Grant Michael J, Molloy Andy P, Mason Lyndon W
Specialty Trainee, University Hospital Aintree, Longmoor Lane, Liverpool, United Kingdom; Specialty Trainee, Health Education North West (Mersey) Regatta Place, Liverpool, United Kingdom.
Consultant Foot & Ankle Surgeon, University Hospital Aintree, Longmoor Lane, Liverpool, United Kingdom.
J Foot Ankle Surg. 2020 Jul-Aug;59(4):753-757. doi: 10.1053/j.jfas.2019.08.034. Epub 2020 Mar 12.
Nonunion after a proximal fifth metatarsal fracture can cause considerable pain, with high morbidity and loss of work. Although many authors advocate early surgical management of zone 3 injuries (Jones fractures), zone 1 and 2 fractures are generally expected to heal with conservative management. Uncommonly, zone 1 and 2 fractures can develop nonunions. The aim of this study was to evaluate the efficacy of closed intramedullary screw fixation for nonunions of the fifth metatarsal base. We performed a prospective study involving all fifth metatarsal base nonunions treated in our department over 2 years. Only minimally displaced adult fractures were considered for this study. The fracture pattern was categorized using the Dameron classification (zone 1, styloid process; zone 2, metadiaphyseal area; zone 3, proximal diaphysis). All nonunions were fixed percutaneously under radiographic guidance, without fracture site preparation. Zone 1 injuries were fixed using a 3-mm headless compression screw, and those of zones 2 and 3, with an intramedullary 4-mm screw. Of 30 patients included in this study, a minimum 6-month clinical follow-up was obtained. The average time from injury to treatment was 5.9 months (range 3 to 36). There were no smokers in this patient cohort. There were 12 zone 1 injuries, 9 zone 2 injuries, and 9 zone 3 injuries. All patients achieved union by 3 months after screw fixation, with 29 of 30 achieving union by 6 weeks. All patients had resolution of symptoms. There were no complications. We conclude that percutaneous fixation of fifth metatarsal base nonunions, without fracture site preparation, achieves excellent results. We believe that the screw alters the strain of the fracture, thus promoting fibrous-to-osseous conversion and therefore union.
第五跖骨近端骨折不愈合可导致相当程度的疼痛，发病率高且会影响工作。尽管许多作者主张对3区损伤（琼斯骨折）进行早期手术治疗，但1区和2区骨折一般预期通过保守治疗即可愈合。1区和2区骨折偶尔也会发生不愈合。本研究的目的是评估闭合髓内螺钉固定治疗第五跖骨基底不愈合的疗效。我们进行了一项前瞻性研究，纳入了本科室在2年期间治疗的所有第五跖骨基底不愈合病例。本研究仅纳入轻度移位的成人骨折。骨折类型采用达默隆分类法（1区，茎突；2区，干骺端区域；3区，近端骨干）。所有不愈合均在影像学引导下经皮固定，无需对骨折部位进行准备。1区损伤采用3毫米无头加压螺钉固定，2区和3区损伤采用4毫米髓内螺钉固定。本研究纳入的30例患者均获得了至少6个月的临床随访。从受伤到治疗的平均时间为5.9个月（范围3至36个月）。该患者队列中无吸烟者。其中1区损伤12例，2区损伤9例，3区损伤9例。所有患者在螺钉固定后3个月均实现愈合，30例中有29例在6周时实现愈合。所有患者症状均消失。无并发症发生。我们得出结论，第五跖骨基底不愈合在无需对骨折部位进行准备的情况下经皮固定可取得优异效果。我们认为螺钉改变了骨折部位的应变，从而促进纤维到骨的转化，进而实现愈合。
