Percutaneous Cannulated Screw Fixation of Fifth Proximal Metatarsal Stress Fracture in Athletes

Jun Young Lee; Sang Ho Ha; Jae Won Yu; Sang Hong Lee; Ki Young Nam; Kyoung Chul Song

doi:10.5763/kjsm.2011.29.1.21

Journal List > Korean J Sports Med > v.29(1) > 1054463

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Ha, Yu, Lee, Nam, and Song: Percutaneous Cannulated Screw Fixation of Fifth Proximal Metatarsal Stress Fracture in Athletes

Clinical Article

Korean J Sports Med 2011;29(1):21-25.

Published online: 20 January 2011

DOI: https://doi.org/10.5763/kjsm.2011.29.1.21

Percutaneous Cannulated Screw Fixation of Fifth Proximal Metatarsal Stress Fracture in Athletes

Jun Young Lee, MD, Sang Ho Ha, MD, Jae Won Yu, MD, Sang Hong Lee, MD, Ki Young Nam, MD, Kyoung Chul Song, MD

Department of Orthopaedic Surgery, Chosun University Collage of medicine, Gwangju, Korea

Received 17 September 2010 Revised 4 November 2010 Accepted 13 April 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of this study was to know utility of percutaneous cannulated screw fixation of fifth proximal metatarsal stress fractures in athletes by assessment of radiological and clinical outcome. This study examined clinical and radiological union time of eleven cases of percutaneous screw fixation, which used the 4.0 mm cannulated screw, of fifth proximal metatarsal stress fracture in athletes. Type I of Torg classification is 7 cases, type II is 3 cases and type III is 1 case. All the cases showed fracture union, and all the patients resumed their athletics at the final follow-up. None of the cases complained of refracture or pain around where they had surgery, and visual analogue scale of pain, and American Orthopedic Foot and Ankle Society score was 0.73 and 93.4. The results of the study confirm that percutaneous screw fixation, which used the cannulated screw, of fifth proximal metatarsal stress fracture would help athletes resume their athletics in early stages.

Keywords: Fifth metatarsal, Stress fractures, Cannulated screw, Athletes

References

1. Larson CM, Almekinders LC, Taft TN, Garrett WE. Intramedullary screw fixation of Jones fractures. Analysis of failure. Am J Sports Med. 2002; 30:55–60.

2. Hatch RL, Alsobrook JA, Clugston JR. Diagnosis and management of metatarsal fractures. Am Fam Physician. 2007; 76:817–26.

3. Kavanaugh JH, Brower TD, Mann RV. The Jones fracture revisited. J Bone Joint Surg Am. 1978; 60:776–82.

4. DeLee JC, Evans JP, Julian J. Stress fracture of the fifth metatarsal. Am J Sports Med. 1983; 11:349–53.

5. Mologne TS, Lundeen JM, Clapper MF, O'Brien TJ. Early screw fixation versus casting in the treatment of acute Jones fractures. Am J Sports Med. 2005; 33:970–5.

6. Wright RW, Fischer DA, Shively RA, Heidt RS Jr, Nuber GW. Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes. Am J Sports Med. 2000; 28:732–6.

7. Weinfeld SB, Haddad SL, Myerson MS. Metatarsal stress fractures. Clin Sports Med. 1997; 16:319–38.

8. Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for nonsurgical and surgical management. J Bone Joint Surg Am. 1984; 66:209–14.

9. Porter DA, Duncan M, Meyer SJ. Fifth metatarsal Jones fracture fixation with a 4.5-mm cannulated stainless steel screw in the competitive and recreational athlete: a clinical and radiographic evaluation. Am J Sports Med. 2005; 33:726–33.

10. Pietropaoli MP, Wnorowski DC, Werner FW, Fortino MD. Intramedullary screw fixation of Jones fractures: a biomechanical study. Foot Ankle Int. 1999; 20:560–3.

11. Nunley JA. Fractures of the base of the fifth metatarsal: the Jones fracture. Orthop Clin North Am. 2001; 32:171–80.

12. Shah SN, Knoblich GO, Lindsey DP, Kreshak J, Yerby SA, Chou LB. Intramedullary screw fixation of proximal fifth metatarsal fractures: a biomechanical study. Foot Ankle Int. 2001; 22:581–4.

Fig. 1.

Twenty-year-old male soccer player, X-ray reveals Torg classification type 1. (A) Before operation. (B) After operation. (C) One month after operation. (D) Three months after operation.

Fig. 2.

Nineteen-year-old male soccer player, X-ray re-veals Torg classification type 2. (A) Before operation. (B) After operation. (C) Two months after operation. (D) Four months after operation.

Table 1.

Athlete information for open reduction and internal fixation of the fifth metatarsal

No.	Sex	Age	Foot	Height (cm)	Weight (kg)	) Torg	CPA (^o)	HA (^o)	TC (^o)	ID (mm)	AOFAS	VAS	Athletics
1	F	20	Lt.	178	70	1	30.2	4.5	22	3.8	92	0	TE
2	M	21	Rt.	180	75	1	29.4	6.5	24	4.1	93	1	BS
3	M	22	Rt.	170	64	1	28.4	5	27	4.5	92	0	BS
4	F	25	Lt.	178	51	1	28.4	4	19	4.0	95	1	BK
5	M	20	Rt.	182	65	1	25.5	5.5	32	3.9	98	2	BK
6	M	22	Lt.	188	62	3	29	4	28	4.6	93	1	BK
7	M	18	Lt.	179	71	1	31.8	4	26	4.4	94	0	SC
8	M	18	Lt.	181	78	2	30.7	5	25	4.7	93	1	SC
9	M	20	Rt.	179	70	2	31.7	8	30	4.8	94	2	SC
10	M	18	Lt.	179	63	1	40	5	32	4.3	92	0	SC
11	M	19	Lt.	176	68	2	27.5	6	26	4.2	92	0	SC

Torg: Torg classification, CPA: calcaneal pitch angle, HA: hind foot angle, TC: talocalcaneal angle, ID: intramedullary diameter, AOFAS: American Orthopedic Foot and Ankle Society, VAS: visual analogue scale of pain, TE: tennis, BS: baseball, BK: basketball, SC: soccer.

TOOLS

Similar articles