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(a) The fifth metatarsal base avulsion fracture confirmed by X-ray. (b) The X-ray after surgery. A hollow screw of 3.0 mm was tapped. (c) The X-ray 12 months after surgery. (d) The fifth metatarsal base avulsion fracture confirmed by CT scan. (e) The incision of 1 cm made at the entry point of Kirschner wire. (f) The Kirschner wire penetrated through the vertex of the fifth metatarsal proximal tuberosity along the fracture line till the contralateral cortex percutaneously. CT: computed tomography.
Source publication
Purpose:
This study aimed to investigate the therapeutic effects and complications of minimally invasive surgery in treating displaced avulsion fractures (2-3 mm) of fifth metatarsal base zone I in young adults or athletes.
Methods:
Forty-six patients with displaced fifth metatarsal base avulsion fractures were assigned to operative and nonopera...
Contexts in source publication
Context 1
... January 2009 to January 2015, a total of 46 patients with displaced (2-3 mm) fifth metatarsal base avulsion fracture (Figure 1(a)) were included. Five patients (11%) lost to follow-up at 12 months after treatment. ...
Context 2
... criteria were as follows: patients with dis- placed (2-3 mm) fifth metatarsal base avulsion fracture (Figure 1(a) and 1(d)), patients aged 18-35 years (young adults or athletes), and patients with fracture within 2 weeks. Exclusion criteria were as follows: patients with other metatarsal fracture besides the fifth metatarsal frac- ture, patients with open fracture, patients with pathological fracture, patients with osteoporotic fracture, or patients with a history of surgery on the affected foot or ankle. ...
Context 3
... tip of the clamp is placed proximally at the inferior side of the fifth metatarsal base to avoid sural nerve injury, and the other tip is placed distal to the fracture site, along the metatarsal shaft. A Kirschner wire (Figure 1(f)) was penetrated through the vertex of the fifth metatarsal proximal tuberosity along the fracture line till the contralateral cortex percutaneously. An incision of 1 cm was made at the entry point of Kirschner wire ( Figure 1(e)). ...
Context 4
... Kirschner wire (Figure 1(f)) was penetrated through the vertex of the fifth metatarsal proximal tuberosity along the fracture line till the contralateral cortex percutaneously. An incision of 1 cm was made at the entry point of Kirschner wire ( Figure 1(e)). Incision should be made at the plantar side of the fifth metatarsal base in order to avoid sural nerve injury. ...
Citations
... For the four most common fractures ( ngers, metacarpals, carpals, and metatarsals), there was no difference in RTP time between treatment methods. Previous studies have reported that surgical treatment with xation tended to result in faster fracture healing than conservative treatment (25)(26)(27)(28). In this study, however, conservative treatment tended to result in a shorter RTP time. ...
The aim of the study was to analyze fracture injuries and post-fracture management in elite taekwondo sparring athletes, with a specific focus on weight classes. Data were collected through a survey of 182 Korean taekwondo athletes using convenience sampling and self-administration methods. Approximately 58% of participants experienced taekwondo-related fractures, with heavyweight players having a significantly higher rate than lightweight players (χ²=3.87, p = .049). Overall, taekwondo-related fractures were most common in the hand region, during defensive maneuvers and caused by a player contact mechanism. Heavyweight players were more likely to sustain fractures during competition, while lightweight players were more likely to sustain fractures during training (χ²=6.39, p = .011). Heavyweight players were more likely to have surgery after fractures, whereas lightweights were more likely to have conservative treatment (χ²=4.270, p = .039). About half of the players (51.4%) returned to play without a diagnosis of bone union after their fractures, and the greatest psychological distress for players after fractures was concern about re-injury (57.2%). The current findings suggest that the fracture injury characteristics of elite taekwondo sparring athletes differ by weight class, highlighting the importance of a weight class-specific injury prevention and management program.
... In our study, the AOFA and VAS score was better after 3 months of surgery. Patients had an excellent outcome which is similar to the study of Wu et al., 8,22 who demonstrate a 100% union rate by the use of cannulated screws for displaced fifth metatarsal fractures with an average union time of 6-8 weeks. ...
