Metatarsal Fractures Research Articles

A Pilot Study of Plantar Mechanics Distributions and Fatigue Profiles after Running on a Treadmill: Using a Support Vector Machine Algorithm.

The treadmill is widely used in running fatigue experiments, and the variation of plantar mechanical parameters caused by fatigue and gender, as well as the prediction of fatigue curves by a machine learning algorithm, play an important role in providing different training programs. This experiment aimed to compare changes in peak pressure (PP), peak force (PF), plantar impulse (PI), and gender differences of novice runners after they were fatigued by running. A support vector machine (SVM) was used to predict the fatigue curve according to the changes in PP, PF, and PI before and after fatigue. 15 healthy males and 15 healthy females completed two runs at a speed of 3.3 m/s ± 5% on a footscan pressure plate before and after fatigue. After fatigue, PP, PF, and PI decreased at hallux (T1) and second-fifth toes (T2-5), while heel medial (HM) and heel lateral (HL) increased. In addition, PP and PI also increased at the first metatarsal (M1). PP, PF, and PI at T1 and T2-5 were significantly higher in females than in males, and metatarsal 3-5 (M3-5) were significantly lower in females than in males. The SVM classification algorithm results showed the accuracy was above average level using the T1 PP/HL PF (train accuracy: 65%; test accuracy: 75%), T1 PF/HL PF (train accuracy: 67.5%; test accuracy: 65%), and HL PF/T1 PI (train accuracy: 67.5%; test accuracy: 70%). These values could provide information about running and gender-related injuries, such as metatarsal stress fractures and hallux valgus. Application of the SVM to the identification of plantar mechanical features before and after fatigue. The features of the plantar zones after fatigue can be identified and the learned algorithm of plantar zone combinations with above-average accuracy (T1 PP/HL PF, T1 PF/HL PF, and HL PF/T1 PI) can be used to predict running fatigue and supervise training. It provided an important idea for the detection of fatigue after running.

Nitinol Staple versus Traditional Plate Osteosynthesis for Primary Arthrodesis of Lisfranc Injuries: A Retrospective Analysis

Category: Trauma; Midfoot/Forefoot Introduction/ Purpose: Primary arthrodesis of Lisfranc and midfoot fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion and dorsiflexion malunion. The use of a new generation of nitinol staples has proliferated in midfoot arthrodesis. The purpose of this study is to examine the use of nitinol staples in primary arthrodesis of acute Lisfranc fracture-dislocations, comparing outcomes to traditional plate and screw fixation. The primary hypothesis is that nonunion rates are lower with constructs that include nitinol staples than those with plates and screws alone. Secondary hypotheses are: 1. Total operative and tourniquet time are shorter using nitinol staples. 2. Reoperation rates are lower using nitinol staples. 3. Dorsiflexion malunion rates are lower using nitinol staples. 4. Functional outcome scores will indicate comparable post-arthrodesis disability. Methods: Midfoot fracture-dislocations treated with primary arthrodesis by seven foot and ankle orthopaedic surgeons at a tertiary referral center from 1/1/2012 to 8/1/2021 were reviewed. Patients with open fractures, fractures managed with external fixation, Charcot arthropathy, neuropathy, previous midfoot surgery, or concomitant hindfoot/ankle fractures were excluded. Of 160 eligible patients, 121 patients met the required 4-month minimum radiographic follow-up. Preoperative records were reviewed, evaluating for associated metatarsal and cuneiform fractures, operative and tourniquet time, joints included, and fixation construct. Outcomes were analyzed at both patient and individual joint levels. Patients (121 total) and individual joints (305 total) were categorized as either staples alone (45 patients, 154 joints), staples plus plates and screws (hybrid) (45 patients, 40 joints), or plates and screws alone (31 patients, 111 joints). Postoperative radiographs were analyzed for union and malunion at each joint fused. Medical records were reviewed for postoperative complications. FAAM, VR-12, and NPRS were collected. Results: When assessed at the individual joint level, the nonunion rate was higher (8.1%, 9/111) among joints fixed with plate and screw constructs than with hybrid (2.5%, 1/40) or staple only constructs (1.3%, 2/154) (P = 0.017). Of the 12 nonunions in the study, 6 had either a metatarsal or cuneiform fracture. Median OR and tourniquet time were both shorter for hybrid (92 & 83 minutes) and staple only (67 & 63 minutes) constructs compared to plate and screw only fixation (106 & 95 minutes) (P = 0.0003 & < 0.0001). There were 15 (12.4%) reoperations including 10 hardware removals, 3 nonunion revisions, and 1 malunion revision. There was no difference in reoperation, malunion (14 total, 11.6%), or patient reported outcome measure between fixation types. Conclusion: Nitinol staples are effective in achieving bony fusion when used alone or in combination with plates and screws. Their use should be considered for primary arthrodesis of Lisfranc and midfoot fracture-dislocations due to lower rates of nonunion and shorter tourniquet and operative time compared to traditional plate and screw fixation. Further studies are needed to determine if staples decrease the risk for dorsiflexion malunion and improve patient reported outcomes.

Neglected Metatarsophalangeal Joint Dislocation of the Lesser Toe with Associated Metatarsal Fracture Malunion in a 4-Year-Old Child: A Case Report.

A 4-year-old girl presented with a 5-week-old, neglected fourth metatarsophalangeal (MTP) joint dislocation with malunion of the fourth metatarsal. A previous attempt at closed reduction had failed. The reduction was hindered by dynamic stabilizing of soft tissues around the MTP joint. Open reduction of the fourth MTP joint dislocation and corrective osteotomy of the fourth metatarsal was performed. The patient was pain-free without any cosmetic deformity at the 1-year follow-up. Prompt recognition of a MTP dislocation is vital. The long extensor tendon to the toe can hinder the closed reduction of the MTP dislocation. Osteotomy of the metatarsal malunion is necessary for stable reduction. 4.

Effect of Autologous Multiple Bone Marrow Aspirate on the Healing of Metacarpal and Metatarsal Fractures Reduced by Internal Fixators in Beetal Goats

Effect of Autologous Multiple Bone Marrow Aspirate on the Healing of Metacarpal and Metatarsal Fractures Reduced by Internal Fixators in Beetal Goats

The Incidence of and Demographic Disparities Among Fifth Metatarsal Fracture Nonunions

The Incidence of and Demographic Disparities Among Fifth Metatarsal Fracture Nonunions

Delayed Reconstruction of Open Multiple Metatarsal Fractures Using Rib Bone Graft after Soft Tissue Coverage with Gracilis Free Flap: Case Report and Literature Commentary

Foot restoration after massive bone and soft tissue loss is a daunting task for surgeons. Existing literature has highlighted various methods of reconstruction. Masquelet technique, use of vascularised and non-vascularized fibular grafts, use of latissimus dorsi, serratus anterior in combination with rib grafts, iliac crest grafts have been described.

FRACTURE OF THE FIFTH METATARSAL.BIBLIOGRAPHIC REVIEW

Introduction: fractures of the fifth metatarsal have various forms of treatment, depending on the type of injury and the person who suffered it. They have great importance and frequency in athletes. They usually occur due to different trauma mechanisms. They were first described in 1902. They are the most prevalent metatarsal fractures and need to be recognized and treated in a timely and appropriate manner. Objective: to detail the current information related to the fifth metatarsal fracture, classification, description, treatment, recovery time as well as the different surgical techniques. Methodology: a total of 29 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 19 bibliographies were used because the other 10 articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fractura de pie, 5th metatarsal fracture, Jones fracture. Fracture of the fifth metatarsal, fratura do quinto metatarso. Results: the anatomical division system of Lawrence and Bottle is still used. CT and MRI could be considered in the case of delayed healing, stress fracture with normal radiographs or in nonunion. Surgical options include intramedullary screw fixation, bone grafting procedures or a combination of both. Surgical treatment of fractures of the base of the fifth metatarsal in professional athletes offers good clinical results. Conclusions: Regarding the current information related to the fracture of the fifth metatarsal, we note the importance of classification, clinical and social history of the patient, for the appropriate choice of treatment, both conservative and surgical. As for the recovery time in conservative treatment varies depending on the affected area. In delayed union or nonunion, surgical intervention should be performed.

