Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 4 Issue 9

Functional Outcomes of Surgical Treatment of the Fifth Diaphyseal Metatarsal Fractures (Dancer’s Fractures). A Case-Series and a Literature Review

Grigorios Kastanis1*, Kapsetakis P1, Magarakis G11, Stavrakakis MI1 and Pantouvaki A2

1Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete, Greece
2Department of Physiotherapy, General Hospital of Heraklion-Venizeleio, Crete, Greece

*Corresponding Author: Grigorios Kastanis, Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete, Greece.

Received: July 26, 2021; Published: August 04, 2021

Abstract

Introduction: Fifth metatarsal fractures represent a significant proportion of injuries, while fractures of the distal diaphyses (dancer fractures) comprise 20% of all fifth metatarsal fractures. Conservative treatment is the preferred method for managing these fractures. The aim of this study is to present our functional outcomes of patients, in long term (one year), who underwent surgical treatment with low profile plates and to analyze the time of fracture union, the complications and final patient satisfaction.

Material and Method: A retrospective study was performed from January 2015 to November 2019 with forty one patients undergone surgical treatment with low profile locking plates 2,3 mm or screws for an unstable (spiral or oblique) fracture of distal diaphyses of 5th metatarsal. The data collected, consisted of patient demographics, radiographic healing times, fracture characteristics, complications and final patients’ satisfaction (AOFAS Ankle-Hindfoot scale). Fractures were classified into two types according to the anatomical location: Type I which is a long oblique fracture that begins distal to lateral surface of metatarsal neck and extends into diaphysis (23 cases 56,1%), and type II which is when the fracture line starts at the distal-lateral metaphysis and extends proximal as spiral pattern (18 cases 43,9%).

Results: Twelve men and twenty nine females were assessed post-surgically with a mean follow-up of 16,2 months. Time to union in all fractures was 7,2 ± 2,9 weeks more specifically in type I the union (6,1 ± 1,1) was more quick than type II (7,9 ± 1,3). Complications encountered were in three cases a delay union, in four cases infection and one with malunion. At final examination the AOFAS Ankle -Hindfoot scale was for the type I, 91,5 (range 89 - 93) and for the type II, 89,7 (range 85 - 91). None of the patients presented at last examination with metatarsalgia and the implants were not removed in any patient.

Conclusion: Based on our results we postulate that open reduction and internal fixation of Dancer fractures offer high incidence of union, low rate of complications and should be considered as the ideal management for patients who need rapid reintegration into their previous activities.

Keywords: Dancer’s Fracture; Fifth Metatarsal; Outcomes; Surgical Treatment; Complications

References

  1. Cakir H., et al. “Demographics and outcome of metatarsal fractures”. Archives of Orthopaedic and Trauma Surgery2 (2011): 241-245.
  2. Petrisor BA., et al. “The epidemiology of metatarsal fractures”. Foot and Ankle International: SAGE Journals3 (2006): 172-174.
  3. Singer G., et al. “A study of metatarsal fractures in children”. Journal of Bone and Joint Surgery American4 (2008): 772-776.
  4. Buddecke DE., et al. “Metatarsal fractures”. Clinics in Podiatric Medicine and Surgery4 (2010): 601-624.
  5. O’Shea MK., et al. “Clinical perspective of the treatment of fifth metatarsal fractures”. Journal of the American Podiatric Medical Association9 (1995): 473-480.
  6. Thompson P., et al. “Surgical management of fifth metatarsal diaphyseal fractures: A retrospective outcomes study”. The Journal of Foot and Ankle Surgery3 (2017): 463-467.
  7. Shereff MJ. “Complex fractures of the metatarsals”. Orthopedics8 (1990): 875-882.
  8. Gösele A., et al. “Early functional treatment of a 5th metatarsal fracture using an orthopedic boot”. Swiss Surgery2 (1997): 81-84.
  9. Zwitser EW and Breederveld RS. “Fractures of the fifth metatarsal: diagnosis and treatment”. Injury6 (2010): 555-562.
  10. Clapper MF., et al. “Fractures of the fifth metatarsal (analysis of a fracture registry)”. Clinical Orthopaedics 315 (1995): 238-241.
  11. O'Malley MJ., et al. “Fractures of the distal shaft of the fifth metatarsal. "Dancer's fracture". American Journal of Sports Medicine2 (1996): 240-243.
  12. Vogler H., et al. “Fifth metatarsal fractures: biomechanics, classification and treatment”. Clinics in Podiatric Medicine and Surgery4 (1995): 725-747.
  13. Kane JM., et al. “The epidemiology of fifth metatarsal fracture”. Foot and Ankle Specialist5 (2015): 354-359.
  14. Hasselman CT., et al. “Foot and ankle fractures in elderly white women Incidence and risk factors”. Journal of Bone and Joint Surgery American5 (2003): 820-824.
  15. Soave RL., et al. “A new radiographic classification for distal shaft fifth metatarsal fractures”. The Journal of Foot and Ankle Surgery4 (2016): 803-807.
  16. Konkel KF., et al. “Nonoperative treatment of fifth metatarsal fractures in an orthopaedic suburban private multi speciality practice”. Foot and Ankle International: SAGE Journals9 (2005): 704-707.
  17. Bryant T., et al. “Union rate and rate of hardware removal following plate fixation of metatarsal shaft and neck fractures”. Foot and Ankle International: SAGE Journals3 (2008): 326-331.
  18. Prisk VR., et al. “Forefoot injuries in dancers”. Clinics in Sports Medicine2 (2008): 305-320.
  19. Aynardi M., et al. “Outcomes of nonoperative management of displaced oblique spiral fractures of the fifth metatarsal shaft”. Foot and Ankle International: SAGE Journals12 (2013): 1619-1623.
  20. Goulart M., et al. “Foot and ankle fractures in dancers”. Clinics in Sports Medicine2 (2008): 295-304.
  21. Hardaker WT Jr. “Foot and ankle injuries in classical ballet dancers”. Orthopedic Clinics of North America4 (1989): 621-627.
  22. Boutefnouchet T., et al. “Metatarsal fractures: A review and current concepts”. Trauma3 (2014): 147-163.
  23. Curtis BD., et al. “Fixation of metacarpal shaft fractures: biomechanical comparison of intramedullary nail crossed K-wires and plate-screw constructs”. Orthopaedic Surgery3 (2015): 256-260.
  24. Stavlas P., et al. “The role of reduction and internal fixation of Lisfranc fracture dislocations: a systematic review of the literature”. International Orthopaedics8 (2010): 1083-1091.
  25. Murphy GA. “Operative treatment of stress fractures of the metatarsals”. Operative Techniques in Sports Medicine 14 (2006): 239-247.
  26. Sánchez Alepuz E., et al. “Fractures of the central metatarsal”. Foot and Ankle International: SAGE Journals4 (1996): 200-203.
  27. Macintyre J and Joy E. “Foot and ankle injuries in dance”. Clinics in Sports Medicine2 (2000): 351-368.

Citation

Citation: Grigorios Kastanis., et al. “Functional Outcomes of Surgical Treatment of the Fifth Diaphyseal Metatarsal Fractures (Dancer’s Fractures). A Case-Series and a Literature Review".Acta Scientific Orthopaedics 4.9 (2021): 09-15.

Copyright

Copyright: © 2021 Grigorios Kastanis., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 10, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US