Metatarsal Fractures Research Articles

Evaluation of Conservative Treatment or Osteosynthesis in the Treatment of Cats with Metacarpal and/or Metatarsal Fractures: A Retrospective Study

Aim: This study aims to assess the merits, drawbacks, and postoperative outcomes associated with conservative treatment and osteosynthesis methods employed in managing metacarpal (MC) and/or metatarsal (MT) bone fractures resulting from trauma in cats. Materials and Methods: The research encompassed a sample of fifty-two cats of varying breeds, genders, and ages, all presenting with metacarpal and/or metatarsal bone fractures between 2022 and 2023. Conservative treatment was administered in 46 cases, while osteosynthesis was applied in the remaining 6 cases. Results: In the group treated conservatively, 29 cases (63.04%) exhibited no signs of lameness at the 6-week examination, indicating a successful recovery with unimpeded mobility. In contrast, mild lameness was observed in the remaining cases (36.96%) at the 6-week check-up. Upon reassessment at the 12-month examination, 43 cases (93.47%) demonstrated unimpeded walking, with only 3 cases (6.53%) experiencing occasional mild lameness. Conversely, 2 cases (33.3%) showed a complication-free recovery among the cats undergoing osteosynthesis, while postoperative issues emerged in 4 cases (66.6%). In one complication-free case (50%), mild lameness was noted at the 6-week examination, and in the other case (50%), occasional mild lameness was observed. Importantly, all cases exhibited uneventful walking during the 12-month assessment. Conclusion: Conservative treatment proves to yield favorable outcomes in cats, both independently and when osteosynthesis applications fall short. However, the limited number of surgical cases examined in the study constrains the findings' generalizability

IS THE DIAGNOSIS OF FIFTH METATARSAL FRACTURE SUBTYPE CONSISTENT? AN INTEROBSERVER RELIABILITY STUDY

IntroductionTreatment pathways of 5th metatarsal fractures are commonly directed based on fracture classification, with Jones types for example, requiring closer observation and possibly more aggressive management.Primary objectiveTo investigate the reliability of assessment of subtypes of 5th metatarsal fractures by different observers.MethodsPatients were identified from our prospectively collected database. We included all patient referred to our virtual fracture clinic with a suspected or confirmed 5th metatarsal fracture. Plain AP radiographs were reviewed by two observers, who were initially trained on the 5th metatarsal classification identification. Zones were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft (DS), distal metaphysis (DM) and head. An inter-observer reliability analysis using Cohen's Kappa coefficient was carried out, and degree of observer agreement described using Landis & Koch's description. All data was analysed using IBM SPSS v.27.Results878 patients were identified. The two observers had moderate agreement when identifying fractures in all zones, apart from metatarsal head fractures, which scored substantial agreement (K=.614). Zones 1.1 (K=.582), 2 (K=.536), 3 (K=.601) and DS (K=.544) all tended towards but did not achieve substantial agreement. Whilst DS fractures achieved moderate agreement, there was an apparent difficulty with distal DS, resulting in a lot of cross over with DM (DS 210 vs 109; DM 76 vs 161). Slight agreement with the next highest adjacent zone was found when injuries were thought to be in zones 1.2, 1.3 and 2 (K=0.17, 0.115 and 0.152 respectively).ConclusionsReliability of sub-categorising 5th metatarsal fractures using standardised instructions conveys moderate to substantial agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow up during a virtual clinic review, defining fractures of zones 1–3 needs careful consideration.

Denosumab and metatarsal fracture healing: potential benefits with delayed remodeling: a case report