Biomechanical Analysis of Foot–Ankle Complex during Jogging with Rearfoot Strike versus Forefoot Strike

Background and Aim. In order to reduce foot and ankle injuries induced by jogging, two-foot strike patterns, rearfoot strike (RFS), and forefoot strike (FFS), were adopted and compared. First, RFS jogging and FFS jogging were experimentally studied, so as to acquire kinematic and kinetic data, including foot strike angle, knee flexion angle, and ground reaction force (GRF). Then, a 3D finite element model of foot–ankle complex was reconstructed from the scanned 2D-stacked images. Biomechanical characteristics, including plantar pressure, stress of metatarsals, midfoot bone, calcaneus and cartilage, and tensile force of plantar fascia and ligaments, were obtained. The results showed that RFS jogging and FFS jogging had a similar change trend and a close peak value of GRF. Since possessing more momentum in the push stage and less momentum in the brake stage, FFS jogging could be in favor of a higher jogging speed. However, FFS jogging produced larger metatarsal stress in the 5th metatarsal and much larger tensile force of plantar fascia, which might cause metatarsal fracture and heel pain. While RFS jogging produced larger plantar pressure in the hindfoot area, larger calcaneus stress, and much larger tarsal navicular stress, which might cause heel tissue injury, calcaneus damage, and stress fracture of naviculocuneiform joint. In addition, talocrural and talocalcaneal joint cartilage could bear jogging loads, as the peak contact pressure were both small in RFS jogging and FFS jogging. Therefore, jogging with rearfoot or FFS pattern should be chosen according to the health condition of foot–ankle parts.

Ankle and Foot Injuries Accompanying 5th Metatarsal Fractures

Ankle and Foot Injuries Accompanying 5th Metatarsal Fractures

An investigation into the hammer toe effects on the lower extremity mechanics and plantar fascia tension: A case for a vicious cycle and progressive damage

Hammer toes are one of the common deformities of the forefoot that can lead to compensatory changes during walking in individuals with this condition. Predicting the adverse effects of tissue damage on the performance of other limbs is very important in the prevention of progressive damage. Finite element (FE) and musculoskeletal modeling can be helpful by allowing such effects to be studied in a way where the internal stresses in the tissue could be investigated. Hence, this study aims to investigate the effects of the hammer toe deformity on the lower extremity, especially on the plantar fascia functions. To compare the joint reactions of the hammer toe foot (HTF) and healthy foot (HF), two musculoskeletal models (MSM) of the feet of a healthy individual and that of a participant with hammer toe foot were developed based on gait analysis. A previously validated 3D finite element model which was constructed using Magnetic Resonance Imaging (MRI) of the diabetic participant with the hammer toe deformity was processed at five different events during the stance phase of gait.It was found that the hammer toe deformity makes dorsiflexion of the toes and the windlass mechanism less effective during walking. Specifically, the FE analysis results showed that plantar fascia (PF) in HTF compared to HF played a less dominant role in load bearing with both medial and lateral parts of PF loaded. Also, the results indicated that the stored elastic energy in PF was less in HTF than the HF, which can indicate a higher metabolic cost during walking. Internal stress distribution shows that the majority of ground reaction forces are transmitted through the lateral metatarsals in hammer toe foot, and the probability of fifth metatarsal fracture and also progressive deformity was subsequently increased. The MSM results showed that the joint reaction forces and moments in the hammer toe foot have deviated from normal, where the metatarsophalangeal joint reactions in the hammer toe were less than the values in the healthy foot. This can indicate a vicious cycle of foot deformity, leading to changes in body weight force transmission line, and deviation of joint reactions and plantar fascia function from normal. These in turn lead to increased internal stress concentration, which in turn lead to further foot deformities. This vicious cycle cause progressive damage and can lead to an increase in the risk of ulceration in the diabetic foot.

