• Journal of Korean Foot and Ankle Society
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• v.26 no.4
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• pp.163-170
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• 2022

Purpose: The proximal fifth metatarsal fracture is one of the most common foot fractures. However, few studies have evaluated the associated injuries in patients with a proximal fifth metatarsal fracture. The purpose of this study was to investigate the incidence of foot and ankle joint injuries associated with proximal fifth metatarsal fractures and compare the incidence of these injuries based on the injury mechanisms and location of the fracture. Materials and Methods: This retrospective study included 157 patients with a proximal fifth metatarsal fracture who underwent surgery from January 2014 to August 2021. Their medical records and radiology images were reviewed to classify and analyze the associated injuries. The proximal fifth metatarsal fractures were classified using Lawrence and Botte's classification. Injury mechanisms were divided into direct and indirect injuries. The incidence of injuries was statistically analyzed according to the injury mechanism and classification. Results: Of the 157 patients with proximal fifth metatarsal fractures, 81 (51.6%) were diagnosed with foot and ankle joint injuries. The incidence of foot injuries was 65.4%, that of ankle joint injuries was 19.8%, and of both foot and ankle joint injuries was 14.8%. In patients with direct injuries, the incidence of foot and ankle joint injuries was 82.5% and that of indirect injuries was 41.0%. Statistical differences were observed between the incidence of direct and indirect injuries (p<0.001). The incidence of injuries, according to Lawrence and Botte's classification, was 54.9% (Zone I), 41.2% (Zone II), and 50.0% (Zone III) respectively. However, there were no statistically significant variations in the locations of the proximal fifth metatarsal fractures (p=0.051). Conclusion: In this study, the incidence of foot and ankle joint injuries associated with proximal fifth metatarsal fractures was found to be high. Therefore, a careful physical examination and appropriate radiological evaluation are recommended for patients with such fractures.

• Journal of Korean Foot and Ankle Society
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• v.16 no.2
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• pp.87-93
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• 2012

Fractures located at the metaphyseal/diaphyseal junction at the base of the fifth metatarsal were first described by Sir Robert Jones in 1902. However, ever since, there has been disagreement and debate regarding the diagnosis, classification, pathomechanics, the incidences, and potential causes of delayed unions and nonunions, and the optimal method of treatment. It appears to be widely agreed that proximal fractures of the metaphyseal/diaphyseal region of the fifth metatarsal are prone to delayed union or even nonunion. Several classifications of proximal fifth metatarsal stress fractures have been devised. Torg et al. classified fractures involving the proximal part of the diaphysis of the fifth metatarsal into three types. The Torg classification is a good grading system that can be used to determine the type of surgery needed as well as for the prediction of prognosis. The ''plantar gap'' might add to the decision-making process for surgery and improve the prediction of patient prognosis. In addition, the new classification using 'plantar gap' might be used for classification of fifth metatarsal stress fracture. Fifth metatarsal stress fractures can be treated conservatively or surgically, and excellent results have been reported for surgery with rapid recovery in athletes. Intramedullary screw fixation has become a popular form of fixation for fifth metatarsal stress fractures. Bone grafting presents the problems of a longer recovery time and additional skin incision for harvesting. The modified tension band wiring is an useful and simple option for surgical treatment of challenging fifth metatarsal stress fractures.

• CELLMED
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• v.13 no.12
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• pp.43.1-43.8
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• 2023

Objective: A case report of pain relief and fracture recovery by ortho-cellular nutrition therapy in a patient with 2nd, 3rd, and 4th metatarsal fractures (closed). Methods: A Korean woman in her 50s was diagnosed with 2nd, 3rd, and 4th metatarsal fractures (closed) with severe initial pain and fractures. Surgery was recommended but could not be performed immediately due to her situations at work. Results: With OCNT performed immediately after the fracture, the pain completely disappeared, and even during subsequent recovery, recovery was faster than in other fracture cases. Conclusion: OCNT may help patients with similar problems relieve symptoms and recover.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.189-196
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• 2008

Purpose: Nonunions and delayed unions are possible complications of fractures of fifth metatarsal base. We tried to report the results of the surgical treatment, which is not prevalent yet. Materials and Methods: Retrospective study of thirty nine patients undergoing operation at our institution between 2003 and 2008 was conducted. Six patients were excluded with loss of follow up before bony union, multiple trauma, pediatric fractures, stress fracture, open fracture. There were 18 males and 15 females with 45.1 years old mean age. The average follow-up period was 18.3 months. We used a midfoot scoring system of AOFAS for clinical assessment and radiologic findings to evaluate bony union, alignment. Results: According to Lawrence's classification, Zone 1 fractures were thirteen and Zone 2 were twenty. Average AOFAS score was 93.61. Conclusion: Early operative treatment with cannulated screw fixation in fractures of the fifth metatarsal base is thought to be an useful and easy treatment option with faster rates of union.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.185-188
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• 2008

Purpose: Zone I fractures of the fifth metatarsal bone can generally be treated by conservative methods while both surgical and conservative methods are used for zone II fractures. However, the clinical results of conservative treatment have been rarely reported. The purpose of this study is to report the clinical results of conservative treatment for zone I and II nondisplaced fractures. Materials and Methods: Between July 2007 and August 2008, consecutive thirty seven patients (38 fractures) with zone I and II fractures of the fifth metatarsal bone were treated with tolerable weight bearing and minimum duration of immobilization based on pain on weight bearing. We evaluated the duration of immobilization, time to clinical and radiographic union, and time to pre-injury activity level. Results: Clinical and radiological union were achieved in all patients without any complications including malunion or nonunion. The mean duration of immobilization was 28.7 days. The mean 33.1 days and 48.9 days were required for clinical union and radiographic union respectively, after the initial injury. The mean time to pre-injury activity level was 4.8 months. Conclusion: Our study shows that the acute nondisplaced zone I, II fracture of fifth metatarsal bone can be treated effectively using tolerable weight bearing and minimum duration of immobilization, which is based on the pain on weight bearing.

