Skip to main content

Advertisement

Log in

LCP distal ulna hook plate as alternative fixation for fifth metatarsal base fracture

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Intramedullary screw fixation is the most common treatment for fifth metatarsal base fractures. Screw application does not achieve accurate reduction in fracture with small fragments, osteoporotic bone, or Lawrence zone 1 fractures, however. On the basis of similar anatomical architectures between the distal ulna and the fifth metatarsal base, the purpose of this study was to assess the results of a locking compression plate (LCP) distal ulna hook plate in stabilizing displaced zone 1 or 2 fifth metatarsal base fractures. Nineteen patients with Lawrence zone 1 (n = 12) or 2 (n = 7) fractures of the fifth metatarsal base were treated surgically with an LCP distal ulna hook plate. The patients were evaluated clinically and radiographically, and functional outcomes were graded by using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system. Radiographic bony union was obtained in all patients, at an average of 7.4 weeks. The mean AOFAS midfoot score improved from 26 (range, 0–45) preoperatively to 94 (range, 72–100) points at the final follow-up. There were three patients with post-traumatic cubometatarsal arthrosis and one patient with sural nerve neuropraxia. In our experience, the distal ulna hook plate achieves a high rate of bony consolidation and anatomically suitable fixation in zone 1 or 2 fifth metatarsal base fractures. We also suggest that the LCP distal ulna hook plate should be considered as an alternative treatment in multifragmentary, osteoporotic, and tuberosity avulsion (zone 1) fifth metatarsal base fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jones R (1902) Fracture of the base of the fifth metatarsal bone by indirect violence. Ann Surg 35(6):697–700

    PubMed  CAS  Google Scholar 

  2. Dameron TB Jr (1975) Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Jt Surg Am 57(6):788–792

    Google Scholar 

  3. Kavanaugh JH, Brower TD, Mann RV (1978) The Jones fracture revisited. J Bone Jt Surg Am 60(6):776–782

    CAS  Google Scholar 

  4. Zwitser EW, Breederveld RS (2010) Fractures of the fifth metatarsal; diagnosis and treatment. Injury 41(6):555–562

    Article  PubMed  CAS  Google Scholar 

  5. DeVries JG, Cuttica DJ, Hyer CF (2011) Cannulated screw fixation of Jones fifth metatarsal fractures: a comparison of titanium and stainless steel screw fixation. J Foot Ankle Surg 50(2):207–212

    Article  PubMed  Google Scholar 

  6. Shereff MJ, Yang QM, Kummer FJ, Frey CC, Greenidge N (1991) Vascular anatomy of the fifth metatarsal. Foot Ankle 11(6):350–353

    Article  PubMed  CAS  Google Scholar 

  7. Dameron TB Jr (1995) Fractures of the proximal fifth metatarsal: selecting the best treatment option. J Am Acd Orthop Surg 3(2):110–114

    Google Scholar 

  8. DeLee JC, Evans JP, Julian J (1983) Stress fracture of the fifth metatarsal. Am J Sports Med 11(5):349–353

    Article  PubMed  CAS  Google Scholar 

  9. Lee KT, Park YU, Young KW, Kim JS, Kim JB (2011) Surgical results of 5th metatarsal stress fracture using modified tension band wiring. Knee Surg Sports Traumatol Arthrosc 19(5):853–857

    Article  PubMed  CAS  Google Scholar 

  10. Torg JS (1990) Fractures of the base of the fifth metatarsal distal to the tuberosity. Orthopedics 13(7):731–737

    PubMed  CAS  Google Scholar 

  11. Stewart IM (1960) Jones’s fracture: fracture of base of fifth metatarsal. Clin Orthop Relat Res 16:190–198

    CAS  Google Scholar 

  12. Lawrence SJ, Botte MJ (1993) Jones fractures and related fractures of the proximal fifth metatarsal. Foot Ankle 14(6):358–365

    Article  PubMed  CAS  Google Scholar 

  13. Egol K, Walsh M, Rosenblatt K, Capla E, Koval KJ (2007) Avulsion fractures of the fifth metatarsal base: a prospective outcome study. Foot Ankle Int 28(5):581–583

    Article  PubMed  Google Scholar 

  14. Quill GE Jr (1995) Fractures of the proximal fifth metatarsal. Orthop Clin North Am 26(2):353–361

    PubMed  Google Scholar 

  15. Rettig AC, Shelbourne KD, Wilckens J (1992) The surgical treatment of symptomatic nonunions of the proximal (metaphyseal) fifth metatarsal in athletes. Am J Sports Med 20(1):50–54

