Background:

Intramedullary screw fixation is the most common operative procedure used for treatment of fifth metatarsal stress fractures in athletes. However, the optimal implant in intramedullary screw fixation is still being investigated.

Purpose:

To review experiences with intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures in high-level athletes.

Study Design:

Case series; Level of evidence, 4.

Methods:

The authors retrospectively analyzed 37 high-level athletes (Tegner activity score ≥7) who underwent intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures between August 2005 and August 2017. The minimum follow-up period of the patients was 2 years. In assessing the surgical results, time to obtain bone union, time to return to original level of sport participation, and treatment failures/complications were reviewed. Additionally, the effect of intraoperative plantar gap widening caused by the screw insertion was analyzed. The surgical results of the 2 groups, the no-gap group (intraoperative plantar gap widening, <1 mm) and the gap group (intraoperative plantar gap widening, ≥1 mm), were compared, while correlations between intraoperative plantar gap widening and the surgical results were statistically analyzed.

Results:

Bone union and return to the original sport were attained in all patients without treatment failures/complications such as delayed union, nonunion, or refracture. The mean time to obtain bone union was 10.1 weeks, and the mean time to return to sport was 10.9 weeks. In comparing the no-gap group (n = 16) and the gap group (n = 21), no significant differences in the time to obtain bone union (P = .392) or to return to sport (P = .399) were noted. Additionally, there was no correlation between intraoperative plantar gap widening and the time to obtain bone union (r = 0.131; P = .428) or to return to sport (r = 0.160; P = .331).

Conclusion:

The use of the Herbert screw for intramedullary screw fixation to treat fifth metatarsal stress fractures in high-level athletes provided satisfactory results enabling all the athletes to return to the original sport without treatment failures/complications. Additionally, intraoperative plantar gap widening does not affect the surgical results using this technique.

中文翻译：

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Herbert螺钉髓内螺钉固定治疗高水平运动员第五跖骨应力性骨折的疗效

背景：

髓内螺钉固定是治疗运动员第五跖骨应力性骨折最常用的手术方法。然而，髓内螺钉固定的最佳植入物仍在研究中。

目的：

回顾使用 Herbert 螺钉进行髓内螺钉固定治疗高水平运动员第五跖骨应力性骨折的经验。

学习规划：

案例系列；证据水平，4。

方法：

作者回顾性分析了 2005 年 8 月至 2017 年 8 月期间接受 Herbert 螺钉髓内螺钉固定治疗第五跖骨应力性骨折的 37 名高水平运动员（Tegner 活动评分≥7）。患者最短随访时间为 2 年。在评估手术结果时，回顾了获得骨愈合的时间、恢复到原始运动参与水平的时间以及治疗失败/并发症。此外，分析了螺钉插入引起的术中足底间隙扩大的影响。比较两组无间隙组（术中足底间隙增宽，<1 mm）和间隙组（术中足底间隙增宽，≥1 mm）的手术效果，

结果：

所有患者均实现骨愈合并恢复原来的运动，没有出现延迟愈合、骨不连或再骨折等治疗失败/并发症。获得骨愈合的平均时间为 10.1 周，恢复运动的平均时间为 10.9 周。在比较无间隙组 (n = 16) 和间隙组 (n = 21) 时，获得骨愈合 ( P = .392) 或恢复运动 ( P = .399)的时间没有显着差异著名的。此外，术中足底间隙扩大与获得骨愈合时间 ( r = 0.131; P = .428) 或恢复运动 ( r = 0.160; P = .331) 之间没有相关性。

结论：

使用Herbert螺钉进行髓内螺钉固定治疗高水平运动员第五跖骨应力性骨折取得了令人满意的效果，使所有运动员能够在没有治疗失败/并发症的情况下恢复原来的运动。此外，术中足底间隙扩大不会影响使用该技术的手术结果。