Background: The fracture of the base of the fifth metatarsal is one of the common fractures that occur in 5th decade of life in the foot. Stable fixation with the cannulated cancellous screw provided early healing and patients can return to their work early.
Aims and Objectives: The aim of the study is to find the functional outcome of closed reduction and internal fixation with cannulated cancellous screw fixation for the displaced base of fifth metatarsal fractures, to evaluate the clinical and radiological union of fifth metatarsal fractures, and to study the complications of treatment of fifth metatarsal fractures.
Materials and Methods: This prospective study was conducted in the Department of Orthopaedics Manipal teaching hospital Pokhara, Nepal, from February 2022 to January 2023. A total of 35 patients with the fractured fifth metatarsal base were included in the study. The patient was kept in a supine position with a pillow under the knee so that the knee was flexed to 90° and the foot was plantigrade. A cannulated cancellous screw of the appropriate size was inserted along with a washer to fix the fracture.
Results: There were a total of 35 patients with the base of 5th metatarsal fractures. The mean age of the patient was 36.94±8.04 years, with males 22 (62.9%) and females 13 (37.1%). The left side commonly involves 22 (62.9%). The history twisting injury is the most common mode of injury. All patients had a union of fracture by 7.09±1.07 weeks ranging from 6 to 9 weeks. There were no cases of sural nerve injuries in our study.
Conclusion: The base of fifth metatarsal fractures is commonly seen in athletes and patients around 40 years of age. Closed reduction under image guidance and stable fixation with cannulated cancellous screw fixation provides early healing of fractures. Patients can return to work early.
... The treatments for the avulsion fractures of the fifth metatarsal base are also diverse [19]. Although Some studies [20][21][22] showed the majority of the fifth metatarsal base avulsion fractures are successfully treated nonoperatively. Although it was not the aim of our study, we followed 30 conservatively treated patients for 3 months and 5 patients (all of them had type III fractures) experienced fracture redisplacement. ...
Background
To clarify the injury mechanism of the avulsion fracture of the fifth metatarsal combining 3-dimensional (3D) fracture mapping with anatomical measurements.
Methods
Two hundred twenty-two patients with the avulsion fractures of the fifth metatarsal base, who were admitted to our hospital from August 2015 to August 2020. The computed tomography (CT) scans were used to generate the 3-D images of all mapped fracture lines for the avulsion fractures of the fifth metatarsal base were compiled in an overall 3D image. The fifth metatarsal base of 8 unpaired lower limbs of adult Asian frozen cadaveric specimens were also dissected to observe and measure the specific locations of the attachment points of the peroneus brevis, lateral band of the plantar fascia, and peroneus tertius to the fifth metatarsal base.
Results
Based on the type of fracture line produced and the specific locations of the attachment points of the tendons or fascia, the avulsion fractures of the fifth metatarsal base can be classified into three types: type I predominantly involves the action of the lateral band of the plantar fascia; type II predominantly involves the action of the peroneus brevis; type IIIA involves the joint action of the peroneus brevis and lateral band of the plantar fascia with one fracture line, and type IIIB involves the joint action of the peroneus brevis and lateral band of the plantar fascia with two fracture lines.
Conclusion
The lateral band of the plantar fascia and peroneus brevis play a major role, either separately or together, in avulsion fractures of the fifth metatarsal base. With this knowledge, we propose a novel classification based on the injury mechanism, which can serve as a reference for clinical treatment and diagnosis.
Level of evidence
Level III, retrospective case series.
... The clinical treatments for the fth metatarsal base avulsion fractures are also diverse [19][20][21] . Although some study showed the vast majority of the fth metatarsal base avulsion fractures are very successfully treated non-operatively, we followed up 30 conserved treated patients for 3 months from January 2021 to September 2021 and 5 patients (all of them were type III) experienced fracture redisplacement. ...
Background: To clarify the injury mechanism of the avulsion fracture of the fifth metatarsal combining 3-dimensional (3D) fracture mapping with anatomical measurements.
Materials and Methods: 222 patients with the fifth metatarsal base avulsion fractures, who were admitted to our hospital from August 2015 to August 2020. The 3D images of all mapped fracture lines for the fifth metatarsal base avulsion fractures were compiled in an overall 3D image. The fifth metatarsal base of 8 unpaired lower limbs of adult Asian frozen cadaveric specimens were also dissected to observe and measure the specific locations of the attachment points of the peroneus brevis, lateral band of the plantar fascia, and peroneus tertius to the fifth metatarsal base.
