SLR - May 2011 - Raffaella Buffolino
Reference: Kennedy, John G., Murawski, Christopher D. (2011). Percutaneous Internal Fixation of Proximal Fifth Metatarsal Jones Fractures (Zones II and II) with Charlotte Carolina Screw and Bone Marrow Aspirate Concentration. The American Journal of Sports Medicine, 20, 1- 7.
Scientific Literature Review
Reviewed by: Raffaella Buffolino, PGY-2
Residency Program: New York Hospital Queens
Podiatric Relevance:
Fifth metatarsal fractures are common, especially among young athletes, in whom an early return to activities is essential. In this population, internal fixation is considered a method of choice to minimize potential time lost to a slow or delayed healing process due to the poor blood supply of the fifth metatarsal. In this study, the authors advocate for surgical correction with internal fixation specifically designed for these types of fractures while also addressing this bone’s poor biological potential by employing bone marrow aspirate.
Methods:
Twenty-six patients (18 male, 8 female) underwent percutaneous fixation of fifth metatarsal Jones fracture (types II and III). Inclusion into the study involved: an acute fifth metatarsal Jones type fracture that was fixated utilizing a Charlotte Carolina screw and bone marrow aspirate concentration. Acute injury was defined as having surgery within 2 weeks of the injury.
The operative technique involved driving a guide wire through the medullary canal. A drill is then advanced to the distal diaphysis, followed by intramedullary taps beginning at 4.5 mm. Next, approximately 60cc of bone marrow aspirate extracted from the ipsilateral iliac crest is prepared with a standard bone marrow concentraion system and injected into the medullary canal. Finally, the screw is placed until compression is seen on flouroscopy. In addition, to ensure adequate blood supply to the fracture site, the authors used a K-wire to drill percutaneously around the fracture site in an effort to create neovascular healing channels. Any remaining bone marrow aspirate concentration is then injected to the fracture site following screw insertion.
Results:
The mean Foot and Ankle Outcome scores were significantly increased from 51.2 points preoperatively to 90.1 post-operatively. Also the SF-12 was significantly improved from 25.7 preoperatively to 54.6 postoperatively. The mean time to fracture healing on standard radiographs was 5 weeks (range 4-24). The mean return to sporting activities 7.6 weeks (range 5-8), while the mean return to play was seen at 10.1 weeks (range 8-14). There were 2 patients who did not return to their pre-injury levels: one who retired due to non-injury related issue and another who refractured during the pre-season and required a subsequent revision.
Conclusions:
In conclusion, the most predictable outcomes in fifth metatarsal fracture are those with surgical intervention, which accounts for its popularity as a first line treatment method in athletes. The authors feel that combining surgical correction with bone marrow aspirate concentration to improve the biological environment of this region provides for optimal results with a 96% union rate at 8 weeks postoperative time.