Reverse sural flap for anteromedial ankle and dorsal foot soft-tissue defect following an injury: A case report

Foot and ankle soft-tissue defects constitute a real challenge to reconstructive surgeons because of restricted local soft tissue availability. We report a 28 years old male with a significant soft-tissue defect on the left anteromedial ankle and dorsal foot. A 28 years old male with soft-tissue necrosis on the left anteromedial ankle and dorsal foot, as well as second - fourth metatarsal fractures with gangrene of the first - third phalanx, presented to our hospital 14 days after a traffic accident. He underwent debridement and amputation of the gangrenous fingers. In the second operation, a pin fixation of the metatarsal fractures and the reverse sural flap was performed. The donor site was covered with a split-thickness skin graft. The wounds began to improve significantly on the tenth day after the surgery, and his wounds were gone entirely in the third week. The pins were removed eight weeks after the surgery with the fractures healed. Skin grafts are easy and quick to cover open wounds but cannot be applied to cover bare tendons or bone. Local flaps of the distal third of the lower extremity have a limited range of motion and arc of rotation. Free flaps are an acceptable but complex reconstructive surgery that requires long operative time, special instruments, and microsurgical training and are expensive. The reverse sural flap was considered feasible in reconstructing patients with soft-tissue defects of the distal leg, ankle, and foot, especially in resource constraint scenarios.

Retrospective analysis of the use of an injectable allograft for bone marrow lesions of the foot and ankle

Background: Stress fractures occur to the musculoskeletal system on a frequent basis. This injury in the foot and ankle is relatively benign and treated conservatively with a walking boot or postoperative shoe. The use of an injectable bone graft has shown success with bone marrow edema and osteoarthritis in the knee, thus the same effects would be seen worthy of stress fractures relating to other parts of the body such as the foot and ankle. The foot and ankle sustains a high level of stress and is prone to stress fractures. This retrospective analysis documents several cases of stress fractures treated with an injectable allograft. Methodology/Procedures: A retrospective analysis was conducted on twenty-eight individuals, ages 20-75, who underwent bone repair with an injectable calcium phosphate graft by one of the study investigators. Diagnosis was made with MRI imaging studies prior to surgical intervention. Intraoperatively, fluoroscopy was used to identify the surgical site to be injected. After appropriate targeted position of a cannula, the graft was injected into the site of injury. Retrospective analysis was performed by chart review and phone contact to each participant with a minimum follow-up of twelve months post-procedure. A prewritten questionnaire was used to acquire patient and procedure feedback after verbal consent was obtained. Results: A total of twenty-seven patients were evaluated. Thirteen underwent injection of bone graft for calcaneal stress fractures, six for talus stress fractures, three for metatarsal fractures, and one for a fibula fracture. One individual presented with both a calcaneus and a talus stress fracture, one with a cuboid and a metatarsal fracture and two patients with both metatarsal and cuneiform fractures. Of those represented in this trial, 24 out of the 27 patients felt no pain and were back to their normal lifestyle and routines four weeks post-procedure. At their 12-month follow-up questionnaire conducted verbally, patients continued to report no pain and actively had resumed their lifestyles. Discussion: The analysis showed that 80% of participants had a minimum of 75% relief twelve-months post-procedure. Only 3/25 patients reported a level 5 or higher on a pain scale of 10, after the use of this treatment. Most participants returned to lifestyle activities quickly and were pain-free after a short postoperative period of treating their bone marrow lesion.

ODP057 The Unusual Case of Hypercortisolism in a Patient with Juvenile Onset Hypophosphatasia

