Clapper M F, O'Brien T J, Lyons P M
Department of Orthopaedics, Naval Medical Center San Diego, CA 92134-5000, USA.
Clin Orthop Relat Res. 1995 Jun(315):238-41.
To understand better the natural history of fractures of the fifth metatarsal, a fracture registry was established consisting of patients who had acute fractures of the fifth metatarsal. The first 100 patients were studied to develop data on the natural history of injuries to this bone, and on the results of standard treatment for those injuries. In this study, 3 fracture subtypes were identified: avulsion, true Jones' fracture, and shaft/neck fracture. Avulsion fractures healed without immobilization, usually in 4 weeks. Shaft/neck fractures healed in plaster casts with weight bearing as tolerated in 4 to 6 weeks. True Jones' fractures required a prolonged time to heal when treated with 8 weeks of nonweight bearing and then weight bearing as tolerated in a cast. This method was, however, successful in 72% of patients (average time until union, 21.2 weeks). For the 7 patients in whom conservative treatment failed, surgical fixation at an average of 25 weeks after injury reliably achieved bony union in half the time required with cast treatment. This low-risk procedure met with higher patient satisfaction than prolonged casting.
为了更好地了解第五跖骨骨折的自然病程，建立了一个骨折登记处，纳入第五跖骨急性骨折患者。对前100例患者进行研究，以获取有关该骨损伤自然病程以及这些损伤标准治疗结果的数据。在本研究中，确定了3种骨折亚型：撕脱性骨折、真性琼斯骨折和骨干/颈部骨折。撕脱性骨折无需固定即可愈合，通常在4周内愈合。骨干/颈部骨折采用石膏固定并根据耐受情况负重，4至6周愈合。真性琼斯骨折采用8周不负重然后根据耐受情况在石膏中负重的治疗方法时，愈合时间较长。然而，该方法在72%的患者中成功（平均愈合时间为21.2周）。对于7例保守治疗失败的患者，受伤后平均25周进行手术固定，可靠地实现了骨愈合，所需时间仅为石膏治疗的一半。这种低风险手术比长时间石膏固定更能让患者满意。
