Kyung Tai Lee, M.D., Ki Won Young, M.D.*, Young Uk Park, M.D. +, Hyuk Jegal, M.D., Jin Su Kim, M.D.*

Transcription

1 Kyung Tai Lee, M.D., Ki Won Young, M.D.*, Young Uk Park, M.D. +, Hyuk Jegal, M.D., Jin Su Kim, M.D.* KT Lee s Foot and Ankle Hospital, Seoul, Korea Foot and Ankle Clinic, Eulji Medical Center, Seoul, Korea* Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, +

2 Disclosure < The precise sagittal location of the fifth metatarsal stress fracture using computed tomography analysis> < Kyung Tai Lee, M.D., Ki Won Young, M.D.*, Young Uk Park, M.D.+, Hyuk Jegal, M.D., Jin Su Kim, M.D.* > My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Purpose We ve observed that those who have wide plantar fracture gap preoperatively comes to be in bad result. To evaluate the precise sagittal and coronal location of 5th MT stress fracture using simple x-ray and CT. Plantar Gap!! Am J Sports Med Oct;39(10): doi: / Epub 2011 Jul 14. The plantar gap: another prognostic factor for fifth metatarsal stress fracture. Lee KT, Park YU, Young KW, Kim JS, Kim JB. Foot & Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Korea

4 Material and Methods From June 2012 to May patients ( 38 cases ) underwent surgery for 5 th MT stress fracture All men Mean age 19.3 y/o 36 of 38 patients - athletes soccer (34) / kick boxing(1) / hand ball(1)

5 Material and Methods Simple x-ray classification by Dameron B Simple x-ray classification 5 th MT length (B) distance from tuberosity to fx. Line (A) -> A/B A

6 Material and Methods CT (25 of 38, Incomplete fx ) location -dorsal -plantar -medial -lateral in coronal section

7 Results Zone I : 0 Zone II : 8 Zone III : 30 Sagittal location Ratio Fx. Line / 5 th MT length 0.35 ( )

8 Results CT (coronal view) plantolateral in all cases Plantar : 1 Lateral : 3 Plantar lateral : 21

9 Discussion Dameron, TB, Jr.: Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg Am. 57(6): , No meaning to differentiate their anatomic location into Zone II or Zone III Josefsson P, et al : Jones Fracture Surgical Versus Nonsurgical Treatment. Clinical orthopaedics and related research Clapper MF, O'Brien TJ, Lyons PM. Fractures of the fifth metatarsal. Analysis of a fracture registry. Clin Orthop Relat Res. 1995(315): Kavanaugh JH, Brower TD, Mann RV. The Jones fracture revisited. J Bone Joint Surg Am. 1978;60(6):

10 Discussion All fractures are located at the plantar lateral side of 5 th Metatarsal base Plantar Gap : Plantar Lateral side of Fracture Am J Sports Med Oct;39(10): doi: / Epub 2011 Jul 14. The plantar gap: another prognostic factor for fifth metatarsal stress fracture. Lee KT, Park YU, Young KW, Kim JS, Kim JB. Foot & Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Korea Proven!! By CT analysis

11 Conclusion 1. 5 th MT stress fx is located at the plantolateral aspect of proximal 1/3, 35% proxmial from the tuberosity on CT analysis 2. Treatment is focused to reduce the tensile force or convert tensile force to compression force with appropriate surgery

12 Reference 1. Carp L (1927) Fracture of the fifth metatarsal bone: with special reference to delayed union. Ann Surg 86(2): Chuckpaiwong B, Queen RM, Easley ME, Nunley JA (2008) Distinguishing Jones and proximal diaphyseal fractures of the fifth metatarsal. Clin Orthop Relat Res 466(8): Clapper MF, O'Brien TJ, Lyons PM (1995) Fractures of the fifth metatarsal. Analysis of a fracture registry. Clin Orthop Relat Res(315): Dameron TB, Jr. (1975) Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg Am 57(6): Dameron TB, Jr. (1995) Fractures of the proximal fifth metatarsal: Selecting the best treatment option. J Am Acad Orthop Surg 3(2): DeLee JC, Evans JP, Julian J (1983) Stress fracture of the fifth metatarsal. Am J Sports Med 11(5): Glasgow MT, Naranja RJ, Jr., Glasgow SG, Torg JS (1996) Analysis of failed surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity: the Jones fracture. Foot Ankle Int 17(8): Hatch RL, Alsobrook JA, Clugston JR (2007) Diagnosis and management of metatarsal fractures. Am Fam Physician 76(6): Hens J, Martens M (1990) Surgical treatment of Jones fractures. Arch Orthop Trauma Surg 109(5): Hulkko A, Orava S, Nikula P (1985) Stress fracture of the fifth metatarsal in athletes. Ann Chir Gynaecol 74(5): Jones R (1902) I. Fracture of the base of the fifth metatarsal bone by indirect violence. Ann Surg 35(6): Josefsson PO, Karlsson M, Redlund-Johnell I, Wendeberg B (1994) Jones fracture. Surgical versus nonsurgical treatment. Clin Orthop Relat Res(299): Kavanaugh JH, Brower TD, Mann RV (1978) The Jones fracture revisited. J Bone Joint Surg Am 60(6): Lawrence SJ, Botte MJ (1993) Jones' fractures and related fractures of the proximal fifth metatarsal. Foot Ankle 14(6): Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS (2013) Prognostic classification of fifth metatarsal stress fracture using plantar gap. Foot Ankle Int 16. Lee KT, Park YU, Young KW, Kim JS, Kim JB (2011) The plantar gap: another prognostic factor for fifth metatarsal stress fracture. Am J Sports Med 39(10): Lee KT, Young KW, Park SY, Lee YK, Na SE (2009) Surgical results of 5th metatarsal stress fracture using two cortical screws and wire determining of time of return to full sports activity in soccer players. Kor J Sports Med 27: Mindrebo N, Shelbourne KD, Van Meter CD, Rettig AC (1993) Outpatient percutaneous screw fixation of the acute Jones fracture. Am J Sports Med 21(5): Polzer H, Polzer S, Mutschler W, Prall WC (2012) Acute fractures to the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury 43(10): Quill GE, Jr. (1995) Fractures of the proximal fifth metatarsal. Orthop Clin North Am 26(2): Rosenberg GA, Sferra JJ (2000) Treatment strategies for acute fractures and nonunions of the proximal fifth metatarsal. J Am Acad Orthop Surg 8(5): Sarimo J, Rantanen J, Orava S, Alanen J (2006) Tension-band wiring for fractures of the fifth metatarsal located in the junction of the proximal metaphysis and diaphysis. Am J Sports Med 34(3): Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M (1984) Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am 66(2): Wright RW, Fischer DA, Shively RA, Heidt RS, Jr., Nuber GW (2000) Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes. Am J Sports Med 28(5): Zelko RR, Torg JS, Rachun A (1979) Proximal diaphyseal fractures of the fifth metatarsal--treatment of the fractures and their complications in athletes. Am J Sports Med 7(2): Zwitser EW, Breederveld RS (2010) Fractures of the fifth metatarsal; diagnosis and treatment. Injury 41(6):