Background: Denosumab is known to enhance callus formation while delaying remodeling. However, its effects on fracture healing are scarcely reported in the literature. This case report, to the best of our knowledge, is the first to report the potential effect of denosumab on a metatarsal fracture in an older adult patient, 4 months after administration, resulting in a favorable clinical course with early weight-bearing 17 days after the fracture. Presentation of case: A 73-year-old female sustained a right-foot second metatarsal fracture due to the fall of a heavy object. She has a history of diabetes mellitus, hypertension, and osteoporosis. Prior to sustaining the fracture, she received seven doses of denosumab spaced 6 months apart, with the last dose administered 4 months earlier. Furthermore, the patient was treated with a backsplint for 6 weeks. After 17 days, follow-up radiographs showed a large callus formation, with no pain and the ability to bear weight. Subsequent radiographs revealed a large callus with delayed remodeling. Discussion: This case report suggests that denosumab remains effective for promoting rapid callus formation even 4 months after administration for osteoporosis, despite delayed remodeling. This delay did not seem to have negative effects on the clinical outcomes, as the patient achieved weight-bearing within 17 days after sustaining the fracture. Conclusion: Denosumab may positively influence fracture healing in older adults with metatarsal fractures, potentially leading to delayed remodeling. However, further studies are needed to confirm these observations.

Effects of functional treatment of V metatarsal bone fracture in athletes – an evaluation of cases

This study presents the rehabilitation process for the management of six cases of fractures of the fifth metatarsal bone in players of various sports playing at high levels of competition in Poland. The course of treatment was based on an intensive rehabilitation protocol with the need for orthopaedic shoe inserts, with full weight bearing on the limb and under close supervision of a physiotherapist. The effectiveness of rehabilitation was assessed by physical examination, X-ray examination and the numerical pain rating scale - NRS. This study focuses on the rehabilitation process for managing fractures of the fifth metatarsal bone in high-level athletes in Poland. The treatment involved an intensive rehabilitation protocol with orthopaedic shoe inserts, full weight bearing, and physiotherapist supervision. The effectiveness of rehabilitation was evaluated through physical exams, X-rays, and the numerical pain rating scale. Introduction Fractures of the fifth metatarsal bone are common in athletes aged 10-29, especially in football, basketball, and dance. Complications include delayed bone fusion and repeat fractures, emphasizing the importance of quick return to fitness. The involvement of physiotherapists and patient positivity is crucial. The debate among clinicians stems from classification variations and interpretations of 'Jones fractures'. Diagnostic and Classification Methods The Lawrence and Bottle classification distinguishes three types of metatarsal fractures: avulsion, Jones, and fatigue fractures. The study presents six cases of conservative treatment for these fractures, showing positive outcomes in returning athletes to competition. Rehabilitation Procedure Patients underwent functional treatment with orthopaedic insoles, immediate weight-bearing, and various therapies like Orthokine®, Exogen, hyperbaric chamber sessions, ESWT, and EPTA. Post-workout treatments included Game Ready®, flossing, manual therapy, dry needling, and lymphatic drainage. Patients also engaged in self-managed rehabilitation exercises. Treatment Results Radiographic examinations showed progressive healing in all cases, with reduced pain and no edema after two weeks. Patients returned to sports within three weeks, with no complaints after 13 months. The study highlights the success of functional treatment in achieving full recovery without complications. Conclusion The study challenges the need for surgical intervention and immobilization in treating fifth metatarsal fractures. Functional treatment led to excellent outcomes and quick return to sports. Literature review supports early mobilization and functional therapy for optimal results. Further research is needed to establish a standard treatment protocol based on evidence-based medicine.

Awareness of fifth metatarsal stress fractures among soccer coaches in Japan: A cross-sectional study.

Although a fifth metatarsal stress fracture is the most frequent stress fracture in soccer players, awareness of fifth metatarsal stress fractures among soccer coaches is unclear. Therefore, we performed an online survey of soccer coaches affiliated with the Japan Football Association to assess their awareness of fifth metatarsal stress fractures. A total of 150 soccer coaches were invited for an original online survey. Data on participants' age, sex, types of coaching licence, coaching category, types of training surface, awareness of fifth metatarsal stress fractures, and measures employed to prevent fifth metatarsal stress fractures were collected using the survey. Data from 117 coaches were analysed. Eighty-seven of the 117 coaches were aware of fifth metatarsal stress fractures; however, only 30% reported awareness of preventive and treatment measures for fifth metatarsal stress fractures. Licensed coaches (i.e., licensed higher than level C) were also more likely to be aware of fifth metatarsal stress fractures than unlicensed coaches were. Furthermore, although playing on artificial turf is an established risk factor for numerous sports injuries, soccer coaches who usually trained on artificial turf were more likely to be unaware of the risks associated with fifth metatarsal stress fractures than coaches who trained on other surfaces were (e.g., clay fields). Soccer coaches in the study population were generally aware of fifth metatarsal stress fractures; however, most were unaware of specific treatment or preventive training strategies for fifth metatarsal stress fractures. Additionally, coaches who practised on artificial turf were not well educated on fifth metatarsal stress fractures. Our findings suggest the need for increased awareness of fifth metatarsal stress fractures and improved education of soccer coaches regarding injury prevention strategies. .

