Foot & Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Korea.
Am J Sports Med. 2011 Oct;39(10):2206-11. doi: 10.1177/0363546511414856. Epub 2011 Jul 14.
There have been diverse results, even in the same Torg type classification, in cases with fifth metatarsal stress fracture.
The "plantar gap" is correlated with the time for bone union and complications. It might be used for a prognostic factor.
Cohort study; Level of evidence, 3.
Seventy-five cases with a fifth metatarsal stress fracture treated with modified tension band wiring from January 2003 to December 2008 were evaluated retrospectively. This consecutive series of patients included 71 male and 2 female patients with a mean of 19.8 years of age at the time of surgery. All of the enrolled patients were elite-level athletes. Each case was classified according to Torg classification and the degree of plantar gap was also measured. After the surgery, bone union was determined by computed tomography findings. Statistical analysis of the Torg classification and time for bone union, as well as plantar gap and time for bone union, was performed.
The mean time for bone union for each Torg type was 71.05 ± 21.77 days for type I, 104.48 ± 54.62 days for type II, and 122.92 ± 51.75 days for type III. There was a significant difference in the time for bone union among the 3 Torg types (P = .008). The mean time for bone union in group A (plantar gap <1 mm) was 71.21 ± 29.95 days and it was 126.4 ± 51.99 days for group B (plantar gap ≥1 mm) (significantly different; P < .001). In addition, there was a positive correlation of the time for bone union with the degree of plantar gap (ρ = .661, P < .001). In cases with Torg type II classification, there was a significant difference in the time for bone union between groups A and B (P < .001) In addition, there was a strong correlation between the time for bone union and the degree of plantar gap (ρ = .657, P < .001). There were 8 cases of nonunion in Torg type II, and 1 case in Torg III. With regard to the plantar gap, there was 1 case of nonunion in group A, and 8 cases in group B.
The results of this study suggest that the plantar gap might be used for prognosis in cases with a fifth metatarsal stress fracture, even in patients with the same Torg classification.
即使在同一 Torg 分型中，第五跖骨应力性骨折的结果也存在差异。
“足底间隙”与骨愈合时间和并发症相关。它可能被用作预后因素。
队列研究；证据水平，3 级。
回顾性评估 2003 年 1 月至 2008 年 12 月期间采用改良张力带固定治疗的 75 例第五跖骨应力性骨折患者。该连续系列患者包括 71 名男性和 2 名女性，手术时平均年龄为 19.8 岁。所有入组患者均为精英级运动员。根据 Torg 分类对每个病例进行分类，并测量足底间隙的大小。手术后，通过计算机断层扫描确定骨愈合情况。对 Torg 分类和骨愈合时间，以及足底间隙和骨愈合时间进行统计学分析。
每型 Torg 的平均骨愈合时间为 I 型 71.05 ± 21.77 天，II 型 104.48 ± 54.62 天，III 型 122.92 ± 51.75 天。3 种 Torg 类型的骨愈合时间有显著差异（P =.008）。A 组（足底间隙＜1mm）的平均骨愈合时间为 71.21 ± 29.95 天，B 组（足底间隙≥1mm）为 126.4 ± 51.99 天（差异显著；P＜.001）。此外，骨愈合时间与足底间隙呈正相关（ρ =.661，P＜.001）。在 Torg II 型分类中，A 组和 B 组的骨愈合时间有显著差异（P＜.001）。此外，骨愈合时间与足底间隙之间存在很强的相关性（ρ =.657，P＜.001）。在 Torg II 型中有 8 例骨折不愈合，在 Torg III 型中有 1 例。关于足底间隙，A 组有 1 例骨折不愈合，B 组有 8 例。
本研究结果表明，即使在同一 Torg 分型中，足底间隙也可用于第五跖骨应力性骨折的预后判断。
