Base of 5th metatarsal fracture · Virtual Fracture Clinic

This information will guide you through the next 6 weeks of your rehabilitation. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery.

Area of your injury

If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please phone the Fracture Care Team for advice.

Or, if you are experiencing pain or symptoms, other than at the site of the original injury or surrounding area, please get in touch using the telephone or e-mail details at the top of this letter.

What to expect

Advice for a new injury

Cold packs: A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief. Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin.                                                    

Rest and Elevation: Try to rest the foot for the first 24-72 hours to allow the early stage of healing to begin. Raise your ankle above the level of your hips to reduce swelling. You can use pillows or a stool to keep your foot up

Early movement and exercise: Early movement of the ankle and foot is important to promote circulation and reduce the risk of developing a DVT (blood clot). Follow the exercises below without causing too much pain. This will ensure your ankle and foot do not become too stiff.  These exercises will help the healing process.

Early weight bearing (putting weight through your injured foot) helps increase the speed of healing. Try to walk as normally as possible as this will help with your recovery.

Smoking advice

Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. It is important that you consider this information with relation to your recent injury. Stopping smoking during the healing phase of your fracture will help ensure optimal recovery from this injury.

For advice on smoking cessation and local support available, please refer to the following website: http://smokefree. nhs.uk or discuss this with your GP.

Boot advice

Diabetic patients: If you are diabetic please contact us to discuss your boot. This is particularly important if you have problems with your skin. We can provide you with a specialist diabetic boot if required.

Footwear for your uninjured foot: We would recommend choosing a supportive shoe or trainer with a firm sole for your uninjured foot. You will notice that the boot you have been given has a thicker sole, by matching this height on the uninjured side you will reduce any stress on your other joints.

Exercises

Initial exercises to do 3-4 times a day

Ankle and foot range of movement exercises. Repeat these 10 times each.

1. Point your foot up and down within a comfortable range of movement.
2. With your heels together, move your toes apart, as shown in the picture.
3. Make circles with your foot in one direction and then change direction.

Foot fracture – 3 weeks in a boot · Virtual Fracture Clinic

This information will guide you through the next 6 weeks of your rehabilitation. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery.

Picture of bones in the foot

If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please phone the Fracture Care Team for advice.

Or, if you are experiencing pain or symptoms, other than at the site of the original injury or surrounding area, please get in touch using the telephone or e-mail details at the top of this letter.

What to expect

Advice for a new injury

Cold packs: A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief. Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin.                                                    

Rest and Elevation: Try to rest the foot for the first 24-72 hours to allow the early stage of healing to begin. Raise your ankle above the level of your hips to reduce swelling. You can use pillows or a stool to keep your foot up

Early movement and exercise: Early movement of the ankle and foot is important to promote circulation and reduce the risk of developing a DVT (blood clot). Follow the exercises below without causing too much pain. This will ensure your ankle and foot do not become too stiff.  These exercises will help the healing process.

Early weight bearing (putting weight through your injured foot) helps increase the speed of healing. Try to walk as normally as possible as this will help with your recovery.

Smoking advice

Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. It is important that you consider this information with relation to your recent injury. Stopping smoking during the healing phase of your fracture will help ensure optimal recovery from this injury.

For advice on smoking cessation and local support available, please refer to the following website: http://smokefree. nhs.uk or discuss this with your GP.

Boot advice

Diabetic patients: If you are diabetic please contact us to discuss your boot. This is particularly important if you have problems with your skin. We can provide you with a specialist diabetic boot if required.

Footwear for your uninjured foot: We would recommend choosing a supportive shoe or trainer with a firm sole for your uninjured foot. You will notice that the boot you have been given has a thicker sole, by matching this height on the uninjured side you will reduce any stress on your other joints.

Exercises

Initial exercises to do 3-4 times a day

Ankle and foot range of movement exercises. Repeat these 10 times each.

1. Point your foot up and down within a comfortable range of movement.
2. With your heels together, move your toes apart, as shown in the picture.
3. Make circles with your foot in one direction and then change direction.

