Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2495-2503. doi: 10.1007/s00167-021-06490-2. Epub 2021 Feb 22.
The primary purpose of this study was to determine the union rate and time for surgical- and non-surgical treatment of stress fractures of the proximal fifth metatarsal (MT5). The secondary purpose was to assess the rate of adverse bone healing events (delayed union, non-union, and refractures) as well as the return to sports time and rate.
A literature search of the EMBASE (Ovid), MEDLINE (PubMed), CINAHL, Web of Science and Google Scholar databases until March 2020 was conducted. Methodological quality was assessed by two independent reviewers using the methodological index for non-randomized studies (MINORS) criteria. The primary outcomes were the union time and rate. Secondary outcomes included the delayed union rate, non-union rate, refracture rate, and return to sport time and rate. A simplified pooling technique was used to analyse the different outcomes (i.e. union rate, time to union, adverse bone healing rates, return to sport rate, and return to sport time) per treatment modality. Additionally, 95% confidence intervals were calculated for the union rate, adverse bone healing rates, and the return to sport rate.
The literature search resulted in 2753 articles, of which thirteen studies were included. A total of 393 fractures, with a pooled mean follow-up of 52.5 months, were assessed. Overall, the methodological quality of the included articles was low. The pooled bone union rate was 87% (95% CI 83-90%) and 56% (95% CI 41-70%) for surgically and non-surgically treated fractures, respectively. The pooled radiological union time was 13.1 weeks for surgical treatment and 20.9 weeks for non-surgical treatment. Surgical treatment resulted in a delayed union rate of 3% (95% CI 1-5%), non-union rate of 4% (95% CI 2-6%) and refracture rate of 7% (95% CI 4-10%). Non-surgical treatment resulted in a delayed union rate of 0% (95% CI 0-8%), a non-union rate of 33% (95% CI 20-47%) and a refracture rate of 12% (95% CI 5-24%), respectively. The return to sport rate (at any level) was 100% for both treatment modalities. Return to pre-injury level of sport time was 14.5 weeks (117 fractures) for surgical treatment and 9.9 weeks (6 fractures) for non-surgical treatment.
Surgical treatment of stress fractures of the proximal fifth metatarsal results in a higher bone union rate and a shorter union time than non-surgical treatment. Additionally, surgical and non-surgical treatment both showed a high return to sport rate (at any level), albeit with limited clinical evidence for non-surgical treatment due to the underreporting of data.
Level IV, systematic review.
本研究的主要目的是确定手术和非手术治疗第五跖骨近端（MT5）应力性骨折的愈合率和时间。次要目的是评估不良骨愈合事件（延迟愈合、不愈合和再骨折）的发生率以及重返运动的时间和率。
对 2020 年 3 月前的 EMBASE（Ovid）、MEDLINE（PubMed）、CINAHL、Web of Science 和 Google Scholar 数据库进行文献检索。两名独立评审员使用非随机研究方法学指数（MINORS）标准评估方法学质量。主要结局是愈合时间和愈合率。次要结局包括延迟愈合率、不愈合率、再骨折率以及重返运动的时间和率。采用简化的汇总技术分析不同治疗方式的不同结局（即愈合率、愈合时间、不良骨愈合率、重返运动率和重返运动时间）。此外，还计算了愈合率、不良骨愈合率和重返运动率的 95%置信区间。
文献检索共得到 2753 篇文章，其中 13 篇文章被纳入。共评估了 393 例骨折，平均随访 52.5 个月。总体而言，纳入文章的方法学质量较低。手术和非手术治疗的骨愈合率分别为 87%（95%CI 83-90%）和 56%（95%CI 41-70%）。手术治疗的影像学愈合时间为 13.1 周，非手术治疗为 20.9 周。手术治疗的延迟愈合率为 3%（95%CI 1-5%），不愈合率为 4%（95%CI 2-6%），再骨折率为 7%（95%CI 4-10%）。非手术治疗的延迟愈合率为 0%（95%CI 0-8%），不愈合率为 33%（95%CI 20-47%），再骨折率为 12%（95%CI 5-24%）。两种治疗方式的重返运动率（任何水平）均为 100%。重返术前运动水平的时间为手术治疗 14.5 周（117 例骨折），非手术治疗 9.9 周（6 例骨折）。
与非手术治疗相比，手术治疗第五跖骨近端应力性骨折的骨愈合率更高，愈合时间更短。此外，手术和非手术治疗的重返运动率均较高（任何水平），但由于数据报告不足，非手术治疗的临床证据有限。
四级，系统评价。
