![]() He reported a 5% failure rate – a combination of refracture and nonunion. 2000) found that failure seemed to be correlated with the dimension rather than the type of screw (cannulated, cancellous or malleolar screws). Several studies, however, report failure after fixation with screw, in particular, in athletes. However, in athletes, treatment is usually surgical, because of the long recovery time, the higher risk of non-union and high rates of re-fracture associated with conservative treatment (Clapper et al. 1994) demonstrated good functional outcomes with non-operative treatment. Fractures interrupt the vascular channels in this area, leading to hypo-vascularisation and difficulty in complete healing.įractures of the proximal MT-5 can be treated either conservatively or surgically Josefsson (Josefsson et al. ![]() 1992 Le and Anderson 2017) between the insertion of peroneus brevis and the diaphyseal blood supply. Zones 2 and 3 are predisposed to delayed healing due to a vascular watershed zone (Smith et al. Fractures in Zones 2 and 3 are commonly referred to as Jones’ fractures, due to their similarity in symptoms, treatment and possible complications. MT-5 fractures have been classified by Lawrence and Botte (Lawrence and Botte 1993) according to the anatomical area affected, and also the mechanism of injury, in Zone 1 (tuberosity area), Zone 2 (tuberosity – metaphyseal area) and Zone 3 (metaphyseal – diaphyseal area). Increased forces during physical activity make it easy to understand how athletes, in particular are predisposed to this type of injury. 2014 Glasgow and Naranja Jr 1997) - is the usual mechanism of injury leading to this proximal fracture. An indirect force secondary to foot plantar-flexion and inversion - transmitted to the MT-5 by the peroneus brevis and plantar fascia traction (Mayer et al. Pre-disposing factors include: cavo-varus foot, prominence of the fifth metatarsus, high body mass index (BMI), and the use of narrow-width shoes (Jastifer et al. This can lead to either acute fractures of the base of the fifth metatarsal or, during high periods of activity, to stress fractures. They highlighted how different athletic gestures, such as jump-off, landing and cutting movements can produce high tensile stress on bone structures - a forceful push-off of acceleration generates a high load on the forefoot, particularly on the fifth metatarsal (Orendurff et al. 2009) demonstrated that during sport activities, bending moments and peak pressure are considerable through the fifth metatarsal. Surgical treatment strategies and outcomes are, therefore, of particular interest among those involved in their care. Fifth metatarsal fractures are an increasing problem, particularly in athletes. 2018) have found that the overall percentage of fifth metatarsal base fractures in NFL players was 3.2%. In an interesting review, Spang RC et al (Spang et al. 2006), both in the general population and also in athletes. These make up approximately 70% of all metatarsal fractures (Petrisor et al. Sir Robert Jones (Jones 1902), in 1902, first described fractures at the metaphyseal/diaphyseal junction of the fifth metatarsal (MT-5). The aim of the presented cadaveric study is to illustrate an innovative concept of internal fixation, named F.E.R.I. In this group of patients, internal fixation is often required to obtain a satisfactory outcome and time to return to play. Conclusionsįifth metatarsal base fractures gain specific interest when occurring in athletes. The authors intend to study this technique in the clinical setting in the near future. technique is indicated in acute proximal fractures, stress fractures or non-union of metatarsal 5 (Zone 2–3 by Lawrence and Botte) and it resulted feasible and stable during manual stress test. In this article, the cadaveric study and proposed surgical technique are explained and illustrated step by step. ![]() On a cadaver, through two mini portals, a full reduction and solid internal fixation with an intramedullary screw and suture cerclage with Fiberwire of a fifth metatarsal base fracture is achieved. ![]() (Fifth metatarsal, Extra-portal, Rigid, Innovative) technique. These reports prompted us to look at new materials and a novel technique through fixation with an intramedullary screw combined with a high-resistance suture via the presented F.E.R.I. One of the main problems of Kirschner wire fixation of fifth metatarsal base fractures (in combination with a tension band wiring technique) seems to be hardware intolerance and several studies in athletes also report failure after isolated fixation with a screw only.
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