Fractures of the fifth metatarsal – Russian Football Union

14:55, 01 August 2019

Today I would like to tell you about the unique experience of treating one of the most unpleasant problems that football players and doctors face – fractures of the fifth metatarsal.

Their treatment is very complex and these injuries often recur (as with Neymar and Manuel Neuer, for example).

Together with colleagues from FC Zenit Vladimir Khaitin and FC Lokomotiv Gleb Chernov, I wrote a short article on this topic with relevant references that simply must be taken into account by both doctors and physical training and rehabilitation coaches so as not to further multiply the myths and legends of deep antiquity))

“Our experience in the treatment of fractures of the fifth metatarsal in professional football players using platelet rich plasma”

Injuries to the metatarsal bones in football are relatively uncommon and most commonly occur in the fifth metatarsal.

The main method of diagnosing fractures of this localization can be called radiography, which in most cases allows you to verify the diagnosis.

Treatment depends on the location of the fracture according to the Lawrence and Botte’s classification, according to which there are three zones of their localization.

Fractures located in 2-3 zones are at high risk for delayed consolidation and nonunion and therefore in athletes are most often treated with osteosynthesis using intramedullary screws.

The average recovery time with this type of treatment is at least 8 weeks.

This report describes five cases of fractures of the fifth metatarsal located in 2-3 zones in professional football players treated with immobilization boots, cryotherapy, calcium and vitamin D supplements, and local injections of platelet-rich plasma containing multiple growth factors.

The period of return to regular training activities was 43-50 days, and no recurrence of damage was detected during 6 months of follow-up.

Introduction

The treatment of fractures of the fifth metatarsal bone among athletes is an urgent problem due to long treatment periods (8 weeks or more) and a large number of relapses [1].

In football, they account for 0.5% of all injuries sustained by elite European football players with an average treatment time of about 80 days, regardless of the type of treatment chosen [2]

This type of fracture is one of the few diagnostics based on radiography, which in most cases allows to verify the diagnosis.

This type of fracture is one of the few diagnoses that are based on X-ray, which in most cases allows the diagnosis to be verified.

In a population of athletes, the tactics of treating such injuries depends on their localization according to the Lawrence and Botte’s classification, in which three zones are distinguished [3].

Fractures of the first zone are most often treated conservatively with good functional results in any of the categories of the population.

Fractures of the second and third zones with conservative treatment tend to slow consolidation and nonunion, therefore, the most common method of their treatment, especially in the population of athletes, is osteosynthesis using intramedullary screws [4].

The development of new methods of conservative treatment of such fractures with minimal treatment time and the number of recurrences is an urgent task for modern professional football.

One such technique may be the use of PRP, which contains multiple growth factors.

BTP is actively used in the treatment of acute and chronic injuries of the musculoskeletal system, in particular muscle injuries, tendinopathies and arthrosis with positive results [5,6].

Animal experiments have shown a favorable effect of BTP on the healing of both traumatic and osteoporotic fractures [7,8].

However, we could not find any data on the use of BTP in the treatment of metatarsal fractures.

Description of cases

The results of treatment of fifth metatarsal fractures in five young football players are presented.

The players were aged 19-21, height 178 cm, weight 71-75 kg.

All injuries occurred between November 2016 and June 2018 during matches during the competitive season. In all cases, the game was played on artificial turf.

There was no discomfort or pain in the area of ​​the fifth metatarsal before the injury.

The mechanism of injury in three cases was contact, in two non-contact – during the run with acceleration, a sharp local pain appeared in the projection of the fifth metatarsal bone.

All football players immediately stopped sports activities and were immobilized with an orthosis.

In all cases, the X-ray performed confirmed the diagnosis (Figure 1).

In the first three days, initial therapy was carried out according to the POLICE protocol, including the use of cyclic compression therapy (7-8 times a day for 20 minutes), wearing compression stockings, as well as the mediROM Walker immobilization orthosis.

