Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review (original) (raw)
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Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review
Orthopaedic Journal of Sports Medicine
Background: As a result of the high physical demand in sport, elite athletes are particularly prone to fifth metatarsal fractures. These injuries are typically managed surgically to avoid high rates of delayed union and allow for quicker return to play (RTP). Purpose: To review studies showing clinical and radiographic outcomes, RTP rates, and complication rates after different surgical treatment modalities for fifth metatarsal fractures exclusively in elite-level athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was conducted within the PubMed, Scopus, and Cochrane databases from January 2000 to January 2020. Inclusion criteria consisted of clinical outcome studies after operative management of fifth metatarsal fractures in elite athletes. Exclusion criteria consisted of nonoperative management, high school or recreational-level athletic participation, nonclinical studies, expert opinions, and case series with <5 patients. Results: A t...
Journal of Human Kinetics
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...
Management and Prevention of 5th Metatarsal Stress Fracture in Sportive People
Orthopedics and Rheumatology Open Access Journal, 2017
Stress fractures of the 5 th metatarsus are common among sportive people, especially in runners. Because of difficulty in diagnosis and evaluation, sometimes these fractures remain without proper treatment. Anyway, after diagnosis, treatment should be properly conducted in order to avoid complications or relapses that may occur when athlete return to sport. The knowledge of risk factors and sportive movements that could be previous to this pathology is the first preventive strategy.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
The purpose of the present study is to assess the clinical results of the arthroscopic treatment of anterior ankle impingement and find predictive factors for poor results. Materials and Methods: Seventy cases (in 70 patients with an average 36 year old) of anterior ankle impingement with arthroscopic treatment were included in this prospective, continuous, multicenter study. Preoperative assessment included sport level, previous trauma (type of injury, type of treatment, delay before surgery), functional impairment (with the functional ankle score of Kitaoka, clinical symptoms of antero-lateral ankle impingement (Liu criteria) and duration of the symptoms before surgery. Intra-operative data with type of impingement (bone, soft tissue or mixed), cartilaginous lesions or synovitis were also assessed. All the patients were reviewed after a mean 17 months follow-up (minimal one year follow-up) with a postoperative clinical assessment including sport level, clinical symptoms, functional ankle score of Kitaoka and satisfaction. Statistical analysis was performed with Wilcoxon test and Mann-Withney test for continuous variables and an univariate and multivariate analysis was also performed for the assessment of predictive factors of poor results. Results: Most of the patients (86%) had had previous ankle trauma before developing anterior ankle impingement symptoms. The mean delay between first ankle trauma and surgery was 22 months. A tibio-talar synovitis was found in 87% of the cases. Only 64% of the patients had no cartilaginous lesion. Functional results were good or very good in 86% of the patients and the Kitaoka score was significatively improved from a mean 70.5 preoperative to a mean 87.2 at final follow-up. All the patients returned to sport activities, with the same level for 75%. Bad results were significantly associated with older patients, longer delay between trauma and arthroscopy, ankle laxity and osteoarthritis. Discussion: Anterior ankle impingement is a clinical syndrom with precise different physical signs and criteria. Arthroscopic treatment is simple and reliable with a 86% rate of good and very good results. In case of anterior ankle impingement longer than 2 years, with ankle laxity and joint space narrowing, the result after arthroscopic treatment is more uncertain.
Archives of Orthopaedic and Trauma Surgery, 2008
Introduction and purpose Intramedullary screw Wxation (ISF) of proximal Wfth-metatarsal fractures is known as Wrst treatment option in young, sports active patients. No study analyzed functional and biomechanical outcome before. Hypothetically ISF leads to (1) a high bony union rate within 12 weeks, (2) normal hindfoot eversion strength, and (3) normal gait and plantar pressure distribution. Methods Fourteen out of 22 patients were available for follow-up with an average follow-up of 42 months; clinical and radiological follow-up, and biomechanical evaluation by isometric muscular strength measurement (inversion, eversion strength) and dynamic pedobarography, comparing to the non-aVected contralateral foot. Level of signiWcance: 0.05. Results Subjective result: Excellent or good result in 14 patients, none fair or poor. AOFAS midfoot score: 100 points in 13 patients and 87 points in 1 patient. The same sports activity level (0-4) was reached in 13 out of 14 patients. Radiologic examination: consolidation after 6 weeks in 9 patients and after 12 weeks in another 4 patients, one partial union. Average maximal eversion strength 59 N (ratio to the contralateral foot: 0.92, not signiWcant). Dynamic pedobarography showed ratios of 0.99-1.01 to the contralateral side for ground reaction force, ground peak time, peak pressure and contact area (not signiWcant). Interpretation A very-high patient-satisfaction, a fast bony healing and complete return to sports were documented. Muscular strength measurement and dynamic pedobarography showed complete functional rehabilitation. Therefore, ISF in proximal Wfth-metatarsal fractures can be recommended as a secure procedure.
BMC musculoskeletal disorders, 2017
Fractures to the base of the fifth metatarsal are common, but their treatment remains controversial. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures. Of special interest were the influence of (1) the fracture location (L&B type I vs. II) and (2) the fracture characteristics (displacement, intra-articular involvement, communition) on the subjective outcome. Retrospective registry study with a prospective follow-up. Patients with an acute, isolated, epi-metaphyseal fracture to the fifth metatarsal bone (L&B type I and II) treated by full weightbearing with a minimum follow-up of 6 months were included. Fracture location (L&B type I and II) and characteristics ...
British Journal of Sports Medicine, 2007
Background: Stress fractures of the second metatarsal are common injuries in athletes and military recruits. There are two distinct areas in the second metatarsal where stress fractures develop: one proximal (at the base) and the other non-proximal (distal). Diagnosis can be difficult, and there is a difference in prognosis and treatment of the two types of stress fracture. Therefore differentiation of fracture location is warranted. Differences in risk factors and clinical outcomes between proximal and non-proximal stress fractures have not been studied. Objective: To determine whether different risk factors and/or clinical outcomes associated with proximal and non-proximal stress fractures of the second metatarsal exist. Methods: Patients diagnosed with proximal stress fractures of the second metatarsal were included in the study. Retrospectively, an age-matched control group with a non-proximal stress fracture was selected for comparison. Statistical analysis involved bivariate comparisons of demographic variables and clinical measurement between the two groups. Results: Patients with proximal stress fractures were more likely to be chronically affected, usually exhibited an Achilles contracture, showed differences in length of first compared with second metatarsal, were more likely to experience multiple stress fractures, and exhibited low bone mass. In addition, a high degree of training slightly increased the risk of a non-proximal fracture, whereas low training volume was associated with a proximal stress fracture. Conclusion: The signs, symptoms and clinical findings associated with proximal metatarsal stress fractures are different from those of non-proximal stress fractures.