Operative Results of Plantar Plating for Fifth Metatarsal Stress Fracture

Abstract

Background: The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating. Methods: Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months. Results: The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks. Conclusion: With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems. Level of Evidence: Level IV, case series.

Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review

“…Compression plating and tension band wiring allow for direct visualization of the fracture, counter the tensile forces of the lateral and plantar aspect of the fifth metatarsal, provide torsional control, and avoid disruption of the blood supply as the primary nutrient artery to the fifth metatarsal enters from the dorsomedial aspect. 30 , 51 The present study found comparable rates of refracture for plantar plating (8.7%; 4/46 fractures) compared with reported refracture rates with intramedullary screw fixation. Additionally, Young et al 51 reported a 23.7% rate of hardware removal in a cohort of 38 patients after plantar plating, in which 2 patients reported hardware prominence and 7 preferred plate removal.…”

“… 30 , 51 The present study found comparable rates of refracture for plantar plating (8.7%; 4/46 fractures) compared with reported refracture rates with intramedullary screw fixation. Additionally, Young et al 51 reported a 23.7% rate of hardware removal in a cohort of 38 patients after plantar plating, in which 2 patients reported hardware prominence and 7 preferred plate removal. Lee et al 27 treated 75 patients who had fifth metatarsal fractures by using lateral tension band fixation and achieved 88% radiographic union with a mean time to union of 14.1 weeks.…”

“…Some form of intraoperative adjunctive treatment was used in 67.1% of cases (188/280). Ipsilateral calcaneal autograft was the most common source of bone graft, 3 , 8 , 17 , 27 , 28 , 51 followed by iliac crest bone autograft, proximal tibial autograft, and distal tibial autograft. 18 , 21 , 22 , 32 , 45 Various techniques for bone grafting were used, from minimally invasive subperiosteal injections to open inlay procedures.…”

“…Additionally, perioperative vitamin D assessment and supplementation were conducted in only 3 studies. 3 , 32 , 51 Bone stimulators were used postoperatively in 3 studies as well. 21 , 28 , 32 A summary of the adjunctive therapies used is outlined in Table 3 .…”

“…Vitamin D testing and supplementation of vitamin D were mentioned in only 3 of the included studies. 3 , 32 , 51 Fishman et al 11 examined vitamin D levels in professional NBA players and found that nearly 80% of players were either deficient (<20 ng/mL) or insufficient (20-32 ng/mL). Shimasaki et al 40 reported that soccer players with 25(OH)D 3 serum levels <20 ng/mL were nearly 3 times as likely to develop a fifth metatarsal stress fracture compared with players who had serum levels >20 ng/mL.…”