Non-steroidal anti-inflammatory drugs were not used in any case.

Calcium 1000 mg daily and vitamin D 5000 IU were started on the first day of treatment for 60 days.

3 days after injury, the first injection of platelet rich plasma (4-5 ml) was performed.

Three such injections were performed 7-10 days apart.

From the 3rd day after the first injection of BTP, low-intensity training on a bicycle ergometer began at 30-40

On the 7th day of treatment, rehabilitation training began, aimed at improving blood circulation using exercises without axial load on the foot.

In all cases, 5-7 days after the second injection of BTP, the pain syndrome with normal walking stopped, but the use of the orthosis continued for 30 days from the moment of injury.

Three days after the disappearance of the pain syndrome, low-intensity running work (10-15 minutes) began with subsequent progression.

Starting from the 30th day, all football players started individual work with the ball in boots.

The return to regular training activities ranged from 43-50 days.

Control radiography was performed 3-5 days before the start of RTD.

There were no allergic reactions or other adverse reactions during treatment.

Discussion

Fractures of zones 2-3 of the fifth metatarsal are at high risk for delayed consolidation and nonunion.

Current data on conservative treatment report long return to RTD and a high number of relapses.

For example, Japjec et al. the average treatment time for most fractures of zones 2–3 after osteosynthesis was 8 weeks, and with conservative treatment, even after 6 months, more than half of the patients had no signs of consolidation and pain persisted [9].

In this regard, in most cases in the group of professional athletes, surgical treatment is currently considered the method of choice for the treatment of such fractures.

Hunt KJ, et al. reported 21 operated athletes with a mean recovery time of 12.3 weeks with intramedullary screw fixation and only one re-fracture.

O’Malley et al. analyzed the results of surgical treatment of 10 basketball players from the NBA, whose average recovery time was 9.8 weeks. At the same time, repeated fractures occurred in three cases [10].

Thus, the currently available data show that even surgical treatment of fractures of the 2-3 zone of the fifth metatarsal bone is characterized by a long rehabilitation period and frequent repeated fractures.

In this regard, our data on the conservative treatment of such lesions using local injections of PRP may be of interest for further research.

References

1. Chi Nok Cheung1 and Tun Hing Lui1,*. Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications Arch Trauma Res. Dec 2016; 5(4): e33298. Published online 2016 Jun 13. doi: 10.5812/atr.33298

2. Ekstrand J1, van Dijk CN. Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. Br J Sports Med. 2013 Aug;47(12):754-8. doi:10.1136/bjsports-2012-092096. Epub 2013 Apr 9.

3. Lawrence SJ1, Botte MJ. Jones’ fractures and related fractures of the proximal fifth metatarsal. Foot Ankle. 1993 Jul-Aug;14(6):358-65.

4. Hunt KJ1, Anderson RB. Treatment of Jones fracture nonunions and refractures in the elite athlete: outcomes of intramedullary screw fixation with bone grafting. Am J Sports Med. 2011 Sep;39(9):1948-54. doi: 10.1177/0363546511408868. Epub 2011 Jun 1.

5. Grambart ST1. Sports medicine and platelet-rich plasma: nonsurgical therapy. Clin Podiatr Med Surg. 2015 Jan;32(1):99-107. doi: 10.1016/j.cpm.2014.09.006.

6. Laudy AB1, Bakker EW2, Rekers M3, Moen Mh5. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med. 2015 May;49(10):657-72. doi: 10.1136/bjsports-2014-094036. Epub 2014 Nov 21.

7. Simman R1, Hoffmann A, Bohinc RJ, Peterson WC, Russ AJ. Role of platelet-rich plasma in acceleration of bone fracture healing. Ann Plast Surg. 2008 Sep;61(3):337-44. doi: 10.1097/SAP.0b013e318157a185.

8. Chen L1, Yang X, Huang G, Song D, Ye XS, Xu H, Li W. Platelet-rich plasma promotes healing of osteoporotic fractures. Orthopedics. 2013 Jun;36(6):e687-94. doi: 10.3928/01477447-20130523-10.

