Array.
Department of Orthopedics and Trauma Surgery, University of Verona.
Acta Biomed. 2020 May 30;91(4-S):36-46. doi: 10.23750/abm.v91i4-S.9724.
Central metatarsal fractures (CMF) are common injuries. More frequently fractures are those of the fifth metatarsal, followed by CMF and therefore by the first metatarsal. Third metatarsal is injured most frequently than the others and up to 63% is associated with second or fourth metatarsal fractures and up to 28% with both. Anatomy and metatarsal kinematics merits attention due to its influence on function, injuries and treatment options. Diagnosis is based on the history of trauma and clinical examination, relating with instrumental exams. Fractures with less than 10° of angulation and 3-4 mm of translation in any plane are typically treated conservatively, while operative treatment is generally reserved for fractures out if these values. Intramedullary fixation with K-wires seem to be the most common and valid surgical treatment in simple fractures. Spiral fractures should be treated by interfragmentary screws, which positioning may result difficult due to the adjacent metatarsals. Therefore, an alternative approach is an osteosynthesis with a dorsal plate. Multiple metatarsal fractures often occur in the contiguous bones, so clinicians will also have to carefully inspect metatarsals and adjacent joints such as Lisfranc articulation. The clinical and functional outcomes are often influenced by the pattern of fractures and patient conditions and are reported in the literature up to 39% of poor results.
跖骨中部骨折（CMF）较为常见。更常见的骨折是第五跖骨骨折，其次是 CMF，然后是第一跖骨骨折。第三跖骨比其他跖骨更容易受伤，高达 63%的第三跖骨骨折与第二或第四跖骨骨折有关，高达 28%的第三跖骨骨折与两者都有关。由于其对功能、损伤和治疗选择的影响，跖骨的解剖结构和运动学值得关注。诊断基于创伤史和临床检查，与仪器检查相关。通常，小于 10°成角和任何平面上 3-4 毫米平移的骨折采用保守治疗，而手术治疗通常保留用于超出这些值的骨折。髓内固定用 K 线似乎是治疗简单骨折最常见和有效的手术治疗方法。螺旋形骨折应采用骨折间螺钉治疗，由于相邻跖骨，螺钉的定位可能会很困难。因此，另一种方法是用背侧钢板进行骨合成。多个跖骨骨折常发生在连续的骨骼中，因此临床医生还必须仔细检查跖骨和相邻关节，如跖跗关节。骨折模式和患者状况常影响临床和功能结果，文献报道不良结果高达 39%。