Results: Based on the type of fracture line produced and the specific locations of the attachment points of the tendons, the fifth metatarsal base avulsion fractures can be classified into three types: type I predominantly involves the action of the lateral band of the plantar fascia; type II predominantly involves the action of the peroneus brevis; type IIIA involves the joint action of the peroneus brevis and lateral band of the plantar fascia with one fracture line; type IIIB involves the joint action of the peroneus brevis and lateral band of the plantar fascia with two fracture lines.
Conclusion: The lateral band of the plantar fascia and peroneus brevis play a major role in the fifth metatarsal base avulsion fracture together or separately and proposed a novel classification based on the injury mechanism, which can serve as a reference for clinical treatment and diagnosis.
Level of Evidence: Level Ⅲ, retrospective case series.
... For fifth MBF without displacement, good therapeutic results can be achieved by conservative treatment [20]. The accepted treatment method for the fifth MBF with displacement more than 2 mm and involving more than 30% of the fifth metatarsal base-cuboid joint is operative intervention [21,22]. In this study, an LCAL injury needed to be actively confirmed before surgery. ...
Background
Fifth metatarsal base fracture (fifth MBF) and lateral collateral ankle ligament (LCAL) injury are mainly caused by plantar flexion and inversion of the foot. However, there is no relevant report on the incidence, injury type and treatment principle of the fifth MBF combined with an LCAL injury.
Materials and methods
We retrospectively analyzed 61 patients with fifth MBF. After admission, patients were given the symptomatic treatment and underwent standard anteroposterior (AP), 30-degree oblique foot radiographs, ankle MR and/or ultrasonic examination. The type of surgery varied base on the individual patients (type of fracture with/without lateral collateral ankle ligament injury).
Results
In 61 patients, there were 39 patients with LCAL injury. Among the 39 patients with LCAL injury, 24 patients with Grade I–II injury, 6 patients with Grade III injury, and 9 patients with avulsion fractures. There was no significant difference between the patients without LCAL injury and the patients with LCAL injury in terms of age ( p = 0.67) and gender ( p = 0.575). The incidence of fifth MBF with LCAL injury accounted for 63.93% of fifth metatarsal base fracture; the most common causes of injury included sprains and falls. The average fracture healing time was 8.3 (range, 6–12) weeks. For fifth MBF with displaced more than 2 mm, hook plate or lag screw was used for fixation; for complete rupture of LCAL, suture anchor was used to repairing the ligament; for partial LCAL injury, plaster was used for fixation after surgery; for avulsion fractures, cannulated screw or suture anchor was used for repair. None of the patients had complications such as delayed union, nonunion, and incision infection.
Conclusion
Early diagnosis and appropriate treatment can obtain good therapeutic results in fifth MBF patients combined with LCAL injury. Moreover, defining a treatment plan for ligament injury is essential for reducing postoperative complications. This study provides a basis for epidemiology, diagnosis, and treatment of fifth MBF with LCAL injury.
... One prospective randomized study comparing nonoperative and operative treatment in zone-1 fractures with displacement of $2 mm did not reveal any significant difference in visual analog scale (VAS) pain and American Orthopaedic Foot & Ankle Society (AOFAS) scores 98 . Another prospective randomized study in young adults and athletes found significantly higher (p , 0.05) AOFAS scores at 6 weeks, lower VAS scores at 12 months, and an earlier return to work after minimally invasive screw fixation when compared with nonoperative treatment in a cast 101 . Similar results were seen in a nonrandomized prospective cohort study in athletes 102 . ...
... OCTOBER 2021 · VOLUME 9, ISSUE 10 · e21.00010 Treatment outcomes have been excellent, regardless of the implant that was used101,111,112,[118][119][120][121][122][123][124][125] . Numerous authors have reported union rates between 96% and 100% with full weight-bearing as tolerated by the patient for 6 to 8 weeks with the use of an elastic bandage or a hard-soled shoe 52,89, 94,95,99,128 . ...
