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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

Stress fracture at screw tip (black arrow head). A thickened bone cortex can be seen at the dorsal bone cortex of the screw tip.
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Figure 6: Stress fracture at screw tip (black arrow head). A thickened bone cortex can be seen at the dorsal bone cortex of the screw tip.

Mentions: There were no refractures during the follow-up period. Diaphyseal stress fractures at the distal tip of the screw occurred in two patients. In both patients, the original fracture had unioned and the screw tip was in contact with the dorsal bone cortex of the diaphysis (Figure 6). For one patient, stress fractures at the screw tip were diagnosed at 19 weeks post primary surgery, and it was unioned by replacing the screw with a shorter one. The patient returned to competitive sports at eight weeks after revision surgery. The other patient was diagnosed at 14 weeks postsurgery. The patient could continue to play without pain wearing a shoe insole, and the stress fracture unioned without time away for the diaphyseal stress fracture at the screw tip. One patient experienced a thermal necrosis of skin, presumably caused by the reaming heat from the pre-drilling for screw insertion. The wound healed after three debridement procedures. At 17 weeks post surgery, the patient returned to competitive level before complete closure of skin necrosis. None of the patients complained of the site from which bone was harvested.


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)

Stress fracture at screw tip (black arrow head). A thickened bone cortex can be seen at the dorsal bone cortex of the screw tip.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Stress fracture at screw tip (black arrow head). A thickened bone cortex can be seen at the dorsal bone cortex of the screw tip.
Mentions: There were no refractures during the follow-up period. Diaphyseal stress fractures at the distal tip of the screw occurred in two patients. In both patients, the original fracture had unioned and the screw tip was in contact with the dorsal bone cortex of the diaphysis (Figure 6). For one patient, stress fractures at the screw tip were diagnosed at 19 weeks post primary surgery, and it was unioned by replacing the screw with a shorter one. The patient returned to competitive sports at eight weeks after revision surgery. The other patient was diagnosed at 14 weeks postsurgery. The patient could continue to play without pain wearing a shoe insole, and the stress fracture unioned without time away for the diaphyseal stress fracture at the screw tip. One patient experienced a thermal necrosis of skin, presumably caused by the reaming heat from the pre-drilling for screw insertion. The wound healed after three debridement procedures. At 17 weeks post surgery, the patient returned to competitive level before complete closure of skin necrosis. None of the patients complained of the site from which bone was harvested.

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