DO RUGBY BOOTS WITH A BLADED STUD INCREASE CONTACT PRESSURES THROUGH THE FIFTH METATARSAL COMPARED WITH A ROUNDED STUD? A BIOMECHANICAL STUDY

Fifth metatarsal fractures in sport are known to be associated with acceleration and cross cutting movements when running. It is also established that playing surface has an impact on the ground reaction forces through the foot, increasing the strain through the fifth metatarsal. But what impact does boot design have on these forces? Current thought is that boots that utilise a blade stud design resist sideways slipping of the planted foot more than boots with a rounded stud. This study aims to compare ground reaction forces through the fifth metatarsal in 2 two different designs of rugby boot to assess what impact stud design might have. The forces across the foot were measured using Tekscan in-shoe pressure plates in 24 rugby players. Each player was asked to complete an agility course to measure acceleration, cutting and cross-cutting in the two different designs of rugby boot, reproducing true playing conditions. The boots used were the Canterbury Phoenix Club 8 Stud boot and the Canterbury Speed Club Blade boot. The trial was conducted on an 4G artificial pitch at the Cardiff Arms Park rugby ground. Ethical approval was obtained from Bath University and a research grant was provided by British Orthopaedic Foot and Ankle Society. The blade boot had significantly higher contact pressures than the stud boot on the fifth metatarsal in the combined movements (17.909 ± 10.442 N/cm2 Blade Vs 16.888 ± 9.992 N/cm2 Boot; P < .0125; n= 864 steps in each boot group). The blade boot also produced higher pressure during cross-cutting (32.331 ± 13.568 N/cm2 Vs 27.651 ± 15.194 N/cm2 p < 0.007). Pressures were also higher in both acceleration and cutting, although not significantly so. These results will guide clinicians advising athletes in shoe design, especially those predisposed to or rehabilitating from a fifth metatarsal fracture.

Foot radiologic morphology as a predictor of pseudo-jones fractures: A retrospective case-control study

BackgroundFifth metatarsal basis fractures are common injuries. Zone 1 fractures are also known as pseudo-jones fractures. This study aimed to elucidate the impact of foot radiologic morphology on pseudo-Jones fractures. MethodsPatients with pseudo-Jones fractures formed the case group and individuals with ankle sprains but no fractures formed control group. Weight-bearing anteroposterior and lateral radiographs were evaluated for pre-determined measurements: metatarsus adductus angle (MAA), intermetatarsal angles (1−2, 4−5), calcaneal inclination (CI) angle, and fifth metatarsal base angle. All measurements were performed by a single investigator using digital PACS tools. Statistical analysis compared these radiographic parameters between the groups. ResultsThe fracture group demonstrated a significantly lower 4–5 intermetatarsal and calcaneal inclination angles than the control group (p < 0.05). Notably, no statistically significant difference was found in the metatarsus adductus angle. ConclusionThis study demonstrates a potential association between foot radiographic morphology and pseudo-Jones fractures. Patients with a lower 4–5 IMA and calcaneal inclination angle may be at a higher risk for developing pseudo-Jones fractures. However, these requires future prospective studies. Level of evidenceLevel III case control study

Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes.

Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation's definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.

Pediatric foot fractures on radiographs: distribution and predictors of surgery.

To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery. This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020-2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery. 1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3%and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%)of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95%CI: 2.48-10.39, p < 0.001), multiple fractures (OR = 3.85, 95%CI: 1.67-8.53, p = 0.001), fracture displacement (OR = 9.16, 95%CI:4.43-19.07, p < 0.001), and articular involvement (OR = 2.72, 95%CI:1.27-5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors. Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.