9. Japjec M1, Starešinić M2, Starjački M2, Žgaljardić I3, Štivičić J2, Šebečić B2. Treatment of proximal fifth metatarsal bone fractures in athletes. injury. 2015 Nov;46 Suppl 6:S134-6. doi: 10.1016/j.injury.2015.10.052. Epub 2015 Nov 10.

10. O’Malley M1, DeSandis B2, Allen A1, Levitsky M1, O’Malley Q1, Williams R1. Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA. Foot Ankle Int. 2016 May;37(5):488-500. doi: 10.1177/1071100715625290. Epub 2016 Jan 18.

How long a fracture heals: stages and terms of bone healing

How long a fracture heals depends on the severity of the injury, the age of the patient and compliance with all medical prescriptions during the recovery period.

In elderly people, the period of bone tissue fusion is much longer due to insufficient amount of calcium in the body and age-related changes, which delay the process of restoration of the whole organism.

Stages of bone regeneration

The following regeneration stages have been identified in medical practice:

• Catabolism of tissue structures and cell infiltration. The tissue dies after damage, cells break down into elements, and hematomas appear.

• Stage of cell differentiation. This stage is characterized by the primary fusion of bones. With a good blood supply, the union proceeds according to the type of primary osteogenesis. The duration of the process takes 10-15 days.

• Stage of primary osteon formation. A callus begins to form on the damaged area. Primary growth takes place. The tissue is pierced by capillaries, its protein base hardens. A chaotic network of bone trabeculae sprouts, and they, connecting, form the primary osteon.

• The stage of callus spongiosis. This stage is characterized by the appearance of a plastic bone cover, a cortical substance appears, and the damaged structure is restored. Depending on the severity of the damage, this stage can last from several months to up to 3 years.

A prerequisite for a normally healing fracture is the course of recovery stages without disturbances and complications.

Fracture healing rate in adults

The process of bone healing is complex and takes a long time. With a closed fracture in one place of the limb, the healing rate is high and ranges from 9 to 14 days. Multiple damage heals on average about 1 month. An open fracture is considered the most dangerous and longest for recovery, the healing period in such cases exceeds 2 months. When the bones are displaced relative to each other, the duration of the regeneration process increases even more.

Fractures of the upper extremities heal slowly, but they are less dangerous to humans than injuries to the lower extremities. They heal in the following terms:

• phalanges of fingers – 22 days;

• wrist bones – 29 days;

• radius – 29-36 days;

• ulna – 61-76 days;

• bones of the forearm – 70-85 days;

• humerus – 42-59 days.

Terms of healing of fractures of the lower extremities:

• calcaneus – 35-42 days;

• metatarsal bone – 21-42 days;

• ankle – 45-60 days;

• patella – 30 days;

• femur – 60-120 days;

• pelvic bones – 30 days.

Poor healing can be caused by improper treatment, overuse of a broken limb, or insufficient levels of calcium in the body.

Healing rate of children’s fractures

In a child, fracture healing is 30% faster compared to adults. This is due to the high content of ossein and protein in the children’s skeleton. The periosteum is thicker, it has an excellent blood supply. The skeleton of children is constantly growing, and the presence of growth zones accelerates bone fusion even more. In children from six to twelve years of age with damaged bone tissue, fragments are corrected without surgical intervention, and therefore, in most situations, specialists manage only by applying gypsum.

Most common fractures in children:

• Full. The bone in such cases is separated into several parts.

• Compression fractures occur due to strong compression along the axis of the long bone. Healing occurs in 15-25 days.

• Green branch fracture. There is a bending of the limb, with the formation of cracks and fragments. Occurs with excessive pressure with a force insufficient for complete destruction.

• Plastic bend. Appears in the knee and elbow joints. Partial destruction of bone tissue without scars and cracks is observed.

