Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes

Lee, Kyung Tai; Kim, Ki Chun; Young, Ki Won; Jegal, Hyuk; Park, Young Uk; Lee, Hong Seop; Roh, Youngju

doi:10.1177/2309499020926282

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…There is a plethora of non-operative treatment modalities, including elastic bandage support, non-weight-bearing casting, a hard-soled shoe, short-leg walking casts, and a cam walker boot (47,48,49,50,51,52). Various surgical techniques exist, with intramedullary screw fixation (6,13,36,53,54,55,56,57,58,59) with or without bone grafting, tension band constructs (60), and low-profile plates (61,62,63,64,65,66,67).…”

Section: Managementmentioning

confidence: 99%

“…Conservative vs surgical treatment is decided based on the fracture type, associated injuries, and individual patient characteristics. Controversies remain regarding surgical treatment options for fifth metatarsal fractures intramedullary screw fixation with or without bone grafting, tension band constructs (60), and low-profile plates (61,62,63,64,65,66,67) being the most popular, especially in the general population. Nevertheless, depending on the zone of fracture, several of these may be treated nonoperatively; however operative fixation (6,13,36) with intramedullary screw and possible biologic augmentation especially for the elite athletes with Zone 2 and 3 injuries remains the standard of care.…”

Section: Patient Specific Injury Specific Surgeon-specific Factors Medicationsmentioning

confidence: 99%

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Fifth metatarsal fractures: an update on management, complications, and outcomes

Chloros

Kakos²,

Tastsidis

et al. 2022

EFORT Open Reviews

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Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture. If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems. Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain. Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.

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Section: Managementmentioning

confidence: 99%

Section: Patient Specific Injury Specific Surgeon-specific Factors Medicationsmentioning

confidence: 99%

Fifth metatarsal fractures: an update on management, complications, and outcomes

Chloros

Kakos²,

Tastsidis

et al. 2022

EFORT Open Reviews

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show abstract

“…Delayed healing was observed after both operative 99,119,121,134,137,172,174 and nonoperative treatment 3,4,47,49,93,99,130 . Refractures were seen after both operative 40,115,134,156,161,162,172,175,182-184 and nonoperative 3,4,47,130 treatment.…”

Section: Complicationsmentioning

confidence: 99%

Fractures of the Base of the Fifth Metatarsal Bone

Bartoníček

Rammelt

2021

JBJS Reviews

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» Fractures of the proximal fifth metatarsal (PFMT) are one of the most common foot injuries, accounting for 61% to 78% of all foot fractures, but full consensus on their classification, diagnosis, and treatment has not yet been reached.» The most commonly accepted classification is that of Lawrence and Botte, who divided the location of PFMT fractures into 3 zones with respect to their healing potential.» Avulsion fractures of the tuberosity of the base (zone 1) generally heal well, and nonoperative treatment is commonly recommended.» Internal fixation may be considered for displaced fractures that extend into the fourth-fifth intermetatarsal joint (zone 2) as well as for nondisplaced fractures in athletes or high-demand patients, with the aims of reducing the healing time and expediting return to sport or work.» Stress fractures of the proximal diaphysis (zone 3) are preferably treated operatively, particularly in the presence of signs of delayed union. With nonoperative treatment, supportive measures such as ultrasonography or external/extracorporeal shockwave therapy have been demonstrated to have limited potential for the enhancement of fracture-healing.

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“…There are several nonsurgical treatment plans used for fifth metatarsal Jones fractures. These modalities vary by anatomical region of the fracture, patient history, and radiological findings[ 41 - 43 ]. Evidence-based medicine has assisted in the tailoring of individual treatment of metatarsal fractures.…”

Section: Non-surgical Treatmentmentioning

confidence: 99%

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

Albloushi¹,

Alshanqiti²,

Qasem³

et al. 2021

WJO

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Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels. These fractures may occur due to several mechanisms, but inversions and twisting injuries are considered some of the leading causes in sports. However, while Jones fracture incidences are frequent in the sporting world, there is still a lack of consensus on how such fractures should be effectively managed. There are numerous treatment options for patients with fifth metatarsal Jones fractures. The role of nonoperative treatment remains controversial, with concerns about delayed union and nonunion. Surgical stabilization of metatarsal Jones fractures is therefore often recommended for athletes, as it is often associated with a low number of complications and a higher rate of union than nonoperative management. This review will focus on literature regarding the prevalence of Jones type fifth metatarsal fracture, alongside the efficacy of both conservative and surgical treatment within this population.

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Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes

Cited by 4 publications

References 33 publications

Fifth metatarsal fractures: an update on management, complications, and outcomes

Fifth metatarsal fractures: an update on management, complications, and outcomes

Fractures of the Base of the Fifth Metatarsal Bone

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

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