![]() Iliac crest bone marrow aspirate with demineralized bone matrix (n = 25, injected into subperiosteal space) bone stimulators until union Solid stainless-steel screw, partially threaded (diameter, 5.5-6.5 mm) Solid stainless-steel screw, partially threaded (diameter, 4.5-6.5 mm)Ĭalcaneal autograft (n = 4), iliac crest bone marrow aspirate (n = 7), demineralized bone matrix (n = 1), iliac crest bone graft + DBM (n = 7), distal tibial autograft + DBM (n = 1), none (n = 1) Torg 1 (acute, n = 20), Torg 2 (delayed, n = 14), Torg 3 (nonunion, n = 4)ģ Basketball, 33 soccer, 1 handball, 1 rugbyĤ-Hole, 3.0-mm titanium locking straight plate (Arthrex) and 3.0-mm screwsĬalcaneal autogenous bone grafting (n = 8) vitamin D assessment preoperatively and supplemented if deficientĢ Cortical screw fixation of the osteotomy site no additional fixation at proximal 5th MT fracture siteĪutograft cancellous bone from calcaneal tuberosity (n = 1, refracture) Torg 1 (acute, n = 2), Torg 2 (delayed, n = 7), Torg 3 (nonunion, n = 6) Stress fracture, acute presentation with prodromal symptoms (n = 20) Torg 1 (acute, n = 7), Torg 2 (n = 2), refracture (n = 1) Stress fracture of proximal 5th MT, Torg 2/3 (n = 37) Sample Size (N = 278 athletes, 280 fractures)Īcute fracture (n = 4), refractures (prior IM screw fixation, n = 4)Ħ Football, 1 basketball, 1 track and fieldĪcute fracture (n = 13), nonunions (n = 3), refractures (n = 3) 2 had osteotomy around IM screw, 1 had screw removal and autograft-from-calcaneus bone graftĢ Football, 3 soccer, 1 hockey, 1 ultimate Frisbee, 12 rugbyĪcute refracture (n = 16, prior IM screw fixation by another surgeon), symptomatic nonunion (n = 5, nonoperative treatment failure)ġ2 Football, 3 basketball, 1 baseball, 1 tennis, 2 golf, 2 cross-countryĪcute fracture of proximal 5th MT (mean time from injury to surgery, 8.5 d)Īcute fracture (n = 2), delayed fracture (n = 4)Ģ Basketball, 4 soccer, 1 track and field This systematic review aimed to evaluate outcomes, rates of RTP, and complications after varying surgical treatment modalities for fifth metatarsal fractures in elite athletes. 7, 39, 48 Despite the overwhelming recommendation of surgical management of fifth metatarsal fractures in the athletic population, to our knowledge, no reviews exist that specifically evaluate the current literature as it pertains to operative management of fifth metatarsal fractures solely in elite-level athletes. Numerous review articles have evaluated nonoperative versus operative management of proximal fifth metatarsal fractures in the general population. 9, 16, 18 – 22 Despite good outcomes with surgical management, several potential complications exist, including refracture, nonunion, sural nerve injury, infection, failed fixation, complex regional pain syndrome, and the inability to return to the same level of play. Additionally, augmentation with bone grafting or modern orthobiologics is commonly used to further enhance healing. 5, 20, 24, 35, 39 Intramedullary screw fixation is considered the gold standard however, many different modes of fixation exist. In elite-level athletes, fifth metatarsal fractures at the metadiaphyseal region are often managed surgically to avoid high rates of delayed union or nonunion and allow for quicker return to play (RTP). Finally, Torg et al 44 described a classification scheme based on radiographic appearance as it pertains to fracture acuity. ![]() 19 The Lawrence and Botte 23 classification system is commonly used and holds prognostic value based on fracture zonal distributions. Sir Robert Jones first described the “Jones fracture” in a small case series of 4 patients, including himself, as fractures at the metadiaphyseal junction. Several classification systems are used to describe fractures of the fifth metatarsal. 4, 21 The tenuous vascular supply to the fifth metatarsal, specifically at the metadiaphyseal junction, makes these fractures susceptible to delayed healing and nonunion, which can also prolong return to sport. 1, 13, 33 Fifth metatarsal fractures can result in significant disability and can prevent athletic participation. 14, 33, 42 Acceleration maneuvers and the cumulative effect of bending moments applied to the fifth metatarsal during sport make it particularly vulnerable to injury. Although the Jones fracture is the most commonly publicized fracture of the fifth metatarsal, the entire bone endures excessive loads during sport.
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