5th metatarsal non-union fixation ,using Stryker Asnis cannulated screws
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Fractures of the 5th metatarsal (MT) are the most frequently encountered fractures in the foot and more than half of these affect the 5th MT especially after sports trauma and can go onto non-union. These fractures require careful evaluation and classification to ensure selection of the optimum treatment.
However even classification of these injuries is controversial. The classic thinking relates to the Lawrence and Botte classification which divides the proximal bone into 3 zones (Foot Ankle 1993). Their classification, like so many in those days, was largely based on observation and anecdote.
Zone 1 fractures are fractures of the styloid, invariably avulsion fractures of the peroneus brevis.
Zone 2 fractures are metaphyseal fractures involving the joint between the bases of the 4th and 5th metatarsal bases —the so-called Jones fracture (named after Sir Robert Jones, who reported his own injury).
Zone 3 fractures are diaphyseal and are often stress fractures.
A more recent paper by Polzer et al (Injury 2012) argued that only 2 zones need to be considered because they believed that the prognosis of fractures in the 2 more proximal zones is identical. Styloid process fractures (Zone 1) and those involving the joint between the bases of the 4th and 5th metatarsal bases (Zone 2) can thus be managed functionally. They argued that zone 3 injuries (from the Lawrence & Botte classification) need operative management.
So in a nutshell, we tend to think of injuries in the metaphyseal region (call this Zone 3) as being the ones with the poorest blood supply and at the highest risk of delayed or non-union. Type 3 fractures should be considered for operative fixation, particularly if there is any cavus posture of the foot, neuropathy, or if the patient is a competitive sportsperson.
If surgery is indicated then the argument is that it may reduce the time needed for immobilisation and improve the chance of healing compared to nonsurgical treatment.
In this case, a 28 year old athlete whom originally had been treated non operatively presented with clinical and radiographic features of a non union 12 months after the original injury.
Author: Andy Goldberg MD FRCS (Tr & Orth)
Institution: The Royal National Orthopaedic Hospital, Stanmore, UK
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Question 1 of 14
With regards fractures of the 5th metatarsal, which of the following statements is most INCORRECT?CorrectIncorrect
Question 2 of 14
With regards fractures of the 5th metatarsal base, which of the following answers is MOST correct?CorrectIncorrect
Question 3 of 14
Which one of the following is NOT an indication for surgery in a 5th metatarsal base fracture?CorrectIncorrect
Question 4 of 14
With regards the non operative modalities available to treat a 5th metatarsal stress fracture, which of the following is LEAST APPROPRIATE?CorrectIncorrect
Question 5 of 14
Which of the following is an absolute contra-indication for operative management of 5th metatarsal base fractures?CorrectIncorrect
Question 6 of 14
When consenting a patient for surgery of a non union of a 5th metatarsal base fracture, which of the following is MOST correct?CorrectIncorrect
Question 7 of 14
Which one of the following is NOT an important part of the set up of a patient being prepared for fixation of a 5th metatarsal fracture?CorrectIncorrect
Question 8 of 14
In your choice of fixation of a 5th metatarsal Jones’ type fracture, which of the following is NOT a requirement?CorrectIncorrect
Question 9 of 14
With regards fractures of the base of the 5th metatarsal, which of the following statements is INCORRECT?CorrectIncorrect
Question 10 of 14
When fixing a base of 5th metatarsal fracture which of the following statements is MOST CORRECT with regards the entry point for the K-wire or screw?CorrectIncorrect
Question 11 of 14
In a non union of the base of the 5th metatarsal, which one of the following steps will NOT encourage healing?CorrectIncorrect
Question 12 of 14
Which one of the following tests are NOT useful in the diagnosis of a 5th metatarsal non union?CorrectIncorrect
Question 13 of 14
With regards the postoperative management of a surgically treated base 5th metatarsal fracture, which one of the following statements is the LEAST appropriate?CorrectIncorrect
Question 14 of 14
In a published study by Habbu et al. in 2011, assessing the outcome of operatively treated Jones’ type fracture non unions, which one of the following statements is INCORRECT?CorrectIncorrect