University of Wisconsin-Madison, Orthopedics and Rehabilitation, Madison, WI, USA.
Foot Ankle Int. 2013 Jul;34(7):962-8. doi: 10.1177/1071100713475613. Epub 2013 Feb 5.
Metatarsal stress fractures account for approximately 28% of all stress fractures reported in the literature. Second and third metatarsal stress fractures are most common, followed by fractures of the fourth and fifth metatarsal. Reports in the literature suggest that proximal fourth metatarsal stress fractures have the same propensity for delayed healing and nonunion as do fifth metatarsal stress fractures. There is a paucity of literature on operative management of fourth metatarsal fractures. This study reports the results of operative management of fourth metatarsal stress fractures in athletes.
A retrospective review with prospectively collected data was undertaken to evaluate utility of operative care of fourth metatarsal stress fractures in an athletic population desiring early return to sports. Eleven athletes over a 13-year period were enrolled with proximal fourth metatarsal stress fractures. The American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot scores were obtained pre- and postoperatively. Midfoot alignment, including the presence or absence of metatarsus adductus, radiographic time to healing, and time to return to sports were also recorded.
All patients were treated with operative open reduction and internal plate fixation with calcaneal autograft. Four of the 11 patients had metatarsus adductus. All had evidence of radiographic healing prior to return to activity, all returned to sports at an average of 12 weeks post surgery, and all would choose surgery again given the same injury. The AOFAS Midfoot scale improved from an average of 55 preoperatively to 94 postoperatively (P < .001) CONCLUSION: Our study suggests that operative repair of fourth metatarsal stress fractures hastens time of healing and return to sports in athletes. It also supports the theory that there is a correlation between metatarsus adductus lateral metatarsal stress fractures.
Level IV, retrospective case series.
跖骨应力性骨折约占文献报道的所有应力性骨折的 28%。第二和第三跖骨应力性骨折最为常见，其次是第四和第五跖骨骨折。文献报道提示，近端第四跖骨应力性骨折与第五跖骨应力性骨折一样，有愈合延迟和不愈合的倾向。关于第四跖骨骨折的手术治疗文献很少。本研究报告了运动人群中第四跖骨应力性骨折手术治疗的结果。
对 13 年来接受手术治疗的 11 例运动员近端第四跖骨应力性骨折患者进行回顾性前瞻性数据评估，这些患者希望能早日重返运动。采用美国矫形足踝协会（AOFAS）中足评分评估术前和术后的疗效。还记录了中足对线，包括有无内收，影像学愈合时间和重返运动时间。
所有患者均采用切开复位内固定加跟骨自体植骨治疗。11 例患者中有 4 例有内收。所有患者在活动前均有影像学愈合证据，所有患者均在术后 12 周平均恢复运动，所有患者在同样的损伤下都愿意再次选择手术。AOFAS 中足评分从术前平均 55 分提高到术后 94 分（P <.001）。
我们的研究表明，第四跖骨应力性骨折的手术修复可以加快运动员的愈合时间和重返运动的时间。它还支持了内收和外侧跖骨应力性骨折之间存在相关性的理论。
IV 级，回顾性病例系列。
