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, +
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.
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. 2011 Oct;39(10):2206-11. doi: 10.1177/0363546511414856. 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
Material and Methods From June 2012 to May 2013 38 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)
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
Material and Methods CT (25 of 38, Incomplete fx ) location -dorsal -plantar -medial -lateral in coronal section
Results Zone I : 0 Zone II : 8 Zone III : 30 Sagittal location Ratio Fx. Line / 5 th MT length 0.35 (0.29-0.40)
Results CT (coronal view) plantolateral in all cases Plantar : 1 Lateral : 3 Plantar lateral : 21
Discussion Dameron, TB, Jr.: Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg Am. 57(6):788-792, 1975. 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. 1994 Clapper MF, O'Brien TJ, Lyons PM. Fractures of the fifth metatarsal. Analysis of a fracture registry. Clin Orthop Relat Res. 1995(315):238-241. Kavanaugh JH, Brower TD, Mann RV. The Jones fracture revisited. J Bone Joint Surg Am. 1978;60(6):776-782.
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. 2011 Oct;39(10):2206-11. doi: 10.1177/0363546511414856. 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
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
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