General Hospital of Agios Nikolaos, Crete, Greece.
University Hospital of Heraklion, Crete, Greece.
Eur J Orthop Surg Traumatol. 2021 Oct;31(7):1263-1271. doi: 10.1007/s00590-020-02869-y. Epub 2021 Jan 23.
Metatarsal fractures are relatively common injuries that they might lead to significant disability and chronic pain if suboptimally treated. Operative treatment is reserved for the displaced fractures. The primary aim of the herein study is to present the union time and rate, as well as the functional outcome of the surgically treated isolated lesser metatarsal shaft and neck fractures. The secondary aim is to present the related complications of each fixation method.
The electronic databases of Pubmed, Scopus, Embase and Cochrane libraries were searched from January 1990 to December 2020. PRISMA guidelines were used for data collection. We retrieved five articles including in total 154 patients, which were compatible to our inclusion criteria and they were used for this systematic review.
A total of 75 patients were treated with percutaneous antegrade pinning resulting in AOFAS score: 96.4 ± 4.8 and time to heal 7.4 ± 1 weeks, 34 patients underwent ante/retrograde pinning resulting in AOFAS score: 95.2 ± 4.75 and time to heal 6.5 ± 1 weeks, and 45 patients underwent open reduction and internal fixation with plate and screws resulting in a time to union 10.9 ± 0.5 weeks.
Our results demonstrate that K wire intramedullary nailing regardless of the specific technique (antegrade, retrograde, ante/retrograde) is associated with better outcomes compared to open reduction and internal fixation as it permits faster weight bearing and quicker rehabilitation. K-wire fixation is related to statistically significant shorter time for the fracture to heal, by approximately three weeks compared to open reduction and internal fixation. Future research should focus on studies directly comparing the different intramedullary K-wiring techniques and also K-wiring versus plate fixation.
跖骨骨折较为常见，如果治疗不当，可能会导致严重的残疾和慢性疼痛。手术治疗适用于移位骨折。本研究的主要目的是介绍手术治疗孤立性较小跖骨干和颈骨折的愈合时间和愈合率以及功能结果。次要目的是介绍每种固定方法的相关并发症。
从 1990 年 1 月至 2020 年 12 月，我们检索了 Pubmed、Scopus、Embase 和 Cochrane 图书馆的电子数据库。我们使用 PRISMA 指南进行数据收集。我们共检索到 5 篇文章，共纳入 154 例患者，这些患者符合我们的纳入标准，用于本系统评价。
共 75 例患者采用经皮顺行克氏针固定，AOFAS 评分：96.4±4.8，愈合时间 7.4±1 周；34 例患者采用前/逆行克氏针固定，AOFAS 评分：95.2±4.75，愈合时间 6.5±1 周；45 例患者采用切开复位内固定钢板螺钉固定，愈合时间为 10.9±0.5 周。
我们的结果表明，与切开复位内固定相比，无论具体技术（顺行、逆行、前/逆行）如何，克氏针髓内固定都与更好的结果相关，因为它允许更快地负重和更快的康复。与切开复位内固定相比，克氏针固定使骨折愈合时间缩短了约 3 周，愈合时间具有统计学意义。未来的研究应侧重于直接比较不同的髓内克氏针技术以及克氏针固定与钢板固定的研究。
