Vogler H W, Westlin N, Mlodzienski A J, Møller F B
Foot and Ankle Medical Center, Tampa, Florida, USA.
Clin Podiatr Med Surg. 1995 Oct;12(4):725-47.
Fractures of the fifth metatarsal are treated conceptually based on anatomic location and character of the fracture site. Intra-articular disruptions require reconstruction, if possible. Malalignment of acute fractures requires either closed reduction or open reduction if the malalignment represents a load-bearing dysfunction to the forefoot. Segmental defects require bone grafting and stabilization with plate and screws. Jones fracture is most effectively managed with medullary lag screw delivery in the active or athletic patient. Casting can be considered for high-risk patients. Late bone grafting for sclerotic nonunion is necessary with inlaid grafts harvested from the calcaneus or tibia. Tuberosity fractures require open reduction only when articular involvement is a problem or when distraction is apparent. Otherwise, they can be expected to heal rapidly without long-term problems.
第五跖骨骨折的治疗理念基于骨折部位的解剖位置和特征。关节内骨折若有可能则需进行重建。急性骨折的畸形对线若对前足构成承重功能障碍，则需要进行闭合复位或切开复位。节段性骨缺损需要植骨并用钢板和螺钉固定。对于活跃或运动的患者，Jones骨折最有效的治疗方法是髓内拉力螺钉植入。对于高危患者可考虑使用石膏固定。对于硬化性骨不连，采用取自跟骨或胫骨的镶嵌植骨进行晚期植骨是必要的。仅当存在关节受累问题或明显有分离时，结节骨折才需要切开复位。否则，预计它们能迅速愈合且不会出现长期问题。