»:
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.
... 19 Both of these studies showed that operative intervention correct the displacement, angulation, rotational deformity that maintain the length of fifth metatarsal and stabilization of insertions of both ligaments and tendons. 20 Their report showed that operative management of displaced fifth metatarsal zone I avulsion fractures in young adults or athletes can result in better outcomes in short-term compared with conservative treatment. Although the AOFAS scores at 12 months after treatments showed no significant difference between surgical and conservative management, non-operative management may increase the incidence of post-trauma complications including delayed union, malunion, nonunion, re-fracture, pain, and even malfunction of mid-foot. ...
... In addition, cannulated screw can offer certain compression at fracture site to maintain anatomic reduction, all of which provided a good condition for bone union and allowed for early rehabilitation exercises. 20 Even though we had not separated the small fragment and large fragment fractures separately in our study, we agree with Wu et al. with use of cannulated screw for surgical fixation of the fracture, however we prefer open reduction and TBW for type I and II varieties because fracture fragment may be very small occasionally which could be easily broken with screw insertion. 20 However we fully agree with use of cannulated screw for type III fractures because of larger fracture fragment and tendency of increased nonunion in these fractures. ...
... 20 Even though we had not separated the small fragment and large fragment fractures separately in our study, we agree with Wu et al. with use of cannulated screw for surgical fixation of the fracture, however we prefer open reduction and TBW for type I and II varieties because fracture fragment may be very small occasionally which could be easily broken with screw insertion. 20 However we fully agree with use of cannulated screw for type III fractures because of larger fracture fragment and tendency of increased nonunion in these fractures. ...
BackgroundThe treatment of displaced base of fifth metatarsal fracture remains controversial regarding the conservative and operative treatment.ObjectiveTo investigate the therapeutic effect of operative and non-operative treatment for base of fifth metatarsal fractures.Method This was retrospective comparative study performed in Civil Service Hospital, Kathmandu, Nepal from December 2014 to November 2019. Patients were randomly divided into two groups by computer generated technique. Group1 included 17 patients who underwent open reduction and internal fixation using tension band wiring, whereas group 2 included 17 patients who underwent non-operative treatment with boot cast.ResultThe AOFAS and VAS-FA scores at 3 months in operative and non-operative groups were 89.34±2.14 versus 86.94±2.22 (p < 0.05) and 5.58±0.87 versus 3.58±0.93 (p < 0.05). Similarly, AOFAS and VAS-FA at 12 months after treatment were 90.94±2.43 versus 90.17±1.55 (p > 0.05) and 0.64±0.280.94±0.39 (p > 0.05) in operative and non-operative groups respectively. The average time to bear full weight and return to work were 6.82±1.13 versus 7.08±1.24 weeks (p > 0.05) and 8.76±1.20 versus 10.35±1.41 weeks ( p < 0.05) respectively. The mean of VAS score at 3months of treatment is 5.58±0.87 for non-operative group and 3.58±0.93 for operative group (p <0.05). ConclusionOperative intervention has been preferred over the non-operative treatment in young adults or athletes with more than 3 mm displaced fifth metatarsal base fracture to achieve anatomical reduction of fracture, hasten the recovery and rehabilitation and to decrease the complications associated with non-operative treatment.
... After surgical treatment, only one refracture was reported (due to an opponent's foul). A higher recurrence rate in the group with conservative treatment, especially athletes, has also been reported in other studies (Wu et al., 2018;Yates et al., 2015). Another problem is the nonunion bone rate, which ranges from 11 to 50% considering conservative treatment (Yates et al., 2015;Valkier et al., 2020). ...