Atypical Metatarsal Fractures: Report of Five Clinical Cases.

Atypical fractures are well elucidated when they occur in the femur and are related to the use of bisphosphonates. Prolonged therapy with this drug leads to excessive suppression of bone remodeling, which makes the bone more brittle. In general, they are caused by minimal trauma or are atraumatic. This type of fracture is also reported in other bony sites, such as the metatarsus. Some reports and studies on atypical metatarsal fractures have been published, but further investigations are required to better understand this type of fracture and establish the proper diagnosis, treatment and conduct. The present study is a report of five cases of patients who presented metatarsal fractures during therapy with bisphosphonates. All patients were female, had osteoporosis as a preexisting disease, were taking bisphosphonates, presented fractures that were either atraumatic or caused by minimal trauma, and the imaging examination showed a transverse meta-diaphyseal fracture of the fifth metatarsal shaft with thickening of the lateral cortex, image characteristics similar to the criteria used by the American Society for Bone and Mineral Research (ASMBR) to define atypical femur fractures.

Functional outcome and risk of non-union for 5th metatarsal base fractures.

Treatment of 5th metatarsal fractures via direct discharge from virtual fracture clinic (VFC) has become common practice in the NHS. We aim to assess the functional outcome and incidence of non-union in a series of 5th metatarsal base fractures, exposed to 1-year of follow-up. 194 patients who sustained a fracture between the period February 2019 to April 2020 were included, referred via the VFC pathway. Radiographs were reviewed to classify in which zone, the fracture occurred along with union on subsequent follow-up. Telephone follow-up was used to measure patient functional outcomes (EQ-5D & FAAM survey) and satisfaction with the VFC service. Off 194 patients, 53 (27.3%) had zone 1, 99 (51%) had zone 2, and 42 (21.6%) had zone 3 fractures. 80 were discharged directly from VFC, with 114 patients being offered at least one face to face clinic follow-up. Six (3.1%) patients had clinical and radiological evidence of non-union; 4 in zone 2, and 2 in zone 3. No zone 1 injuries were identified as a non-union. Only 2 patients had surgery, 1 of which was for symptomatic non-union. Of the 6 non-union patients, 1 had surgery, 4 did not wish to have surgery and the final non-union patient was deemed unsuitable for surgery. The VFC is an effective way of managing 5th metatarsal fractures, with high patient satisfaction. Conservative management has excellent outcomes, with a low percentage of zone 2 and 3 injuries developing a symptomatic non-union. Functional outcome surveys provide further reassurance.

Ayurvedic intervention as an adjunct therapy in Non-union 5th metatarsal fracture: A case report

Proximal 5th metatarsal (MT) fractures are a common sequel of foot injury and painful nonunion is one of its well-described consequences. The purpose of this study is to present the manifestation and determine the effectiveness of ayurvedic healing measure for symptomatic 5th MT non unions. Here we narrate a case study presented with the painful nonunion of 5th metatarsal bone following failure of conventional management. The subject was investigated for following parameters: (1) injury mechanism; (2) time to solid radiographic union; and (3) time to resume usual activities. The subject was monitored until there was a clear clinical and radiological union. The mechanism of injury in this case was a fall over forefoot with plantar flexion, inversion and abduction. The nonunion was demonstrated in radiograph even after 3 months of fracture. “Sarivadi lepa” (therapeutic application of drug) was used as external application and bandaging to reduce pain, inflammation, and compliment healing process of the fracture along with immobilization. By the end of 60 days, radiograph showed evidence of callus formation and solid radiographic union was demonstrated. The subject resumed to his usual activities after complete union and maintained well till last follow up. Thus, we can claim that Sarivadi bandhana (bandaging) is beneficial in subsiding pain, swelling and to facilitate healing of fracture along with immobilization. We recommend further study on Sarivadi Lepa in larger sample to establish its assistance in fracture healing action.

Auditing the Representation of Female Athletes in Sports Medicine Research: Fifth-Metatarsal Fractures.

