Resultados del tratamiento funcional de las fracturas del metatarso en las fracturas del primer radio / Results of Functional Treatment of Metatarsal Fractures in First Radius Fractures

Introducción: Las fracturas del metatarso son las lesiones traumáticas más comunes del pie, y las del primer metatarsiano son las cuartas en frecuencia. El tratamiento funcional de las fracturas metatarsianas consiste en el apoyo efectivo y precoz, sin inmovilización del miembro. Objetivo: Comparar la efectividad del tratamiento funcional en las fracturas del primer metatarsiano con los tratamientos convencionales Métodos: Se realizó un estudio analítico, observacional, retrospectivo, de casos y controles, en 102 fracturas del primer metatarsiano durante un período de ocho años. La muestra incluyó a pacientes de ambos sexos, entre 16 y 65 años de edad. Se comparó el tratamiento funcional con los tratamientos ortopédico y quirúrgico. Las fracturas fueron clasificadas según su localización, recomendación terapéutica y tratamiento efectuado. Los resultados fueron evaluados en función de la duración de la incapacidad temporal y las complicaciones. Resultados: 48 fracturas fueron tratadas con el método funcional y 41 mediante descarga e inmovilización. Los 13 pacientes con criterio de indicación quirúrgica fueron intervenidos mediante reducción y osteosíntesis. Se obtuvo una menor duración de la incapacidad y menos complicaciones con el tratamiento funcional que con los tratamientos convencionales. Conclusiones: En los últimos años ha aumentado la tendencia a tratar las fracturas metatarsianas de manera conservadora y muchos autores recomiendan el método funcional como tratamiento de elección. Este proporciona una curación más temprana y ocasiona menos complicaciones que los tratamientos convencionales(AU)

Introduction: Metatarsal fractures are the most common traumatic injuries of the foot, and those of the first metatarsal are the fourth in frequency. The functional treatment of metatarsal fractures consists of effective and early support, without limb immobilization. Objective: To compare the effectiveness of functional treatment in fractures of the first metatarsal with conventional treatments. Methods: An analytical, observational, retrospective, case-control study was conducted on 102 first metatarsal fractures over a period of eight years. The sample included patients of both sexes, between 16 and 65 years of age. Functional treatment was compared with orthopedic and surgical treatments. The fractures were classified according to location, therapeutic recommendation and treatment. The results were evaluated according to the duration of the temporary incapacity and the complications. Results: Forty eight fractures were treated with the functional method and 41 by offloading and immobilization. The thirteen patients with surgical indication criteria were operated by reduction and osteosynthesis. A shorter duration of disability and fewer complications were achieved with functional treatment than with conventional treatments. Conclusions: In recent years, the tendency to treat metatarsal fractures conservatively has increased and many authors recommend the functional method as the treatment of choice. This provides earlier healing and causes fewer complications than conventional treatments(AU)

Intermittent vibrations accelerate fracture healing in sheep

Abstract Purpose: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. Methods: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. Results: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. Conclusions: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.

Osteossíntese com parafuso intramedular nas fraturas proximais do quinto metatarsiano do atleta / Intramedullary screw fixation of proximal fifth metatarsal fractures in athletes

OBJETIVO: Avaliar os resultados clínicos e radiológicos da osteossíntese com parafuso de compressão intramedular nas fraturas proximais do quinto metatarsiano no atleta. MÉTODOS: Foram incluídos no estudo 11 homens e seis mulheres com diagnóstico de fratura das zonas II e III do quinto metatarsiano. Quinze dos pacientes praticavam esporte a nível profissional ou de alto rendimento (futebol: n=11; basquetebol: n=1; atletismo: n=3) e dois praticavam atividade esportiva regular a nível recreacional. Foram submetidos a fixação cirúrgica com parafuso canulado de compressão (4.5mm de diâmetro). Todos os pacientes foram avaliados clinicamente e através da revisão do processo clínico e dos estudos imagiológicos. O tempo médio de seguimento após a cirurgia foi 54 meses (38-70). RESULTADOS: O tempo médio de consolidação (como demonstrado pelo estudo radiológico) e de retorno à atividade esportiva foi 7.3 e 7.5 semanas, respectivamente. Todos os atletas retornaram aos níveis de atividade prévios. Não verificamos atrasos de consolidação, não-união ou refraturas à data do estudo. CONCLUSÃO: A osteossíntese com parafuso de compressão intramedular nas fraturas proximais do quinto metatarsiano demonstrou, nos nossos pacientes, ser um procedimento eficaz com taxas de morbilidade muito reduzidas e que permite ao atleta um retorno precoce à atividade esportiva. Nível de evidência I, Série de Casos.

