMF between 2005 and 2015 in a tertiary care foot and ankle referral center were included. Retrospective chart review recorded patient demographics, suspected risk factors for impaired healing of PFMF (rheumatoid arthritis, diabetes mellitus, osteoporosis, nutritional and hormonal disorders, foot deformities, (neuropathic) arthropathy of the foot and/or ankle and peripheral neuropathy of the lower extremity), and treatment indication. Multivariable logistic regression analysis was used to determine factors associated with healing difficulties. Propensity score matching was used to minimize selection bias between treatments in Jones fractures and proximal diaphyseal fractures. Results: In total, 489(43.2%) patients were diagnosed with a tuberosity avulsion fracture, 391(34.5%) patients with a Jones fracture and 253(22.3%) patients with a proximal diaphyseal fracture. In the tuberosity fracture group, a nonunion was found in 5.3%(25/473) of the patients treated conservatively and in 0%(0/16) treated operatively. For the Jones fractures and proximal diaphyseal fractures the non-union rate for conservative treatment was 10%(35/337) and 5.9%(14/238), and for surgical treatment 11%(6/54) and 0%(0/15), respectively. No independent risk factors for complicating the healing process of PFMF were identified. With propensity score matching, 37 patients treated operatively were matched to 37 patients undergoing conservative treatment. The risk for a nonunion was lower in the operative group compared to the conservative treatment group (relative risk 0.8, P=0.006). Conclusion: In this propensity-matched cohort, surgical treatment for Jones fractures and proximal diaphyseal fractures were associated with better fracture healing compared to conservative treatment. In addition, no factors were found to be associated with healing difficulties of proximal fifth metatarsal fractures.

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