孤立性跖骨头剪切骨折的切开复位内固定治疗：病例系列。
Isolated Shear Fracture of the Metatarsal Head in Lesser Toes Treated With ORIF: Case Series.
机构信息
Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, the Fourth Clinical Medical College of Peking University, Beijing, China.
Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the Fourth Clinical Medical College of Peking University, Beijing, China.
出版信息
Foot Ankle Int. 2021 Jan;42(1):46-54. doi: 10.1177/1071100720952794. Epub 2020 Sep 26.
BACKGROUND
Isolated shear fractures of a metatarsal head in the lesser toes are rare in clinical practice. We report the clinical and imaging characteristics, and treatment results, of these fractures.
METHODS
A retrospective consecutive case-series study was performed on 7 patients with symptomatic isolated shear fracture of a metatarsal head in the lesser toes who were operatively treated using open reduction and internal fixation (ORIF). Radiographs and computed tomographic (CT) scans of the patients were analyzed. The American Orthopaedic Foot & Ankle Society-lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS) score, and passive dorsiflexion range of motion (ROM) of the metatarsophalangeal (MTP) joint were determined preoperatively and at final follow-up. Postoperative complications were also recorded.
RESULTS
There were 5 males and 2 females, with a mean age of 21 years (range, 16-36) at the time of surgery. Four fractures occurred at the fourth metatarsal. There were 3 chronic cases, 1 was not diagnosed initially; the other 2 failed conservative treatment. The main symptom of the chronic fractures was limited dorsiflexion at the MTP joint. Preoperative radiographs and CT scans revealed dorsal displacement of the fragment without dislocation of the MTP joint. At the final follow-up (mean, 17.4 months; range 9-27), the AOFAS-LMI scores had improved from 70.6 (range, 59-79) preoperatively to 93.3 (range, 92-100) ( = .001). VAS scores showed a decrease in pain from 4.0 to 0.0 ( = .016). Mean passive dorsiflexion ROM of the MTP joint improved significantly from 8.6 degrees preoperatively to 35.7 degrees at final follow-up ( < .001). All patients returned to their respective preinjury activity levels.
CONCLUSION
Patients with an acute or chronic isolated shear fracture of a metatarsal head in the lesser toes treated by ORIF achieved good short-term clinical and radiologic outcomes.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
背景
临床实践中，小趾跖骨的孤立性剪切骨折较为少见。我们报告了这些骨折的临床和影像学特征，以及治疗结果。
方法
对 7 例接受切开复位内固定（ORIF）手术治疗的小趾跖骨孤立性剪切骨折患者进行回顾性连续病例系列研究。分析患者的 X 线和 CT 扫描。术前和末次随访时采用美国矫形足踝协会小趾跖趾-趾间（AOFAS-LMI）评分、视觉模拟评分（VAS）和跖趾关节（MTP）被动背屈活动范围（ROM）评估。还记录了术后并发症。
结果
男性 5 例，女性 2 例，手术时的平均年龄为 21 岁（16-36 岁）。4 例骨折发生在第 4 跖骨。慢性骨折 3 例，其中 1 例最初未被诊断，另外 2 例保守治疗失败。慢性骨折的主要症状是 MTP 关节活动受限。术前 X 线和 CT 扫描显示骨折块背侧移位，MTP 关节无脱位。末次随访（平均 17.4 个月；9-27 个月）时，AOFAS-LMI 评分从术前的 70.6（59-79）提高到 93.3（92-100）（ =.001）。VAS 评分显示疼痛从 4.0 分降至 0.0 分（ =.016）。MTP 关节的平均被动背屈 ROM 明显从术前的 8.6°改善至末次随访时的 35.7°（ <.001）。所有患者均恢复到各自的伤前活动水平。
结论
接受 ORIF 治疗的急性或慢性小趾跖骨孤立性剪切骨折患者获得了良好的短期临床和影像学结果。
证据等级
IV 级，回顾性病例系列研究。
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