FRACTURES OF THE FIFTH METATARSAL RESULTS OF THE EARLY OPERATIVE TREATMENT OF ACUTE DISPLACED FRACTURES
Background. Fracture of the proximal 5th metatarsal bone (MTB) reach almost 2% of all fractures of the foot. Conservative treatment is method of choice in almost all cases. Selected cases can benefit from acute surgery especially if the proximal fragment is severe displaced or the excessive articular step off is present.
Materials and methods. In a 4 year period 14 patients were operated due to the acute fracture of proximal 5th MTB. All patients were treated in less than 2 weeks after the injury. 10 patients had base avulsion fracture in zone I and 4 had Jones fracture in zone II with dislocation of fragments? 5 mm, articular step off of 2 mm and 30% of articulation surface. We used tension bend wire in 9 cases (64%), partially threaded cancellous screw in 4 cases (28%) and bone sutures in 1 case (7%). Postoperatively all patients used crutches with nonweight bearing for 4 weeks and afterwards partial weight bearing till the end of the treatment. All patients were practicing active exercises for ankle, foot and toes. The results were evaluated according to the Maryland Foot Score (MFS) at least 20 months after injury.
Results. 13 patients (93%) were included in follow up. 12 patients were evaluated as excellent and only one as a good. All 13 patients have no or slight pain with no change in ADL or work ability. 9 patients (69%) reached full functional result and 4 (31%) patients had slight limitation during distance walk. Patients reached full weight bearing in average 7 weeks (5–13).
Conclusions. Early operative treatment of selected cases allows fast return to preoperative activity without long term functional sequel. Both operative procedures, screw fixation and tension wire, yielded comparable and excellent end result.
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