The Experts below are selected from a list of 417 Experts worldwide ranked by ideXlab platform

Wolf Christian Prall - One of the best experts on this subject based on the ideXlab platform.

  • Functional treatment for fractures to the base of the 5th Metatarsal - influence of fracture location and fracture characteristics
    BMC Musculoskeletal Disorders, 2017
    Co-Authors: Sebastian F. Baumbach, Mareen Braunstein, Wolf Christian Prall, Wolfgang Böcker, Michael Kramer, H. Polzer
    Abstract:

    BackgroundFractures to the base of the Fifth Metatarsal are common, but their treatment remains controversial. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures. Of special interest were the influence of (1) the fracture location (L&B type I vs. II) and (2) the fracture characteristics (displacement, intra-articular involvement, communition) on the subjective outcome.MethodsRetrospective registry study with a prospective follow-up. Patients with an acute, isolated, epi-metaphyseal fracture to the Fifth Metatarsal Bone (L&B type I and II) treated by full weightbearing with a minimum follow-up of 6 months were included. Fracture location (L&B type I and II) and characteristics (displacement 2 mm, intra-articular involvement, and number of fragments) were assessed. Outcome parameters were return to work, return to sports, VAS-FA, and SF-12. The influence of the fracture (1) location and (2) -characteristics on these parameters was tested.ResultsThirty-nine patients (40 ± 15 years, 56% female) were enrolled with a mean follow-up of 22 ± 10 months. L&B type I fractures occurred in 59%, type II in 41%. Thirty-one percent of all fractures were dislocated, 74% intra-articular, and 41% multi-fragmentary. Patients returned to work after 17 ± 12 days, to sports after 53 ± 22 days. The VAS-FA score at the final follow-up was 96 ± 4, SF-12 PCS score 57 ± 5 and MCS score 51 ± 8. No complications were reported, no patient required surgery. None of the assessed outcome parameters differed significantly between (1) the different fracture locations (L&B type I vs. II) or (2) the different fracture characteristics (displacement, intra-articular involvement, and number of fragments).Conclusions(1) Both, L&B I and II fractures featured excellent results with immediate full weightbearing. Consequently, L&B type I and II fractures should be summarized as epi-metaphyseal fractures. (2) Fracture displacement, articular involvement, and number of fragments did not influence the outcome. Therefore, functional treatment should be recommended for all epi-metaphyseal fractures.

  • functional treatment for fractures to the base of the 5th Metatarsal influence of fracture location and fracture characteristics
    BMC Musculoskeletal Disorders, 2017
    Co-Authors: Sebastian F. Baumbach, Mareen Braunstein, Wolf Christian Prall, Wolfgang Böcker, Michael Kramer, H. Polzer
    Abstract:

    Fractures to the base of the Fifth Metatarsal are common, but their treatment remains controversial. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures. Of special interest were the influence of (1) the fracture location (L&B type I vs. II) and (2) the fracture characteristics (displacement, intra-articular involvement, communition) on the subjective outcome. Retrospective registry study with a prospective follow-up. Patients with an acute, isolated, epi-metaphyseal fracture to the Fifth Metatarsal Bone (L&B type I and II) treated by full weightbearing with a minimum follow-up of 6 months were included. Fracture location (L&B type I and II) and characteristics (displacement 2 mm, intra-articular involvement, and number of fragments) were assessed. Outcome parameters were return to work, return to sports, VAS-FA, and SF-12. The influence of the fracture (1) location and (2) -characteristics on these parameters was tested. Thirty-nine patients (40 ± 15 years, 56% female) were enrolled with a mean follow-up of 22 ± 10 months. L&B type I fractures occurred in 59%, type II in 41%. Thirty-one percent of all fractures were dislocated, 74% intra-articular, and 41% multi-fragmentary. Patients returned to work after 17 ± 12 days, to sports after 53 ± 22 days. The VAS-FA score at the final follow-up was 96 ± 4, SF-12 PCS score 57 ± 5 and MCS score 51 ± 8. No complications were reported, no patient required surgery. None of the assessed outcome parameters differed significantly between (1) the different fracture locations (L&B type I vs. II) or (2) the different fracture characteristics (displacement, intra-articular involvement, and number of fragments). (1) Both, L&B I and II fractures featured excellent results with immediate full weightbearing. Consequently, L&B type I and II fractures should be summarized as epi-metaphyseal fractures. (2) Fracture displacement, articular involvement, and number of fragments did not influence the outcome. Therefore, functional treatment should be recommended for all epi-metaphyseal fractures.