Abstract Juvenile onset hypophosphatasia is a rare, genetic disease that is caused by inactivating mutations in the ALPL gene which encodes tissue non-specific alkaline phosphatase (TNSALP). This leads to decreased activity of the TNSALP enzyme in target tissues and accumulation of TNSALP substrates, including inorganic pyrophosphate, an inhibitor of mineralization. This disease is characterized by low levels of alkaline phosphatase in serum and bone, osteomalacia, and periodontal disease. Patients with juvenile onset hypophosphatasia present with premature loss of primary teeth, delayed walking, and a waddling gait. These symptoms may improve spontaneously after puberty and recur later in life. Here we report the case of a 51 year old male who presented initially to endocrinology clinic with a metatarsal stress fracture with subsequent diagnosis of osteoporosis, periodontal infections, and associated myopathy and joint calcifications. The patient also had a prior history of a low alkaline phosphatase level as a child. Genetic testing showed a single variant of undetermined significance found in the ALPA gene. Of note, recent lab work for the patient showed AM cortisol 27.7 mcg/dL (reference range 4. 0-22. 0 mcg/dL) with ACTH 60 pg/mL (reference range 6 - 50 pg/mL). Prior 24 hour urine free cortisol measurements with LC/MS have demonstrated elevated values 159 mcg/24 hr and 256 mcg/24 hr (reference range 4. 0 - 50. 0 mcg/24 hr) . However, most recent testing demonstrated 24 hour urine free cortisol 3.6 mcg/24 hr, and the majority of midnight salivary cortisol tests were within normal. Pituitary MRI demonstrated no abnormalities. The patient has in the past reported findings of a dorsocervical fat pad, abdominal striae, and weight gain. There is no history of diabetes mellitus or hypertension, and the patient at this time reports stable weight without current presence of a fat pad or striae. There are no clinical features of Cushing's syndrome on exam. To our knowledge, this is the second case in the literature detailing hypercortisolism in a patient with hypophosphatasia. The etiology of the hypercortisolism is likely multifactorial, with unknown association with hypophosphatasia. Based on the clinical data it appears that the patient's chronic stress, pain, and anxiety are contributing to the hypercortisolism, and that this is not a true Cushing's or cyclical Cushing's case. Repeated midnight salivary cortisol tests have excluded the possibility of Cushing's as well. Presentation: No date and time listed

ODP125 Soft Bones in Crohn's: Tumor-induced osteomalacia and inflammatory bowel disease

Abstract Introduction Bone loss is common in patients with inflammatory bowel disease (IBD) and is usually attributed to Vitamin D malabsorption, treatment with glucocorticoids or chronic inflammation. We report a case of bone loss, hypophosphatemia, and atypical fractures in a patient with IBD who was ultimately diagnosed with tumor-induced osteomalacia (TIO), a rare paraneoplastic syndrome of chronic hypophosphatemia and impaired vitamin D metabolism. Clinical Case A 39-year-old male presented for evaluation of low bone density, hypophosphatemia, and multiple stress fractures. His medical history includes Crohn's disease in biochemical remission on adalimumab and bilateral hip avascular necrosis. There was no history of significant steroid use or known family history of metabolic bone disease. He was previously highly active as a modern dancer. Over the course of 3 years, he developed progressive diffuse bony pain and he became wheelchair-bound. A whole body bone scan visualized multiple age-indeterminate atraumatic fractures, including bilateral metatarsal fractures and numerous rib fractures. Dual energy x-ray absorptiometry showed significantly low bone mass for age (Z-scores –3.4, -3.1, -3.7 at the L1-L4 spine, total right femur and right femoral neck, respectively). Physical exam was notable for a soft, subcutaneous 8 cm mass posterior to the left paraspinal muscle at the level of T12, which had previously been diagnosed as a lipoma. Laboratory evaluation revealed phosphorus 1 mg/dL (2.5-4.5 mg/dL), calcium 9.1 mg/dL (8.6-10.2 mg/dL), PTH 35 pg/mL (15-65 pg/mL), c-telopeptide 592 pg/mL (38-724 pg/mL), bone specific alkaline phosphatase 114.5 mcg/L (4-27 mcg/L), vitamin D-1,25 8.9 pg/mL (19.9-79.3 pg/mL), and vitamin D-25 34 ng/mL (normal >30 ng/mL). Fibroblast growth factor-23 (FGF-23) level was 1200 RU/mL (44-215 RU/mL), consistent with TIO. Thyroid function, dexamethasone suppression test, testosterone and IGF-1 were normal. Ga-DOTATATE PET scan demonstrated that the paraspinal soft tissue mass was strongly somatostatin avid. The patient was treated with oral calcitriol and phosphate replacement. He underwent a biopsy of the left paraspinal mass, which was consistent with a bland epithelioid and spindle cell neoplasm, most suggestive of a phosphaturic mesenchymal tumor. He is scheduled for a radical resection of the soft tissue mass. Conclusion To date, there are no published case reports of TIO with coexisting IBD. Inflammatory cytokines, such as tumor necrosis factor alpha, have been shown to positively correlate with FGF-23 levels, and FGF-23 has been documented to be elevated during IBD flares. Given this, the presence of IBD may portend a worsened metabolic bone prognosis in patients who simultaneously develop FGF-23 secreting tumors. Presentation: No date and time listed

