Functional outcome of 103 fractures of the proximal fifth metatarsal bone

Background Metatarsal fractures are common skeletal injuries of the lower extremity in adults. The majority involves the proximal fifth metatarsal bone. In the current literature, there still exists controversy regarding treatment recommendations for the different fracture entities. Methods All patients suffering from single fractures to the proximal fifth metatarsal bone between 2003 and 2015 were enrolled in this retrospective analysis. Only patients with a minimum follow-up of 12 months were included. The fractures were classified according to Lawrence and Botte (L&B). Data were collected via patient registry, radiographs and a standardized questionnaire (Foot and Ankle Outcome Score = FOAS). For outcome analysis, the nonparametric Mann–Whitney U test was performed and Spearman’s rank correlation coefficient calculated. Results In total, the functional outcomes of 103 patients suffering from fractures to the proximal fifth metatarsal bone were analyzed. L&B type I fractures (n = 13) had a FAOS score of 91 ± 23, L&B type II (n = 67) presented a score of 91 ± 15 and L&B type III (n = 23) a score of 93 ± 11. Surgically treated patients with an L&B type II fracture had no statistically significant better functional outcome in comparison to conservative management (p = 0.89). Operatively treated L&B type III fractures tended to have a better functional score (p = 0.16). The follow-up time was 58 (min: 15; max: 164) months. Conclusions Overall, the functional outcome following fractures to the proximal fifth metatarsal bone is satisfactory. Conservatively treated L&B type II fractures showed an equivalent functional outcome compared to surgical management. Patients with an L&B type III fracture mainly were treated surgically, but difference in FAOS score did not reach level of significance.

Conservative Treatment of the Fifth Metatarsal Bone Fractures in Professional Football Players Using Platelet-Rich Plasma

Injuries of the metatarsal bones in football are relatively rare and in most cases are localized in the fifth metatarsal. The gold standard of the diagnosis of fractures in this area can be X-rays, which in most cases allows verifying the diagnosis. The treatment tactics depend on the localization of the fracture according to Lawrence and Botte’s classification: 3 zones of localization are distinguished. Fractures located in zones 2 and 3 belong to a high-risk group due to delayed consolidation and nonunion and therefore athletes are most often treated with osteosynthesis using intramedullary screws. The minimal recovery time for this type of treatment is at least 8 weeks. This report describes 7 cases of the fifth metatarsal bone fractures, located in zones 2 and 3 in professional football players who were treated with an immobilization boot, cryotherapy, nutritional supplements of calcium and vitamin D, and local injections of platelet-rich plasma, which contains numerous growth factors. The deadline for returning to regular training activities was 43 to 50 days, and there was no relapse of damage within 6 months of follow-up. Levels of Evidence: Level of evidence 4: case report study

Anatomic Characteristics of Tissues Attached to the Fifth Metatarsal Bone

Background: Two types of stress, bending stress and traction stress, have been reported to be involved in the mechanism of Jones fracture. However, little is known about the risk factors for traction stress. Purpose: To classify the attachment position of the peroneus brevis muscle (PB), peroneus tertius (PT), lateral band of the plantar aponeurosis (LB), and the long plantar ligament (LPL), focusing on the zone where a Jones fracture occurs (zone 2), and to compare the footprint area of each tissue type. Study Design: Descriptive laboratory study. Methods: This study examined 102 legs from 55 Japanese cadavers. Type classification was performed by focusing on the positional relationship between each tissue attachment and the zone where Jones fracture occurs (zone 2). The classifications were as follows: type I, attached proximal to the border between zones 1 and 2; type IIa, attached to the border between zones 1 and 2 with one attached part; and type IIb, attached across the border between zones 1 and 2 with two or more attached parts. The footprint areas of the PB, PT, LB, and LPL were compared between tissue types and within each attachment classification. Results: The PB was recorded as type I in 41 feet (40.2%), type IIa in 56 feet (54.9%), and type IIb in 5 feet (4.9%); the PT was recorded as type IIa in 54 feet (60.0%) and type IIb in 36 feet (40.0%); and the LB was recorded as type I in 27 feet (26.5%) and type IIa in 75 feet (73.5%). The LPL did not attach to the fifth metatarsal bone. No significant difference was found in the footprint area between type I PB and type I LB. Conclusion: The results indicate that type I, which attaches proximal to zone 2, occurs with PB and LB, and there was no significant difference in the footprint area between them. These findings suggest that type I is involved in traction stress. In the future, biomechanical research based on the results of this study will be necessary. Clinical Relevance: The results of this study provide basic research for investigating the mechanism of Jones fracture and the cause of delayed healing.

Pathoanatomy of the Jones Fracture in Male University Soccer Players

Background: Jones fractures are relatively common in soccer players and require an extended recovery period because this type of fracture has a high incidence of delayed union, nonunion, and refracture. There has been some previous research on risk factors for Jones fracture, but no study has yet investigated the effect of the length of the fifth metatarsal bone and the positional relationship of the articular surface of the fifth metatarsal bones and the tarsal bones. Clarification of the characteristics of the foot structure that predispose soccer players to Jones fracture may aid in the prevention of this injury. Purpose: To investigate the association between Jones fracture and foot structure as assessed with a mapping system on weightbearing dorsoplantar and lateral foot radiographs. Study Design: Cohort study; Level of evidence, 3. Methods: We used a mapping system to evaluate the radiographs of 60 feet from 30 university soccer players with Jones fractures and a control group of 60 feet from 60 male university soccer players without Jones fracture. The groups were compared regarding the length of the fifth metatarsal and the positions of the metatarsal and tarsal bones. Results: Analysis of weightbearing dorsoplantar foot radiographs showed that the fifth metatarsal was significantly longer and that its proximal tip was positioned more proximally in the Jones fracture group as compared with the control group. Analysis of weightbearing lateral foot radiographs showed that the reference points for the medial arch were significantly higher in the Jones fracture group than in the control group. Conclusion: This study indicated that the proximally longer fifth metatarsal may cause greater stress at the base of the fifth metatarsal bone because the lever arm becomes long. In addition, high medial longitudinal arch may contribute to increased load on the lateral side of the foot. Thus, these anatomic features may be useful to identify soccer players at high risk of Jones fracture at medical checkup.