Author/Editor		Mihaljević, Slaviša; Brilej, Drago; Kosanović, Miloš; Komadina, Radko; Vlaović, Miodrag
Title		Zlomi baze 5. stopalnice: rezultati zgodnjega zdravljenja zlomov s premaknitvijo
Translated title		Fractures of the fifth metatarsal: results of the early operative treatment of acute displaced fractures
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 4
Publication year		2004
Volume		str. 281-4
Language		slo
Abstract		Background. Fracture of the proximal 5th metatarsal bone (MTB) reach almost 2% of all fractures of the foot. Conservative treatment is method of choice in almost all cases. Selected cases can benefit from acute surgery especially if the proximal fragment is severe displaced or the excessive articular step off is present. Materials and methods. In a 4 year period 14 patients were operated due to the acute fracture of proximal 5th MTB. All patients were treated in less than 2 weeks after the injury. 10 patients had base avulsion fracture in zone 1 and 4 had Jones fracture in zone 11 with dislocation of fragments? 5 mm, articular step off of 2 mm and 30% of articulation surface. We used tension bend wire in 9 cases (64%), partially threaded cancellous screw in 4 cases (28%) and bone sutures in Z case (7%). Postoperatively all patients used crutches with nonweight bearing for 4 weeks and afterwards partial weight bearing till the end of the treatment. All patients were practicing active exercises for ankle, foot and toes. The results were evaluated according to the Maryland Foot Score (MFS) at least 20 months after injury. Results. 13 patients (93%) were included in follow up. 12 patients were evaluated as excellent and only one as a good. All 13 patients have no or slight pain with no change in ADL or work ability. 9 patients (69%) reached full functional result and 4 (31%) patients had slight limitation during distance walk. Patients reached full weight bearing in average 7 weeks (5-13). Conclusions. Early operative treatment of selected cases allows fast return to preoperative activity without long term functional sequel. Both operative procedures, screw fixation and tension wire, yielded comparable and excellent end result.
Summary		Izhodišča. Zlomov baze 5. stopalnice je skoraj 2% vseh zlomov stopala. V skoraj vseh primerih zdravimo konzervativno. Pri izbranih primerih je zgodnje operativno zdravljenje koristno, saj pospeši rehabilitacijo in zanesljivo pripelje do dobrega končnega rezultata. Materiali in metode. V 4-letnem obdobju je bilo operiranih 14 poškodovancev zaradi akutnega zloma baze 5. stopalnice. Oskrbljeni so bili v manj kot dveh tednih po poškodbi (3-14 dni). Deset jih je imelo zlom v coni I (avulzijski zlom tuberozitas) in štirje pacienti v coni II (Jonesov zlom) z dislokacijo fragmentov > 5 mm, sklepno stopnico > 2 mm ali z zajetimi 30% sklepne površine. Devetkrat smo uporabili pritezno zanko, 4-krat spongiozni vijak in enkrat kostne šive. Rezultate smo ovrednotili po lestvici MFS (Maryland Foot Score) vsaj 20 mesecev po poškodbi. Rezultati. V analizo je bilo vključenih 13 poškodovancev (93%). 12 jih je doseglo odličen rezultat in eden dober. Vseh 13 je bilo brez bolečin ali z blagimi bolečinami, ki niso vplivale na vsakdanje dejavnosti ali delo. Devet (69%) jih je doseglo polni funkcionalni rezultat, štirje (31%) so imeli blage omejitve pri daljši hoji oziroma hoji po neravnem terenu. Poškodovanci so dosegli polno obremenitev v povprečju 7 tednov (513) po posegu. Zaključki. Zgodnje operativno zdravljenje je učinkovita metoda za zdravljenje dislociranih zlomov baze 5. stopalnice. Omogoča hitro vrnitev k polni obremenitvi brez dolgotrajnih funkcionalnih posledic. Z obema metodama, pritezno zanko in bikortikalnim spongioznim vijakom, dosežemo odlične končne rezultate.
Descriptors		METATARSAL BONES FOOT INJURIES FRACTURE FIXATION, INTERNAL TREATMENT OUTCOME