Which Surgical Method is More Effective in the Fifth Metatarsal Base Fracture?

Abstract

Category: Trauma Introduction/Purpose: The aim of this study was to evaluate and compare the clinical and radiological results of internal fixation with headless cannulated screw and locking compression distal ulna hook plate for the fracture at the base of fifth metatarsal bone, Zone 1. Methods: From April 2012 to April 2015, thirty cases (29 patients) were evaluated retrospectively. The mean follow up periods was 13 months. There were divided two groups based on use of the screw (group A, n=15) or the plate (group B, n=15).We measured the displacement to diastasis of the fracture on the foot oblique radiographs taken pre- and post-operatively in each group, checked the time to bone union and the difference of the reduction distance in each group. Clinical results were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) midfoot score at 12 months postoperative. Results: In group A, the mean time to union was 54.2±9.3 days, the mean displacement to diastasis improved to 0.3±0.4 mm postoperatively (p<0.001), and the mean reduction distance was 2.9±1.0 mm. In group B, the mean time to union was 41.5±7.0 days, the mean displacement to diastasis improved to 0.06±0.2 mm postoperatively (p<0.001), and the mean reduction distance was 4.1±1.6 mm. AOFAS score was verified 97.7±3.4 in group A and 98.2±3.2 in group B. The time to union was significantly different between groups A and B (p=0.01).There were no complications. Conclusion: We suggest that the plate is more effective method for the shorter union time in surgical treatment of fifth metatarsal base fractures.

Fractures of the Base of the Fifth Metatarsal Bone

“…A below-the-knee cast is not required. Treatment outcomes have been excellent, regardless of the implant that was used 101,111,112,118-125 .…”

“…Options for internal fixation include Kirschner wires 111,112 , simple intraosseous wire fixation 30,113 , and tension-band wiring alone 76,109,114 or in combination with interfragmentary lag screws 115,116 . Several custom or preshaped plates for tuberosity fractures 117-121 , various types of screws 101,120-124 (Fig. 3), and, recently, anchors 125 are available.…”

“…5). Other types of internal fixation include a bicortical screw 123 , tension-band wiring, Kirschner wires 120 , and plates 118,119,145 . The latter are preferred for comminuted fractures, and designs include ulnar locking compression 119 and hook plates 145 .…”