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Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series.

Tsukada S, Ikeda H, Seki Y, Shimaya M, Hoshino A, Niga S - Sports Med Arthrosc Rehabil Ther Technol (2012)

Bottom Line: The purpose of this study was to evaluate the result of the procedure.There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing.These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, Kawaguchi Kogyo General Hospital, 1-18-15 Aoki, Kawaguchi, Saitama 332-0031, Japan. ikeda@kogyohsp.gr.jp.

ABSTRACT

Background: Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure.

Methods: The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity.

Results: All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient.

Conclusions: There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

No MeSH data available.


Related in: MedlinePlus

X-ray immediately following surgery. The fracture site was curetted, a cannulated cancellous screw with a diameter of 5 mm was inserted, and autologous bone was grafted.
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Figure 1: X-ray immediately following surgery. The fracture site was curetted, a cannulated cancellous screw with a diameter of 5 mm was inserted, and autologous bone was grafted.

Mentions: The procedure was performed in the lateral or supine position under fluoroscopy. For the supine position, a pillow was placed under the buttocks and the affected limb was rotated internally. Pneumatic tourniquet was used in all surgeries. First, a skin incision was made laterally to the fracture site, and the fracture site was freshened with a curette. A small incision was placed proximal to the fifth metatarsal. Careful blunt dissection was carried out to the area proximal to the fifth metatarsal. Care was taken to avoid or protect the sural nerve. An assistant inverted the ankle joint, and a surgeon inserted a guide pin for the titanium cancellous screw (ACE cannulated cancellous screw, Japan Medical Dynamic Marketing, Tokyo, Japan). Drilling was performed after confirming the satisfactory position of the guide pin under fluoroscopy. The target screw diameter was more than 5 mm, and the screw with the largest possible diameter was inserted. In the case that the medullary canal was narrow, drilling began with a thin bit appropriate for a 4-mm screw, and the diameter was gradually increased to that of the screw scheduled for insertion. If the fracture site showed osteosclerosis, we removed as much of this as possible by drilling. The screw length was determined such that the threads of the partially threaded screw were past the fracture site and the screw heads were countersunk. At the time of screw insertion, the screw head was completely buried. Finally, the autologous bone harvested from the proximal tibia medially to the tibial tuberosity was grafted to the fracture site opened in advance (Figure 1).


Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series.

Tsukada S, Ikeda H, Seki Y, Shimaya M, Hoshino A, Niga S - Sports Med Arthrosc Rehabil Ther Technol (2012)

X-ray immediately following surgery. The fracture site was curetted, a cannulated cancellous screw with a diameter of 5 mm was inserted, and autologous bone was grafted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475029&req=5

Figure 1: X-ray immediately following surgery. The fracture site was curetted, a cannulated cancellous screw with a diameter of 5 mm was inserted, and autologous bone was grafted.
Mentions: The procedure was performed in the lateral or supine position under fluoroscopy. For the supine position, a pillow was placed under the buttocks and the affected limb was rotated internally. Pneumatic tourniquet was used in all surgeries. First, a skin incision was made laterally to the fracture site, and the fracture site was freshened with a curette. A small incision was placed proximal to the fifth metatarsal. Careful blunt dissection was carried out to the area proximal to the fifth metatarsal. Care was taken to avoid or protect the sural nerve. An assistant inverted the ankle joint, and a surgeon inserted a guide pin for the titanium cancellous screw (ACE cannulated cancellous screw, Japan Medical Dynamic Marketing, Tokyo, Japan). Drilling was performed after confirming the satisfactory position of the guide pin under fluoroscopy. The target screw diameter was more than 5 mm, and the screw with the largest possible diameter was inserted. In the case that the medullary canal was narrow, drilling began with a thin bit appropriate for a 4-mm screw, and the diameter was gradually increased to that of the screw scheduled for insertion. If the fracture site showed osteosclerosis, we removed as much of this as possible by drilling. The screw length was determined such that the threads of the partially threaded screw were past the fracture site and the screw heads were countersunk. At the time of screw insertion, the screw head was completely buried. Finally, the autologous bone harvested from the proximal tibia medially to the tibial tuberosity was grafted to the fracture site opened in advance (Figure 1).

Bottom Line: The purpose of this study was to evaluate the result of the procedure.There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing.These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, Kawaguchi Kogyo General Hospital, 1-18-15 Aoki, Kawaguchi, Saitama 332-0031, Japan. ikeda@kogyohsp.gr.jp.

ABSTRACT

Background: Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure.

Methods: The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity.

Results: All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient.

Conclusions: There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

No MeSH data available.


Related in: MedlinePlus