OBJECTIVE: The purpose of this study was to review the short- and long-term clinical and radiological results of intramedullary compression screw fixation of proximal fifth metatarsal fractures in athletes. METHODS: Eleven male and six female active patients with fifth metatarsal zone II and zone III fractures fixed with a 4.5-mm cannulated compression screw were evaluated by chart review, review of radiographs, and clinical evaluation. Fifteen of the patients were high-level athletes (soccer: n=11; basketball: n=1; track and field: n=3) and two were recreational-level athletes. Mean follow-up from surgery to evaluation was 54 (38-70) months. RESULTS: Mean time to healing as shown on radiographs and mean time to return to full activity after surgery were 7.3 and 7.5 weeks, respectively. All patients were able to return to their previous levels of activity. There were no reports of union delay, nonunion or refracture to date. CONCLUSION: In our patients, cannulated screw fixation of proximal fifth metatarsal fractures was a reliable procedure with low morbidity associated that provided athletes a quick return to activity. Level of Evidence I, Case Series.

Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation

BACKGROUND: Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures. METHODS: Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months. RESULTS: Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases. CONCLUSIONS: The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.

Novo Parafuso (Acutrak®) No tratamento cirúrgico de jogadores de futebol de elite com fraturas do quinto metatarso / New screw (Acutrak®) in the surgical treatment of elite football players with fifth metatarsal

OBJETIVO: Há uma variabilidade considerável na literatura no que tange ao tratamento ideal de fraturas do quinto metatarso. O objetivo deste estudo é apresentar os resultados da fixação cirúrgica de fraturas do quinto metatarso usando o parafuso Acutrak® em jogadores de futebol de elite. MATERIAL E MÉTODOS: Três casos de fratura do quinto metatarso em jogadores de futebol de elite são apresentados. A média de idade dos pacientes era de 24 anos (18-26 anos). Tratamos as três fraturas do quinto metatarso em jogadores de futebol de elite. Os casos em nosso estudo consistiam de uma fratura diafisiária do quinto metatarso e duas fraturas de Jones. As fraturas ocorreram durante a participação nos jogos. Aplicamos fixação interna utilizando um parafuso Acutrak® percutâneo sob anestesia local com o auxílio de um fluoroscópio. Os pacientes foram clinica e radiograficamente avaliados. RESULTADOS: O restabelecimento clínico foi obtido em 10 semanas após a cirurgia. A consolidação radiográfica ocorreu em 8 semanas de pós-operatório, sendo que os pacientes retornaram a seus níveis prévios de atividade em 11 semanas de pós-operatório. Não foi relatada nenhuma complicação pósoperatória. Não se observou nenhuma irritação de pele devido à ausência de cabeça do parafuso Acutrak®. CONCLUSÃO: Os resultados sugerem que Acutrak® pode ser usado em jogadores de futebol com fraturas do quinto metatarso. Apesar de fatores como facilidade de implante, o custo e a resistência a inclinação também devem ser considerados.

OBJECTIVE: There is considerable variability in the literature concerning the optimal treatment of fifth metatarsal fracture. The purpose of this study is to report the outcome of surgical fixation of fifth metatarsal fractures using Acutrak® screw in elite football players. MATERIAL AND METHOD: Three cases of fifth metatarsal fracture in elite football players. The mean age was 24 years old (18-26 years). We treated three fifth metatarsal fractures in elite football players. The cases in our study consisted of one diaphyseal fifth metatarsal fracture and two Jones fractures. The fractures had been occurred during sports participation. We applied internal fixation using a percutaneous Acutrak® screw under local anesthesia with the aid of fluoroscopy. The patients were clinically and radiographycally evaluated. RESULTS: Clinic healing was obtained at 10 weeks postoperatively. Radiographic consolidation occurred at 8 weeks postoperatively and the patients returned to pre-injury activity levels at 11 weeks postoperatively. No postoperative complication was seen. No skin irritation due to a headless screw of Acutrak® was observed. CONCLUSION: The result suggested that Acutrak® may be used in elite football players with fifth metatarsal fractures. In spite of factors such as ease of implementation, cost and resistance to bending also need to be considered.

Fixação esquelética externa em fratura tarsometatársica de seriema (Cariama cristata): relato de caso / External skeletal fixation in tarsumetatarsus fracture of red-legged seriema (Cariama cristata): a case report

Uma seriema (Cariama cristata) adulta foi atendida com histórico de traumatismo por tentativa de captura. A ave apresentava dificuldade de apoio do membro pélvico direito, dor à manipulação e fratura exposta do osso tarsometatarso. Optou-se pelo tratamento cirúrgico com redução fechada, utilizando-se fixador esquelético externo tipo II, com barra de conexão acrílica. A técnica cirúrgica utilizada foi satisfatória para o tratamento da fratura, possibilitando reparação óssea e retorno funcional do membro 60 dias após a cirurgia.

