FRACTURES OF THE FIFTH METATARSAL RESULTS OF THE EARLY OPERATIVE TREATMENT OF ACUTE DISPLACED FRACTURES

  • Slaviša Mihaljević Oddelek za travmatologijo Splošna bolnišnica Celje Oblakova 5 3000 Celje
  • Drago Brilej Oddelek za travmatologijo Splošna bolnišnica Celje Oblakova 5 3000 Celje
  • Miloš Kosanović Oddelek za travmatologijo Splošna bolnišnica Celje Oblakova 5 3000 Celje
  • Radko Komadina Oddelek za travmatologijo Splošna bolnišnica Celje Oblakova 5 3000 Celje
  • Miodrag Vlaović Oddelek za travmatologijo Splošna bolnišnica Celje Oblakova 5 3000 Celje
Keywords: proximal 5th metatarsal bone, fracture, operative treatment, outcome

Abstract

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.

Downloads

Download data is not yet available.

References

Yu WD, Shapiro MS. Fracture of the fifth metatarsal. Phis Sportsmedicine 1998; 26: 47–7.

Clapper MF, OBrien TJ, Lyons PM. Fractures of the fifth metatarsal. Analysis of a fracture registry. Clin Orthop 1995; 315: 238–41.

Fernandez FM, Guillen J, Busto JM, Roura J. Fractures of the fifth metatarsal in basketball players. Knee Surg Sports Traumatol Arthrosc 1999; 7: 373–7.

Heineck J, Liebscher T, Zwipp H. Fifth metatarsal base avulsion fractures. Orthop Trauma 2000; 2: 141–7.

Strayer SM, Reece SG, Petruzzi MJ. Fractures of the proximal fifth metatarsal. American Family Physician 1999; 59: 2516–23.

Buckley RE, Meek RN. Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. J Orthop Trauma 1992; 6: 195–205.

Jones R. Fracture of the base of the fifth metatarsal bone by inderect violence. Am Surg 1902; 35: 697–7.

Richli WR, Rosentol DI. Avulsion fracture of the fifth metatarsal: expermental study of patomechanics. Am J Radiol 1984; 143: 889–9.

Stewart IM. Jones fracture: fracture of the base of the fifth metatarsal. Clin Orthop. 1960; 16: 190–8.

Nunley JA. Fractures of the base of the fifth metatarsal. The Jones fracture. Orthopedic Clinics of North America 2001; 32: 171–80.

Clapper MF, O’Brien TJ, Lyons PM. Fracture of the fifth metatarsal: analysis of a fracture registry. Clin Orthop 1995; 315: 238–8.

Wiener BD, Linder JF, Giattini JF. Treatment of fractures of the fifth metatarsal: a prospective study. Foot Ankle Int 1997; 18: 267–9.

Husain ZS, DeFronzo DJ. Relative stability of the tension band versus twocortex screw fixation for treating fifth metatarsal base avulsion fractures. J Foot Ankle Surg 2000; 39: 89–95.

OShea MK, Spak W, Sant Anna S, Johnson C. Clinical perspective of the treatment of fifth metatarsal fracture. J Am Pediatr Med Assoc 1995; 85: 472– 80.

How to Cite
1.
Mihaljević S, Brilej D, Kosanović M, Komadina R, Vlaović M. FRACTURES OF THE FIFTH METATARSAL RESULTS OF THE EARLY OPERATIVE TREATMENT OF ACUTE DISPLACED FRACTURES. ZdravVestn [Internet]. 1 [cited 27May2019];73(4). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2300
Section
Professional Article