ContextFractures of proximal fifth metatarsal are one of the most common fractures of the foot.Evidence AcquisitionA search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.ResultsThe vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.ConclusionsLawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

Introduction: Partial knee replacement (PKR) is one of the treatment options in middle-aged patients with less extensive knee osteoarthritis, with unicompartmental knee replacement (UKR) most commonly done for medial osteoarthritis. There are numerous advantages like bone/ligament preserving and faster recovery. However, the indications of UKR remain controversial, as most patients have some patellofemoral joint (PFJ) osteoarthritis. We performed modular bicruciate-retaining bicompartmental knee replacement (BKR) in this group of patients and compared the outcome with total knee replacement (TKR). Materials and Methods: From 2016 to 2017, 14 BKR were performed in patients with medial and PFJ osteoarthritis. They were retrospectively compared with 14 TKR performed in patients with similar age and severity. The incision length, operative time, blood loss (in terms of hemoglobin drop), and length of stay were recorded. Pre- and postoperative range of motion and Knee Society knee score at 1-year follow-up were compared. Results: The mean incision length for BKR was shorter than TKR (130.1 vs. 185.1 mm), but the mean operative time was also longer (152.6 vs. 88.1 min). There was also less mean hemoglobin drop (1.8 vs. 2.6 g/dL) and shorter length of stay (7.4 vs. 9.2 days). The mean postoperative function score is better in BKR group (90.4 vs. 77.5), and the mean postoperative knee score (87.2 vs 88.9) and flexion (115.7° vs. 111.4°) were similar for both groups. Discussion: In selected patients, BKR is a good alternative to TKR. It preserves advantages of UKR while also tackle the PFJ which is the most controversial aspect of UKR. The early clinical outcome in our study is promising. However, there is a learning curve. Longer follow-up is necessary to study on the performance and survivorship as compared with UKR and TKR.