    Article  PubMed  CAS  Google Scholar 

  16. Sarimo J, Rantanen J, Orava S, Alanen J (2006) Tension-band wiring for fractures of the fifth metatarsal located in the junction of the proximal metaphysis and diaphysis. Am J Sports Med 34(3):476–480

    Article  PubMed  Google Scholar 

  17. Thomas JL, Davis BC (2011) Three-wire fixation technique for displaced fifth metatarsal base fractures. J Foot Ankle Surg 50(6):776–779

    Article  PubMed  Google Scholar 

  18. Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M (1984) Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Jt Surg Am 66(2):209–214

    CAS  Google Scholar 

  19. Carpenter B, Garrett A (2003) Using a hook plate as alternate fixation for fifth metatarsal base fracture. J Foot Ankle Surg 42(5):315–316

    Article  PubMed  Google Scholar 

  20. Donley BG, McCollum MJ, Murphy GA, Richardson EG (1999) Risk of sural nerve injury with intramedullary screw fixation of fifth metatarsal fractures: a cadaver study. Foot Ankle Int 20(3):182–184

    Article  PubMed  CAS  Google Scholar 

  21. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353

    Article  PubMed  CAS  Google Scholar 

  22. Carp L (1927) Fracture of the fifth metatarsal bone. With a special reference to delayed union. Ann Surg 86(2):308–320

    Article  PubMed  CAS  Google Scholar 

  23. Rammelt S, Heineck J, Zwipp H (2004) Metatarsal fractures. Injury 35:77–85

    Article  Google Scholar 

  24. Smith JW, Arnoczky SP, Hersh A (1992) The intraosseous blood supply of the fifth metatarsal: implications for proximal fracture healing. Foot Ankle 13(3):143–152

    Article  PubMed  CAS  Google Scholar 

  25. Raikin SM, Slenker N, Ratigan B (2008) The association of a varus hindfoot and fracture of the fifth metatarsal metaphyseal-diaphyseal junction: the Jones fracture. Am J Sports Med 36(7):1367–1372

    Article  PubMed  Google Scholar 

  26. Zelko RR, Torg JS, Rachun A (1979) Proximal diaphyseal fractures of the fifth metatarsal treatment of the fractures and their complications in athletes. Am J Sports Med 7(2):95–101

    Article  PubMed  CAS  Google Scholar 

  27. Clapper MF, O’Brien TJ, Lyons PM (1995) Fractures of the fifth metatarsal. Analysis of a fracture registry. Clin Orthop Relat Res 315:238–241

    PubMed  Google Scholar 

  28. Mindrebo N, Shelbourne KD, Van Meter CD, Rettig AC (1993) Outpatient percutaneous screw fixation of the acute Jones fracture. Am J Sports Med 21(5):720–723

    Article  PubMed  CAS  Google Scholar 

  29. Laurich LJ, Witt CS, Zielsdorf LM (1983) Treatment of fractures of the fifth metatarsal bone. J Foot Surg 22(3):207–211

    PubMed  CAS  Google Scholar 

  30. Vogler HW, Westlin N, Mlodzienski AJ, Moller FB (1995) Fifth metatarsal fractures. Biomechanics, classification, and treatment. Clin Podiatr Med Surg 12(4):725–747

    PubMed  CAS  Google Scholar 

  31. Mofidi A, Hamer P, Thomas RH, Hemmadi SS (2009) Stress fracture of the fifth metatarsal base caused by tension band wiring: an isolated case report. Foot ankle Spec 2(2):79–82

    Article  PubMed  Google Scholar 

  32. Wiener BD, Linder JF, Giattini JF (1997) Treatment of fractures of the fifth metatarsal: a prospective study. Foot Ankle Int 18(5):267–269

    Article  PubMed  CAS  Google Scholar 

  33. Nunley JA (2001) Fractures of the base of the fifth metatarsal: the Jones fracture. Orthop Clin North Am 32(1):171–180

    Article  PubMed  CAS  Google Scholar 

  34. Wright RW, Fischer DA, Shively RA, Heidt RS Jr, Nuber GW (2000) Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes. Am J Sports Med 28(5):732–736

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sang Ki Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, S.K., Park, J.S. & Choy, W.S. LCP distal ulna hook plate as alternative fixation for fifth metatarsal base fracture. Eur J Orthop Surg Traumatol 23, 705–713 (2013). https://doi.org/10.1007/s00590-012-1061-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-012-1061-5

Keywords

Navigation