The Fifth Metatarsal Bone Fracture In Athletes ‐ Modalities of Treatment Related to Agility In Soccer Players

The 5th metatarsal fracture is a common foot fracture which could exclude a player from competition for several months and significantly affect his or her career. This manuscript presents the treatment and rehabilitation of professional soccer players who had acute fractures of the 5th metatarsal bone and a cannulated screw fixation. The main purpose of the analysis was to determine the minimum time necessary for a permanent return to the sport after a 5th metatarsal fracture among professional soccer players. We followed the surgical and rehabilitation path of 21 professional soccer players from the Polish League (Ist and IInd divisions) who suffered from the 5th metatarsal bone fracture. All players underwent standard percutaneous internal fixation with the use of cannulated screws. The total inability to play lasted for 9.2 (± 1.86) weeks among players treated only surgically (n = 10), 17.5 (± 2.5) weeks in the conservative and later surgery group, excluding players with nonunion (n = 6), and 24.5 (± 10.5) weeks for nonunion and switch treatment (n = 4) players. Prompt fracture stabilization surgery is recommended for athletes, enabling the implementation of an aggressive rehabilitation protocol as soon as possible. Early limb loading after surgery (from week 2) does not delay fracture healing or hinder the bone union, thus rehabilitation plays a crucial role in shortening the time of RTP (return to play) and is obligatory for each athlete who undergoes surgical treatment.

Multiple Metatarsal Fractures: The First Manifestation of Cushing's Disease—A Case Report

Cushing's syndrome is an uncommon clinical condition most frequently presenting with central obesity, facial rounding, proximal muscle weakness, and skin thinning. The objective of this case report is to highlight an unusual presentation of Cushing's syndrome. A 35-year-old woman presented to the orthopedic clinic with a 1-year history of foot pain without any history of trauma. Radiography of the foot showed multiple metatarsal fractures. Evaluation for secondary causes of reduced bone strength revealed that the patient had Cushing's disease, although other typical signs and symptoms were not remarkable. It can be concluded that Cushing's syndrome should always be included in the differential diagnosis of foot fracture without any evidence of trauma.

Complex regional pain syndrome and bone marrow oedema syndrome: family ties potentially closer than expected

Complex regional pain syndrome (CRPS) and bone marrow edema syndrome (BMES) are two rare conditions that are still being discussed. They are generally considered as two distinct entities, yet they share similarities such as a homogeneous bone marrow edema is also often found in the early phase of CRPS. We present the case of a 41-year-old man with CRPS after a foot fracture followed by the development of painful BMES of the ipsilateral knee and hip a few weeks later. The search for another pathology was negative. After pamidronate infusions, the evolution was spectacular: the disappearance of hip pain at 1 month and more than 50% reduction in knee and foot pain at 2 months. At final follow-up (1 year), the patient was asymptomatic. This case reinforces the idea of a possible link between CRPS and BMES probably through similar trabecular bone involvement. Imaging remains useful in diagnosis of CRPS.

Radiologic Evaluation of Lower Leg, Ankle, and Foot Fracture Fixation Hardware

Radiologists should be familiar with basic principles of fracture fixation and the normal imaging appearances of implant constructs and their complications. The surgeon's selection of external fixation, intramedullary nail fixation, open reduction and internal fixation, or some combination depends on patient factors, fracture configuration, injury to the soft tissue envelope, and surgeon experience. Complications including loss of fixation with resultant malalignment, nonunion, infection, and posttraumatic osteoarthritis present additional challenges for the surgeon as well as the radiologist. This article reviews the rationale behind fracture fixation in fractures of the lower leg, ankle, and foot. Examples of postoperative complications are also reviewed.

ANKLE AND MIDFOOT FRACTURES;

Objectives: To determine the diagnostic accuracy of Ottawa rule in ankle andmidfoot fracture keeping x-ray as gold standard. Study Design: Descriptive study. Setting:Department of Orthopedics, Lady Reading Hospital Peshawar. Period: June 2014 to May 2016.Materials and Methods: Through a Cross Sectional Study Design, a total of 175 patientspresenting with suspicion of ankle/mid foot fracture were selected in a consecutive mannerfrom the OPD and subjected to detection of fracture through Ottawa Ankle Rule followed byX-ray to confirm the diagnosis of fracture. Results: The mean age group of patients in ourstudy was 36.1+10.4 years. There were 85.7% males and 14.3% were females. The sensitivityanalysis shows OAR has a sensitivity of 81.2% and specificity 61.9%., positive predictive valueof the OAR is 79.1% and negative predictive value is 65.0% keeping X-ray as a gold standard.Conclusion: The overall sensitivity and specificity of the OAR lies within an acceptable rangein our local population however, we still recommend further research work over it beforerecommendations as a routine screening test for the fracture of ankle or mid foot.