Surgical excision of symptomatic nonunions of the fifth metatarsal base fractures: A systematic review of outcomes and complications

Zack Hill DPM, AACFAS , Ceclina Cao PMS-3 , Patcharathorn Pookun PMS-2 , Fely Jhae D. Ebanculla PMS-2 , Guanjin Chen PMS-3
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引用次数: 0

Abstract

Background

Symptomatic non-unions of the fifth metatarsal base, particularly in Zones 1 and 2, pose significant treatment challenges. Surgical management includes open reduction internal fixation (ORIF) or excision of the non-union fragment. Though less technically demanding, excision procedures risk disrupting important tendon and ligamentous attachments, potentially affecting foot function.

Methods

This review synthesizes available data on surgical excision as a definitive treatment, addressing outcomes and complications. A systematic review of PubMed, Embase, Cochrane Library, and Google Scholar was performed to identify studies reporting on the excision of nonunion fragments at the proximal fifth metatarsal. Inclusion criteria required studies to present functional outcomes and complications following excision in Zones 1 and 2. Of 156 studies reviewed, 4 met the criteria, encompassing 18 patient cases.

Results

All 18 patients underwent excision of the proximal fragment, with various techniques used to preserve peroneal tendon function. Twelve patients were high-level athletes, and all returned to sport without pain or functional limitations. One study reported a significant improvement in AOFAS forefoot scores (from 58.6 to 95; p = 0.024) and VAS scores (from 8.0 to 1.6; p = 0.023). At an average follow-up of 18.3 months, 100 % of patients were pain-free, and no complications were reported.

Conclusion

Excision of symptomatic non-unions of the fifth metatarsal base, particularly in Zone 1 and selective cases for Zone 2, appears to be a safe and effective treatment option, allowing for significant pain relief and return to activity in high-level athletes. Further research is needed to validate long-term outcomes and optimal surgical techniques.
手术切除第五跖骨基底骨折的症状性骨不连:结果和并发症的系统回顾
背景:第五跖骨基底部的症状性骨不连,特别是在1区和2区,给治疗带来了重大挑战。手术治疗包括切开复位内固定(ORIF)或切除不愈合碎片。虽然技术要求较低,但切除手术有可能破坏重要的肌腱和韧带附着物,可能影响足部功能。方法本综述综合了手术切除作为最终治疗方法的现有资料,讨论了结果和并发症。我们对PubMed、Embase、Cochrane Library和谷歌Scholar进行了系统的综述,以确定关于第五跖近端不愈合碎片切除的研究。纳入标准要求研究显示1区和2区切除后的功能结局和并发症。在156项研究中,有4项符合标准,包括18例患者。结果所有18例患者均行近端碎片切除术,并采用各种技术保留腓肌腱功能。12名患者是高水平运动员,所有患者都恢复了运动,没有疼痛或功能限制。一项研究报告了AOFAS前足得分的显著改善(从58.6到95;p = 0.024)和VAS评分(从8.0到1.6;P = 0.023)。平均随访18.3个月,100%患者无疼痛,无并发症发生。结论:切除第5跖骨基底部症状性骨不连,特别是第1区和第2区选择性病例,似乎是一种安全有效的治疗选择,可显著缓解高水平运动员的疼痛并使其恢复活动。需要进一步的研究来验证长期结果和最佳的手术技术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Foot & ankle surgery (New York, N.Y.)
Foot & ankle surgery (New York, N.Y.) Orthopedics, Sports Medicine and Rehabilitation, Podiatry
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