RF30 | PSAT138 Romosozumab-aqqg in the Treatment of Osteoporosis in a Patient with Hypophosphatasia

Abstract Background Hypophosphatasia (HPP) is a rare inherited condition that causes osteomalacia and recurrent fractures. Therapeutic options for osteoporosis in patients with concomitant HPP are limited due to concerns for a greater likelihood of atypical femoral fractures (AFF) with anti-resorptive agents such as bisphosphonates and denosumab. We present a patient with HPP and OP who was treated with the anti-sclerostin antibody romosozumab-aqqg (Romo). Clinical Case An 81-year-old female was referred for management of OP. Fracture history included a hip fracture around age 40, and bilateral metatarsal fractures around age 65. Her initial DXA scan at age 57 showed osteoporosis at the lumbar spine (LS, T-score: -2.8) and femoral neck (FN, T-score -3.2). Sequential osteoporosis treatment over the subsequent 20 years included several years of oral bisphosphonates, hormone replacement therapy, teriparatide for one year followed by two years of alendronate, and one denosumab injection. Despite almost 20 years of pharmacologic osteoporosis treatment, her bone mineral density (BMD) worsened. HPP was suspected on the basis of low serum alkaline phosphatase (AP) levels ranging from 25-37 U/L (ref: 35-104 U/L). The diagnosis was substantiated by an elevated plasma vitamin B6 level of 305 mcg/L (ref: 5-50 mcg/L) and confirmed by genetic testing showing a diagnostic missense mutation c.571G>A in exon 6 in the ALPL gene. After diagnosing HPP, her osteoporosis was treated with an additional year of teriparatide followed by raloxifene, which she tolerated poorly. Following two years of expectant management, during which time her BMD worsened despite calcium and vitamin D supplementation to T-scores of –4.4 at the LS, she was started on Romo. After 11 monthly injections, a follow up DXA scan showed improvements of 21%, and 10% at the LS and total hip, respectively. These changes were substantially greater than what she experienced with her first year of teriparatide therapy (+4% and +8%, respectively). Blood AP remained low on Romo (37 IU/L and 29 IU/L at 9 and 12 months post-Romo initiation). She tolerated Romo and well and experienced no fractures during treatment. Discussion Management of osteoporosis in patients with HPP is challenging, as bisphosphonates and denosumab are generally avoided due to concern for an increased risk of AFF. Case reports of patients with HPP have suggested good BMD response to teriparatide. To our knowledge, this is the first report of a patient with HPP and osteoporosis treated with Romo. In our patient, Romo did not significantly impact serum AP, but improved BMD significantly more than in response to teriparatide. In conclusion, Romo is a potential treatment option for OP in patients with HPP for whom limited alternatives exist. Optimal osteoporosis treatment following a 1-year course of Romo remains to be determined. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 1:05 p.m. - 1:11 p.m.

Running Velocity and Longitudinal Bending Stiffness Influence the Asymmetry of Kinematic Variables of the Lower Limb Joints.

Running-related limb asymmetries suggest specific sports injuries and recovery circumstances. It is debatable if running speed affected asymmetry, and more research is required to determine how longitudinal bending stiffness (LBS) affected asymmetry. The purpose of this study was to investigate the influence of running velocity and LBS on kinematic characteristics of the hip, knee, ankle, metatarsophalangeal joint (MTP) and the corresponding asymmetry. Kinematic (200 Hz) running stance phase data were collected bilaterally for 16 healthy male recreational runners (age: 23.13 ± 1.17, height: 175.2 ± 1.6 cm, body mass: 75.7 ± 3.6 kg, BMI: 24.7 ± 1.3 kg/m2) running on a force plate at three different velocities (10, 12 and 14 km/h) and three increasing-LBS shoes in a randomized order. The symmetry angle (SA) was calculated to quantify gait asymmetry magnitude at each running velocity and LBS. Changes in running velocity and LBS led to differences in kinematic variables between the hip, knee, ankle and MTP (p < 0.05). Significant changes in SA caused by running velocity were found in the knee flexion angle (p = 0.001) and flexion angle peak velocity (p < 0.001), ankle plantarflexion angle (p = 0.001) and plantarflexion angle peak velocity (p = 0.043) and MTP dorsiflexion angle (p = 0.001) and dorsiflexion angle peak velocity (p = 0.019). A significant change in the SA caused by LBS was found in the MTP dorsiflexion peak angle velocity (p = 0.014). There were interaction effects between running velocity and LBS on the MTP plantarflexion angle (p = 0.033) and plantarflexion angle peak velocity (p = 0.038). These findings indicate the existence of bilateral lower limb asymmetry. Meanwhile, it was proved that running velocity and LBS can influence the asymmetry of lower limb joints. Additionally, there was an interaction between running velocity and LBS on the asymmetry of the lower limb. These findings can provide some information for sports injuries, such as metatarsal stress fractures and anterior cruciate ligament injuries. They can also provide some useful information for running velocities and running shoes.

Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture.

ObjectiveVenous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk/benefit consideration. The goal of this study was to determine what patients are most at risk.MethodsThe M53Ortho Pearldiver database was used to identify patients with fractures isolated to the foot and ankle that were treated non-operatively or operatively. Patients with pilon, other appendicular fractures remote from the foot and ankle, and other traumatic injuries were excluded. The 90-day occurrence of VTE was identified based on codes for deep vein thrombosis or pulmonary embolism. Characteristics of those patients who did and did not have VTEs were compared using chi-square analyses. Multivariate logistical regression was then performed to determined factors independently associated with VTE. Finally, timing of VTE relative to fracture was analyzed.ResultsA total of 298,886 patients with isolated foot or ankle fractures were identified, of which 1,661 (0.56%) had VTE in the 90 days following fracture. In terms of timing, 27.3% occurred in the first week, and 49.8% occurred in the first three weeks. Independent risk factors for VTE included (in decreasing order):prior VTE (odd ratio [OR] = 25.44), factor V Leiden (OR = 24.34), active cancer (OR = 1.84), specific fracture relative to metatarsal fracture (multiple fractures [OR: 1.51], ankle fracture [OR = 1.51], and calcaneus fracture [OR = 1.24]), surgical treatment (OR = 1.41), male sex (OR = 1.19), greater Elixhauser index (OR = 1.05), and increasing age (OR:1.05 per decade) (p<0.05 for each).ConclusionsThe present study found that, although only 0.56% of isolated foot and ankle fractures had a VTE within ninety days. Defined risk factors, such as Factor V Leiden, prior VTE, surgical treatment, active cancer, specific fracture patterns, and surgical treatment significantly affected the odds of their occurrence.

Intra-articular base of 5th metatarsal fractures (Zone 2) – Should we be operating on more of these fractures?

A 21yo man twists his foot while playing pick-up basketball when he missteps on the foot of another player. He suffers a base of 5th intra-articular metatarsal fracture (Zone 2 fracture). He is otherwise unhurt.

Determining the Key Predictive Factors for Non-Union in Fifth Metatarsal Fractures: A Machine Learning-Based Study

Category: Midfoot/Forefoot; Trauma; Other Introduction/Purpose: Metatarsal fractures account for over 35% of all foot fractures, and of these 68% specifically involve the fifth metatarsal [1],[2]. Subgroups of fractures affecting the fifth metatarsal base may be at higher risk of nonunion and therefore benefit from early surgical fixation, but traditional predictive models focus on the location of the fracture and little else. In this study, we aimed to determine predictive factors associated with non-union of fifth metatarsal fractures to assist surgeons and patients, alike, in identifying those at higher risk of nonunion. Methods: A retrospective machine learning-based analysis of 1,000 patients, &gt;=18 y/o, diagnosed with a fifth metatarsal fracture at three tertiary medical centers was conducted. The fifth metatarsal base fracture was confirmed radiographically. We gathered imaging and narrative data including demographics (age, height, weight, BMI, gender, race, smoking habits, activity level), medications, chronic conditions, and fracture status (fracture zone, displacement, treatment method, healing status, and healing time). Non-union was described as failing to heal within 180 days of initial injury [3]. A machine learning analysis together with Pearson's correlation test and T-test were utilized where applicable. Five imputation methods were used to fill in missing datapoints. P&lt;0.05 was considered statistically significant. Results: Overall, this cohort of patients demonstrated a non-union rate of 22.4%. When divided by fracture zone, Zone 2 fractures results in a statistically significant increased rate of delayed union (17.2%) and non-union (8.6%), when compared to Zone 1 (10.8% and 5.8%, respectively) and Zone 3 (9.7%, 2.3%). Analysis of correlation between demographics data and union rates found no correlation with age, gender, race, or BMI. Our machine learning algorithm outcomes showed a significant correlation between nonunion and seven chronic diseases: diabetes, thyroid disease, hypertension, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS) obstructive sleep apnea (OSA), and glaucoma. In terms of medications, significant correlation with nonunion was demonstrated with the use of levothyroxine, lisinopril, aspirin, steroids, and acetaminophen. Conclusion: Zone 2 fifth metatarsal base fractures have a significantly higher rate of nonunion as compared to other zones. Comorbid conditions including diabetes, thyroid disease, OSA, and glaucoma as well as medications, may also play a role, though their mechanism or correlative precipitants are yet to be determined. Although our results demonstrated correlation, causality can only be assessed using studies with limited confounding factors, such as clinical trials. Our outcomes suggest that physicians should pay attention not only to the location of the fracture, but also past medical history and medication use when making treatment decisions and discussing prognosis with patients.

Functional and Radiologic Outcomes Following Fifth Metatarsal Fracture Non-Operative Treatment: A Retrospective Chart Review with Application of the RUST Score From 2019-2021

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Fifth metatarsal fractures are a common injury of the foot, however, there remains a lack of consensus regarding the management of Zone I and II fifth metatarsal fractures. The evidence shows varied outcomes between operative management and non-operative interventions. Additionally, there is limited discussion on radiographic outcomes following these fractures, with no established scoring system to assess radiographic healing. The radiographic union scale in tibial (RUST) fractures is an assessment tool designed to standardize radiographic assessment and outcome measures based on cortical bridging. The aim of this study is to assess the functional and radiologic outcomes for patients with base of fifth metatarsal fractures (Zone I-III) utilizing the RUST score as a method for standardized assessment of radiographic healing. Methods: We performed a secondary retrospective chart review of patients with base of fifth metatarsal fractures treated by six orthopedic surgeons at University of Colorado Orthopaedics from 2018-2021. We collected information on treatment modality and the functional, radiographic, and patient reported outcomes. Patients were included who attended minimum two visits and had x-ray available. The x-rays were read by a fellowship trained foot and ankle surgeon, and were assessed based on presence of displacement, resorption, and overall healing. The RUST scoring system was applied when fracture appeared healed and assessed on the four cortices (anterior, posterior, medial, and lateral) of the 5th metatarsal bone by assigning a score from 1 to 3 based on appearance. The scores were combined for a minimum of 4 (not healed) and a maximum of 12 (completely healed). Differences between outcomes were evaluated using an unpaired t-test and figures are reported with standard error. Results: Out of 196 total patients, 109 were excluded due to shaft fracture or insufficient follow-up, leaving 87 non-operative patients with base of fifth metatarsal fractures available for analysis. Radiographically, the average time to resorption was 37 days and average time to healing was 98 days, which was significantly longer than when patients began weight bearing at 44 days (p&lt;0.001), but not significantly different than return to normal shoe wearing at 75 days (p=0.077). While 96% of patients at visit 4 were weight bearing and wearing normal shoes, only 73% had radiographic healing. The average RUST score at visit 2 was 10.14 (n=21) improving to 10.5 (n=12) by visit 4. To note, only 30% of patients presented for all four visits and the average final follow- up was 106 days after injury. Conclusion: Patients treated non-operatively for base of fifth metatarsal fractures have significantly shorter timelines for functional healing compared to evidence of radiographic healing. Overall RUST score at visit 4 supports those patients did not reach full cortical healing as the average score was 10.5 out of 12 possible points. Most patients have signs of resorption on x-ray by their second visit, but many do not continue follow up for complete evidence of healing. This highlights the importance of functional healing in treatment decisions for Zone I and II fractures and overall good prognosis regardless of complete healing radiographically.