Stress Fracture Of Metatarsal Bone Research Articles

Predictive factors for the bone union disorder of intramedullary screw fixation in proximal fifth metatarsal bone fractures.

Although intramedullary screw fixation likely leads to successful union of Jones fractures compared to that of nonoperative treatments, bony union disorder after surgical treatment remains to be elucidated. Intramedullary screw fixation was performed for the surgical treatment of proximal fifth metatarsal stress fractures in this series. Between January 2008 and December 2019, the feet of 222 patients were investigated regarding the effective factors for postoperative bony union between the normal union group and the bony union disorder group according to the patients' physical status, radiological assessment, and screw size. The mean postoperative follow-up period was 11.1months. Bone union disorder was defined as delayed union, nonunion, or a re-fracture recognized through a radiographic image. The prevalence rate of union disorders occurred in 14% (31/222) of the patients. The risk of bone union disorder significantly increased when using a small-diameter screw (odds ratio 4.81, 95% confidence interval [CI] 1.62-14.2, p = 0.004) and non-bone graft procedures (odds ratio 3.13, 95% CI 1.22-8.02, p = 0.02). Screw length, preoperative Torg's classification, or patients' physical status did not affect postoperative bony union. Approximately 14.0% of the patients in our study had postoperative bone union disorder. Small-diameter screws and non-bone graft procedures increased the risk of bone union disorder in the intramedullary screw fixation technique of fifth metatarsal bone stress fractures. Level 4, case series.

A comparative overview of metatarsal stress fractures in premenopausal and postmenopausal women: our single-centre experience with eighty-one patients.

To compare the demographic, clinical, and laboratory features of metatarsal bone stress fractures encountered in premenopausal and postmenopausal women. This retrospective study was carried out in the orthopaedics and traumatology department of our tertiary care centre. Data were collected from the hospital records of a total of 81 women (average age 42.65 ± 12.97) allocated in premenopausal (n = 36) and postmenopausal (n = 45) groups. These two groups were compared in terms of age, body mass index, side, and level of the metatarsal stress fracture, serum levels of vitamin D, duration of complaint and treatment, and T-scores of femur and vertebra as measured by dual-energy X-ray absorptiometry. The average body mass index (BMI) was 27.00 ± 2.49kg/m2 (range 21.8 to 31.2). The right side was involved in 44 cases (54.3%), while the left side was affected in 37 patients. DXA T-scores were significantly high for group 2 for both femur and vertebra (p< 0.001 for both). Two groups did not exhibit any significant differences in terms of BMI, side of the stress fracture, level and location of the fracture, seasonal distribution, smoking habits, comorbidities, serum levels of vitamin D, durations of complaints, and treatment. Our results indicated that there was no difference between 2 groups in terms of serum vitamin D levels; however, postmenopausal women had higher T-scores of femur and vertebra. Identification of patients under higher risk for stress fractures and elucidation of the possible role of menopause necessitate further controlled, randomized trials on larger series.

Subtalar extra-articular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children.

PurposeThe aim of this study was to describe a subtalar extra-articular screw arthroereisis (SESA) technique for the correction of flexible flatfoot (FFF) in children and report the outcome.MethodsFrom 1990 to 2012, data were collected on 485 patients who underwent SESA at the San Raffaele Hospital. The average age of the patient cohort was 11.5 ± 1.81 years (range 5.0–17.9 years; median 11.5 years). Inclusion criteria were FFF and marked flexible hindfoot valgus, and the exclusion criterion was rigid flatfoot. SESA was performed in 732 cases of FFF—bilaterally in 247 patients and monolaterally in 238 patients.ResultsThe values of the pre- and post-SESA weight-bearing X-ray angles were 146° ± 7° and 129° ± 5°, respectively, for the Costa-Bartani angle, 43° ± 8° and 25° ± 6°, respectively, for the talar inclination angle and 11° ± 6° and 14° ± 5°, respectively, for calcaneal pitch (p <0.001). All data were analysed statistically with Student’s t test. Data on 398 patients were ultimately available for analysis. In 93.7 % of cases the results were good in terms of improved clinical aspects and X-ray measurement, absence of complications, normal foot function 3 months post-SESA and no requirement for further surgery. The complication rate was 6.3 % and included ankle joint effusion, painful contracture of peroneal muscles and fourth metatarsal bone stress fractures. A sample of 76 patients (121 feet) were evaluated after screw removal, which occurred on average 2.9 years after SESA. The angle measurements of this sample showed no statistically significant modification.ConclusionBased on our >20 years of experience, we believe that SESA is an optimal technique for the correction of FFF as it is simple and can be performed rapidly, and the corrective effect results from the screw’s mechanical and proprioceptive effect. The indication for surgery must be accurate. We suggest that the patient be at least 10 years of age in order that all of the foot’s growth potential can be utilized and to allow for spontaneous resolution and thereby avoid the possibility of over-treatment.

Ultrasonography in Early Diagnosis of Metatarsal Bone Stress Fractures. Sensitivity and Specificity

To the Editor: The recent article by Banal, et al 1 demonstrated intriguing evidence about the potential for diagnostic musculoskeletal ultrasonography in laboratory investigations of metatarsal stress fractures. It was noted that there were no false-positives for stress fracture when “cortical thickening” was observed on ultrasound. It …

Sensitivity and Specificity of Ultrasonography in Early Diagnosis of Metatarsal Bone Stress Fractures: A Pilot Study of 37 Patients

To date, early diagnosis of stress fractures depends on magnetic resonance imaging (MRI) or bone scan scintigraphy, as radiographs are usually normal at onset of symptoms. These examinations are expensive or invasive, time-consuming, and poorly accessible. A recent report has shown the ability of ultrasonography (US) to detect early stress fractures. Our objective was to evaluate sensitivity and specificity of US versus dedicated MRI (0.2 Tesla), taken as the gold standard, in early diagnosis of metatarsal bone stress fractures. A case-control study from November 2006 to December 2007 was performed. All consecutive patients with mechanical pain and swelling of the metatarsal region for less than 3 months and with normal radiographs were included. US and dedicated MRI examinations of the metatarsal bones were performed the same day by experienced rheumatologists with expertise in US and MRI. Reading was undertaken blind to the clinical assessment and MRI/US results. Forty-one feet were analyzed on US and dedicated MRI from 37 patients (28 women, 9 men, mean age 52.7 +/- 14.1 yrs). MRI detected 13 fractures in 12 patients. Sensitivity of US was 83%, specificity 76%, positive predictive value 59%, and negative predictive value 92%. Positive likehood ratio was 3.45, negative likehood ratio 0.22. In cases of normal radiographs, US is indicated in the diagnosis of metatarsal bone stress fractures, as it is a low cost, noninvasive, rapid, and easy technique with good sensitivity and specificity. From these data, we propose a new imaging algorithm including US.

99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis

Stress fractures are the injuries of soft tissues and bones caused by intensive and repeated stress on a bone. Repeated submaximal stress disturbs the balance between the processes of bone production and resorption that results in fracture. We presented a case of a patient with stress fracture of metatarsal bone. The patient was diagnosed and treated as having reactive oligoarthritis caused by Chlamydia trachomatis and administered antibiotics. Initial plain radiography was negative for bone fracture. Tc-99m bone scintigraphy suggested stress fracture of the second metatarsal. Plain radiography was became positive three weeks later, showing callus formation in the proximal part of the second metatarsal. Bone scintigraphy is a diagnostic test of choice in early diagnosis of stress fracture, and it is important to apply it timely in order to include the entire therapy and prevent complications, as well as to let a patient return to previous daily activities.