Wright R W, Fischer D A, Shively R A, Heidt R S, Nuber G W
Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
Am J Sports Med. 2000 Sep-Oct;28(5):732-6. doi: 10.1177/03635465000280051901.
This study details six instances of refracture of clinically and radiographically healed fractures of the base of the fifth metatarsal after intramedullary screw fixation. Four professional football players, one college basketball player, and one recreational athlete underwent intramedullary screw fixation of fifth metatarsal fractures. The athletes were released to full activities an average of 8.5 weeks (range, 5.5 to 12) after fixation, when healing was clinically and radiographically documented. Three football players developed refracture within 1 day of return to full activity. The other three athletes refractured at 2.5, 4, and 4.5 months after return to activity. Two football players underwent repeat fixation with larger screws and returned to play in the same season. The college basketball player underwent bone grafting and returned to play in subsequent seasons. The other three athletes underwent nonoperative management and healed uneventfully over 6 to 8 weeks. On the basis of this series, we recommend that 1) screw fixation using a large-diameter screw should be given careful consideration for patients with large body mass for whom early return to activity is important; 2) functional bracing, shoe modification, or an orthosis should be considered for return to play; 3) if refracture occurs, exchange to a larger screw may allow return to play in the same season; and 4) alternative imaging should be considered to help document complete healing.
本研究详细介绍了6例第五跖骨基底骨折经髓内螺钉固定后临床及影像学显示已愈合但又发生再骨折的病例。4名职业足球运动员、1名大学篮球运动员和1名业余运动员接受了第五跖骨骨折的髓内螺钉固定。运动员在固定后平均8.5周（范围5.5至12周）恢复全面活动，此时临床及影像学均证实骨折已愈合。3名足球运动员在恢复全面活动后1天内发生再骨折。另外3名运动员在恢复活动后2.5、4和4.5个月时发生再骨折。2名足球运动员用更大的螺钉进行了再次固定，并在同一赛季重返赛场。那名大学篮球运动员接受了植骨手术，并在随后的赛季中重返赛场。另外3名运动员接受了非手术治疗，在6至8周内顺利愈合。基于这一系列病例，我们建议：1）对于体重较大且尽早恢复活动很重要的患者，应谨慎考虑使用大直径螺钉进行螺钉固定；2）恢复比赛时应考虑使用功能性支具、修改鞋子或使用矫形器；3）如果发生再骨折，更换为更大的螺钉可能允许在同一赛季重返赛场；4）应考虑采用其他影像学检查方法以帮助证明骨折完全愈合。
