title: Surgical treatment of diaphyseal stress fractures of the fifth metatarsal in competitive athletes: long-term follow-up and computerized pedobarographic analysis.
abstract: BACKGROUND
  Proximal diaphyseal stress fractures of the fifth metatarsal are common in athletes. Conservative treatment has been shown to result in high rates of delayed union, nonunion, and refracture, so internal fixation has become the treatment of choice in competitive athletes.
  
  
  METHODS
  Twenty top-level athletes with diaphyseal stress fractures fixed with intramedullary malleolar screws were evaluated. Functional outcome was assessed by American Orthopaedic Foot and Ankle Society midfoot score. Static and dynamic maximum vertical force and peak plantar pressures were evaluated with a computerized pedobarograph.
  
  
  RESULTS
  Mean follow-up from surgery to interview was 10.3 years (range, 3.5-19.0 years). Clinical healing was 95%, and there has been one refracture (5%). The mean time from surgery to return to sport was 9 weeks (range, 5-14 weeks). Twelve athletes (60%) returned to a higher level of training, 7 (35%) to the same level, and 1 (5%) to a lower level compared with the level of training before injury. Average American Orthopaedic Foot and Ankle Society midfoot score was 93.8 (range, 85-100). During the computerized pedobarographic evaluations, 18 patients (90%) presented with varus of the metatarsus and the midfoot and 2 (10%) presented with a normal plantigrade foot.
  
  
  CONCLUSIONS
  Intramedullary malleolar screws can yield reliable and effective healing of fifth metatarsal stress fractures in athletes. Varus of the metatarsus and the midfoot were predisposing factors for stress fractures in this population of competitive athletes, and all were recommended to wear orthoses until their competitive careers were completed.
authors: Department of Orthopaedic Surgery, School of Medicine, Zagreb University, Croatia.
authors: Marko
authors: M
authors: Pecina
authors: Ivan
authors: I
authors: Bojanic
authors: Tomislav
authors: T
authors: Smoljanovic
authors: Alan
authors: A
authors: Ivkovic
authors: Maja
authors: M
authors: Mirkovic
authors: Miroslav
authors: M
authors: Jelic
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D001863:Bone Screws; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000502:physiology*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D015775:Fractures, Stress / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D011312:Pressure; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult