Abstract
BackgroundIntramedullary screw fixation is considered the standard treatment for proximal fifth metatarsal stress fractures. Low-intensity pulsed ultrasound (LIPUS) is a well-known bone-healing enhancement device. However, to the best of our knowledge, no clinical study has focused on the effect of LIPUS for postoperative bone union in proximal fifth metatarsal stress fractures. This study aimed to investigate the effect of LIPUS treatment after intramedullary screw fixation for proximal fifth metatarsal stress fractures.MethodsBetween January 2015 and March 2020, patients who underwent intramedullary screw fixation for proximal fifth metatarsal stress fractures were investigated retrospectively. All patients underwent intramedullary screw fixation using a headless compression screw with autologous bone grafts from the base of the fifth metatarsal. The time to restart running and return to sports, as well as that for radiographic bone union, were compared between groups with or without LIPUS treatment. LIPUS treatment was initiated within 3 weeks of surgery in all cases.ResultsOf the 101 ft analyzed, 57 ft were assigned to the LIPUS treatment group, and 44 ft were assigned to the non-LIPUS treatment group. The mean time to restart running and return to sports was 6.8 and 13.7 weeks in the LIPUS treatment group and was 6.2 and 13.2 weeks in the non-LIPUS treatment group, respectively. There were no significant differences in these parameters between groups. In addition, the mean time to radiographic bone union was not significantly different between the LIPUS treatment group (11.9 weeks) and the non-LIPUS treatment group (12.0 weeks). The rate of postoperative nonunion in the LIPUS treatment group was 0% (0/57), while that in the non-LIPUS treatment group was 4.5% (2/44). However, this difference was not statistically significant.ConclusionsThere were no statistically significant differences regarding the time to start running, return to sports, and radiographic bone union in patients with or without LIPUS treatment after intramedullary screw fixation for proximal fifth metatarsal stress fractures. Therefore, we cannot recommend the routine use of LIPUS to shorten the time to bone union after intramedullary screw fixation for proximal fifth metatarsal stress fractures.
Highlights
Intramedullary screw fixation is considered the standard treatment for proximal fifth metatarsal stress fractures
We cannot recommend the routine use of Low-intensity pulsed ultrasound (LIPUS) to shorten the time to bone union after intramedullary screw fixation for proximal fifth metatarsal stress fractures
Return to sports following intramedullary screw fixation for proximal fifth metatarsal stress fractures does not increase the risk of nonunion, but lengthens the time to bone union [11]
Summary
Intramedullary screw fixation is considered the standard treatment for proximal fifth metatarsal stress fractures. To the best of our knowledge, no clinical study has focused on the effect of LIPUS for postoperative bone union in proximal fifth metatarsal stress fractures. This study aimed to investigate the effect of LIPUS treatment after intramedullary screw fixation for proximal fifth metatarsal stress fractures. Return to sports after a bone union is generally advocated [6, 7], and many studies on proximal fifth metatarsal stress fractures have adopted this criterion [8,9,10]. Return to sports following intramedullary screw fixation for proximal fifth metatarsal stress fractures does not increase the risk of nonunion, but lengthens the time to bone union [11]. An early bone union is important for patients who undergo surgery for these fractures because it leads to a safe and early return to sports and, as a result, meets patient demands
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