  • acute fractures to the proximal Fifth Metatarsal Bone development of classification and treatment recommendations based on the current evidence
    Injury-international Journal of The Care of The Injured, 2012
    Co-Authors: Hans Polzer, S Polzer, Wolf Mutschler, Wolf Christian Prall
    Abstract:

    Fractures to the proximal Fifth Metatarsal Bone are among the most frequent injuries to the foot. Various classifications intend to distinguish different fracture entities in regard to prognosis and treatment. The most commonly used classification by Lawrence and Botte delineates three fracture zones and gives treatment recommendations based on retrospective case series. Aim of our study was to critically review the literature and reevaluate the classification and treatment recommendations based on the highest level of evidence available. We performed a systematic literature search in Medline, Embase and Cochrane library and identified six prospective trials either comparing the same treatment for different fracture entities or different treatment strategies for the same fracture entity. The studies reveal that all ‘‘tuberosity avulsion fractures’’ (Zone 1, according to Lawrence and Botte) heal well using functional treatment. Even multifragmentary, displaced and intraarticular fractures in Zone 1 give comparable good results. Treatment with a short leg cast leads to a significant delay in return to preinjury level when compared to functional treatment. ‘‘Jones’ fractures’’ (Zone 2) also demonstrate good to excellent results and complete Bone healing when treated functionally. In contrast, ‘‘diaphyseal stress fractures’’ (Zone 3) at the distal limit of the fourth-Fifth interMetatarsal articulation and just distally feature a significantly higher rate of treatment failure when treated non-operatively in a nonweight bearing short leg cast. Early intramedullary screw fixation leads to a significantly shorter time to Bone healing and return to sport. In conclusion, acute fractures to the proximal Fifth Metatarsal Bone should be classified into two entities only: First, metaphyseal fractures not extending beyond the distal end of the fourth–Fifth interMetatarsal articulation, as these fractures, regardless the number of fragments, displacement and intraarticular involvement, should be treated functionally. Second, meta-diaphyseal fractures located at the distal end of the fourth–Fifth interMetatarsal articulation or just distally, as these fractures require early intramedullary screw fixation.

Sandeep Hemmadi - One of the best experts on this subject based on the ideXlab platform.

  • stress fracture of the Fifth Metatarsal base caused by tension band wiring an isolated case report
    Foot and Ankle Specialist, 2009
    Co-Authors: A Mofidi, Piret Hamer, Rhys Huw Thomas, Sandeep Hemmadi
    Abstract:

    : Tension band technique has been described as a successful method of treatment for the fractures of the proximal part of the Fifth Metatarsal Bone. A high rate of union and a low rate of complications have made this mode of treatment popular, especially in patients with nonunion and high-level athletes with stress fracture of the proximal Fifth Metatarsal Bone. The authors report a case of an avulsion fracture of the base of the Fifth Metatarsal Bone treated with tension band wiring fixation, which resulted in a stress fracture 1 year after the tension band wiring. The authors recommend a K-wire perforation and tension band drill hole distal to the watershed area of the Fifth Metatarsal Bone and removal of metalwork 6 to 12 months after fracture union to avoid this complication.

Fatih Yazar - One of the best experts on this subject based on the ideXlab platform.

  • insertional characteristics of the peroneus tertius tendon revisiting the anatomy of an underestimated muscle
    Journal of Foot & Ankle Surgery, 2016
    Co-Authors: Nurcan Ercikti, Necdet Kocabiyik, Nihal Apaydin, Fatih Yazar
    Abstract:

    The present study was performed to describe the morphologic characteristics of the peroneus tertius (PT) tendon, evaluate the variations in its insertion point, investigate the interconnections with the tendons of the extensor digitorum longus, and discuss whether these insertion differences of the muscle tension might have an effect on fracture formation. The length and width of the PT tendon and the width at its midpoint were measured in 44 lower extremities. The data obtained were compared statistically. The PT was found to occur in 2 types according to the number of tendons: type 1, a single tendon without a slip; and type 2, 2 tendons with a slip. It has been suggested that the PT tendon could contribute to avulsion fractures of the tuberosity of the Fifth Metatarsal Bone. Therefore, to understand the mechanism of Jones fracture, knowledge of the PT tendon would be beneficial to determine the insertion points.

  • the peroneus brevis tendon at its insertion site on Fifth Metatarsal Bone
    Foot and Ankle Surgery, 2016
    Co-Authors: Nurcan Imre, Necdet Kocabiyik, Tuba H Sanal, Murat Uysal, Hasan Ozan, Fatih Yazar
    Abstract:

    Abstract Background The differences at the attachment site of peroneus brevis (PB) to the Fifth Metatarsal Bone is important in terms of the forces exerted on the Bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of Fifth Metatarsal Bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site. Methods The length and the width of PB tendons at their mid- and end-points were measured and classified according to the insertion types. Besides, the length and the width of the base of Fifth Metatarsal Bone were assessed. The slips extending from the PB tendons and their relationship with PT were also evaluated. The data was compared statistically with each other and between the right and left sides. Results The length of PB tendon was measured 79.57±15.40mm on the right side; 81.48±14.31mm on the left. The width of PB tendon at the mid-point was 4.46±0.80mm on the right side; 4.42±0.94mm on the left. The width of the tendon at its insertion point was measured 14.85±3.40mm and 15.16±3.42mm on the right and left sides respectively. PB was divided into three types according to its attachment to base of Fifth Metatarsal Bone (5thMB). Type I, Type II and Type III were observed at the rates of 59.5%, 28.6% and 11.5% respectively. It was observed that the slips to the Bone were extending more commonly from PB than from PT and that the large majority of them were single having their insertions on the base of the proximal phalanx of the Fifth toe. Conclusions Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot.