First aid for fractures

First aid for fractures plays an important role in the rate of healing of broken bones. If it is an open fracture, it is very important that no infection gets into the wound in order to avoid inflammation and suppuration in this area. Therefore, the damaged area must be decontaminated, for this the circumference of the wound should be treated with an antiseptic and covered with a sterile napkin until the medical team arrives.

In order to transport the victim to a medical institution, it is necessary to organize the immobilization of the limb. They use improvised means to complete the task – plywood, flat boards, tree branches, which are fixed to the injured limb with a cloth or bandage. If a person has a spinal injury, then a solid stretcher is used for transportation, or improvised means, such as flat boards, on which the patient must be carefully laid.

The timing of fracture consolidation directly depends on the provision of first aid and emergency transportation of the victim to the hospital.

Healing mechanism

Fracture healing begins immediately after injury. Fusion can be of two types:

1. Primary splicing. If the bones are firmly connected, there is no need to build up a callus on the broken area, the fracture heals easily and with good blood circulation.
2. Secondary splicing. In this case, it is necessary to increase the callus, due to the active movement of bone fragments.

The mechanism of fracture fusion is very complex, therefore it is divided into certain stages:

1. The first stage is the formation of a clot formed from the blood surrounding the damaged area. After some time, they are transformed into a new tissue for the structure of the bone. Such a clot forms within a few days after the injury.
2. In the second stage, this clot is filled with osteoblasts and osteoclasts. They are very helpful in healing and recovery. By filling the clot around the fracture, they smooth and flatten the bone fragments, after which a granular bridge is created. It is he who will hold the edges of the bone to prevent displacement.
3. The third stage is characterized by the appearance of callus. After a few weeks (2-3) from injury, the granular bridge turns into bone tissue. During this period of time, it is still very fragile, and differs from ordinary bone tissue. This area is called the callus. To prevent injury, it is important that the fracture is securely immobilized.
4. During the fourth stage, the fracture is completely healed. After a certain time after the incident, depending on its severity and site (3-10 weeks), blood circulation is completely normalized at this place, which helps to strengthen the bone. The tissue recovers a little longer (6-12 months).

At the end of all stages, the fused bone regains its strength and is able to withstand different loads.

Factors affecting the rate of bone healing

The healing of a broken bone depends on a number of factors that either accelerate it or hinder it. The regeneration process itself is individual for each patient.

First aid is critical to the speed of healing. With an open fracture, it is important to prevent infection from entering the wound, because. inflammation and suppuration will slow down the regeneration process.

Healing is faster when small bones are fractured.

In open fractures, callus formation takes much longer if wound infection develops, which is accompanied by bone sequestration and post-traumatic osteomyelitis. That is why, with improper fracture therapy, the formation of callus slows down or does not occur at all. In such situations, fractures that do not heal for a long time, characterized by slow consolidation, as well as false joints appear:

• If patients suffer from hypovitaminosis and beriberi (osteomalacia in pregnant women, rickets, scurvy).

• If there are violations of the activity of the parathyroid glands (decrease in the concentration of calcium in the blood) and adrenal hyperfunction.

• The presence of concomitant diseases occurring in the chronic stage, as well as inflammatory processes. Any pathological processes in the body significantly delay the recovery period after a fracture.

• The presence of excess body weight negatively affects the process of bone tissue healing.

• Metabolic disorders.

• Non-compliance with the terms of wearing a plaster cast. Many cases of too long fusion of bone tissue are due to the fact that a person does not want to walk in a cast for a long time, removes it ahead of time set by the doctor. The fused area of ​​the bone is under pressure, displacement occurs.

How quickly the bones grow together also depends on factors such as the need for an implant. This occurs in cases where there are too many bone fragments, they are very small, and it is not possible to collect them again.

How to accelerate bone healing?

In order for the process of bone regeneration to proceed faster, it is necessary to receive adequate treatment, provide the patient with proper nutrition, intake of vitamin complexes enriched with calcium, vitamin D. The source of the last component is chicken yolk and sunlight.

The process of bone fusion after a fracture, not least depends on the amount of calcium in the body (a “building” mineral element for bone tissue).