Female representation within athletics has increased as a result of Title IX, rising popularity, demand for equal compensation, and greater participation in multiple sports. Despite this, gender disparities in sports medicine research are apparent. This project serves to review the literature available on fifth-metatarsal fractures and assess the representation of female athletes in current literature. We used a standardized protocol to audit the representation of female athletes in sports science and sports medicine research for fifth-metatarsal fractures. Primary factors included population, athletic caliber, menstrual status, research theme, sample of males and females, journal impact factor, and Altmetric score. Thirty articles met the inclusion criteria. A total of 472 fifth-metatarsal fractures were identified, with 373 of 472 fractures (79%) occurring in males and 99 of 472 (21%) in females. The majority of studies (18/30, 60%) were mixed cohort, followed by 10 male only (33.33%), 1 female only (3.33%), and 1 male vs female (3.33%). Out of 831 total patients in the 18 mixed-cohort studies, 605 of 831 patients (72.8%) were male and 226 of 831 patients (27%) were female. All 18 mixed-sex cohorts investigated health outcomes. Male-only studies evaluated health outcomes and performance metrics. No studies investigated female performance. The one female-only study investigated health outcomes and was the only study to account for menstrual status. There was a single metatarsal fracture in this study population. Females are underrepresented in research regarding sports science and sports medicine research for fifth-metatarsal fractures. Research focused on female-only fifth-metatarsal fracture studies exploring the potential impact of female sex-specific factors such as menstrual status in study design are needed.

Clinical and Radiographic Healing of Nonoperative and Operative Treatment of Jones Fractures.

Significant heterogeneity in the classification and treatment of zone 3 proximal fifth metatarsal base fractures ("true Jones fractures") exists. This study compared time to clinical and radiographic healing between patients treated operatively and nonoperatively. We hypothesized that patients treated nonoperatively may demonstrate a greater time to clinical healing. This was a retrospective cohort study of patients presenting to a large, urban, academic medical center with "Jones" fractures between December 2012 and April 2022. Jones fractures were defined as fifth metatarsal base fractures occurring in the proximal metadiaphyseal region, distal to the articulation of the fourth and fifth metatarsals on the oblique radiographic view. Clinical healing was the time point at which the patient had returned to their baseline ambulatory status with no tenderness to palpation. Radiographic healing was the presence of bridging callus across at least 3 cortices. A total of 2450 patients presented with fifth metatarsal fractures, and 166 fractures (6.8%) were true Jones fractures. Among patients with Jones fractures, 120 patients with 121 Jones fractures followed up at our institution and were included in the analysis (mean age 46.5 ± 18.5 years). Ninety-nine fractures (81.8%) were treated nonoperatively and 22 fractures (18.2%) operatively. There were no differences between nonoperative and operative groups in time to clinical healing (12.7 ± 7.1 vs 12.8 ± 4.8 weeks, P = .931) or radiographic healing (13.2 ± 8.1 vs 11.7 ± 5.9 weeks, P = .331). Overall healing rate was 96% for the nonoperative group compared with 96.2% for the operative group. In this study, nonoperative and operative treatment of true Jones fractures were associated with equivalent clinical and radiographic healing. The rate of delayed union in true Jones fractures was lower than previously described, and there was no difference in delayed union rate between nonoperative and operative management. Level III, retrospective cohort study.

Ultrasound ability in early diagnosis of metatarsal stress fractures.

Stress fractures are common in young and active individuals, associated with aggressive or repetitive physical activity and their early detection is fundamental to optimise patient care, decrease complications and avoid unnecessary exams. Currently, magnetic resonance imaging is the standard of care for detecting these lesions. Recently, ultrasound has been getting an increasing interest for the detection of stress fractures. In this article, we describe a clinical case that involved a second metatarsal stress fracture diagnosed by ultrasound and review the literature regarding the use of ultrasound in the diagnosis of stress fractures, particularly of the metatarsals.