Madeleine Willegger - One of the best experts on this subject based on the ideXlab platform.

  • Peroneus brevis tendon in proximal 5th Metatarsal fractures: Anatomical considerations for safe hook plate placement.
    Injury-international Journal of The Care of The Injured, 2018
    Co-Authors: Nargiz Seyidova, Lena Hirtler, Reinhard Windhager, Reinhard Schuh, Madeleine Willegger
    Abstract:

    Abstract INTRODUCTION: The peroneus brevis tendon (PBT) inserts into the proximal aspect of the 5th Metatarsal. Metatarsal Bone fractures are encountered to be the most common fractures in the foot with predominantly fractures at the base of the Fifth Metatarsal Bone. Mechanism of injury and treatment of the proximal 5th Metatarsal fractures vary due to the complex anatomy and diverse biomechanical properties. The purpose of this study was to analyze the footprint of the PBT with regards to the proximal 5th Metatarsal fractures and to define a "safe zone" for hook plate placement. MATERIALS AND METHODS: Forty-one (41) fixed human lower leg specimens were dissected to expose the PBT insertion. The following footprint characteristics were evaluated: area of insertion (AOI) (mm2), length (mm), width (mm), shape and insertional variations. The position of the main PBT footprint was localized according to the Lawrence and Botte classification for the proximal 5th Metatarsal fractures (Zone I-III). A "safe zone" was defined for the fracture-specific hook plate placement. RESULTS: In 25 (61%) feet the PBT footprint was situated in Zone I and in 16 feet (39%) in Zone I&II. The mean AOI, length and width measured 54.5 mm2 (SD 16.5), 16.0 mm (SD 5.1) and 4.7 mm (SD 1.4), respectively. Analysis of the footprint shapes revealed four different shape types: kidney (29.3%), diamond (22.0%), crescent (31.7%) and oval (17.0%). A "safe zone" for hook plate placement without or minimal interference of the PBT at its insertion could be defined at the lateral aspect of the 5th Metatarsal. CONCLUSION: The majority of the PBT footprints were found in Zone I. Hook plate placement demonstrated to be safe when placed strictly laterally at the proximal aspect of the 5th Metatarsal. Precise knowledge of the peroneus brevis anatomy may help to better understand the biomechanical aspects of the proximal 5th Metatarsal fractures.

Piret Hamer - One of the best experts on this subject based on the ideXlab platform.

  • Stress Fracture of the Fifth Metatarsal Base Caused by Tension Band Wiring
    2016
    Co-Authors: An Isolated, Piret Hamer
    Abstract:

    The mainstay of management for the Fifth Metatarsal base (tubracle) is conservative.”“ Abstract: Tension band technique has been described as a successful method of treatment for the fractures of the proximal part of the Fifth meta-tarsal Bone. A high rate of union and a low rate of complications have made this mode of treatment popular, espe-cially in patients with nonunion and high-level athletes with stress fracture of the proximal Fifth Metatarsal Bone. The authors report a case of an avulsion fracture of the base of the Fifth meta-tarsal Bone treated with tension band wiring fixation, which resulted in a stress fracture 1 year after the tension band wiring. The authors recommend a K-wire perforation and tension band drill hole distal to the watershed area of the Fifth Metatarsal Bone and removal of metalwork 6 to 12 months after frac-ture union to avoid this complication

  • stress fracture of the Fifth Metatarsal base caused by tension band wiring an isolated case report
    Foot and Ankle Specialist, 2009
    Co-Authors: A Mofidi, Piret Hamer, Rhys Huw Thomas, Sandeep Hemmadi
    Abstract:

    : Tension band technique has been described as a successful method of treatment for the fractures of the proximal part of the Fifth Metatarsal Bone. A high rate of union and a low rate of complications have made this mode of treatment popular, especially in patients with nonunion and high-level athletes with stress fracture of the proximal Fifth Metatarsal Bone. The authors report a case of an avulsion fracture of the base of the Fifth Metatarsal Bone treated with tension band wiring fixation, which resulted in a stress fracture 1 year after the tension band wiring. The authors recommend a K-wire perforation and tension band drill hole distal to the watershed area of the Fifth Metatarsal Bone and removal of metalwork 6 to 12 months after fracture union to avoid this complication.