An adult red-legged seriema (Cariama cristata) was referred for examination with history of trauma by capture. The physical examination revealed lameness in the right pelvic limb, sensibility to touch and open fracture of tarsumetatarsus. The treatment was done with surgical closed reduction using a external skeletal fixator type II with acrylic connecting bar. The surgical technique applied was satisfactory for the treatment of the fracture of tarsumetatarsus, since there was bone healing and functional return of the limb at 60 days after surgery.

[Osteoarthritis after open reducation and internal fixation of lisfranc fracture]

Open reduction and internal fixation is the standard surgical approach for lisfranc fracture, however, osteoarthritis is a long term complication. We surveyed the frequency of osteoarthritis after open reduction and internal fixation of lisfranc fracture and its associated factors including accompanied fracture, delayed diagnosis and open or closed fracture. Patients who suffered from lisfranc fracture between 1997 and 2005 and underwent open reduction and internal fixation at least 2 years ago were included. Tarsometatarsal osteoarthritis was investigated among these patients. Of 94 patients, 44 were included with a mean follow up duration of 36 months, among whom, 34 had anatomic reduction while 12 [35.3%] developed osteoarthritis. Meanwhile, of 10 patients with non-anatomic reduction, 8 [80%] developed osteoarthritis. The difference is statistically significant [p=0.004]. Unfortunately, 4 patients [9.1%] were misdiagnosed during the first visit, while 10 [22.7%] patients referred late. Accompanied fractures were reported in 34 [77%] patients. Higher prevalence of osteoarthritis among patients with non-anatomic reduction support the prior theory that open reduction and internal fixation could prevent further degenerative changes in lisfranc joint

Secuestro óseo en el metatarso derecho de un toro raza Carora / Right metatarsal osseous sequestrum in a Carora breed bull

Las fracturas del metatarso, son las más comunes en bovinos de cualquier edad. Sin embargo, cuando ocurre un trauma a este nivel, el hueso no siempre se fractura por completo, sino que se produce una fractura incompleta que deja una conminuta que puede convertirse en un secuestro. En el caso descrito, el animal sufrió un traumatismo con herida abierta, que provocó la fractura parcial de la diáfisis del metatarso del miembro posterior derecho en su cara medial. Luego de 50 días de evolución, al no ceder la claudicación, el toro fue remitido al Hospital Dr. Daniel Cabello de la Facultad de Ciencias Veterinarias de la Universidad Central de Venezuela, para su evaluación. La zona afectada presentaba una herida cicatrizada con drenaje de material seropurulento y aumento de tamaño indurado. No se determinó crepitación a la palpación y reveló presencia de dolor agudo. Se hizo un estudio radiológico que evidenció la presencia de un secuestro óseo en la diáfisis proximal del metatarso y un proceso de osificación alrededor de la zona fracturada con evidencia radiográfica de osteomielitis. El paciente fue sometido a cirugía para la remoción del secuestro, debridamiento del callo óseo y limpieza de la superficie del metatarso. La evolución fue satisfactoria y el animal recobró su condición 45 días luego del proceso quirúrgico. El secuestro extraído fue de 6cm x 3cm x 3mm de espesor, por lo que se consideró que sólo la corteza del metatarso fue afectada. El animal retornó al servicio por monta natural 60 días posteriores a la cirugía y no acusó ningún tipo de dolor ni claudicación durante dicha actividad. En este paciente, el proceso de osteomielitis cedió a la aplicación de antibióticos postquirúrgicos con Florfenicol y Enrofloxacina, la herida quirúrgica cicatrizó por segunda intención con tratamiento local y la recuperación del hueso fue total.

[ case report of floating metatarsal: concomitant dislocation of the tarsometatarsal and metatarsophlangeal joints of the second toe]

An extremely rare case of floating second metatarsal is reported. The reported case is a young man with simultaneous dislocation of tarsometatarsal and metatarsophalangeal joints of the second metatarsus following a car accident. Because of patient's discontent for open surgery, blind percutaneus pinning was performed that was not completely successful and in follow up radiography, 18 months later, degenerative joint disease [DJD] signs were observed. In examining patients with injuries of the tarsometatarsal joint, the physician must pay attention to the whole foot as the forces acting on it which are axial and compressive can injure the metatarsophalangeal joint [in the same or the adjacent ray] as well. After reporting the case, we will discuss the probable mechanism and different aspects of this rare traumatic injury

Tratamento da fratura-luxaçäo de Lisfranc / Lisfranc fracture dislocation treatment