Stress fractures of the foot - current evidence on management

Stress fractures are a consequence of repeated submaximal loads with inadequate time for recovery and biologic repair or remodelling. The foot and ankle complex (FAC) represents a common site for development of stress fractures. Whilst the overall incidence of stress fractures is low, they are prevalent in athletes and military personnel causing significant time away from sports or work. Within these populations, certain stress fractures directly correlate to specific activities.Factors that commonly influence these fractures include an acute increase in new repetitive physical activity combined with muscle fatigue, training errors or improper athletic techniques, which challenge the regenerative and remodelling capacity of bone. Depending on the site that is subject to repetitive loading, various biomechanical factors can result in abnormal concentration of forces to specific areas of the FAC resulting in stress fracture. Decreased bone marrow density (BMD) is a major biologic cause for developing stress fractures. The female athlete triad comprising eating disorder, amenorrhea and osteoporosis in competitive athletes also predisposes to stress fractures. Vitamin D deficiency is also postulated to be the cause of these fractures and may contribute to poor healing.Clinical presentation is usually with vague pain of insidious onset which worsens with activity and improves with rest. Diffuse tenderness over the affected bone is common with only a minority having any visible swelling. Plain radiographs are the first line of investigation but rarely reveal an obvious fracture. MRI scans aid in diagnosis and CT scans help in treatment and characterisation of the fracture and monitor healing.Management relates to the site of injury, which stratifies them into high or low-risk. Stress fractures of the calcaneus, cuboid and cuneiforms are classed as low-risk fractures as they usually heal with simple activity modification or short duration of non-weight bearing. Stress fractures of the navicular, talus and hallucal sesamoids are classed as high-risk fractures due to higher rates of non-union and prolonged recovery time. Metatarsal fractures can be considered high or low-risk depending on location. These warrant aggressive management, often requiring surgical intervention. Adjuncts such as vitamin D supplements, external shockwave therapy, low-intensity pulsed ultrasound therapy have been used with varying success but there remains little supportive evidence of superiority in the available literature.

Effects of different contact angles during forefoot running on the stresses of the foot bones: a finite element simulation study.

Introduction: The purpose of this study was to compare the changes in foot at different sole-ground contact angles during forefoot running. This study tried to help forefoot runners better control and improve their technical movements by comparing different sole-ground contact angles. Methods: A male participant of Chinese ethnicity was enlisted for the present study, with a recorded age of 25years, a height of 183cm, and a body weight of 80kg. This study focused on forefoot strike patterns through FE analysis. Results: It can be seen that the peak von Mises stress of M1-5 (Metatarsal) of a (Contact angle: 9.54) is greater than that of b (Contact angle: 7.58) and c (Contact angle: 5.62) in the three cases. On the contrary, the peak von Mises stress of MC (Medial Cuneiform), IC (Intermediate Cuneiform), LC (Lateral Cuneiform), C (Cuboid), N (Navicular), T (Tarsal) in three different cases is opposite, and the peak von Mises stress of c is greater than that of a and b. The peak von Mises stress of b is between a and c. Conclusion: This study found that a reduced sole-ground contact angle may reduce metatarsal stress fractures. Further, a small sole-ground contact angle may not increase ankle joint injury risk during forefoot running. Hence, given the specialized nature of the running shoes designed for forefoot runners, it is plausible that this study may offer novel insights to guide their athletic pursuits.

Impressive clinical improvement and disappearance of neuropathic pain in an adult patient with hypophosphatasia treated with asfotase alfa

Hypophosphatasia (HPP) is a rare disorder, resulting from loss-of-function variants of the ALPL gene encoding non-tissue specific alkaline phosphatase (TNSALP). Presentation varies largely, with increased severity usually occurring with earlier disease onset. Here we describe the clinical improvement of a 57-year-old woman with childhood onset HPP, after initiating treatment with asfotase alfa (Strensiq®). This was started because of the rapid and progressive radiological deterioration of bone structure after placement of nails in both upper legs for spontaneous atypical femur fracture (AFF) - like fractures. Initiation of treatment, not only resulted in stabilization of bone structure on X-rays, but within a few weeks there was a dramatic reduction of burning pain sensations in the lower legs, attributed in retrospect to neuropathic pain, and also almost complete disappearance of headaches. Additionally, unhealed metatarsal fractures finally healed after almost 10 years. Drug efficacy was further evaluated through -quality of life questionnaires and multiple tests conducted by the physiotherapist, and showed clear improvements. Within 3 months after starting asfotase alfa, the patient was able to carry out her daily tasks indoors without relying on a walker and even started electric bike rides for 20 km/day. In conclusion, treatment with asfotase alfa, halted rapid radiological bone deterioration after bilateral intramedullary femoral pen placement and strongly increased quality of life, marked by rapid disappearance of neuropathic pain, reduction in headaches and musculoskeletal pains, and enhanced muscle strength and mobility. The quick and almost complete disappearance of neuropathic pain and headache suggests a relation with disturbed levels of metabolites in HPP.

