Issue link: https://viewer.e-digitaledition.com/i/125940
CliniCal diSCuSSiOn Putting the best Foot Forward a FiFth Metatarsal Fracture is a debilitating inJury coMMonly seen aMong athletes. a recent study by south korean researchers Found that coMPressing and stabiliZing certain breaks in the FiFth Metatarsal bone resulted in raPid, Predictable healing and return to norMal actiVities. L OCatEd bEHind tHE fifth toe, the fifth metatarsal is the long middle bone of the foot and consists of three zones. This study, published in the January 2013 issue of Orthopedics, focused on patients with fractures in the first two zones located near the base of the bone. Injuries in both areas were treated surgically with locking compression plates modified by researchers to closely follow the bone's shape and size and hook into the bone for added compression. The study – compiled by Jae Hyuck Choi, M.D.; Kyung Tai Lee, M.D.; Young Koo Lee, M.D.; Jun Young Lee, M.D.; and Hwa Rye Kim, Ph.D. – follows the progress of 17 patients, all of whom exhibited mended bones in approximately 54 days and returned to normal activity in an average of 74 days. By comparison, patients with fifth metatarsal fractures that are treated nonsurgically by taking weight off the foot generally take six or more months to recover, with a success rate between 56% and 100%. Here's the Hook After exposing the bone and correcting the damage, surgeons attached low-profile plates contoured to the unique U shape of the proximal fifth metatarsal bone. A hook replaced the last hole of the plate. Added compression and reinforcement provided additional stability to standard screw fixation, helping the bone resist rotational forces and remain stationary as it healed. The plate-and-hook construction used by the research team is light, more easily contoured than previous versions and curved to match the shape of the fifth metatarsal. Study participants were evaluated using the American Orthopaedic Foot and Ankle Society middle foot scale, allowing researchers to compare levels of alignment, function and pain both before and after treatment. Placement of the mini-hook plate and healing progress were confirmed via computed tomography (CT) scans. no mean feat Because the fifth metatarsal is in close proximity to the plantar fascia, the tissue connecting the heel bone to the toes, treating fractures of the bone can be challenging. It also connects to several strong tendons, including the peroneus brevis tendon, and has low blood supply to portions of the bone. The mini-hook plate technique provided additional stability and, when properly executed, appeared to reduce hardware-related complications. Other surgical treatment options, such as intramedullary screw fixation, often have risk of related complications, such as bones binding incorrectly and repeat fractures. In this study, one patient experienced hardware-related complications due to improper plate molding. While the results of the study are a positive indication the mini-hook plate procedure can lead to rapid healing and help patients return to regular activities, additional research will be needed to confirm these findings, as the study is limited by a small sample base and lacks a comparison group. ■ mdnEwS.COm ■ MD News Greater Boston | 15