• Journal of Korean Foot and Ankle Society
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• v.2 no.2
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• pp.57-63
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• 1998

Stress or march fractures among military personnel, especially recruits, has been appreciated for many years. According to the classical references, the second metatarsal was one of the first sites identified as a focus for march fractures and radiological evidence of fracture appeared as late as several weeks. The purpose of this study was to document the clinical feature of march fractures in Korean infantry soldiers. From 1997 to 1998, at one infantry medical company of OO infantry corps in Korea, 15 (19cases) patients with march fracture were detected among infantry soldiers. There were some different finding in the fracture site and its clinical features from the previous foreign reports. 1. There were pain and local swelling in all cases as clinical manifestation. By physical examination, direct point tenderness on the location of the fractured metatarsal shaft was characteristic. 2. On roentgenographic examination, cortical fissuring or break was seen one week after onset of symptoms and external callus was seen from two weeks or at the least four weeks. Oblique view was more useful than AP view in the diagnosis of march fractures. 3. The third metatarsal was the most frequently involved site(7 cases, 48%). and the second metatarsal was Jess frequent(3 cases, 20%). This difference of frequent site with previous reports might be attributed to the relatively long shaft of the third metatarsal, but should be analyzed in further study. 4. The incidence of the development of march fracture was 1 per 104 infantry soldiers.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.91-94
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• 2009

Metatarsal head and neck fractures are injuries that often result from a direct blow of a heavy objects to the metatarsal head. The head is often impacted or displaced to the plantar aspect that if not treated may cause malunion which later induces painful plantar calluses. If the fracture fragment is large enough, closed reduction may be successfully performed, but when the fragment is small or closed reduction is unsuccessful, open reduction is needed. We present our reduction and fixation technique for the metatarsal head and neck fractures using antegrade intramedullary Kirschner wire (K-wire) without opening the fracture site or infringing the metatarsophalangeal (MTP) joint which allows immediate motion of the joint and partial weight bearing in a stiff soled shoe.

• Journal of Korean Foot and Ankle Society
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• v.17 no.1
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• pp.34-39
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• 2013

Purpose: To evaluate the effectiveness of intraoperative stress test for diagnosis of occult Lisfranc injury. Materials and Methods: Between April 2009 and October 2012, 21 patients with occult Lisfranc injuries underwent intraoperative stress test and internal fixation. There were 11 males and 10 females with an average age of 45.3 years (range, 23~79 years). Injuries were caused by traffic accident in 10 cases, indirect force (twisting injury) in 8 cases, and crush in 2 cases, falling from a height in 1 case. Unstable injuries on stress radiograph in occult injury of Lisfranc joint were treated by open reduction or closed reduction and fixation with cannulated screw or K-wire. Radiological evaluation was assessed according to preoperative and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base. Results: Assoicated injuries were 9 cases of metatarsal fractures, 6 cases of cuneiform fractures and 6 cases of both metatarsal and cuneiform fractures. Medial and middle column fixation was in 13 cases, and three columns fixation was in 8 cases. Initial diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 2.8 mm (1.3~4.7 mm) on AP radiograph and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 1.2 mm (0.5~2.4 mm) on AP radiograph. Conclusion: Even there is no sign of clear Lisfranc injury, it is necessary to pay attention and give evaluation on circumstances of occult Lisfranc injuries with metatarsal or cuneiform fractures. Intraoperative stress test is helpful to diagnose an occult Lisfranc injury. For unstable injuries on stress radiographs of occult Lisfranc joint injury, operative treatment with open or closed reduction and internal fixation is useful method.

• 대한족부족관절학회:학술대회논문집
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• 2009.04a
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• pp.8-8
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• 2009

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.119-122
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• 2010

Purpose: One of the main contributors to proximal fifth metatarsal fracture is ankle inversion and the incidence of recurrence may increase in patients with ankle instability. So, the authors confirmed the patients of proximal fifth metatarsal fracture with ankle instability by checking the history and magnetic resonance imaging (MRI) and assessed the value of MRI as therapeutic prognosis and clinical indicators for prevention of recurrence. Materials and Methods: Patients with proximal fifth metatarsal fractures visited our hospital during recent five years were reviewed. 35 patients with suspected damage by ankle inversion had been identified a history of ankle instability and checked the hindfoot malalignment through hindfoot alignment view and MRI was performed prospectively. The patients was devided to three groups on the location of fracture site and the groups were compared each other. Results: The mean time from injury to checking MRI was 10.7 days. There was no structural abnormality and was no significant difference according to the location of fracture. The patients with history of ankle inversion were 31(88.6%) and the patients with history of chronic or recurrent injury were 22 patients (62.9%). The lesion of MRI related to lateral ankle instability were identified in all patients. Conclusion: This study noted a high incidence of lateral ankle instability that was identified by MRI in the patients of proximal fifth metatarsal fracture. Aggressive treatment for lateral ankle instability should be needed for complications as proximal fifth metatarsal fracture to reduce the recurrence and occurrence.