Entre 1990 e 1997, os autores avaliaram 12 pacientes que apresentavam fratura-luxaçao da articulaçao de Lisfranc submetidos a tratamento ortopédico no Hospital Universitário de Taubaté. O sexo masculino predominou sobre o feminino, numa proporçao de 11 : 1. No mecanismo de açao do traumatismo, houve maior predominância do indireto sobre o direto (8 : 4). Obtivemos dez fraturas-luxaçoes fechadas e duas abertas. A classificaçao adotada pelo Serviço foi a de Quénu & Kuss, modificada por Hardcastle, que enfatiza o tipo de mecanismo de açao, sendo três casos do tipo A (incongruência total), cinco casos do tipo B (incrongruência parcial) e quatro casos do tipo C (divergente). O tratamento realizado foi: reduçao incruenta seguida de aparelho gessado (um caso), reduçao incruenta com fixaçao percutânea (seis casos) e reduçao aberta com fixaçao (cinco casos). Como complicaçoes, registraram-se infecçao superficial (dois casos), síndrome compartimental (um caso), osteodistrofia de Sudek (um caso), osteoartrose (dez casos) e rigidez articular (três casos). Os resultados classificaram-se em bons (dois casos), regulares (sete casos) e ruins (três casos). Conclui-se que a fixaçao com fios de Kirschner percutâneo pode ser realizada desde que a reduçao incruenta esteja anatômica. Nos casos com pequenos desvios articulares, a reduçao aberta seguida de fixaçao poderá levar a melhores resultados a longo prazo.

Tratamento cirúrgico da fratura-luxaçäo de Lisfranc / Surgical treatment of Lisfranc fracture dislocation

Os autores apresentam o estudo crítico de 16 pacientes (16 pTs) com fratura-luxaçäo da articulaçäo de Lisfranc tratados pelo método cruento através de incisöes longitudinais e fixaçäo com fios de Kirschner. Os deslocamentos da junta de Lisfranc säo ferimentos que apresentam grande potencial para incapacidade crônica quando näo diagnosticados e tratados de maneira correta. Discutem neste trabalho os aspectos clínicos, anatômicos e radiográficos para avaliaçäo do diagnóstico e detalhes da técnica cirúrgica, evoluçäo e complicaçöes. Obtiveram 80 por cento de bons resultados com o tratamento cruento. Os casos considerados como maus geralmente se associam a cominuiçäo da fratura, lesöes de partes moles ou reduçäo anatômica inadequada. Concluem que o melhor tratamento para as lesöes de Lisfranc é a reduçäo aberta com fixaçäo das fraturas por meios de fios de Kirschner ou parafusos.

Efeitos da desnervaçäo periférica sobre a formaçäo do calo ósseo: estudo experimental em ratos / Effects of the peripheral denervation on fracture healing: experimental study in rats

Foi feito estudo experimental em 24 ratos de raça Wistar, com 30 dias de vida. Foram produzidas fraturas fechadas na diáfise dos metatarsais de ambas as patas, ao mesmo tempo em que se procedeu à neurectomia ciática esquerda, ao nível de regiäo glútea. O processo de consolidaçäo das fraturas foi analisado através de estudo histológico nas 1ª, 2ª, 3ª e 6ª semanas após a produçäo da fratura, comparando-se o lado desnervado com o contralateral. A desnervaçäo ciática nao resultou em alteraçöes no processo de formaçäo do calo ósseo.

Fracturas del antepie / Forefoot fractures

Se hace una revisión de las fracturas cerradas del antepié analizando las fracturas del cuboides, de las cuñas, metatarsianos y ortejos. Son fracturas de ocurrencia común en la vida civil y militar cuya recuperación funcional dependen estrechamente de un buen enfoque diagnóstico y terapéutico. Se destacan el adecuado estudio clínico y radiológico y se detallan las medidas teraéuticas que generalmente se pueden tomar en forma y con elementos simples

Injuries of the Lisfranc joint

Twenty-two cases with 23 tarsometatarsal fracture dislocation were treated and followed up for an average of 20 months. Fourteen fractures achieved good results, six achieved fair results and three achieved poor results. It was found that anatomical reduction is mandatory for satisfactory results whatever the method of treatment adopted. Redisplacement is a common sequel of unstable injuries. In this series, it occurred in seven fractures due to early removal of the Kirschner wire, subsidence of edema after closed reduction without Kirschner wire fixation or failure to achieve anatomical reduction due to severe comminution. Not all cases of post-traumatic degenerative arthritis were symptomatic; 6 out of 14 feet with degenerative arthritis in this series were symptomatic

Fratura-luxaçäo de Lisfranc: tratamento / Lisfranc's fracture-dislocation: treatment

Os autores descrevem 35 casos de fratura-luxaçäo de Lisfrane, discorrendo sobre os diversos tipos de fratura e seu tratamento. Concluem que os melhores resutlados ocorreram naqueles em que se efetuou reduçäo cruenta e fixaçäo r1=gida