Unconventional mobility, conventional trauma: a comparative analysis of e-scooter-related fractures.

The present research aimed to compare the different types of fractures to those caused by e-scooter use as well as reveal the severity of e-scooter injuries via an epidemiological analysis of fractures over the course of 6months. This retrospective study assessed medical records of patients with fractures or dislocations admitted to a Turkish level three trauma centre emergency orthopaedic department between June 2021 and January 2022. Using a two-group design, the first group encompassed all fractures and dislocations treated, while the second focused on e-scooter-related cases. Comparative analysis covered fracture patterns and factors within the e-scooter group, like demographics, injury mechanism, and timing. Surgical need and types were explored for e-scooter injuries. Among 4481 upper extremity fractures, finger fractures (27.47%) and distal radius fractures (25.37%) were common, while e-scooter-related cases exhibited radius and ulna shaft fractures (23.07%). Of 2400 lower extremity fractures, toe fractures (30.2%) and metatarsal fractures (19.66%) predominated, with e-scooter-related injuries largely featuring metatarsal fractures (30%). The surgery rate in all patients was 8.92%, whereas the surgery rate specifically for e-scooter injuries was 48.2%. Significantly greater occurrence of lower extremity fractures was evident in e-scooter-related injuries compared to upper extremities (p = 0.011). Collisions involving stationary or moving objects were linked to injuries in the lower extremities, whereas falls were primarily associated with injuries in the upper extremities. Treatment included surgery (48.2%) and conservative management (52.8%), with ORIF (35.7%) and CRIF (10.7%) utilised. E-scooter-related fractures and dislocations are typically more severe, often requiring surgery, compared to other fractures during the same period. The study emphasises the link between injury type and increased risk of lower extremity fractures or dislocations.

A Delphi panel to build consensus on assessing disease severity and disease progression in adult patients with hypophosphatasia in the United States

BackgroundHypophosphatasia (HPP) is an inborn error of metabolism with a variable presentation. We conducted a modified Delphi panel to obtain expert consensus on knowledge gaps regarding disease severity and progression in adult patients with HPP.MethodsHealthcare professionals (HCPs) with experience managing adult patients with HPP were recruited to participate in a 3-round Delphi panel (round 1: paper survey and 1:1 interview; rounds 2–3: email survey). Panelists rated the extent of their agreement with statements about disease severity and progression in adult patients with HPP. Consensus was defined as ≥ 80% agreement.ResultsTen HCPs completed round 1; nine completed rounds 2 and 3. Consensus was reached on 46/120 statements derived from steering committee input. Disease severity markers in adult patients with HPP can be bone-related (recurrent/poorly healing fractures, pseudo-fractures, metatarsal fractures, osteomalacia) or involve dentition or physiologic/functional manifestations (use of mobility devices/home modifications, abnormal gait, pain). Disease progression markers can include recurrent/poorly healing low-trauma fractures, development of ectopic calcifications, and/or impairment of functional activity. Panelists supported the development of a tool to help assess disease severity in the clinic and track changes in severity over time. Panelists also highlighted the role of a multidisciplinary team, centers with expertise, and the need to refer patients when disease severity is not clear.ConclusionsThese statements regarding disease severity, progression, and assessment methods address some knowledge gaps in adult patients with HPP and may be helpful for treating HCPs, although the small sample size affects the ability to generalize the healthcare provider experience.