Intramedullary screw fixation for proximal fifth metatarsal zone II and III fractures on athlete population: a systematic review

Authors

  • Bernadus Riyan Hartanto Faculty of Medicine, Universitas Diponegoro, Semarang; RAA. Soewondo Regional Public Hospital, Pati, Indonesia
  • Agus Priambodo Orthopaedic and Traumatology Department Dr. Kariadi General Hospital, Semarang, Indonesia
  • Rofi'i Orthopaedic and Traumatology Department RAA. Soewondo Regional Hospital, Pati, Indonesia

DOI:

https://doi.org/10.31282/joti.v3n2.55

Keywords:

Intramedullary screw fixation, Jones fracture, proximal fifth metatarsal fracture

Abstract

Introduction: Metatarsal fractures are the most common fractures in foot with an incidence of 6.7 per 10.000 persons. Fifth metatarsal fractures account for 70% of metatarsal fractures. Proximal 5th metatarsal zone II and III fractures have minimal vascularization, known as a ‘watershed area’, with delayed to non-union rate up to 50%. This study will review clinical and functional effectiveness from intramedullary screw fixation for proximal 5th metatarsal zone II and III fractures.

Methods: Publications from 2010-2020 in PubMed and Scopus databases were systematically reviewed using PRISMA guideline within the searching period from the 1st of June to the 10th of July 2020. Inclusion criteria for this study were published journal from the last 10 years, athlete population, undergone intramedullary screw fixation, assessed for time to bone union or return to sport duration, acute fractures, clearly stated followed-up period, and reported complications. All data were statistically analyzed using SPSS version 23.

Results: Data from 2010 to 2020 were systematically searched, there were 146 cases of proximal 5th metatarsal zone II and III fractures which undergone intramedullary screw fixation with a mean follow up of 5.6 + 3.1 years. Time to bone union was 8.5 weeks on average. Return to sport was 8.7 weeks, the average reported midfoot AOFAS functional score was 98.4. Complications in the form of diaphyseal stress fracture, thermal necrosis of the skin, irritation of soft tissue, non-union, and refracture were reported.

Conclusion: The current study demonstrates the effectiveness of intramedullary screw fixation as the management of proximal 5th metatarsal zone II and III (Lawrence and Botte classification) fractures. We recommend this treatment modality as one of the techniques that provide optimal outcomes.

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Published

2021-08-01