The 5th metatarsal fracture is a common foot fracture which could exclude a player from competition for several months and significantly affect his or her career. This manuscript presents the treatment and rehabilitation of professional soccer players who had acute fractures of the 5th metatarsal bone and a cannulated screw fixation. The main purpose of the analysis was to determine the minimum time necessary for a permanent return to the sport after a 5th metatarsal fracture among professional soccer players. We followed the surgical and rehabilitation path of 21 professional soccer players from the Polish League (Ist and IInd divisions) who suffered from the 5th metatarsal bone fracture. All players underwent standard percutaneous internal fixation with the use of cannulated screws. The total inability to play lasted for 9.2 (± 1.86) weeks among players treated only surgically (n = 10), 17.5 (± 2.5) weeks in the conservative and later surgery group, excluding players with nonunion (n = 6), and 24.5 (± 10.5) weeks for nonunion and switch treatment (n = 4) players. Prompt fracture stabilization surgery is recommended for athletes, enabling the implementation of an aggressive rehabilitation protocol as soon as possible. Early limb loading after surgery (from week 2) does not delay fracture healing or hinder the bone union, thus rehabilitation plays a crucial role in shortening the time of RTP (return to play) and is obligatory for each athlete who undergoes surgical treatment.
... 19 Both of these studies showed that operative intervention correct the displacement, angulation, rotational deformity that maintain the length of fifth metatarsal and stabilization of insertions of both ligaments and tendons. 20 Their report showed that operative management of displaced fifth metatarsal zone I avulsion fractures in young adults or athletes can result in better outcomes in short-term compared with conservative treatment. Although the AOFAS scores at 12 months after treatments showed no significant difference between surgical and conservative management, non-operative management may increase the incidence of post-trauma complications including delayed union, malunion, nonunion, re-fracture, pain, and even malfunction of mid-foot. ...
... In addition, cannulated screw can offer certain compression at fracture site to maintain anatomic reduction, all of which provided a good condition for bone union and allowed for early rehabilitation exercises. 20 Even though we had not separated the small fragment and large fragment fractures separately in our study, we agree with Wu et al. with use of cannulated screw for surgical fixation of the fracture, however we prefer open reduction and TBW for type I and II varieties because fracture fragment may be very small occasionally which could be easily broken with screw insertion. 20 However we fully agree with use of cannulated screw for type III fractures because of larger fracture fragment and tendency of increased nonunion in these fractures. ...
... 20 Even though we had not separated the small fragment and large fragment fractures separately in our study, we agree with Wu et al. with use of cannulated screw for surgical fixation of the fracture, however we prefer open reduction and TBW for type I and II varieties because fracture fragment may be very small occasionally which could be easily broken with screw insertion. 20 However we fully agree with use of cannulated screw for type III fractures because of larger fracture fragment and tendency of increased nonunion in these fractures. ...
Background The treatment of displaced base of fifth metatarsal fracture remains controversial regarding the conservative and operative treatment. Objective To investigate the therapeutic effect of operative and non-operative treatment for base of fifth metatarsal fractures. Method This was retrospective comparative study performed in Civil Service Hospital, Kathmandu, Nepal from December 2014 to November 2019. Patients were randomly divided into two groups by computer generated technique. Group1 included 17 patients who underwent open reduction and internal fixation using tension band wiring, whereas group 2 included 17 patients who underwent non-operative treatment with boot cast. Result The AOFAS and VAS-FA scores at 3 months in operative and non-operative groups were 89.34±2.14 versus 86.94±2.22 (p < 0.05) and 5.58±0.87 versus 3.58±0.93 (p < 0.05). Similarly, AOFAS and VAS-FA at 12 months after treatment were 90.94±2.43 versus 90.17±1.55 (p > 0.05) and 0.64±0.280.94±0.39 (p > 0.05) in operative and non-operative groups respectively. The average time to bear full weight and return to work were 6.82±1.13 versus 7.08±1.24 weeks (p > 0.05) and 8.76±1.20 versus 10.35±1.41 weeks ( p < 0.05) respectively. The mean of VAS score at 3months of treatment is 5.58±0.87 for non-operative group and 3.58±0.93 for operative group (p <0.05). Conclusion Operative intervention has been preferred over the non-operative treatment in young adults or athletes with more than 3 mm displaced fifth metatarsal base fracture to achieve anatomical reduction of fracture, hasten the recovery and rehabilitation and to decrease the complications associated with non-operative treatment.
... G.B.Wu [17]for example, compared the effectiveness of operative and non-operative interventions on 41 young adults, during a one year follow up. The authors reported that internal fixation of an avulsion fracture (2 to 3 mm displacement) allowed substantial enhancements in the clinical outcomes such as rate and duration of union as compared to the group administered immobilization with a plaster cast. ...
