Gahr Patrick, Schleese Lennart, Mittlmeier Thomas
Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
Oper Orthop Traumatol. 2024 Aug;36(3-4):211-222. doi: 10.1007/s00064-024-00853-x. Epub 2024 Jul 29.
Minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in a correct position to restore anatomy and biomechanics of the foot.
A. Dislocated diaphyseal and subcapital fractures of the second to fifth metatarsal (> 3 mm, > 10° dislocation). B. Fifth metatarsal fracture at the metadiaphyseal junction (Lawrence and Botte type III).
High grade soft tissue damage or infection at the implant insertion site.
A. Fluoroscopically assisted closed reduction and antegrade intramedullary fixation of diaphyseal and subcapital fractures of the second to fifth metatarsal. B. Fluoroscopically assisted wire-guided intramedullary screw fixation of fifth metatarsal fractures at the metadiaphyseal junction.
A. Mobilization with partial weight bearing (20 kg) for 6 weeks wearing a stiff sole; implant removal under local anesthesia after 6-8 weeks, followed by a free range of movement and weight-bearing as tolerated (WBAT). B. Early mobilization with weight-bearing as tolerated (WBAT); removal of the orthosis after 6 weeks, implant removal optional.
A. Antegrade nailing of subcapital and shaft fractures of metatarsals II-V achieves good clinical results with low complication rates both when using prepared Kirschner wires or elastically stable intramedullary nails (ESIN). B. According to current literature, intramedullary screw osteosynthesis of proximal metatarsal V fractures of zone II and III according to Lawrence and Botte leads to faster bony healing with a lower nonunion rate compared with conservative treatment. It is recommended especially, but not only, for active athletes.
采用微创技术稳定跖骨骨折，使骨折在正确位置充分愈合，以恢复足部的解剖结构和生物力学。
A. 第二至第五跖骨干骺端和骨干脱位骨折（>3mm，>10°脱位）。B. 第五跖骨干部交界处骨折（劳伦斯和博特III型）。
植入部位存在严重软组织损伤或感染。
A. 在C形臂X线透视辅助下对第二至第五跖骨干骺端和骨干骨折进行闭合复位及顺行髓内固定。B. 在C形臂X线透视辅助下通过导丝对第五跖骨干部交界处骨折进行髓内螺钉固定。
A. 穿硬底鞋部分负重（20kg）活动6周；6 - 8周后在局部麻醉下取出植入物，随后根据耐受情况进行自由活动和负重（可耐受负重）。B. 早期根据耐受情况负重活动；6周后去除矫形器，可选择取出植入物。
A. 采用预弯克氏针或弹性稳定髓内钉（ESIN）对第二至第五跖骨头下和骨干骨折进行顺行髓内钉固定，临床效果良好，并发症发生率低。B. 根据现有文献，按照劳伦斯和博特分型，对第二和第三区的第五跖骨近端骨折采用髓内螺钉内固定，与保守治疗相比，骨折愈合更快，骨不连发生率更低。尤其推荐给活跃的运动员，但不仅限于此。
