Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA
Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA
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DOI：
10.1177/1071100715625290
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发表时间：
2016-05-01
影响因子：
2.7
通讯作者：
Williams, Riley
中科院分区：
文献类型：
--
作者：
O'Malley, Martin;DeSandis, Bridget;Williams, Riley
背景：第五跖骨近端骨折（II区和III区）在优秀运动员中很常见，由于延迟愈合、不愈合或再骨折的倾向，可能难以治疗。本病例系列的目的是报告我们治疗10名NBA球员的经验，确定这些运动员的治愈率、恢复率、再骨折率和足型的作用。方法：对10名职业篮球运动员的病历进行回顾性分析。7名运动员接受了标准的经皮骨髓浓缩物（BMAC）内固定，而其他3名运动员除了固定和BMAC外，主要进行了开放式植骨。影像学特征评估包括第4 - 5跖骨间、第5跖骨外侧偏、跟骨节和跖内收角。结果：x线片平均愈合时间为7.5周，恢复比赛时间为9.8周。3名运动员出现骨折再骨折。除了再骨折组的跖骨内收角最高外，两组的临床特征和影像学测量均无显著差异。大多数运动员为扁平足，10名运动员中有9名在第5跖茎突下有骨突出。结论：这是已发表的最大的手术治疗职业篮球运动员系列，这些运动员是第五跖骨骨折高风险的特定患者群体的例证。这些球员身材高大，脚型独特，似乎与第五跖骨骨折和再骨折的风险增加有关。这种脚型的前足跖骨内收，第五跖骨弯曲，底部突出。我们继续使用骨髓抽吸的标准内固定，但提倡对第四至第五跖骨间高、第五跖骨外侧偏曲、跖骨内收角以及第五跖骨茎突突出的患者进行额外的预防性开放植骨，以改善骨折愈合并潜在地降低再骨折的风险。
Background: Proximal fractures of the fifth metatarsal (zone II and III) are common in the elite athlete and can be difficult to treat because of a tendency toward delayed union, nonunion, or refracture. The purpose of this case series was to report our experience in treating 10 NBA players, determine the healing rate, return to play, refracture rate, and role of foot type in these athletes.Methods: The records of 10 professional basketball players were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) whereas the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features evaluated included fourth-fifth intermetatarsal, fifth metatarsal lateral deviation, calcaneal pitch, and metatarsus adductus angles.Results: Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. There were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest metatatarsus adductus angles. Most athletes were pes planus and 9 of 10 had a bony prominence under the fifth metatarsal styloid.Conclusion: This is the largest published series of operatively treated professional basketball players who exemplify a specific patient population at high risk for fifth metatarsal fracture. These players were large and possessed a unique foot type that seemed to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type had forefoot metatarsus adductus and a fifth metatarsal that was curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high fourth-to-fifth intermetatarsal, fifth metatarsal lateral deviation, and metatarsus adductus angles as well as prominent fifth metatarsal styloids in order to improve fracture healing and potentially decrease the risk of refracture.