SLR - October 2010 - Stacie D. Anderson
Reference: Koslowsky, T; Gausephol, T; Mader, K; Heck, S; Pennig, D. (2010). Treatment of displaced proximal fifth metatarsal fractures using a new one-step fixation technique. Journal of Trauma, 68(1):122-125.
Scientific Literature Reviews
Reviewed by: Stacie D. Anderson
Residency Program: OCPM and University Hospital Richmond Heights MC
Podiatric Relevance:
This article is relevant to the field of podiatric surgery because fifth metatarsal fractures are common and have been previously treated conservatively. This article demonstrates that through ORIF, patients can return to prior activity levels faster. The described FFS system seems to show good clinical and radiographic outcomes, and provides a new treatment option.
Methods:
35 patients (13 male and 22 female) were treated in a three year period for displaced fractures of the fifth metatarsal tuberosity. Operative procedure was performed on an average of eight days post trauma. Operative technique involved reducing the fracture with a hook retractor, and then assessed with fluroscopy. Then, either a 2.2 or 1.6 mm fine-threaded K-wire (FFS) with a length of 25 to 35 mm was inserted with a washer. A second 1.6 FFS of the same length was then inserted across the fracture site to control for rotational stability. Washers were used along with the fine-threaded K-wires to increase compression, and the excess K-wire were cut allowing 1 to 2 mm in order for hardware removal later. Patients were initially placed in a cast for six days, transitioned to a WB with cructhes for three weeks, and full weight bearing after six weeks.Typically, implants were removed between three and twenty-four months. Three patients were lost to follow-up, leaving 32 patients for clinical and radiographic evaluation between 15 and 60 months.
Results:
Patients were evaulated clinically, radiographically, and subjectively using the AOFAS Midfoot Scale. All of the fractures that were fixated with the FFS implant achieved healing within the first 3 to 6 months, except one which had delayed bone healing. On the Midfoot Scale, patients reached a mean of 96.5 (out of 100). Most patients, 24, demonstrated a total lack of pain. Anatomic reduction was seen in all radiographs.
Conclusions:
This article studied the FFS system in the treatment of dispalced tuberosity fractures of the fifth metatarsal. Previous studies have looked a conservative treatment and ORIF with tension band. Conservative treatment has shown to be an effective treatment; however, it may take patients up to 6 months to return to prior activity level. Whereas with the FFS system, most patients returned to prior activity level after 6 weeks. Also, the FFS system showed union of all fractures in this study. It has beens shown in other studies that fine-threaded wires have a similar pull out strength with conventional implants. Hardware removal can also be easily performed or the implant can remain in place.
Although this study demonstrated stable fixation and union of dispalced tuberosity fractures, there was no control group in this study - either with conservative, non-surgical treatment or other internal fixation devices.